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Monzeglio O, Melissa VM, Rodolfi S, Valentini E, Carriero A. Exploring the potential of contrast agents in breast cancer echography: current state and future directions. J Ultrasound 2023; 26:749-756. [PMID: 37566194 PMCID: PMC10632334 DOI: 10.1007/s40477-023-00809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
Breast cancer stands as the most frequent malignancy and leading cause of death among women. Early and accurate detection of this pathology represents a crucial factor in enhancing both incidence and mortality rates. Ultrasound (US) examination has been extensively adopted in clinical practice due to its non-invasiveness, affordability, ease of implementation, and wide accessibility, thus representing a valuable first-line diagnostic tool for the study of the mammary gland. In this scenario, recent developments in nanomedicine are paving the way for new interpretations and applications of US diagnostics, which are becoming increasingly personalized based on the molecular phenotype of each tumor, allowing for more precise and accurate evaluations. This review highlights the current state-of-the-art of US diagnosis of breast cancer, as well as the recent advancements related to the application of US contrast agents to the field of molecular diagnostics, still under preclinical study.
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Affiliation(s)
- Oriana Monzeglio
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy.
| | - Vittoria Maria Melissa
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Sara Rodolfi
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Valentini
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Carriero
- Department of Translation Medicine, University of Eastern Piemonte UPO, Via Solaroli 17, 28100, Novara, Italy
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Pesapane F, Nicosia L, Tantrige P, Schiaffino S, Liguori A, Montesano M, Bozzini A, Rotili A, Cellina M, Orsi M, Penco S, Pizzamiglio M, Carrafiello G, Cassano E. Inter-reader agreement of breast magnetic resonance imaging and contrast-enhanced mammography in breast cancer diagnosis: a multi-reader retrospective study. Breast Cancer Res Treat 2023; 202:451-459. [PMID: 37747580 DOI: 10.1007/s10549-023-07093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Breast magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM) are nowadays used in breast imaging but studies about their inter-reader agreement are lacking. Therefore, we compared the inter-reader agreement of CEM and MRI in breast cancer diagnosis in the same patients. METHODS Breast MRI and CEM exams performed in a single center (09/2020-09/2021) for an IRB-approved study were retrospectively and independently evaluated by four radiologists of two different centers with different levels of experience who were blinded to the clinical and other imaging data. The reference standard was the histological diagnosis or at least 1-year negative imaging follow-up. Inter-reader agreement was examined using Cohen's and Fleiss' kappa (κ) statistics and compared with the Wald test. RESULTS Of the 750 patients, 395 met inclusion criteria (44.5 ± 14 years old), with 752 breasts available for CEM and MRI. Overall agreement was moderate (κ = 0.60) for MRI and substantial (κ = 0.74) for CEM. For expert readers, the agreement was substantial (κ = 0.77) for MRI and almost perfect (κ = 0.82) for CEM; for non-expert readers was fair (κ = 0.39); and for MRI and moderate (κ = 0.57) for CEM. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.50) for breast MRI and substantial (κ = 0.74) for CEM and it showed a statistically superior agreement of the expert over the non-expert readers only for MRI (p = 0.011) and not for CEM (p = 0.062). CONCLUSIONS The agreement of CEM was superior to that of MRI (p = 0.012), including for both expert (p = 0.031) and non-expert readers (p = 0.005).
