1
|
Bellini C, Pugliese F, Bicchierai G, Amato F, De Benedetto D, Di Naro F, Boeri C, Vanzi E, Migliaro G, Incardona L, Tommasi C, Orzalesi L, Miele V, Nori J. Contrast-enhanced mammography in the management of breast architectural distortions and avoidance of unnecessary biopsies. Breast Cancer 2024; 31:851-857. [PMID: 38811515 DOI: 10.1007/s12282-024-01599-x] [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: 03/10/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND To assess contrast-enhanced mammography (CEM) in the management of BI-RADS3 breast architectural distortions (AD) in digital breast tomosynthesis (DBT). METHODS We retrospectively reviewed 328 women with 332 ADs detected on DBT between 2017 and 2021 and selected those classified as BI-RADS3 receiving CEM as problem-solving. In CEM recombined images, we evaluated AD's contrast enhancement (CE) according to its presence/absence, type, and size. AD with enhancement underwent imaging-guided biopsy while AD without enhancement follow-up or biopsy if detected in high/intermediate-risk women. RESULTS AD with enhancement were 174 (52.4%): 72 (41.4%) were malignant lesions, 102 (59.6%) false positive results: 28 (16%) B3 lesions, and 74 (42.5%) benign lesions. AD without enhancement were 158 (47.6%): 26 (16.5%) were subjected to biopsy (1 malignant and 25 benign) while the other 132 cases were sent to imaging follow-up, still negative after two years. CEM's sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy were 98.63%, 60.62%, 41.38%, 99.37%, and 68.98%. The AUC determined by ROC was 0.796 (95% CI, 0.749-0.844). CONCLUSION CEM has high sensitivity and NPV in evaluating BI-RADS3 AD and can be a complementary tool in assessing AD, avoiding unnecessary biopsies without compromising cancer detection.
Collapse
Affiliation(s)
- Chiara Bellini
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesca Pugliese
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Bicchierai
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Amato
- Department of Radiology, Breast Imaging Unit, "Ospedale San Giovanni di Dio", Agrigento, Italy
| | - Diego De Benedetto
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuliano Migliaro
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ludovica Incardona
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cinzia Tommasi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Department of Radiology, Breast Imaging Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
2
|
Schiaffino S, Cozzi A, Clauser P, Giannotti E, Marino MA, van Nijnatten TJA, Baltzer PAT, Lobbes MBI, Mann RM, Pinker K, Fuchsjäger MH, Pijnappel RM. Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI). Eur Radiol 2024; 34:5439-5450. [PMID: 38227202 DOI: 10.1007/s00330-023-10574-7] [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: 11/26/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM). METHODS A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics. RESULTS Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (p < 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (p = 0.004) and future indications (p < 0.001). CONCLUSIONS Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique. CLINICAL RELEVANCE STATEMENT In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications. KEY POINTS • Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice. • Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications. • The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.
Collapse
Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Elisabetta Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
3
|
Patel BK, Carnahan MB, Northfelt D, Anderson K, Mazza GL, Pizzitola VJ, Giurescu ME, Lorans R, Eversman WG, Sharpe RE, Harper LK, Apsey H, Cronin P, Kling J, Ernst B, Palmieri J, Fraker J, Mina L, Batalini F, Pockaj B. Prospective Study of Supplemental Screening With Contrast-Enhanced Mammography in Women With Elevated Risk of Breast Cancer: Results of the Prevalence Round. J Clin Oncol 2024:JCO2202819. [PMID: 39058970 DOI: 10.1200/jco.22.02819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/14/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) have shown similar diagnostic performance in detection of breast cancer. Limited CEM data are available for high-risk breast cancer screening. The purpose of the study was to prospectively investigate the efficacy of supplemental screening CEM in elevated risk patients. MATERIALS AND METHODS A prospective, single-institution, institutional review board-approved observational study was conducted in asymptomatic elevated risk women age 35 years or older who had a negative conventional two-dimensional digital breast tomosynthesis screening mammography (MG) and no additional supplemental screening within the prior 12 months. RESULTS Four hundred sixty women were enrolled from February 2019 to April 2021. The median age was 56.8 (range, 35.0-79.2) years; 408 of 460 (88.7%) were mammographically dense. Biopsy revealed benign changes in 22 women (22/37, 59%), high-risk lesions in four women (4/37, 11%), and breast cancer in 11 women (11/37, 30%). Fourteen cancers (10 invasive, tumor size range 4-15 mm, median 9 mm) were diagnosed in 11 women. The overall supplemental cancer detection rate was 23.9 per 1,000 patients, 95% CI (12.0 to 42.4). All cancers were grade 1 or 2, ER+ ERBB2-, and node negative. CEM imaging screening offered high specificity (0.875 [95% CI, 0.844 to 0.906]), high NPV (0.998 [95% CI, 0.993 to 1.000), moderate PPV1 (0.164 [95% CI, 0.076 to 0.253), moderate PPV3 (0.275 [95% CI, 0.137 to 0.413]), and high sensitivity (0.917 [95% CI, 0.760 to 1.000]). At least 1 year of imaging follow-up was available on all patients, and one interval cancer was detected on breast MRI 4 months after negative screening CEM. CONCLUSION A pilot trial demonstrates a supplemental cancer detection rate of 23.9 per 1,000 in women at an elevated risk for breast cancer. Larger, multi-institutional, multiyear CEM trials in patients at elevated risk are needed for validation.
Collapse
Affiliation(s)
- Bhavika K Patel
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Donald Northfelt
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Karen Anderson
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Roxanne Lorans
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | | | - Laura K Harper
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Heidi Apsey
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Patricia Cronin
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Juliana Kling
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Brenda Ernst
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Jessica Fraker
- Department of Surgical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Lida Mina
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Felipe Batalini
- Department of Medical Oncology, Mayo Clinic in Arizona, Phoenix, AZ
| | - Barbara Pockaj
- Division of Women's Health Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| |
Collapse
|
4
|
Kim JH, Kessell M, Taylor D, Hill M, Burrage JW. The verification of the utility of a commercially available phantom combination for quality control in contrast-enhanced mammography. Phys Eng Sci Med 2024:10.1007/s13246-024-01461-6. [PMID: 38954379 DOI: 10.1007/s13246-024-01461-6] [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: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
Contrast-enhanced mammography is being increasingly implemented clinically, providing much improved contrast between tumour and background structures, particularly in dense breasts. Although CEM is similar to conventional mammography it differs via an additional exposure with high energy X-rays (≥ 40 kVp) and subsequent image subtraction. Because of its special operational aspects, the CEM aspect of a CEM unit needs to be uniquely characterised and evaluated. This study aims to verify the utility of a commercially available phantom set (BR3D model 020 and CESM model 022 phantoms (CIRS, Norfolk, Virginia, USA)) in performing key CEM performance tests (linearity of system response with iodine concentration and background subtraction) on two models of CEM units in a clinical setting. The tests were successfully performed, yielding results similar to previously published studies. Further, similarities and differences in the two systems from different vendors were highlighted, knowledge of which may potentially facilitate optimisation of the systems.
Collapse
Affiliation(s)
- J-H Kim
- Health Technology Management Unit, Royal Perth Hospital, Perth, WA, 6000, Australia
- Department of Medical Physics, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - M Kessell
- Department of Radiology, Royal Perth Hospital, Perth, WA, 6000, Australia
| | - D Taylor
- Department of Radiology, Royal Perth Hospital, Perth, WA, 6000, Australia
- Medical School, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
- BreastScreen WA Eastpoint Plaza 233 Adelaide Terrace, Perth, WA, 6000, Australia
| | - M Hill
- Imaging Science Consulting, Issy Les Moulineaux, France
| | - J W Burrage
- Health Technology Management Unit, Royal Perth Hospital, Perth, WA, 6000, Australia.
| |
Collapse
|
5
|
Mann RM, Longo V. Contrast-enhanced Mammography versus MR Imaging of the Breast. Radiol Clin North Am 2024; 62:643-659. [PMID: 38777540 DOI: 10.1016/j.rcl.2024.02.003] [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: 05/25/2024]
Abstract
Breast MR imaging and contrast-enhanced mammography (CEM) are both techniques that employ intravenously injected contrast agent to assess breast lesions. This approach is associated with a very high sensitivity for malignant lesions that typically exhibit rapid enhancement due to the leakiness of neovasculature. CEM may be readily available at the breast imaging department and can be performed on the spot. Breast MR imaging provides stronger enhancement than the x-ray-based techniques and offers higher sensitivity. From a patient perspective, both modalities have their benefits and downsides; thus, patient preference could also play a role in the selection of the imaging technique.
Collapse
Affiliation(s)
- Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Valentina Longo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, Rome 00168, Italy
| |
Collapse
|
6
|
Cheng BWT, Ko TY, Lai YTA. Radiologic-Pathologic Correlation: Is There an Association Between Contrast-Enhanced Mammography Imaging Features and Molecular Subtypes of Breast Cancer? Cureus 2024; 16:e64791. [PMID: 39156463 PMCID: PMC11329886 DOI: 10.7759/cureus.64791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE This study aims to assess the correlation between imaging features of contrast-enhanced mammography (CEM) and molecular subtypes of breast cancer. METHODS This is a retrospective single-institution study of patients who underwent CEM from December 2019 to August 2023. Each patient had at least one histologically proven invasive breast cancer with a core biopsy performed. Patients with a history of breast cancer treatment and lesions not entirely included in the CEM images were excluded. The images were interpreted using the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) lexicon for CEM, published in 2022. Different imaging features, including the presence of calcifications, architectural distortion, non-mass enhancement, mass morphology, internal enhancement pattern, the extent of enhancement, and lesion conspicuity, were analyzed. The molecular subtypes were studied as dichotomous variables, including luminal A, luminal B, HER2, and basal-like. The association between the imaging features and molecular subtypes was analyzed with a Fisher's exact test. Statistical significance was assumed when the p-value was <0.05. RESULTS A total of 31 patients with 36 malignant lesions were included in this study. Sixteen lesions (44.4%) were luminal A, four lesions (11.1%) were luminal B, 10 lesions (27.8%) were HER2, and six (16.7%) were basal-like subtypes. The presence of calcifications was associated with the HER2 subtype (p=0.024). Rim-enhancement on recombined images was associated with a basal-like subtype (p=0.001). Heterogeneous enhancement on recombined images was associated with non-basal-like breast cancer (p=0.027). No statistically significant correlation was found between other analyzed CEM imaging features and molecular subtypes. CONCLUSION CEM imaging features, including the presence of calcifications and certain internal enhancement patterns, were correlated with distinguishing breast cancer molecular subtypes and thus may further expand the role of CEM.
