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Grubstein A, Friehmann T, Dahan M, Abitbol C, Gadiel I, Schejtman DM, Shochat T, Atar E, Tamir S. Digital Breast Tomosynthesis for Upgraded BIRADS Scoring towards the True Pathology of Lesions Detected by Contrast-Enhanced Mammography. Tomography 2024; 10:806-815. [PMID: 38787021 PMCID: PMC11125662 DOI: 10.3390/tomography10050061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE To determine the added value of digital breast tomosynthesis (DBT) in the assessment of lesions detected by contrast-enhanced mammography (CEM). MATERIAL AND METHODS A retrospective study was conducted in a tertiary university medical center. All CEM studies including DBT performed between January 2016 and December 2020 were included. Lesions were categorized and scored by four dedicated breast radiologists according to the recent CEM and DBT supplements to the Breast Imaging Reporting and Data System (BIRADS) lexicon. Changes in the BIRADS score of CEM-detected lesions with the addition of DBT were evaluated according to the pathology results and 1-year follow-up imaging study. RESULTS BIRADS scores of CEM-detected lesions were upgraded toward the lesion's pathology with the addition of DBT (p > 0.0001), overall and for each reader. The difference in BIRADS scores before and after the addition of DBT was more significant for readers who were less experienced. The reason for changes in the BIRADS score was better lesion margin visibility. The main BIRADS descriptors applied in the malignant lesions were spiculations, calcifications, architectural distortion, and sharp or obscured margins. CONCLUSIONS The addition of DBT to CEM provides valuable information on the enhancing lesion, leading to a more accurate BIRADS score.
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Affiliation(s)
- Ahuva Grubstein
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Tal Friehmann
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Marva Dahan
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Chen Abitbol
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Ithai Gadiel
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Dario M. Schejtman
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Tzippy Shochat
- Biostatistics, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel;
| | - Eli Atar
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
| | - Shlomit Tamir
- Radiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 49100, Israel; (T.F.); (M.D.); (C.A.); (I.G.); (D.M.S.); (E.A.); (S.T.)
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2
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Weaver OO, Yang WT, Scoggins ME, Adrada BE, Arribas E, Moseley TW, Esquivel J, Melgar Y, Kornecki A. Challenging Contrast-Enhanced Mammography-Guided Biopsies: Practical Approach Using Real-Time Multimodality Imaging and a Proposed Procedural Algorithm. AJR Am J Roentgenol 2023; 220:512-523. [PMID: 36321982 DOI: 10.2214/ajr.22.28572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Contrast-enhanced mammography (CEM) is an emerging functional breast imaging technique that entails the acquisition of dual-energy digital mammographic images after IV administration of iodine-based contrast material. CEM-guided biopsy technology was introduced in 2019 and approved by the U.S. FDA in 2020. This technology's availability enables direct sampling of suspicious enhancement seen only on or predominantly on recombined CEM images and addresses a major obstacle to the clinical implementation of CEM technology. The literature describing clinical indications and procedural techniques of CEM-guided biopsy is scarce. This article describes our initial experience in performing challenging CEM-guided biopsies and proposes a step-by-step procedural algorithm designed to proactively address anticipated technical difficulties and thereby increase the likelihood of achieving successful targeting.