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Priyan Tantrige
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Alessandro Liguori
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Marta Montesano
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Anna Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Michaela Cellina
- Department of Radiology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20131, Milan, Italy
| | - Marcello Orsi
- Department of Radiology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20131, Milan, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
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Kennard K, Wang O, Kjelstrom S, Larson S, Sizer LM, Carruthers C, Carter WB, Ciocca R, Sabol J, Frazier TG, Carp NZ. Outcomes of Abbreviated MRI (Ab-MRI) for Women of any Breast Cancer Risk and Breast Density in a Community Academic Setting. Ann Surg Oncol 2022; 29:6215-6221. [PMID: 35857199 DOI: 10.1245/s10434-022-12194-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging (Ab-MRI) has been evaluated for elevated breast cancer risk or dense breasts but has not been evaluated across all risk profiles. METHODS Patients selected underwent Ab-MRI from February 2020 to September 2021. Women were older than aged 30 years, up to date with screening mammography, and paid $299 cash. RESULTS A total of 93 patients were identified with a mean age of 52 years; 92.5% were Caucasian, 0% black, and 97.9% were from high socioeconomic status. Mean Gail score was 14.2, and 83.3% had a lifetime risk of breast cancer <20%. Reasons for Ab-MRI: dense breasts (36.6%); family history (24.7%); palpable mass (12.9%). Providers ordering: OBGYN (49.5%); breast surgeon (39.1%); primary care (6.6%). Thirteen biopsies (14%) detected one breast cancer. 31.1% had a change in follow-up screening: 58.6% 6-month MRI, 20.7% 6-month mammogram, and 10.3% 6-month ultrasound. Negative predictive value was 100% (95% confidence interval [CI]: 95-100%, p < 0.0001). Sensitivity was 100% (95% CI: 2.5-100%, p < 0.0001), and specificity was 87% (95% CI: 78.3-93.1%, p < 0.0001) compared with 77.6% and 98.8% for mammography. Only one cancer was detected: cost of $27,807 plus cost of 13 MRI or ultrasound (US)-guided biopsies and additional follow-up imaging. Historically 20% of abnormalities detected on full MRI are malignant; however, 7.7% of ab-MRI abnormalities were malignant CONCLUSIONS: One third of women were recommended a change in follow-up, which predominantly included a 6-month MRI. Ab-MRI may introduce average risk women to unnecessary follow-up and increased biopsies with a lower cancer detection rate. Ab-MRI should be evaluated closely before implementation.
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Affiliation(s)
- Kaitlyn Kennard
- The Bryn Mawr Hospital, Bryn Mawr, PA, USA. .,Lankenau Medical Center, Wynnewood, PA, USA. .,Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA.
| | | | - Stephanie Kjelstrom
- Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Sharon Larson
- Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | | | | | | | | | | | | | - Ned Z Carp
- Lankenau Medical Center, Wynnewood, PA, USA
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Dispelling myths: The case for women in radiology and radiation oncology. Clin Imaging 2022; 85:55-59. [DOI: 10.1016/j.clinimag.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
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Pesapane F, Rotili A, Penco S, Montesano M, Agazzi GM, Dominelli V, Trentin C, Pizzamiglio M, Cassano E. Inter-Reader Agreement of Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Detection: A Multi-Reader Retrospective Study. Cancers (Basel) 2021; 13:cancers13081978. [PMID: 33924033 PMCID: PMC8073591 DOI: 10.3390/cancers13081978] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers. MATERIAL AND METHODS Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen's and Fleiss' kappa (κ) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers. RESULTS Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 ± 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (κ = 0.74) for expert readers and poor (κ = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003). CONCLUSIONS DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.
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Affiliation(s)
- Filippo Pesapane
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
- Correspondence:
| | - Anna Rotili
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Silvia Penco
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Marta Montesano
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | | | - Valeria Dominelli
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Chiara Trentin
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Maria Pizzamiglio
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Enrico Cassano
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
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Liu Z, Li X, Feng B, Li C, Chen Y, Yi L, Li Z, Li R, Long W. MIP image derived from abbreviated breast MRI: potential to reduce unnecessary sub-nipple biopsies during nipple-sparing mastectomy for breast cancer. Eur Radiol 2020; 31:3683-3692. [PMID: 33247343 DOI: 10.1007/s00330-020-07550-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the value of a maximum-intensity projection (MIP) image derived from abbreviated breast MRI for excluding occult nipple-areolar complex (NAC) involvement in patients with breast cancer. METHODS This prospective study included breast cancer patients with clinically normal NACs between April 2016 and May 2019. Abbreviated breast MRI was performed, and an MIP image was generated for each patient. MIP images were examined for the following features: asymmetric nipple enhancement, tumor-nipple distance (TND), tumor diameter, lesion type, location, and multifocality. Independent predictive MIP features for occult NAC involvement were identified by univariable and multivariable logistic regression analyses. Models based on independent predictive MIP features were developed, and their diagnostic performances were evaluated using ROC analysis. The utility of an MIP image for excluding occult NAC involvement was assessed by considering NPVs across patient subgroups. RESULTS Eight hundred forty-three patients (67 NAC-positive and 776 NAC-negative) were enrolled. On MIP images, asymmetric nipple enhancement (odds ratio, 6.098; p < 0.001) and TND (odds ratio, 0.564; p = 0.003) were independent predictors of occult NAC involvement. A parallel test model of "asymmetric nipple enhancement or TND ≤ 15 mm" yielded the highest AUC value (0.838) among prediction models. The NPV of MIP images for excluding occult NAC involvement was 99.5%, which was applicable across various patient subgroups. CONCLUSIONS A single MIP image derived from abbreviated breast MRI has utility for excluding occult NAC involvement in breast cancer patients and reducing the number of unnecessary sub-nipple biopsies in nipple-sparing mastectomy. KEY POINTS • On MIP images derived from abbreviated breast MRI, asymmetric nipple enhancement and tumor-nipple distance were independent predictors for occult nipple involvement in patients with breast cancer. • Negative findings on MIP image can help select patients at minimal risk of occult nipple involvement, for whom unnecessary intraoperative sub-nipple biopsies in nipple-sparing mastectomy can be omitted.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China
| | - Xiaoping Li
- Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China
| | - Bao Feng
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, 541004, China
| | - Changlin Li
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, 541004, China
| | - Yehang Chen
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, 541004, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, China
| | - Zhiwei Li
- Department of Radiology, Sanya Central Hospital, Sanya, 572000, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, China.