Collapse
Affiliation(s)
| | - Tsz Yan Ko
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, HKG
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, HKG
| |
Collapse
|
7
|
Petrillo A, Fusco R, Petrosino T, Vallone P, Granata V, Rubulotta MR, Pariante P, Raiano N, Scognamiglio G, Fanizzi A, Massafra R, Lafranceschina M, La Forgia D, Greco L, Ferranti FR, De Soccio V, Vidiri A, Botta F, Dominelli V, Cassano E, Sorgente E, Pecori B, Cerciello V, Boldrini L. A multicentric study of radiomics and artificial intelligence analysis on contrast-enhanced mammography to identify different histotypes of breast cancer. LA RADIOLOGIA MEDICA 2024; 129:864-878. [PMID: 38755477 DOI: 10.1007/s11547-024-01817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To evaluate the performance of radiomic analysis on contrast-enhanced mammography images to identify different histotypes of breast cancer mainly in order to predict grading, to identify hormone receptors, to discriminate human epidermal growth factor receptor 2 (HER2) and to identify luminal histotype of the breast cancer. METHODS From four Italian centers were recruited 180 malignant lesions and 68 benign lesions. However, only the malignant lesions were considered for the analysis. All patients underwent contrast-enhanced mammography in cranium caudal (CC) and medium lateral oblique (MLO) view. Considering histological findings as the ground truth, four outcomes were considered: (1) G1 + G2 vs. G3; (2) HER2 + vs. HER2 - ; (3) HR + vs. HR - ; and (4) non-luminal vs. luminal A or HR + /HER2- and luminal B or HR + /HER2 + . For multivariate analysis feature selection, balancing techniques and patter recognition approaches were considered. RESULTS The univariate findings showed that the diagnostic performance is low for each outcome, while the results of the multivariate analysis showed that better performances can be obtained. In the HER2 + detection, the best performance (73% of accuracy and AUC = 0.77) was obtained using a linear regression model (LRM) with 12 features extracted by MLO view. In the HR + detection, the best performance (77% of accuracy and AUC = 0.80) was obtained using a LRM with 14 features extracted by MLO view. In grading classification, the best performance was obtained by a decision tree trained with three predictors extracted by MLO view reaching an accuracy of 82% on validation set. In the luminal versus non-luminal histotype classification, the best performance was obtained by a bagged tree trained with 15 predictors extracted by CC view reaching an accuracy of 94% on validation set. CONCLUSIONS The results suggest that radiomics analysis can be effectively applied to design a tool to support physician decision making in breast cancer classification. In particular, the classification of luminal versus non-luminal histotypes can be performed with high accuracy.
Collapse
Affiliation(s)
- Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy.
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013, Naples, Italy
| | - Teresa Petrosino
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Vallone
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Maria Rosaria Rubulotta
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Pariante
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Nicola Raiano
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Giosuè Scognamiglio
- Pathology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Annarita Fanizzi
- Direzione Scientifica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Raffaella Massafra
- SSD Fisica Sanitaria, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Miria Lafranceschina
- Struttura Semplice Dipartimentale Di Radiodiagnostica Senologica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale Di Radiodiagnostica Senologica, IRCCS Istituto Tumori Giovanni Paolo II, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Laura Greco
- Radiology and Diagnostic Imaging, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, 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
| | - Valeria De Soccio
- Radiology and Diagnostic Imaging, 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
| | - Francesca Botta
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO Istituto Europeo Di Oncologia, 20141, Milan, Italy
| | - Eugenio Sorgente
- Radiation Protection and Innovative Technology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Biagio Pecori
- Radiation Protection and Innovative Technology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Vincenzo Cerciello
- Medical Physics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131, Naples, Italy
| | - Luca Boldrini
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| |
Collapse
|
8
|
Giannotti E, Van Nijnatten TJA, Chen Y, Bicchierai G, Nori J, De Benedetto D, Lalji U, Lee AHS, James J. The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast. Clin Radiol 2024; 79:e799-e806. [PMID: 38383254 DOI: 10.1016/j.crad.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05. RESULTS One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI. CONCLUSION CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.
Collapse
Affiliation(s)
- E Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK; Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK.
| | - T J A Van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Y Chen
- University of Nottingham, School of Medicine, Division of Cancer and Stem Cells, City Hospital Campus, Nottingham, UK
| | - G Bicchierai
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - J Nori
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - D De Benedetto
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - U Lalji
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A H S Lee
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - J James
- Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK
| |
Collapse
|
9
|
McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
10
|
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.
Collapse
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.)
| |
Collapse
|
11
|
Wen C, Wang S, Ma M, Xu Z, Zeng F, Zeng H, Liao X, He Z, Xu W, Chen W. Breast masses with rim enhancement on contrast-enhanced mammography: morphological and enhancement features for diagnosis and differentiation of benign and malignant. Br J Radiol 2024; 97:1016-1021. [PMID: 38521539 DOI: 10.1093/bjr/tqae064] [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: 09/03/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES To investigate the imaging characteristics and clinicopathological features of rim enhancement of breast masses demonstrated on contrast-enhanced mammography (CEM). METHODS 67 cases of breast lesions confirmed by pathology and showing rim enhancement on CEM examinations were analyzed. The lesions were divided into benign and malignant groups, and the morphological and enhanced features were described. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated separately for each morphology descriptor to evaluate the diagnostic ability of each indicator. RESULTS There were 35 (52.2%) malignant and 32 (47.8%) benign lesions. There are significant differences in the morphological and enhanced features between benign and malignant lesions. 29/35 (82.9%) malignant lesions exhibited irregular shapes, and 31/35 (88.6%) showed indistinct margins. 28/35 (80%) malignant lesions displayed strong enhancement on CEM, while 12/32 (37.5%) benign lesions exhibited weak enhancement (P = 0.001). Malignant lesions showed a higher incidence of unsmooth inner walls than benign lesions (28/35 vs 7/32; P <.001). Lesion margins showed high sensitivity of 88.57% and NPV of 81.8%. The presence of suspicious calcifications had the highest specificity of 100% and PPV of 100%. The diagnostic sensitivity, specificity, PPV, and NPV of the combined parameters were 97.14%, 93.15%, 94.44%, and 96.77%, respectively. CONCLUSIONS The assessment of morphological and enhanced features of breast lesions exhibiting rim enhancement on CEM can improve the differentiation between benign and malignant breast lesions. ADVANCES IN KNOWLEDGE This article provides a reference for the differential diagnosis of ring enhanced lesions on CEM.
Collapse
Affiliation(s)
- Chanjuan Wen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Sina Wang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Mengwei Ma
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zeyuan Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Fengxia Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Hui Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xin Liao
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zilong He
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Weimin Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Weiguo Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
12
|
Su T, Zheng Y, Yang H, Ouyang Z, Fan J, Lin L, Lv F. Nomogram for preoperative differentiation of benign and malignant breast tumors using contrast-enhanced cone-beam breast CT (CE CB-BCT) quantitative imaging and assessment features. LA RADIOLOGIA MEDICA 2024; 129:737-750. [PMID: 38512625 DOI: 10.1007/s11547-024-01803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Breast cancer's impact necessitates refined diagnostic approaches. This study develops a nomogram using radiology quantitative features from contrast-enhanced cone-beam breast CT for accurate preoperative classification of benign and malignant breast tumors. MATERIAL AND METHODS A retrospective study enrolled 234 females with breast tumors, split into training and test sets. Contrast-enhanced cone-beam breast CT-images were acquired using Koning Breast CT-1000. Quantitative assessment features were extracted via 3D-slicer software, identifying independent predictors. The nomogram was constructed to preoperative differentiation benign and malignant breast tumors. Calibration curve was used to assess whether the model showed favorable correspondence with pathological confirmation. Decision curve analysis confirmed the model's superiority. RESULTS The study enrolled 234 female patients with a mean age of 50.2 years (SD ± 9.2). The training set had 164 patients (89 benign, 75 malignant), and the test set had 70 patients (29 benign, 41 malignant). The nomogram achieved excellent predictive performance in distinguishing benign and malignant breast lesions with an AUC of 0.940 (95% CI 0.900-0.940) in the training set and 0.970 (95% CI 0.940-0.970) in the test set. CONCLUSION This study illustrates the effectiveness of quantitative radiology features derived from contrast-enhanced cone-beam breast CT in distinguishing between benign and malignant breast tumors. Incorporating these features into a nomogram-based diagnostic model allows for breast tumor diagnoses that are objective and possess good accuracy. The application of these insights could substantially increase reliability and efficacy in the management of breast tumors, offering enhanced diagnostic capability.
Collapse
Affiliation(s)
- Tong Su
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China
| | - Hongyu Yang
- Department of Radiology, Chongqing Changshou District People's Hospital, Chongqing, China
| | - Zubin Ouyang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China
| | - Jun Fan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China
| | - Lin Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, China.
| |
Collapse
|
13
|
Wang L, Wang P, Shao H, Li J, Yang Q. Role of contrast-enhanced mammography in the preoperative detection of ductal carcinoma in situ of the breasts: a comparison with low-energy image and magnetic resonance imaging. Eur Radiol 2024; 34:3342-3351. [PMID: 37853174 DOI: 10.1007/s00330-023-10312-z] [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: 09/08/2022] [Revised: 08/13/2023] [Accepted: 08/20/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To compare contrast-enhanced mammography (CEM) with low-energy image (LEI) alone and with magnetic resonance imaging (MRI) in the preoperative diagnosis of ductal carcinoma in situ (DCIS). METHODS In this single-center retrospective study, we reviewed 98 pure DCIS lesions in 96 patients who underwent CEM and MRI within 2 weeks preoperatively. The diagnostic performances of each imaging modality, lesion morphology, and extent were evaluated. RESULTS The sensitivity of CEM to DCIS was similar to that of MRI (92.9% vs. 93.9%, p = 0.77) and was significantly higher than that of LEI alone (76.5%, p = 0.002). The sensitivity of CEM to calcified DCIS (92.4%) was not significantly different from LEI alone (92.4%) and from MRI (93.9%, p = 1.00). However, CEM contributed to the simultaneous comparison of calcifications with enhancements. CEM had considerably higher sensitivity compared with LEI alone (93.8% vs. 43.8%, p < 0.001) and performed similarly to MRI (93.8%, p = 1.00) for noncalcified DCIS. All DCIS lesions were enhanced in MRI, whereas 94.9% (93/98) were enhanced in CEM. Non-mass enhancement was the most common presentation (CEM 63.4% and MRI 66.3%). The difference between the lesion size on each imaging modality and the histopathological size was smallest in MRI, followed by CEM, and largest in LEI. CONCLUSION CEM was more sensitive than LEI alone and comparable to MRI in DCIS diagnosis. The enhanced morphology of DCIS in CEM was consistent with that in MRI. CEM was superior to LEI alone in size measurement of DCIS. CLINICAL RELEVANCE STATEMENT This study investigated the value of CEM in the diagnosis and evaluation of DCIS, aiming to offer a reference for the selection of examination methods for DCIS and contribute to the early diagnosis and precise treatment of DCIS. KEY POINTS • DCIS is an important indication for breast surgery. Early and accurate diagnosis is crucial for DCIS treatment and prognosis. • CEM overcomes the deficiency of mammography in noncalcified DCIS diagnosis, exhibiting similar sensitivity to MRI; and CEM contributes to the comparison of calcification and enhancement of calcified DCIS, thereby outperforming MRI. • CEM is superior to LEI alone and slightly inferior to MRI in the size evaluation of DCIS.