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Affiliation(s)
- Olena O Weaver
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Wei T Yang
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Marion E Scoggins
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Beatriz E Adrada
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Elsa Arribas
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Tanya W Moseley
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joanna Esquivel
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Yamile Melgar
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Anat Kornecki
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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4
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Taylor DB, Burrows S, Saunders CM, Parizel PM, Ives A. Contrast-enhanced mammography (CEM) versus MRI for breast cancer staging: detection of additional malignant lesions not seen on conventional imaging. Eur Radiol Exp 2023; 7:8. [PMID: 36781808 PMCID: PMC9925630 DOI: 10.1186/s41747-022-00318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is more available than MRI for breast cancer staging but may not be as sensitive in assessing disease extent. We compared CEM and MRI in this setting. METHODS Fifty-nine women with invasive breast cancer underwent preoperative CEM and MRI. Independent pairs of radiologists read CEM studies (after reviewing a 9-case set prior to study commencement) and MRI studies (with between 5 and 25 years of experience in breast imaging). Additional lesions were assigned National Breast Cancer Centre (NBCC) scores. Positive lesions (graded NBCC ≥ 3) likely to influence surgical management underwent ultrasound and/or needle biopsy. True-positive lesions were positive on imaging and pathology (invasive or in situ). False-positive lesions were positive on imaging but negative on pathology (high-risk or benign) or follow-up. False-negative lesions were negative on imaging (NBCC < 3 or not identified) but positive on pathology. RESULTS The 59 women had 68 biopsy-proven malignant lesions detected on mammography/ultrasound, of which MRI demonstrated 66 (97%) and CEM 67 (99%) (p = 1.000). Forty-one additional lesions were detected in 29 patients: six of 41 (15%) on CEM only, 23/41 (56%) on MRI only, 12/41 (29%) on both; CEM detected 1/6 and MRI 6/6 malignant additional lesions (p = 0.063), with a positive predictive value (PPV) of 1/13 (8%) and 6/26 (23%) (p = 0.276). CONCLUSIONS While MRI and CEM were both highly sensitive for lesions detected at mammography/ultrasound, CEM may not be as sensitive as MRI in detecting additional otherwise occult foci of malignancy. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN 12613000684729.
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Affiliation(s)
- Donna B. Taylor
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Sally Burrows
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Christobel M. Saunders
- grid.416153.40000 0004 0624 1200Department of Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC Australia
| | - Paul M. Parizel
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Angela Ives
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
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Vasselli F, Fabi A, Ferranti FR, Barba M, Botti C, Vidiri A, Tommasin S. How Dual-Energy Contrast-Enhanced Spectral Mammography Can Provide Useful Clinical Information About Prognostic Factors in Breast Cancer Patients: A Systematic Review of Literature. Front Oncol 2022; 12:859838. [PMID: 35941874 PMCID: PMC9355886 DOI: 10.3389/fonc.2022.859838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In the past decade, a new technique derived from full-field digital mammography has been developed, named contrast-enhanced spectral mammography (CESM). The aim of this study was to define the association between CESM findings and usual prognostic factors, such as estrogen receptors, progesterone receptors, HER2, and Ki67, in order to offer an updated overview of the state of the art for the early differential diagnosis of breast cancer and following personalized treatments. Materials and Methods According to the PRISMA guidelines, two electronic databases (PubMed and Scopus) were investigated, using the following keywords: breast cancer AND (CESM OR contrast enhanced spectral mammography OR contrast enhanced dual energy mammography) AND (receptors OR prognostic factors OR HER2 OR progesterone OR estrogen OR Ki67). The search was concluded in August 2021. No restriction was applied to publication dates. Results We obtained 28 articles from the research in PubMed and 114 articles from Scopus. After the removal of six replicas that were counted only once, out of 136 articles, 37 articles were reviews. Eight articles alone have tackled the relation between CESM imaging and ER, PR, HER2, and Ki67. When comparing radiological characterization of the lesions obtained by either CESM or contrast-enhanced MRI, they have a similar association with the proliferation of tumoral cells, as expressed by Ki-67. In CESM-enhanced lesions, the expression was found to be 100% for ER and 77.4% for PR, while moderate or high HER2 positivity was found in lesions with non-mass enhancement and with mass closely associated with a non-mass enhancement component. Conversely, the non-enhancing breast cancer lesions were not associated with any prognostic factor, such as ER, PR, HER2, and Ki67, which may be associated with the probability of showing enhancement. Radiomics on CESM images has the potential for non-invasive characterization of potentially heterogeneous tumors with different hormone receptor status. Conclusions CESM enhancement is associated with the proliferation of tumoral cells, as well as to the expression of estrogen and progesterone receptors. As CESM is a relatively young imaging technique, a few related works were found; this may be due to the “off-label” modality. In the next few years, the role of CESM in breast cancer diagnostics will be more thoroughly investigated.