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Suter MB, Pesapane F, Agazzi GM, Gagliardi T, Nigro O, Bozzini A, Priolo F, Penco S, Cassano E, Chini C, Squizzato A. Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. Breast 2020; 53:8-17. [PMID: 32540554 PMCID: PMC7375655 DOI: 10.1016/j.breast.2020.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%-91%], with a sensitivity of 85% [95% CI 73%-93%], and a specificity of 77% [95% CI 60%-88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.
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Affiliation(s)
| | - Filippo Pesapane
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Giorgio Maria Agazzi
- University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Tania Gagliardi
- Department of Radiology, Royal Marsden Hospital, London, UK.
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
| | - Anna Bozzini
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Francesca Priolo
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Silvia Penco
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Enrico Cassano
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Claudio Chini
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
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State-of-the-Art in Integrated Breast Imaging. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7596059. [PMID: 30723743 PMCID: PMC6339726 DOI: 10.1155/2019/7596059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022]
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Sah BR, Ghafoor S, Burger IA, Ter Voert EEGW, Sekine T, Delso G, Huellner M, Dedes KJ, Boss A, Veit-Haibach P. Feasibility of 18F-FDG Dose Reductions in Breast Cancer PET/MRI. J Nucl Med 2018; 59:1817-1822. [PMID: 29880506 DOI: 10.2967/jnumed.118.209007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
Abstract
The goal of this study was to determine the level of clinically acceptable 18F-FDG dose reduction in time-of-flight PET/MRI in patients with breast cancer. Methods: Twenty-six consecutive women with histologically proven breast cancer were analyzed (median age, 51 y; range, 34-83 y). Simulated dose-reduced PET images were generated by unlisting the list-mode data on PET/MRI. The acquired 20-min PET frame was reconstructed in 5 ways: a reconstruction of the first 2 min with 3 iterations and 28 subsets for reference, and reconstructions simulating 100%, 20%, 10%, and 5% of the original dose. General image quality and artifacts, image sharpness, image noise, and lesion detectability were analyzed using a 4-point scale. Qualitative parameters were compared using the nonparametric Friedman test for multiple samples and the Wilcoxon signed-rank test for paired samples. Different groups of independent samples were compared using the Mann-Whitney U test. Results: Overall, 355 lesions (71 lesions with 5 different reconstructions each) were evaluated. The 20-min reconstruction with 100% injected dose showed the best results in all categories. For general image quality and artifacts, image sharpness, and noise, the reconstructions with a simulated dose of 20% and 10% were significantly better than the 2-min reconstructions (P ≤ 0.001). Furthermore, 20%, 10%, and 5% reconstructions did not yield results different from those of the 2-min reconstruction for detectability of the primary lesion. For 10% of the injected dose, a calculated mean dose of 22.6 ± 5.5 MBq (range, 17.9-36.9 MBq) would have been applied, resulting in an estimated whole-body radiation burden of 0.5 ± 0.1 mSv (range, 0.4-0.7 mSv). Conclusion: Ten percent of the standard dose of 18F-FDG (reduction of ≤90%) results in clinically acceptable PET image quality in time-of-flight PET/MRI. The calculated radiation exposure would be comparable to the effective dose of a single digital mammogram. A reduction of radiation burden to this level might justify partial-body examinations with PET/MRI for dedicated indications.