Collapse
Affiliation(s)
- Liping Wang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Ping Wang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Huafei Shao
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong, People's Republic of China
| | - Qinglin Yang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangdingdong Road, Yantai, 264000, Shandong, People's Republic of China.
| |
Collapse
|
14
|
Watt GP, Keshavamurthy KN, Nguyen TL, Lobbes MBI, Jochelson MS, Sung JS, Moskowitz CS, Patel P, Liang X, Woods M, Hopper JL, Pike MC, Bernstein JL. Association of breast cancer with quantitative mammographic density measures for women receiving contrast-enhanced mammography. JNCI Cancer Spectr 2024; 8:pkae026. [PMID: 38565262 PMCID: PMC11060476 DOI: 10.1093/jncics/pkae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Women with high mammographic density have an increased risk of breast cancer. They may be offered contrast-enhanced mammography to improve breast cancer screening performance. Using a cohort of women receiving contrast-enhanced mammography, we evaluated whether conventional and modified mammographic density measures were associated with breast cancer. Sixty-six patients with newly diagnosed unilateral breast cancer were frequency matched on the basis of age to 133 cancer-free control individuals. On low-energy craniocaudal contrast-enhanced mammograms (equivalent to standard mammograms), we measured quantitative mammographic density using CUMULUS software at the conventional intensity threshold ("Cumulus") and higher-than-conventional thresholds ("Altocumulus," "Cirrocumulus"). The measures were standardized to enable estimation of odds ratio per adjusted standard deviation (OPERA). In multivariable logistic regression of case-control status, only the highest-intensity measure (Cirrocumulus) was statistically significantly associated with breast cancer (OPERA = 1.40, 95% confidence interval = 1.04 to 1.89). Conventional Cumulus did not contribute to model fit. For women receiving contrast-enhanced mammography, Cirrocumulus mammographic density may better predict breast cancer than conventional quantitative mammographic density.
Collapse
Affiliation(s)
- Gordon P Watt
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tuong L Nguyen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prusha Patel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaolin Liang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Woods
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John L Hopper
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
15
|
Terzoni A, Basile P, Gambaro AC, Attanasio S, Rampi AM, Brambilla M, Carriero A. Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging. LA RADIOLOGIA MEDICA 2024; 129:558-565. [PMID: 38512618 PMCID: PMC11021306 DOI: 10.1007/s11547-024-01789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/15/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Breast cancer diagnosis often involves assessing the locoregional spread of the disease through MRI, as multicentricity, multifocality and/or bilaterality are increasingly common. Contrast-enhanced mammography (CEM) is emerging as a potential alternative method. This study compares the performance of CEM and MRI in preoperative staging of women with confirmed breast carcinoma. Patients were also asked to fill in a satisfaction questionnaire to rate their comfort level with each investigation. METHODS From May 1st, 2021 to May 1st, 2022, we enrolled 70 women with confirmed breast carcinoma who were candidates for surgery. For pre-operative locoregional staging, all patients underwent CEM and MRI examination, which two radiologists evaluated blindly. We further investigated all suspicious locations for disease spread, identified by both CEM and MRI, with a second-look ultrasound (US) and eventual histological examination. RESULTS In our study cohort, MRI and CEM identified 114 and 102 areas of focal contrast enhancement, respectively. A true discrepancy between MRI and CEM occurred in 9 out of 70 patients examined. MRI reported 8 additional lesions that proved to be false positives on second-look US in 6 patients, while it identified 4 lesions that were not detected by CEM and were pathological (true positives) in 3 patients. CONCLUSIONS CEM showed results comparable to MRI in the staging of breast cancer in our study population, with a high rate of patient acceptability.
Collapse
Affiliation(s)
- Andrea Terzoni
- Scuola di Specializzazione Radiodiagnostica, University of Piemonte Orientale, Novara, Italy.
| | - Paola Basile
- Scuola di Specializzazione Radiodiagnostica, University of Piemonte Orientale, Novara, Italy
| | | | | | | | - Marco Brambilla
- Health Physics Department, University Hospital, Novara, Italy
| | | |
Collapse
|
16
|
Ancona A, Telegrafo M, Fella RR, Iamele D, Cantore S, Moschetta M. CEM immediately after contrast-enhanced CT: a one-step staging of breast cancer. Eur Radiol Exp 2024; 8:32. [PMID: 38556593 PMCID: PMC10982147 DOI: 10.1186/s41747-024-00440-6] [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: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is a promising technique. We evaluated the diagnostic potential of CEM performed immediately after contrast-enhanced computed tomography (CE-CT). METHODS Fifty patients with breast cancer underwent first CE-CT and then CEM without additional contrast material injection. Two independent radiologists evaluated CEM images. The sensitivity of CEM for detecting index and additional malignant lesions was compared with that of mammography/ultrasonography by the McNemar test, using histopathology as a reference standard. Interobserver agreement for detection of malignant lesions, for classifying index tumors, and for evaluating index tumor size and extent was assessed using Cohen κ. Pearson correlation was used for correlating index tumor size/extent at CEM or mammography/ultrasonography with histopathology. RESULTS Of the 50 patients, 30 (60%) had unifocal disease while 20 (40%) had multicentric or multifocal disease; 5 of 20 patients with multicentric disease (25%) had bilateral involvement, for a total of 78 malignant lesions, including 72 (92%) invasive ductal and 6 (8%) invasive lobular carcinomas. Sensitivity was 63/78 (81%, 95% confidence interval 70.27-88.82) for unenhanced breast imaging and 78/78 (100%, 95.38-100) for CEM (p < 0.001). The interobserver agreement for overall detection of malignant lesions, for classifying index tumor, and for evaluating index tumor size/extent were 0.94, 0.95, and 0.86 κ, respectively. For index tumor size/extent, correlation coefficients as compared with histological specimens were 0.50 for mammography/ultrasonography and 0.75 for CEM (p ≤ 0.010). CONCLUSIONS CEM acquired immediately after CE-CT without injection of additional contrast material showed a good performance for local staging of breast cancer. RELEVANCE STATEMENT When the CEM suite is near to the CE-CT acquisition room, CEM acquired immediately after, without injection of additional contrast material, could represent a way for local staging of breast cancer to be explored in larger prospective studies. KEY POINTS • CEM represents a new accurate tool in the field of breast imaging. • An intravenous injection of iodine-based contrast material is required for breast gland evaluation. • CEM after CE-CT could provide a one-stop tool for breast cancer staging.
Collapse
Affiliation(s)
- Antonietta Ancona
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Michele Telegrafo
- Breast Care Unit, University Hospital Consortium Policlinico of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Rita Roberta Fella
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Donato Iamele
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Sebastiano Cantore
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Marco Moschetta
- DIM, Interdisciplinary Department of Medicine, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, 70124, Italy.
| |
Collapse
|
17
|
van Haaren ERM, Spiekerman van Weezelenburg MA, van Bastelaar J, Janssen A, van Nijnatten T, Bouwman LH, Vissers YLJ, Lobbes MBI. Impact of low dose superparamagnetic iron oxide tracer for sentinel node biopsy in breast conserving treatment on susceptibility artefacts on magnetic resonance imaging and contrast enhanced mammography. Surg Oncol 2024; 53:102045. [PMID: 38330805 DOI: 10.1016/j.suronc.2024.102045] [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: 10/16/2023] [Revised: 01/16/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Residual particles of superparamagnetic iron oxide (SPIO) tracer, used for sentinel node biopsy, cause susceptibility artefacts on breast Magnetic Resonance Imaging (MRI). We investigated the impact of these artefacts on the imaging quality of MRI and explored whether contrast-enhanced mammography (CEM) could be an alternative in the follow-up of breast cancer patients. MATERIALS AND METHODS Data on patients' characteristics, injection site, presence, size (mm) of artefacts on full-field digital mammography (FFDM)/CEM, MRI after 1 ml SPIO was recorded. Image quality scored by two breast radiologists using a 4-point Likert system: 0: no artefacts 1: good diagnostic quality 2: impaired but still readable 3: hampered clinical assessment. Continuous variables reported as means and standard deviations (SD), categorical variables as count and percentage. RESULTS On FFDM/CEM, performed 13 months postoperatively, no iron SPIO particles were detected, with a Likert score of 0. In all MRI (100%) images, executed at 16.6 months after SPIO injection, susceptibility artefacts at the injection sites i.e., retroareolair and lateral quadrant were observed with a mean size of 41.9 ± 9.8 mm (SD) by observer 1, and 44.8 ± 12.5 mm (SD) by observer 2, independent of the injection site. Both observers scored a Likert score of 2: locally impaired on all MRI images and sequences. CONCLUSIONS Even 1 ml SPIO tracer used for sentinel node procedure impairs the evaluation of breast MRI at the tracer injection site beyond one year of follow-up. No impairment was observed on FFDM/CEM, suggesting that CEM might be a reliable alternative to breast MRI if required.
Collapse
Affiliation(s)
| | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Thiemo van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands.
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands.