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Affiliation(s)
- Federica Vasselli
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Romana Ferranti
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Division of Breast Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Antonello Vidiri,
| | - Silvia Tommasin
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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6
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Fusco R, Granata V, Grazzini G, Pradella S, Borgheresi A, Bruno A, Palumbo P, Bruno F, Grassi R, Giovagnoni A, Grassi R, Miele V, Barile A. Radiomics in medical imaging: pitfalls and challenges in clinical management. Jpn J Radiol 2022; 40:919-929. [PMID: 35344132 DOI: 10.1007/s11604-022-01271-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Radiomics and radiogenomics are two words that recur often in language of radiologists, nuclear doctors and medical physicists especially in oncology field. Radiomics is the technique of medical images analysis to extract quantitative data that are not detected by human eye. METHODS This article is a narrative review on Radiomics in Medical Imaging. In particular, the review exposes the process, the limitations related to radiomics, and future prospects are discussed. RESULTS Several studies showed that radiomics is very promising. However, there were some critical issues: poor standardization and generalization of radiomics results, data-quality control, repeatability, reproducibility, database balancing and issues related to model overfitting. CONCLUSIONS Radiomics procedure should made considered all pitfalls and challenges to obtain robust and reproducible results that could be generalized in other patients cohort.
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Affiliation(s)
| | - Vincenza Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli", Naples, Italy.
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy
| | - Silvia Pradella
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical Special and Dental Sciences, School of Radiology, University Politecnica delle Marche, Ancona, Italy
| | - Alessandra Bruno
- Department of Clinical Special and Dental Sciences, School of Radiology, University Politecnica delle Marche, Ancona, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100, L'Aquila, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Division of Radiology, "Università Degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Andrea Giovagnoni
- Department of Clinical Special and Dental Sciences, School of Radiology, University Politecnica delle Marche, Ancona, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Division of Radiology, "Università Degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, via della Signora 2, 20122, Milan, Italy.,Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
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7
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Granata V, Fusco R, Vallone P, Setola SV, Picone C, Grassi F, Patrone R, Belli A, Izzo F, Petrillo A. Not only lymphadenopathy: case of chest lymphangitis assessed with MRI after COVID 19 vaccine. Infect Agent Cancer 2022; 17:8. [PMID: 35300727 PMCID: PMC8929244 DOI: 10.1186/s13027-022-00419-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To date, no paper reports cases of lymphangitis after COVID 19 vaccination. We present a case of lymphangitis after vaccination from COVID 19, in a patient with colorectal liver metastases. METHODS We described the case of a 56-year-old woman with history of a surgical resection of colorectal cancer and liver metastases, without any kind of drug therapy for about a month. In addition, a recent administration (2 days ago) of Spikevax (mRNA-1273, Moderna vaccine), as a booster dose, on the right arm was reported. RESULTS The magnetic resonance (MR) examination showed the effects of the previous surgical resection and five new hepatic metastases, located in the VIII, VI, V, IV and II hepatic segments. As an accessory finding the presence of lymphadenopathy in the axillary area and lymphangitis of the right breast and chest were identified. The computed tomography scan performed a week earlier, and re-evaluated in light of the MR data, did not identify the presence of lymphadenopathy in the axillary area and lymphangitis signs. CONCLUSIONS Lymphangitis could occur after COVID 19 vaccine and it is important to know this data to avoid alarmism in patients and clinicians and economic waste linked to the execution of various radiological investigations for the search for a tumour that probably does not exist. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.