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Affiliation(s)
- Bert-Ram Sah
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland .,Department of Cancer Imaging, King`s College London, London, United Kingdom.,Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Soleen Ghafoor
- Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Cancer Center Zurich, Zurich, Switzerland
| | - Edwin E G W Ter Voert
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Tetsuro Sekine
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Gaspar Delso
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.,GE Healthcare, Waukesha, Wisconsin
| | - Martin Huellner
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Konstantin J Dedes
- Cancer Center Zurich, Zurich, Switzerland.,Department of Gynaecology, University Hospital of Zurich, Zurich, Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland.,Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; and.,University of Toronto, Toronto, Ontario, Canada
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10
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Jabbar SB, Lynch B, Seiler S, Hwang H, Sahoo S. Pathologic Findings of Breast Lesions Detected on Magnetic Resonance Imaging. Arch Pathol Lab Med 2017; 141:1513-1522. [PMID: 28782985 DOI: 10.5858/arpa.2016-0552-oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Breast magnetic resonance imaging (MRI) is now used routinely for high-risk screening and in the evaluation of the extent of disease in newly diagnosed breast cancer patients. Morphologic characteristics and the kinetic pattern largely determine how suspicious a breast lesion is on MRI. Because of its high sensitivity, MRI identifies a large number of suspicious lesions. However, the low to moderate specificity and the additional cost have raised questions regarding its frequent use. OBJECTIVES - To identify the pathologic entities that frequently present as suspicious enhancing lesions and to identify specific MRI characteristics that may be predictive of malignancy. DESIGN - One hundred seventy-seven MRI-guided biopsies from 152 patients were included in the study. The indication for MRI, MRI features, pathologic findings, and patient demographics were recorded. The MRI findings and the pathology slides were reviewed by a dedicated breast radiologist and breast pathologists. RESULTS - Seventy-one percent (126 of 177) of MRI-guided breast biopsies were benign, 11% (20 of 177) showed epithelial atypia, and 18% (31 of 177) showed malignancy. The vast majority (84%; 62 of 74) of MRI lesions with persistent kinetics were benign. However, 57% (17 of 30) of lesions with washout kinetics and 65% (62 of 95) of mass lesions were also benign. CONCLUSIONS - Magnetic resonance imaging detects malignancies undetected by other imaging modalities but also detects a wide variety of benign lesions. Benign and malignant lesions identified by MRI share similar morphologic and kinetic features, necessitating biopsy for histologic confirmation.
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Affiliation(s)
- Seema B Jabbar
- From the Departments of Pathology and Laboratory Medicine (Drs Jabbar, Lynch, Hwang, and Sahoo), and Radiology (Dr Seiler), University of Texas Southwestern Medical Center, Dallas. Dr Jabbar and Dr Lynch contributed equally to the study
| | - Beverly Lynch
- From the Departments of Pathology and Laboratory Medicine (Drs Jabbar, Lynch, Hwang, and Sahoo), and Radiology (Dr Seiler), University of Texas Southwestern Medical Center, Dallas. Dr Jabbar and Dr Lynch contributed equally to the study
| | - Stephen Seiler
- From the Departments of Pathology and Laboratory Medicine (Drs Jabbar, Lynch, Hwang, and Sahoo), and Radiology (Dr Seiler), University of Texas Southwestern Medical Center, Dallas. Dr Jabbar and Dr Lynch contributed equally to the study
| | - Helena Hwang
- From the Departments of Pathology and Laboratory Medicine (Drs Jabbar, Lynch, Hwang, and Sahoo), and Radiology (Dr Seiler), University of Texas Southwestern Medical Center, Dallas. Dr Jabbar and Dr Lynch contributed equally to the study
| | - Sunati Sahoo
- From the Departments of Pathology and Laboratory Medicine (Drs Jabbar, Lynch, Hwang, and Sahoo), and Radiology (Dr Seiler), University of Texas Southwestern Medical Center, Dallas. Dr Jabbar and Dr Lynch contributed equally to the study
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