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands.
| |
Collapse
|
18
|
Deng T, Liang J, Yan C, Ni M, Xiang H, Li C, Ou J, Lin Q, Liu L, Tang G, Luo R, An X, Gao Y, Lin X. Development and validation of ultrasound-based radiomics model to predict germline BRCA mutations in patients with breast cancer. Cancer Imaging 2024; 24:31. [PMID: 38424620 PMCID: PMC10905812 DOI: 10.1186/s40644-024-00676-w] [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: 07/05/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Identifying breast cancer (BC) patients with germline breast cancer susceptibility gene (gBRCA) mutation is important. The current criteria for germline testing for BC remain controversial. This study aimed to develop a nomogram incorporating ultrasound radiomic features and clinicopathological factors to predict gBRCA mutations in patients with BC. MATERIALS AND METHODS In this retrospective study, 497 women with BC who underwent gBRCA genetic testing from March 2013 to May 2022 were included, including 348 for training (84 with and 264 without a gBRCA mutation) and 149 for validation(36 patients with and 113 without a gBRCA mutation). Factors associated with gBRCA mutations were identified to establish a clinicopathological model. Radiomics features were extracted from the intratumoral and peritumoral regions (3 mm and 5 mm) of each image. The least absolute shrinkage and selection operator regression algorithm was used to select the features and logistic regression analysis was used to construct three imaging models. Finally, a nomogram that combined clinicopathological and radiomics features was developed. The models were evaluated based on the area under the receiver operating characteristic curve (AUC), calibration, and clinical usefulness. RESULTS Age at diagnosis, family history of BC, personal history of other BRCA-related cancers, and human epidermal growth factor receptor 2 status were independent predictors of the clinicopathological model. The AUC of the imaging radiomics model combining intratumoral and peritumoral 3 mm areas in the validation set was 0.783 (95% confidence interval [CI]: 0.702-0.862), which showed the best performance among three imaging models. The nomogram yielded better performance than the clinicopathological model in validation sets (AUC: 0.824 [0.755-0.894] versus 0.659 [0.563-0.755], p = 0.007). CONCLUSION The nomogram based on ultrasound images and clinicopathological factors performs well in predicting gBRCA mutations in BC patients and may help to improve clinical decisions about genetic testing.
Collapse
Affiliation(s)
- Tingting Deng
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Jianwen Liang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, 518000, China
| | - Cuiju Yan
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Mengqian Ni
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Huiling Xiang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Chunyan Li
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Jinjing Ou
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Qingguang Lin
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Lixian Liu
- Department of Ultrasound, Guangdong Second Provincial General Hospital, Guangzhou, 510060, China
| | - Guoxue Tang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Rongzhen Luo
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yi Gao
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, 518000, China.
| | - Xi Lin
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
| |
Collapse
|
19
|
Piccolo CL, Celli I, Bandini C, Tommasiello M, Sammarra M, Faggioni L, Cioni D, Beomonte Zobel B, Neri E. The Correlation between Morpho-Dynamic Contrast-Enhanced Mammography (CEM) Features and Prognostic Factors in Breast Cancer: A Single-Center Retrospective Analysis. Cancers (Basel) 2024; 16:870. [PMID: 38473232 DOI: 10.3390/cancers16050870] [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: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Breast cancer, a major contributor to female mortality globally, presents challenges in detection, prompting exploration beyond digital mammography. Contrast-Enhanced Mammography (CEM), integrating morphological and functional information, emerges as a promising alternative, offering advantages in cost-effectiveness and reduced anxiety compared to MRI. This study investigates CEM's correlation with breast cancer prognostic factors, encompassing histology, grade, and molecular markers. In a retrospective analysis involving 114 women, CEM revealed diverse lesion characteristics. Statistical analyses identified correlations between specific CEM features, such as spiculated margins and irregular shape, and prognostic factors like tumor grade and molecular markers. Notably, spiculated margins predicted lower grade and HER2 status, while irregular shape correlated with PgR and Ki-67 status. The study emphasizes CEM's potential in predicting breast cancer prognosis, shedding light on tumor behavior. Despite the limitations, including sample size and single-observer analysis, the findings advocate for CEM's role in stratifying breast cancers based on biological characteristics. CEM features, particularly spiculated margins, irregular shape, and enhancement dynamics, may serve as valuable indicators for personalized treatment decisions. Further research is crucial to validate these correlations and enhance CEM's clinical utility in breast cancer assessment.
Collapse
Affiliation(s)
- Claudia Lucia Piccolo
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Ilenia Celli
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Claudio Bandini
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Manuela Tommasiello
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Matteo Sammarra
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Dania Cioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Bruno Beomonte Zobel
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Operative Research Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
20
|
Sammarra M, Piccolo CL, Sarli M, Stefanucci R, Tommasiello M, Orsaria P, Altomare V, Beomonte Zobel B. Contrast-Enhanced Mammography-Guided Biopsy: Preliminary Results of a Single-Center Retrospective Experience. J Clin Med 2024; 13:933. [PMID: 38398247 PMCID: PMC10889410 DOI: 10.3390/jcm13040933] [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: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Background: CEM-guided breast biopsy is an advanced diagnostic procedure that takes advantage of the ability of CEM to enhance suspicious breast lesions. The aim pf this paper is to describe a single-center retrospective experience on CEM-guided breast biopsy in terms of procedural features and histological outcomes. Methods: 69 patients underwent the procedure. Patient age, breast density, presentation, dimensions, and lesion target enhancement were recorded. All the biopsy procedures were performed using a 7- or 10-gauge (G) vacuum-assisted biopsy needle. The procedural approach (horizontal or vertical) and the decubitus of the patient (lateral or in a sitting position) were noted. Results: A total of 69 patients underwent a CEM-guided biopsy. Suspicious lesions presented as mass enhancement in 35% of cases and non-mass enhancement in 65% of cases. The median size of the target lesions was 20 mm. The median procedural time for each biopsy was 10 ± 4 min. The patients were placed in a lateral decubitus position in 52% of cases and seated in 48% of cases. The most common approach was horizontal (57%). The mean AGD was 14.8 mGy. At histology, cancer detection rate was 28% (20/71). Conclusions: CEM-guided biopsy was feasible, with high procedure success rates and high tolerance by the patients.
Collapse
Affiliation(s)
- Matteo Sammarra
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Claudia Lucia Piccolo
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Marina Sarli
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rita Stefanucci
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Manuela Tommasiello
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| |
Collapse
|
21
|
Qian N, Jiang W, Guo Y, Zhu J, Qiu J, Yu H, Huang X. Breast cancer diagnosis from contrast-enhanced mammography using multi-feature fusion neural network. Eur Radiol 2024; 34:917-927. [PMID: 37610440 DOI: 10.1007/s00330-023-10170-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/25/2023] [Accepted: 07/08/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To develop an end-to-end deep neural network for the classification of contrast-enhanced mammography (CEM) images to facilitate breast cancer diagnosis in the clinic. METHODS In this retrospective mono-centric study, patients who underwent CEM examinations from January 2019 to August 2021 were enrolled. A multi-feature fusion network combining low-energy (LE) and dual-energy subtracted (DES) images and dual view, as well as bilateral information, was trained and tested using a large CEM dataset with a diversity of breast tumors for breast lesion classification. Its generalization performance was further evaluated on two external datasets. Results were reported using AUC, accuracy, sensitivity, and specificity. RESULTS A total of 2496 patients (mean age, 53 years ± 12 (standard deviation)) were included and divided into a training set (1718), a validation set (255), and a testing set (523). The proposed CEM-based multi-feature fusion network achieved the best diagnosis performance with an AUC of 0.96 (95% confidence interval (CI): 0.95, 0.97), compared with the no-fusion model, the left-right fusion model, and the multi-feature fusion network with only LE image inputs. Our models reached an AUC of 0.90 (95% CI: 0.85, 0.94) on a full-field digital mammograph (FFDM) external dataset (86 patients), and an AUC of 0.92 (95% CI: 0.89, 0.95) on a CEM external dataset (193 patients). CONCLUSION The developed multi-feature fusion neural network achieved high performance in CEM image classification and was able to facilitate CEM-based breast cancer diagnosis. CLINICAL RELEVANCE STATEMENT Compared with low-energy images, CEM images have greater sensitivity and similar specificity in malignant breast lesion detection. The multi-feature fusion neural network is a promising computer-aided diagnostic tool for the clinical diagnosis of breast cancer. KEY POINTS • Deep convolutional neural networks have the potential to facilitate contrast-enhanced mammography-based breast cancer diagnosis. • The multi-feature fusion neural network reaches high accuracies in the classification of contrast-enhanced mammography images. • The developed model is a promising diagnostic tool to facilitate clinical breast cancer diagnosis.
Collapse
Affiliation(s)
- Nini Qian
- Department of Biomedical Engineering, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Wei Jiang
- Department of Biomedical Engineering, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
- Department of Radiotherapy, Yantai Yuhuangding Hospital, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, China
| | - Yu Guo
- Department of Biomedical Engineering, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China.
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital, Jiyan Road, Jinan, 250117, Shandong, China
| | - Jianfeng Qiu
- Medical Engineering and Technology Research Center, School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, Shandong, China
| | - Hui Yu
- Department of Biomedical Engineering, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Xian Huang
- Department of Biomedical Engineering, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| |
Collapse
|
22
|
Corines MJ, Sogani J, Hogan MP, Mango VL, Bryce Y. The Role of Contrast-Enhanced Mammography After Cryoablation of Breast Cancer. AJR Am J Roentgenol 2024; 222:e2330250. [PMID: 38019473 DOI: 10.2214/ajr.23.30250] [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: 11/30/2023]
Abstract
Image-guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is a treatment strategy that is an effective alternate to surgery in select patients. Tumor features impacting the efficacy of cryoablation include size, location in relation to skin, and histology (e.g., extent of intraductal component), underscoring the importance of imaging for staging and workup in this patient population. Contrast-enhanced mammography (CEM) utilization is increasing in both the screening and diagnostic settings and may be useful for follow-up imaging after breast cancer cryoablation, given its high sensitivity for cancer detection and its advantages in terms of PPV, time, cost, eligibility, and accessibility compared with contrast-enhanced MRI. This Clinical Perspective describes the novel use of CEM after breast cancer cryoablation, highlighting the advantages and disadvantages of CEM compared with alternate imaging modalities, expected benign postablation CEM findings, and CEM findings suggestive of residual or recurrent tumor.