| | | | - Paolo Vallone
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Sergio Venanzio Setola
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Carmine Picone
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122, Milan, Italy.,Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Renato Patrone
- Division of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
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8
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Granata V, Fusco R, Setola SV, Simonetti I, Cozzi D, Grazzini G, Grassi F, Belli A, Miele V, Izzo F, Petrillo A. An update on radiomics techniques in primary liver cancers. Infect Agent Cancer 2022; 17:6. [PMID: 35246207 PMCID: PMC8897888 DOI: 10.1186/s13027-022-00422-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiomics is a progressing field of research that deals with the extraction of quantitative metrics from medical images. Radiomic features detention indirectly tissue features such as heterogeneity and shape and can, alone or in combination with demographic, histological, genomic, or proteomic data, be used for decision support system in clinical setting. METHODS This article is a narrative review on Radiomics in Primary Liver Cancers. Particularly, limitations and future perspectives are discussed. RESULTS In oncology, assessment of tissue heterogeneity is of particular interest: genomic analysis have demonstrated that the degree of tumour heterogeneity is a prognostic determinant of survival and an obstacle to cancer control. Therefore, that Radiomics could support cancer detection, diagnosis, evaluation of prognosis and response to treatment, so as could supervise disease status in hepatocellular carcinoma (HCC) and Intrahepatic Cholangiocarcinoma (ICC) patients. Radiomic analysis is a convenient radiological image analysis technique used to support clinical decisions as it is able to provide prognostic and / or predictive biomarkers that allow a fast, objective and repeatable tool for disease monitoring. CONCLUSIONS Although several studies have shown that this analysis is very promising, there is little standardization and generalization of the results, which limits the translation of this method into the clinical context. The limitations are mainly related to the evaluation of data quality, repeatability, reproducibility, overfitting of the model. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Via Mariano Semmola 80131, Naples, Italy.
| | | | - Sergio Venazio Setola
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Via Mariano Semmola 80131, Naples, Italy
| | - Igino Simonetti
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Via Mariano Semmola 80131, Naples, Italy
| | - Diletta Cozzi
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122, Milan, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122, Milan, Italy
| | - Francesca Grassi
- Division of Radiology, "Università Degli Studi Della Campania Luigi Vanvitelli", Naples, Italy
| | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", 80131, Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122, Milan, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", 80131, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Via Mariano Semmola 80131, Naples, Italy
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9
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Bicchierai G, Busoni S, Tortoli P, Bettarini S, Naro FD, De Benedetto D, Savi E, Bellini C, Miele V, Nori J. Single Center Evaluation of Comparative Breast Radiation dose of Contrast Enhanced Digital Mammography (CEDM), Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT). Acad Radiol 2022; 29:1342-1349. [PMID: 35065889 DOI: 10.1016/j.acra.2021.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this retrospective study is to compare the radiation dose received during CEDM, short and long protocol (CEDM SP and CEDM LP), with dose received during DM and DBT on patients with varying breast thickness, age and density. MATERIALS AND METHODS Between January 2019 and December 2019, patients having 6214 DM, 3662 DBT and 173 CEDM examinations in our department were analyzed. Protocol total single breast AGD has been evaluated for all clinical imaging protocols, extracting AGD values and exposure data from the dose DICOM Structured Report (SR) information stored in the hospital PACS system. Protocol AGD was calculated as the sum of single projection AGDs carried out in every exam for each clinical protocol. A total amount of 23,383 exams for each breast were analyzed. Protocol AGDs, stratified as a function of patient breast compression thickness, age, and breast density were assessed. RESULTS The total protocol AGD median values for each protocol are: 2.8 mGy for DM, 3.2 mGy for DBT, 6.0 mGy for DM+DBT, 4.5 mGy for CEDM SP, 7.4 mGy for CEDM SP_DBT (CEDM SP protocol with DBT), 8.4 mGy for CEDM LP and 11.6 mGy for CEDM LP_DBT (CEDM LP protocol with DBT). CEDM SP AGD median value is 59% higher than DM AGD median value and 40% lesser than DM+DBT AGD median; this last difference was statistically confirmed with a p-value <0.001. AGD value for each standard breast CEDM SP projection results to be below 3-mGy limit. AGD value for each standard breast CEDM SP projection results to be below 3 mGy, as required by international legislation. For dense breasts, the AGD median value is 4.2 mGy, with the first and third quartile of 3.3 mGy and 6.0 mGy respectively; for non-dense breasts, the AGD median value is 4.7 mGy, with first and third quartile of 3.5 mGy and 6.3 mGy respectively. The difference between the two groups was statistically tested and confirmed, with a p-value of 0.039. CONCLUSION CEDM SP results in higher radiation exposure compared with conventional DM and DBT but lower than the Combo mode. The dose administered during the CEDM SP is lower in patients with dense breasts regardless of their size. An interesting outcome, considering the ongoing studies on CEDM screening in patients with dense breasts.