Collapse
Affiliation(s)
- Marina J Corines
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Julie Sogani
- Department of Radiology, Englewood Hospital and Medical Center, Englewood, NJ
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Victoria L Mango
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Yolanda Bryce
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| |
Collapse
|
23
|
Thanh Ha Nguyen M, Varma N, Lan Cheong Wah D, Chew R, Botha T, Kouloyan-Ilic S, Paiva J. Performance of contrast-enhanced mammography for detecting multifocal and multicentric breast cancer and evaluating tumour size, and implications for surgical management: Early experience in a tertiary centre. J Med Imaging Radiat Oncol 2023. [PMID: 38146085 DOI: 10.1111/1754-9485.13616] [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: 06/05/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION To compare diagnostic accuracy of contrast-enhanced mammography (CEM) with standard 2D digital mammography (equivalent to low-energy image; LEM) for detection of multifocal and multicentric breast cancer and evaluation of tumour size and disease extent for preoperative planning. METHODS Biopsy proven breast cancer patients who underwent CEM preoperatively between January 2021 and January 2023 were included in this study. CEM and LEM images were independently reviewed by at least two blinded readers. Lesion location, number, size (maximal diameter) and extension across the midline and/or nipple invasion were recorded. Tumour number and size estimated on imaging were compared with final operative histology, which served as the gold standard. RESULTS Forty-nine patients (48 females and 1 male) and 50 cases (one patient had bilateral breast lesions) were included in the analysis. Median patient age was 60 (IQR 51, 69). CEM had significantly higher lesion detection rate compared with LEM, with sensitivities of 78% for LEM and 92% for CEM for the index tumour and 15% for LEM and 100% for CEM for multicentric and multifocal cancer. We found no statistically significant difference in median tumour size measurements on CEM and final surgical specimen (P value = 0.97); however, a significant difference was identified in the tumour size measured on LEM and surgical specimen (P value < 0.001). CONCLUSION CEM is superior to standard 2D digital mammography for detection of multifocal and multicentric breast cancer and is a reliable and more accurate method for estimating tumour size.
Collapse
Affiliation(s)
- Margaret Thanh Ha Nguyen
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Nisha Varma
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - David Lan Cheong Wah
- Department of Breast Surgery, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Renny Chew
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Tanita Botha
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Susan Kouloyan-Ilic
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| | - Joseph Paiva
- Department of Medical Imaging, Western Health - Sunshine Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
TEKİNHATUN M, SABİR N, ERDEM E, YILMAZ S, UFUK F. Dynamic contrast-enhanced mammography and breast MRI in the diagnosis of breast cancer and detection of tumor size. Turk J Med Sci 2023; 54:249-261. [PMID: 38812642 PMCID: PMC11031179 DOI: 10.55730/1300-0144.5786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 02/15/2024] [Accepted: 12/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The aim of this study is to evaluate the performance of contrast-enhanced mammography (CEM) and dynamic breast MRI techniques for diagnosing breast lesions, assess the diagnostic accuracy of CEM's using histopathological findings, and compare lesion size measurements obtained from both methods with pathological size. Materials and methods This prospective study included 120 lesions, of which 70 were malignant, in 104 patients who underwent CEM and MRI within a week. Two radiologists independently evaluated the MR and CEM images in separate sessions, using the BI-RADS classification system. Additionally, the maximum sizes of lesion were measured. Diagnostic accuracy parameters and the receiver operating characteristics (ROC) curves were constructed for the two modalities. The correlation between the maximum diameter of breast lesions observed in MRI, CEM, and pathology was analyzed. Results The overall diagnostic values for MRI were as follows: sensitivity 97.1%, specificity 60%, positive predictive value (PPV) 77.3%, negative predictive value (NPV) 93.8%, and accuracy 81.7%. Correspondingly, for CEM, the sensitivity, accuracy, specificity, PPV, and NPV were 97.14%, 81.67%, 60%, 77.27%, and 93.75%, respectively. The ROC analysis of CEM revealed an area under the curve (AUC) of 0.907 for observer 1 and 0.857 for observer 2, whereas MRI exhibited an AUC of 0.910 for observer 1 and 0.914 for observer 2. Notably, CEM showed the highest correlation with pathological lesion size (r = 0.660 for observer 1 and r = 0.693 for observer 2, p < 0.001 for both). Conclusion CEM can be used with high sensitivity and similar diagnostic performance comparable to MRI for diagnosing breast cancer. CEM proves to be a successful diagnostic method for precisely determining tumor size.
Collapse
Affiliation(s)
- Muhammed TEKİNHATUN
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakır,
Turkiye
| | - Nuran SABİR
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Ergun ERDEM
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Sevda YILMAZ
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| | - Furkan UFUK
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli,
Turkiye
| |
Collapse
|
25
|
Carnahan MB, Harper L, Brown PJ, Bhatt AA, Eversman S, Sharpe RE, Patel BK. False-Positive and False-Negative Contrast-enhanced Mammograms: Pitfalls and Strategies to Improve Cancer Detection. Radiographics 2023; 43:e230100. [PMID: 38032823 DOI: 10.1148/rg.230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Contrast-enhanced mammography (CEM) is a relatively new breast imaging modality that uses intravenous contrast material to increase detection of breast cancer. CEM combines the structural information of conventional mammography with the functional information of tumor neovascularity. Initial studies have demonstrated that CEM and MRI perform with similar accuracies, with CEM having a slightly higher specificity (fewer false positives), although larger studies are needed. There are various reasons for false positives and false negatives at CEM. False positives at CEM can be caused by benign lesions with vascularity, including benign tumors, infection or inflammation, benign lesions in the skin, and imaging artifacts. False negatives at CEM can be attributed to incomplete or inadequate visualization of lesions, marked background parenchymal enhancement (BPE) obscuring cancer, lack of lesion contrast enhancement due to technical issues or less-vascular cancers, artifacts, and errors of lesion perception or characterization. When possible, real-time interpretation of CEM studies is ideal. If additional views are necessary, they may be obtained while contrast material is still in the breast parenchyma. Until recently, a limitation of CEM was the lack of CEM-guided biopsy capability. However, in 2020, the U.S. Food and Drug Administration cleared two devices to support CEM-guided biopsy using a stereotactic biopsy technique. The authors review various causes of false-positive and false-negative contrast-enhanced mammograms and discuss strategies to reduce these diagnostic errors to improve cancer detection while mitigating unnecessary additional imaging and procedures. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Molly B Carnahan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Laura Harper
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Parker J Brown
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Asha A Bhatt
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Sarah Eversman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Richard E Sharpe
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Bhavika K Patel
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| |
Collapse
|
26
|
Lyu SH, Hernandez AM, Shakeri SA, Abbey CK, Boone JM. Model observer performance in contrast-enhanced lesions in breast CT: The influence of contrast concentration on detectability. Med Phys 2023; 50:6748-6761. [PMID: 37639329 PMCID: PMC10847956 DOI: 10.1002/mp.16667] [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: 10/17/2022] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The use of iodine-based contrast agent for better delineation of tumors in breast CT (bCT) has been shown to be compelling, similar to the tumor enhancement in contrast-enhanced breast MRI. Contrast-enhanced bCT (CE-bCT) is a relatively new tool, and a structured evaluation of different imaging parameters at play has yet to be conducted. In this investigation, data sets of acquired bCT images from 253 patients imaged at our institution were used in concert with simulated mathematically inserted spherical contrast-enhanced lesions to study the role of contrast enhancement on detectability. PURPOSE To quantitatively evaluate the improvement in lesion detectability due to contrast enhancement across lesion diameter, section thickness, view plane, and breast density using a pre-whitened matched filter (PWMF) model observer. METHODS The relationship between iodine concentration and Hounsfield units (HU) was measured using spectral modeling. The lesion enhancement from clinical CE-bCT images in 22 patients was evaluated, and the average contrast enhancement (ΔHU) was determined. Mathematically generated spherical mass lesions of varying diameters (1, 3, 5, 9, 11, 15 mm) and contrast enhancement levels (0, 0.25, 0.50, 0.75, 1) were inserted at random locations in 253 actual patient bCT datasets. Images with varying thicknesses (0.4-19.8 mm) were generated by slice averaging, and the role of view plane (coronal and axial planes) was studied. A PWMF was used to generate receiver operating characteristic (ROC) curves across parameters of lesion diameter, contrast enhancement, section thickness, view plane, and breast density. The area under the ROC curve (AUC) was used as the primary performance metric, generated from over 90,000 simulated lesions. RESULTS An average 20% improvement (ΔAUC = 0.1) in lesion detectability due to contrast enhancement was observed across lesion diameter, section thickness, breast density, and view plane. A larger improvement was observed when stratifying patients based on breast density. For patients with VGF ≤ 40%, detection performance improved up to 20% (until AUC →1), and for patients with denser breasts (VGF > 40%), detection performance improved more drastically, ranging from 20% to 80% for 1- and 5-mm lesions. For the 1 mm lesion, detection performance raised slightly at the 1.2 mm section thickness before falling off as thickness increased. For larger lesions, detection performance was generally unaffected as section thickness increased up until it reached 5.8 mm, where performance began to decline. Detection performance was higher in the axial plane compared to the coronal plane for smaller lesions and thicker sections. CONCLUSIONS For emerging diagnostic tools like CE-bCT, it is important to optimize imaging protocols for lesion detection. In this study, we found that intravenous contrast can be used to detect small lesions in dense breasts. Optimal section thickness for detectability has dependencies on breast density and lesion size, therefore, display thickness should be adjusted in real-time using display software. These findings may be useful for the development of CE-bCT as well as other x-ray-based breast imaging modalities.