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Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
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The diagnostic value of contrast-enhanced 2D mammography in everyday clinical use. Sci Rep 2021; 11:22224. [PMID: 34782698 PMCID: PMC8593172 DOI: 10.1038/s41598-021-01622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022] Open
Abstract
Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.
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Steinhof-Radwańska K, Lorek A, Holecki M, Barczyk-Gutkowska A, Grażyńska A, Szczudło-Chraścina J, Bożek O, Habas J, Szyluk K, Niemiec P, Gisterek I. Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer. Curr Oncol 2021; 28:4016-4030. [PMID: 34677259 PMCID: PMC8534697 DOI: 10.3390/curroncol28050341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The multifocality and multicentrality of breast cancer (MFMCC) are the significant aspects that determine a specialist's choice between applying breast-conserving therapy (BCT) or performing a mastectomy. This study aimed to assess the usefulness of mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in women diagnosed with breast cancer before qualifying for surgical intervention to visualize other (additional) cancer foci. METHODS The study included 60 breast cancer cases out of 630 patients initially who underwent surgery due to breast cancer from January 2015 to April 2019. MG, CESM, and MRI were compared with each other in terms of the presence of MFMCC and assessed for compliance with the postoperative histopathological examination (HP). RESULTS Histopathological examination confirmed the presence of MFMCC in 33/60 (55%) patients. The sensitivity of MG in detecting MFMCC was 50%, and its specificity was 95.83%. For CESM, the sensitivity was 85.29%, and the specificity was 96.15%. For MRI, all the above-mentioned parameters were higher as follows: sensitivity-91.18%; specificity-92.31%. CONCLUSIONS In patients with MFMCC, both CESM and MRI are highly sensitive in the detection of additional cancer foci. Both CESM and MRI change the extent of surgical intervention in every fourth patient.
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Affiliation(s)
- Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Michał Holecki
- Department of Internal, Autoimmune and Metabolic Diseases, Faculty of Medical Science, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Anna Grażyńska
- Students’ Scientific Society Department of Nuclear Medicine and Diagnostic Imaging, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 40-752 Katowice, Poland;
| | | | - Oskar Bożek
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Justyna Habas
- Faculty of Pharmaceutical Sciences, Medical University of Silesia in Sosnowiec, 41-200 Sosnowiec, Poland;
| | - Karol Szyluk
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland;
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Iwona Gisterek
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-515 Katowice, Poland;
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Kornecki A. Current Status of Contrast Enhanced Mammography: A Comprehensive Review. Can Assoc Radiol J 2021; 73:141-156. [PMID: 34492211 DOI: 10.1177/08465371211029047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this article is to provide a detailed and updated review of the physics, techniques, indications, limitations, reporting, implementation and management of contrast enhanced mammography. BACKGROUND Contrast enhanced mammography (CEM), is an emerging iodine-based modified dual energy mammography technique. In addition to having the same advantages as standard full-field digital mammography (FFDM), CEM provides information regarding tumor enhancement, relying on tumor angiogenesis, similar to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). This article reviews current literature on CEM and highlights considerations that are critical to the successful use of this modality. CONCLUSION Multiple studies point to the advantage of using CEM in the diagnostic setting of breast imaging, which approaches that of DCE-MRI.