Collapse
Affiliation(s)
- Su Hyun Lyu
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95618, USA
- Department of Radiology, University of California Davis, Sacramento, CA, 95817, USA
| | - Andrew M. Hernandez
- Department of Radiology, University of California Davis, Sacramento, CA, 95817, USA
| | | | - Craig K. Abbey
- Department of Psychological and Brain Sciences, UC Santa Barbara, Santa Barbara, CA, 93106 USA
| | - John M. Boone
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95618, USA
- Department of Radiology, University of California Davis, Sacramento, CA, 95817, USA
| |
Collapse
|
27
|
Cockmartin L, Bosmans H, Marshall NW. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: I. Iodine signal testing. Phys Med Biol 2023; 68:215017. [PMID: 37820689 DOI: 10.1088/1361-6560/ad027d] [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: 05/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
The technique of dual-energy contrast enhanced mammography (CEM) visualizes iodine uptake in cancerous breast lesions following an intravenous injection of a contrast medium. The CEM image is generated by recombining two images acquired in rapid succession: a low energy image, with a mean energy below the iodine K-edge, and a higher energy image. The first part of this study examines the use of both commercially available and custom made phantoms to investigate iodine imaging under different imaging conditions, with the focus on quality control (QC) testing. Four CEM equipped systems were included in the study, with units from Fujifilm, GE Healthcare, Hologic and Siemens-Healthineers. The CEM parameters assessed in part I were: (1) image signal as a function of iodine concentration, measured in breast tissue simulating backgrounds of varying thickness and adipose/glandular compositions; (2) normal breast texture cancellation in homogeneous and structured backgrounds; (3) visibility of iodinated structures. For all four systems, a linear response to iodine concentration was found but the degree to which this was independent of background composition differed between the systems. Good cancellation of the glandular tissue inserts was found on all the units. Visibility scores of iodinated targets were similar between the four systems. Specialized phantoms are needed to fully evaluate important CEM performance markers, such as system response to iodine concentration and the ability of the system to cancel background texture. An extensive evaluation of the iodine signal imaging performance is recommended at the Commissioning stage for a new CEM device.
Collapse
Affiliation(s)
- L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| |
Collapse
|
28
|
Dontchos BN, Rahbar H. Cost-Effectiveness of Breast Cancer Staging Modalities: Counterpoint-Breast MRI Can Be Cost-Effective for Breast Cancer Staging, Particularly in This Era of Treatment De-Escalation. AJR Am J Roentgenol 2023; 221:436. [PMID: 37098967 DOI: 10.2214/ajr.23.29501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Brian N Dontchos
- Department of Radiology, University of Washington Fred Hutchinson Cancer Center, 1144 Eastlake Ave E, LG-200, Seattle, WA 98109
| | - Habib Rahbar
- Department of Radiology, University of Washington Fred Hutchinson Cancer Center, 1144 Eastlake Ave E, LG-200, Seattle, WA 98109
| |
Collapse
|
29
|
Lorente-Ramos RM, Azpeitia-Armán J, Oliva-Fonte C, Pérez-Bartolomé A, Azpeitia Hernández J. Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation. Radiographics 2023; 43:e230021. [PMID: 37792595 DOI: 10.1148/rg.230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Contrast-enhanced mammography (CEM) involves addition of intravenous iodinated contrast material at digital mammography, thus increasing the ability to detect breast cancer owing to tumor contrast enhancement. After image acquisition, interpretation includes careful assessment of the technique, artifacts, and pitfalls and reporting with a standard lexicon category and appropriate follow-up recommendations. Artifacts and pitfalls that may cause image misinterpretation should be detected and distinguished from pathologic conditions. Different artifacts apparent on CEM images are usually caused during image acquisition and include CEM-specific and contrast agent-related artifacts, apart from the typical digital mammography artifacts. The pitfalls are related to technical and diagnostic difficulties. One disadvantage of CEM that MRI does not have is a technical factor related to a mammography technique that consists of blind spots that may not be included in the imaging field of mammography views, including the axilla, medial region of the breast, or areas close to the breast wall. Normal breast tissue enhancement called background parenchymal enhancement is also present at CEM and may affect interpretation performance. Diagnostic pitfalls are caused by minimally enhancing lesions, such as invasive lobular carcinomas and mucinous carcinomas, which are difficult to detect with CEM, resulting in false-negative findings. Benign lesions can show enhancement at CEM and represent false-positive lesions that should also be recognized. The authors discuss image interpretation of CEM studies and focus on the artifacts and pitfalls that may be encountered. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Rosa M Lorente-Ramos
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia-Armán
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Carlos Oliva-Fonte
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Ana Pérez-Bartolomé
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia Hernández
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| |
Collapse
|
30
|
Taylor DB, Hobbs MM, Ronald MM, Burrows S, Ives A, Parizel PM, Saunders CM. Interpreting contrast imaging to plan breast surgery. ANZ J Surg 2023; 93:2197-2202. [PMID: 37438677 DOI: 10.1111/ans.18583] [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: 01/18/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Contrast enhanced mammography (CEM) and magnetic resonance imaging (MRI) are more accurate than conventional imaging (CI) for breast cancer staging. How adding CEM and MRI to CI might change the surgical plan is understudied. METHODS Surgical plans (breast conserving surgery (BCS), wider BCS, BCS with diagnostic excision (>1BCS), mastectomy) were devised by mock-MDT (radiologist, surgeon and pathology reports) according to disease extent on CI, CI + CEM and CI + MRI. Differences in the mock-MDT's surgical plans following the addition of CEM or MRI were investigated. Using pre-defined criteria, the appropriateness of the modified plans was assessed by comparing estimated disease extent on imaging with final pathology. Surgery performed was recorded from patient records. RESULTS Contrast imaging modified mock-MDT plans for 20 of 61(32.8%) breasts. The addition of CEM changed the plan in 16/20 (80%) and MRI in 17/20 breasts (85%). Identical changes were proposed by both CEM and MRI in 13/20 (65%) breasts. The modified surgical plan based on CI + CEM was possibly appropriate for 6/16 (37.5%), and CI + MRI in 9/17, (52.9%) breasts. The surgery performed was concordant with the mock-MDT plan for all 10 patients where the plans could be compared (BCS 1, >1 BCS 2 and mastectomy 7). CONCLUSION Adding CEM or MRI to CI changed mock-MDT plans in up to one third of women, but not all were appropriate. Changing surgical plans following addition of contrast imaging to CI without biopsy confirmation could lead to over or under-treatment.
Collapse
Affiliation(s)
- Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- BreastScreen WA, Perth, Western Australia, Australia
| | - Max M Hobbs
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Maxine Mariri Ronald
- Department of Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sally Burrows
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - Angela Ives
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Paul M Parizel
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Christobel M Saunders
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
31
|
Chen Y, Hua Z, Lin F, Zheng T, Zhou H, Zhang S, Gao J, Wang Z, Shao H, Li W, Liu F, Wang S, Zhang Y, Zhao F, Liu H, Xie H, Ma H, Zhang H, Mao N. Detection and classification of breast lesions using multiple information on contrast-enhanced mammography by a multiprocess deep-learning system: A multicenter study. Chin J Cancer Res 2023; 35:408-423. [PMID: 37691895 PMCID: PMC10485921 DOI: 10.21147/j.issn.1000-9604.2023.04.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify breast lesions using multiple contrast-enhanced mammography (CEM) images. Methods In this study, a total of 1,903 females who underwent CEM examination from three hospitals were enrolled as the training set, internal testing set, pooled external testing set and prospective testing set. Here we developed a CEM-based multiprocess detection and classification system (MDCS) to perform the task of detection and classification of breast lesions. In this system, we introduced an innovative auxiliary feature fusion (AFF) algorithm that could intelligently incorporates multiple types of information from CEM images. The average free-response receiver operating characteristic score (AFROC-Score) was presented to validate system's detection performance, and the performance of classification was evaluated by area under the receiver operating characteristic curve (AUC). Furthermore, we assessed the diagnostic value of MDCS through visual analysis of disputed cases, comparing its performance and efficiency with that of radiologists and exploring whether it could augment radiologists' performance. Results On the pooled external and prospective testing sets, MDCS always maintained a high standalone performance, with AFROC-Scores of 0.953 and 0.963 for detection task, and AUCs for classification were 0.909 [95% confidence interval (95% CI): 0.822-0.996] and 0.912 (95% CI: 0.840-0.985), respectively. It also achieved higher sensitivity than all senior radiologists and higher specificity than all junior radiologists on pooled external and prospective testing sets. Moreover, MDCS performed superior diagnostic efficiency with an average reading time of 5 seconds, compared to the radiologists' average reading time of 3.2 min. The average performance of all radiologists was also improved to varying degrees with MDCS assistance. Conclusions MDCS demonstrated excellent performance in the detection and classification of breast lesions, and greatly enhanced the overall performance of radiologists.
Collapse
Affiliation(s)
- Yuqian Chen
- School of Information and Electronic Engineering, Shandong Technology and Business University, Yantai 264005, China
| | - Zhen Hua
- School of Information and Electronic Engineering, Shandong Technology and Business University, Yantai 264005, China
| | - Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Tiantian Zheng
- School of Medical Imaging, Binzhou Medical University, Yantai 264003, China
| | - Heng Zhou
- School of Information and Electronic Engineering, Shandong Technology and Business University, Yantai 264005, China
| | - Shijie Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Jing Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Zhongyi Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Huafei Shao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Wenjuan Li
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Fengjie Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Simin Wang
- Department of Radiology, Fudan University Cancer Center, Shanghai 200433; China
| | - Yan Zhang
- Department of Radiology, Guangdong Maternal and Child Health Hospital, Guangzhou 510010, China
| | - Feng Zhao
- School of Computer Science and Technology, Shandong Technology and Business University, Yantai 264005, China
| | - Hao Liu
- Yizhun Medical AI Co. Ltd., Beijing 100080, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Haicheng Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, China
| |
Collapse
|
32
|
Grigoryants NF, Sass S, Alexander J. Novel Technologies in Breast Imaging: A Scoping Review. Cureus 2023; 15:e44061. [PMID: 37746370 PMCID: PMC10517733 DOI: 10.7759/cureus.44061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Breast cancer is one of the leading causes of death in the United States and can cause considerable suffering for not only the patient but their families as well. The current mainstay of screening is mammography, although this screening modality has its drawbacks. Multiple technologies have been recently explored in hopes of increasing breast cancer detection rates and decreasing false positive rates. Overall, improving breast cancer screening techniques has the potential to decrease cost, patient anxiety, and the use of unnecessary procedures. This review discusses multiple modalities including digital breast tomosynthesis, contrast-enhanced dual-energy digital mammography (CE DE DM), MRI with diffusion-weighted sequences and proton magnetic resonance spectroscopy. This paper was written with the objective of synthesizing information across several databases to provide clinicians with a more accessible tool to understand the underlying concepts behind these imaging modalities, as well as present reviewed data which highlights the benefits and drawbacks of these breast cancer-detecting techniques.