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Affiliation(s)
- Anat Kornecki
- Department of Medical Imaging, Breast Division, Western University, St. Joseph Health Care, London, Ontario, Canada
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Granata V, Grassi R, Fusco R, Belli A, Cutolo C, Pradella S, Grazzini G, La Porta M, Brunese MC, De Muzio F, Ottaiano A, Avallone A, Izzo F, Petrillo A. Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma. Infect Agent Cancer 2021; 16:53. [PMID: 34281580 PMCID: PMC8287696 DOI: 10.1186/s13027-021-00393-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Milan, Italy
| | | | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Silvia Pradella
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Grazzini
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Ottaiano
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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Granata V, Fusco R, Barretta ML, Picone C, Avallone A, Belli A, Patrone R, Ferrante M, Cozzi D, Grassi R, Grassi R, Izzo F, Petrillo A. Radiomics in hepatic metastasis by colorectal cancer. Infect Agent Cancer 2021; 16:39. [PMID: 34078424 PMCID: PMC8173908 DOI: 10.1186/s13027-021-00379-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background Radiomics is an emerging field and has a keen interest, especially in the oncology field. The process of a radiomics study consists of lesion segmentation, feature extraction, consistency analysis of features, feature selection, and model building. Manual segmentation is one of the most critical parts of radiomics. It can be time-consuming and suffers from variability in tumor delineation, which leads to the reproducibility problem of calculating parameters and assessing spatial tumor heterogeneity, particularly in large or multiple tumors. Radiomic features provides data on tumor phenotype as well as cancer microenvironment. Radiomics derived parameters, when associated with other pertinent data and correlated with outcomes data, can produce accurate robust evidence based clinical decision support systems. The principal challenge is the optimal collection and integration of diverse multimodal data sources in a quantitative manner that delivers unambiguous clinical predictions that accurately and robustly enable outcome prediction as a function of the impending decisions. Methods The search covered the years from January 2010 to January 2021. The inclusion criterion was: clinical study evaluating radiomics of liver colorectal metastases. Exclusion criteria were studies with no sufficient reported data, case report, review or editorial letter. Results We recognized 38 studies that assessed radiomics in mCRC from January 2010 to January 2021. Twenty were on different tpics, 5 corresponded to most criteria; 3 are review, or letter to editors; so 10 articles were included. Conclusions In colorectal liver metastases radiomics should be a valid tool for the characterization of lesions, in the stratification of patients based on the risk of relapse after surgical treatment and in the prediction of response to chemotherapy treatment.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy
| | - Roberta Fusco
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy.
| | - Maria Luisa Barretta
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy
| | - Carmine Picone
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Andrea Belli
- Hepatobiliary Surgical Oncology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Renato Patrone
- Hepatobiliary Surgical Oncology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Marilina Ferrante
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Diletta Cozzi
- Division of Radiology, "Azienda Ospedaliera Universitaria Careggi", Florence, Italy
| | - Roberta Grassi
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy.,Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Via della Signora 2, 20122, Milan, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy
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Sudhir R, Sannapareddy K, Potlapalli A, Krishnamurthy PB, Buddha S, Koppula V. Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast. Br J Radiol 2021; 94:20201046. [PMID: 33242249 DOI: 10.1259/bjr.20201046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard. METHODS It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis. RESULTS This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24-72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG. CONCLUSION CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast. ADVANCES IN KNOWLEDGE CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.
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Affiliation(s)
- Rashmi Sudhir
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Kamala Sannapareddy
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Alekya Potlapalli
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Suryakala Buddha
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Veeraiah Koppula
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
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Introduction to Special Issue of Radiology and Imaging of Cancer. Cancers (Basel) 2020; 12:cancers12092665. [PMID: 32961946 PMCID: PMC7565136 DOI: 10.3390/cancers12092665] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
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Bicchierai G, Amato F, Vanzi B, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cirone D, Cozzi D, Miele V, Nori J. Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)? Breast 2020; 54:15-24. [PMID: 32889303 PMCID: PMC7479440 DOI: 10.1016/j.breast.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm. The variables associated with an increased risk of no enhancement were unifocal disease extension, non-classifiable molecular subtype, DCIS histotype, lesion dimensions <10 mm, index lesion represented by microcalcifications. A greater probability of showing enhancement entailed the presence of an invasive ductal component, index lesion represented by ultrasound mass, Luminal B HER2 negative molecular subtype, lesion dimensions ≥10 mm, multifocal disease extension.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Bianca Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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