Collapse
Affiliation(s)
| | - Sarah Sass
- Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Julia Alexander
- Diagnostic Radiology, Alabama College of Osteopathic Medicine, Dothan, USA
| |
Collapse
|
33
|
Tang YC, Cheung YC. Contrast-enhanced mammography-guided biopsy: technique and initial outcomes. Quant Imaging Med Surg 2023; 13:5349-5354. [PMID: 37581028 PMCID: PMC10423379 DOI: 10.21037/qims-23-137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/17/2023] [Indexed: 08/16/2023]
Abstract
Contrast-enhanced mammography-guided biopsy (CEM-Bx), a novel technique for diagnosing suspicious enhanced lesions, was commercialized for clinical application in 2021; however, there are only a few publications documenting this technique in the existing literature. The aim of this study was to evaluate the procedural performance and preliminary outcomes of CEM-Bx performed in our hospital between from September 2021 to June 2022. We reviewed data of 12 women who underwent CEM-Bx during the study period, including their demographic and procedural characteristics, biopsy success rate, histopathological diagnosis, and average glandular dose (AGD). All women (mean age ± standard deviation: 54±6 years) showed enhanced breast lesions on CEM and underwent CEM-Bx within one week. The success rate of CEM-Bx was 100%. The vertical needle approach was used in a decubitus position (N=7, 58%), while the horizontal needle approach was used in an upright sitting position (N=5, 42%). The mean procedure time for the CEM-Bx was 17±6.3 min. The mean AGD was 14.3±12.3 mGy. Histopathologic examination revealed a malignancy rate of 66.7%. In summary, CEM-Bx is a feasible technique, with a high success rate of diagnosing contract-enhanced lesions.
Collapse
Affiliation(s)
- Ya-Chun Tang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Center, Taoyuan
- Medical College of Chang Gung University, Taoyuan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Center, Taoyuan
- Medical College of Chang Gung University, Taoyuan
| |
Collapse
|
34
|
Xu C, Jiang M, Lin F, Zhang K, Xie H, Lv W, Ji H, Mao N. Qualitative assessments of density and background parenchymal enhancement on contrast-enhanced spectral mammography associated with breast cancer risk in high-risk women. Br J Radiol 2023; 96:20220051. [PMID: 37227804 PMCID: PMC10392639 DOI: 10.1259/bjr.20220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To investigate the correlation between the risk of breast cancer for high-risk females and the density and background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM). METHODS Females at high-risk, without breast cancer history and received CESM from July 2016 to December 2017 were retrospectively enrolled. The longest follow-up time was 4.5 years, and patients who developed breast cancer with maximized follow-up time were classified as cancer cohort, while females who did not develop breast cancer were categorized as control cohort. These two cohorts were one-to-one matched in age, family and/or genetic history of breast cancer, menopausal status and BRCA status. The density and BPE at CESM imaging were assessed. Conditional logistic regression was applied to evaluate the relationship between imaging features and breast cancer risk. RESULTS During the follow-up interval, 90 women at high-risk without history of breast cancer were newly diagnosed. Compared with minimal BPE, increasing BPE levels were associated with the risk of breast cancer among high-risk females in a time interval of 4.5 years (mild: odds ratio [OR]=3.2, p = 0.001; moderate: OR = 4.0, p = 0.002; marked: OR = 11.2, p < 0.001). In addition, females with mild, moderate or marked BPE were four times more likely to be diagnosed with breast cancer than females with minimal BPE in a time interval of 4.5 years (OR = 4.0, p < 0.001). CONCLUSION Qualitative CESM BPE assessment may be useful in the prediction of breast cancer risk among high-risk females. ADVANCES IN KNOWLEDGE • Qualitative CESM BPE assessment may be useful in the prediction of breast cancer risk among high-risk women during the follow-up period of 4.5 years. • The significance of breast density as an independent risk factor is not fully established for high-risk women during the follow-up period of 4.5 years.
Collapse
Affiliation(s)
- Cong Xu
- Physical Examination Center, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Meiping Jiang
- Department of Ultrasound, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Kun Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Wei Lv
- Physical Examination Center, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Haixia Ji
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | | |
Collapse
|
35
|
van Nijnatten TJA, Lobbes MBI, Cozzi A, Patel BK, Zuley ML, Jochelson MS. Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:3-6. [PMID: 36448912 PMCID: PMC11025563 DOI: 10.2214/ajr.22.28567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound and comparable diagnostic performance to MRI for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited because of a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These factors include the following: the risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments needed when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently mitigate or are expected to mitigate these factors are also highlighted.
Collapse
Affiliation(s)
- Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
36
|
Daniaux M, Gruber L, De Zordo T, Geiger-Gritsch S, Amort B, Santner W, Egle D, Baltzer PAT. Preoperative staging by multimodal imaging in newly diagnosed breast cancer: Diagnostic performance of contrast-enhanced spectral mammography compared to conventional mammography, ultrasound, and MRI. Eur J Radiol 2023; 163:110838. [PMID: 37080064 DOI: 10.1016/j.ejrad.2023.110838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To compare contrast-enhanced spectral mammography (CESM) with mammography (Mx), ultrasound (US), and magnetic resonance imaging (MRI) regarding breast cancer detection rate and preoperative local staging. MATERIAL AND METHODS This prospective observational, single-centre study included 128 female patients (mean age 55.8 ± 11.5 years) with a newly diagnosed malignant breast tumour during routine US and Mx were prospectively enrolled. CESM and MRI examinations were performed within the study. Analysis included interreader agreement, tumour type and grade distribution, detection rates (DR), imaging morphology, contrast-enhancement and was performed by two independent readers blinded to patient history and histopathological diagnosis. Assessment of local disease extent was compared between modalities via Bland-Altman plots. RESULTS One-hundred-and-ten tumours were classified as NST (85.9%), 4 as ILC (3.1%) and 10 as DCIS (7.8%). DR was highest for MRI (128/128, 100.0%), followed by US (124/128, 96.9%) and CESM (123/128, 96.1%) and lowest for conventional Mx (106/128, 82.8%) (p = 0.0002). Higher breast density did not negatively affect DR of US, CESM or MRI. Local tumour extent measurements based on CESM (Bland-Altman bias 6.6, standard deviation 30.2) showed comparable estimation results to MRI, surpassing Mx (23.4/43.7) and US (35.4/40.5). Even though detection of multifocality and multicentricity was highest for CESM and MRI (p < 0.0001), second-look rates, i.e., targeted US examinations after MRI or CESM, were significantly lower for CESM (10.2% of cases) compared to MRI (16.2%) with a significantly higher true positive rate for CESM (72.0%) vs. MRI (42.5%). CONCLUSION CESM is a viable alternative to MRI for lesion detection and local staging in newly diagnosed malignant breast cancer and provides higher specificity in regard to second-look examinations.
Collapse
Affiliation(s)
- Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria.
| | - Tobias De Zordo
- Department of Radiology, Brixsana Private Clinic, Julius-Durst-Straße 28, Brixen, Italy
| | - Sabine Geiger-Gritsch
- Medizinisches Projektmanagement, Tirol Kliniken GmbH, Anichstraße 35, Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Wolfram Santner
- Department of Radiology, Privatklinik Hirslanden, Rigistrasse 1, Cham, Switzerland
| | - Daniel Egle
- Department of Gynaecology and Obstetrics, Medical University Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
| |
Collapse
|
37
|
Zhang K, Lin J, Lin F, Wang Z, Zhang H, Zhang S, Mao N, Qiao G. Radiomics of contrast-enhanced spectral mammography for prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023:XST221349. [PMID: 37066960 DOI: 10.3233/xst-221349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has been regarded as one of the standard treatments for patients with locally advanced breast cancer. No previous study has investigated the feasibility of using a contrast-enhanced spectral mammography (CESM)-based radiomics nomogram to predict pathological complete response (pCR) after NAC. OBJECTIVE To develop and validate a CESM-based radiomics nomogram to predict pCR after NAC in breast cancer. METHODS A total of 118 patients were enrolled, which are divided into a training dataset including 82 patients (with 21 pCR and 61 non-pCR) and a testing dataset of 36 patients (with 9 pCR and 27 non-pCR). The tumor regions of interest (ROIs) were manually segmented by two radiologists on the low-energy and recombined images and radiomics features were extracted. Intraclass correlation coefficients (ICCs) were used to assess the intra- and inter-observer agreements of ROI features extraction. In the training set, the variance threshold, SelectKBest method, and least absolute shrinkage and selection operator regression were used to select the optimal radiomics features. Radiomics signature was calculated through a linear combination of selected features. A radiomics nomogram containing radiomics signature score (Rad-score) and clinical risk factors was developed. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate prediction performance of the radiomics nomogram, and decision curve analysis (DCA) was used to evaluate the clinical usefulness of the radiomics nomogram. RESULTS The intra- and inter- observer ICCs were 0.769-0.815 and 0.786-0.853, respectively. Thirteen radiomics features were selected to calculate Rad-score. The radiomics nomogram containing Rad-score and clinical risk factor showed an encouraging calibration and discrimination performance with area under the ROC curves of 0.906 (95% confidence interval (CI): 0.840-0.966) in the training dataset and 0.790 (95% CI: 0.554-0.952) in the test dataset. CONCLUSIONS The CESM-based radiomics nomogram had good prediction performance for pCR after NAC in breast cancer; therefore, it has a good clinical application prospect.
Collapse
Affiliation(s)
- Kun Zhang
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jun Lin
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Fan Lin
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Zhongyi Wang
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Haicheng Zhang
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shijie Zhang
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ning Mao
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guangdong Qiao
- Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| |
Collapse
|
38
|
De Jesus C, Moseley TW, Diaz V, Vishwanath V, Jean S, Elhatw A, Ferreira Dalla Pria HR, Chung HL, Guirguis MS, Patel MM. Supplemental Screening for Breast Cancer. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
|
39
|
Hogan MP, Horvat JV, Ross DS, Sevilimedu V, Jochelson MS, Kirstein LJ, Goldfarb SB, Comstock CE, Sung JS. Contrast-enhanced mammography in the assessment of residual disease after neoadjuvant treatment. Breast Cancer Res Treat 2023; 198:349-359. [PMID: 36754936 PMCID: PMC10375516 DOI: 10.1007/s10549-023-06865-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE To investigate the utility of contrast-enhanced mammography (CEM) as an alternative to breast MRI for the evaluation of residual disease after neoadjuvant treatment (NAT). METHODS This prospective study enrolled consecutive women undergoing NAT for breast cancer from July 2017-July 2019. Breast MRI and CEM exams performed after completion of NAT were read independently by two breast radiologists. Residual disease and lesion size on MRI and CEM recombined (RI) and low-energy images (LEI) were compared. Histopathology was considered the reference standard. Statistical analysis was performed using McNemar's and Leisenring's tests. Multiple comparison adjustment was made using Bonferroni procedure. Lesion sizes were correlated using Kendall's tau coefficient. RESULTS There were 110 participants with 115 breast cancers. Residual disease (invasive cancer or ductal carcinoma in situ) was detected in 83/115 (72%) lesions on pathology, 71/115 (62%) on MRI, 55/115 (48%) on CEM RI, and 75/115 (65%) on CEM LEI. When using multiple comparison adjustment, no significant differences were detected between MRI combined with CEM LEI and CEM RI combined with CEM LEI, in terms of accuracy (MRI: 77%, CEM: 72%; p ≥ 0.99), sensitivity (MRI: 88%, CEM: 81%; p ≥ 0.99), specificity (MRI: 47%, CEM: 50%; p ≥ 0.99), PPV (MRI: 81%, CEM: 81%; p ≥ 0.99), or NPV (MRI: 60%, CEM: 50%; p ≥ 0.99). Size correlation between pathology and both MRI combined with CEM LEI and CEM RI combined with CEM LEI was moderate: τ = 0. 36 vs 0.33 (p ≥ 0.99). CONCLUSION Contrast-enhanced mammography is an acceptable alternative to breast MRI for the detection of residual disease after neoadjuvant treatment.
Collapse
Affiliation(s)
- Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Dara S Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10017, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shari B Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christopher E Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| |
Collapse
|
40
|
Kowalski A, Arefan D, Ganott MA, Harnist K, Kelly AE, Lu A, Nair BE, Sumkin JH, Vargo A, Berg WA, Zuley ML. Contrast-enhanced Mammography-guided Biopsy: Initial Trial and Experience. JOURNAL OF BREAST IMAGING 2023; 5:148-158. [PMID: 38416936 DOI: 10.1093/jbi/wbac096] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Evaluate lesion visibility and radiologist confidence during contrast-enhanced mammography (CEM)-guided biopsy. METHODS Women with BI-RADS ≥4A enhancing breast lesions were prospectively recruited for 9-g vacuum-assisted CEM-guided biopsy. Breast density, background parenchymal enhancement (BPE), lesion characteristics (enhancement and conspicuity), radiologist confidence (scale 1-5), and acquisition times were collected. Signal intensities in specimens were analyzed. Patient surveys were collected. RESULTS A cohort of 28 women aged 40-81 years (average 57) had 28 enhancing lesions (7/28, 25% malignant). Breast tissue was scattered (10/28, 36%) or heterogeneously dense (18/28, 64%) with minimal (12/28, 43%), mild (7/28, 25%), or moderate (9/28, 32%) BPE on CEM. Twelve non-mass enhancements, 11 masses, 3 architectural distortions, and 2 calcification groups demonstrated weak (12/28, 43%), moderate (14/28, 50%), or strong (2/28, 7%) enhancement. Specimen radiography demonstrated lesion enhancement in 27/28 (96%). Radiologists reported complete lesion removal on specimen radiography in 8/28 (29%). Average time from contrast injection to specimen radiography was 18 minutes (SD = 5) and, to post-procedure mammogram (PPM), 34 minutes (SD = 10). Contrast-enhanced mammography PPM was performed in 27/28 cases; 13/19 (68%) of incompletely removed lesions on specimen radiography showed residual enhancement; 6/19 (32%) did not. Across all time points, average confidence was 2.2 (SD = 1.2). Signal intensities of enhancing lesions were similar to iodine. Patients had an overall positive assessment. CONCLUSION Lesion enhancement persisted through PPM and was visible on low energy specimen radiography, with an average "confident" score. Contrast-enhanced mammography-guided breast biopsy is easily implemented clinically. Its availability will encourage adoption of CEM.
Collapse
Affiliation(s)
- Aneta Kowalski
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Dooman Arefan
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Marie A Ganott
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Kimberly Harnist
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Amy E Kelly
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Amy Lu
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Bronwyn E Nair
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Jules H Sumkin
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Adrienne Vargo
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Wendie A Berg
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Margarita L Zuley
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| |
Collapse
|
41
|
Savaridas SL, Agrawal U, Fagbamigbe AF, Tennant SL, McCowan C. Radiomic analysis in contrast-enhanced mammography using a multivendor data set: accuracy of models according to segmentation techniques. Br J Radiol 2023; 96:20220980. [PMID: 36802982 PMCID: PMC10161926 DOI: 10.1259/bjr.20220980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Radiomic analysis of contrast-enhanced mammographic (CEM) images is an emerging field. The aims of this study were to build classification models to distinguish benign and malignant lesions using a multivendor data set and compare segmentation techniques. METHODS CEM images were acquired using Hologic and GE equipment. Textural features were extracted using MaZda analysis software. Lesions were segmented with freehand region of interest (ROI) and ellipsoid_ROI. Benign/Malignant classification models were built using extracted textural features. Subset analysis according to ROI and mammographic view was performed. RESULTS 269 enhancing mass lesions (238 patients) were included. Oversampling mitigated benign/malignant imbalance. Diagnostic accuracy of all models was high (>0.9). Segmentation with ellipsoid_ROI produced a more accurate model than with FH_ROI, accuracy:0.947 vs 0.914, AUC:0.974 vs 0.86, p < 0.05. Regarding mammographic view all models were highly accurate (0.947-0.955) with no difference in AUC (0.985-0.987). The CC-view model had the greatest specificity:0.962, the MLO-view and CC + MLO view models had higher sensitivity:0.954, p < 0.05. CONCLUSIONS Accurate radiomics models can be built using a real-life multivendor data set segmentation with ellipsoid-ROI produces the highest level of accuracy. The marginal increase in accuracy using both mammographic views, may not justify the increased workload. ADVANCES IN KNOWLEDGE Radiomic modelling can be successfully applied to a multivendor CEM data set, ellipsoid_ROI is an accurate segmentation technique and it may be unnecessary to segment both CEM views. These results will help further developments aimed at producing a widely accessible radiomics model for clinical use.
Collapse
Affiliation(s)
- Sarah L Savaridas
- School of Medicine, University of Dundee, Dundee, Scotland.,Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Utkarsh Agrawal
- School of Medicine, University of St. Andrews, St. Andrews, Scotland
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Sarah L Tennant
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St. Andrews, Scotland
| |
Collapse
|
42
|
Taylor DB, Burrows S, Dessauvagie BF, Saunders CM, Ives A. Accuracy and precision of contrast enhanced mammography versus MRI for predicting breast cancer size: how "good" are they really? Br J Radiol 2023; 96:20211172. [PMID: 36753450 PMCID: PMC10078876 DOI: 10.1259/bjr.20211172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE To evaluate and compare the accuracy and precision of contrast-enhanced mammography (CEM) vs MRI to predict the size of biopsy-proven invasive breast cancer. METHODS Prospective study, 59 women with invasive breast cancer on needle biopsy underwent CEM and breast MRI. Two breast radiologists read each patient's study, with access limited to one modality. CEM lesion size was measured using low-energy and recombined images and on MRI, the first post-contrast series. Extent of abnormality per quadrant was measured for multifocal lesions. Reference standards were size of largest invasive malignant lesion, invasive (PathInvasive) and whole (PathTotal). Pre-defined clinical concordance ±10 mm. RESULTS Mean patient age 56 years, 42 (71%) asymptomatic. Lesions were invasive ductal carcinoma 40 (68%) with ductal carcinoma in situ (31/40) in 78%, multifocal in 12 (20%). Median lesion size was 17 mm (invasive) and 27 mm (total), range (5-125 mm). Lin's concordance correlation coefficients for PathTotal 0.75 (95% CI 0.6, 0.84) and 0.71 (95% CI 0.56, 0.82) for MRI and contrast-enhanced spectral mammography (CESM) respectively. Mean difference for total size, 3% underestimated and 4% overestimated, and for invasive 41% and 50% overestimate on MRI and CESM respectively. LOAs for PathTotal varied from 60% under to a 2.4 or almost threefold over estimation. MRI was concordant with PathTotal in 36 (64%) cases compared with 32 (57%) for CESM. Both modalities concordant in 26 (46%) cases respectively. CONCLUSION Neither CEM nor MRI have sufficient accuracy to direct changes in planned treatment without needle biopsy confirmation. ADVANCES IN KNOWLEDGE Despite small mean differences in lesion size estimates using CEM or MRI, the 95% limits of agreement do not meet clinically acceptable levels.
Collapse
Affiliation(s)
- Donna Blanche Taylor
- Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia
| | - Sally Burrows
- Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
- Medical School, Crawley, Perth, Western Australia, Australia
| | - Benjamin Frederik Dessauvagie
- Division of Pathology and Laboratory Medicine, Medical School, UWA, Crawley, WA, Australia
- Anatomical Pathology, PathWest Laboratory Medicine WA, Perth, WA, Australia
| | - Christobel Mary Saunders
- Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Angela Ives
- Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia
| |
Collapse
|
43
|
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: 6] [Impact Index Per Article: 6.0] [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.
Collapse
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
| |
Collapse
|
44
|
Savaridas SL, Jin H. Costing analysis to introduce a contrast-enhanced mammography service to replace an existing breast MRI service for local staging of breast cancer. Clin Radiol 2023; 78:340-346. [PMID: 36804270 DOI: 10.1016/j.crad.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
AIM To assess the cost impact of switching from contrast-enhanced magnetic resonance imaging (CE-MRI) to contrast-enhanced spectral mammography (CESM) for loco-regional staging of breast cancer from a public healthcare perspective. MATERIALS AND METHODS The CE-MRI cost was obtained from the NHS reference cost. The CESM cost was calculated using a bottom-up approach including use of the machine, pump injector, contrast medium, image storage, and time allocation for staff reporting and cannulation. The cost of upgrading existing machines to CESM or purchasing new mammographic machines was obtained via national procurement. Other costs were obtained from local pharmacy, published unit cost data, or estimated based on surveys. RESULTS For large health boards in Scotland (≥500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £64,069 to £81,570. For small health boards (<500 cancers diagnosed per annum), the cost savings of switching from CE-MRI to CESM range from £6,453 to £23,953. The cost savings are most sensitive to the number of tests conducted per year, and whether the existing mammography machine can be upgraded to CESM or not. CONCLUSION Switching from CE-MRI to CESM for loco-regional staging of breast cancer is likely to be cost saving for both large and small health boards in Scotland. Further research is urgently needed to confirm the non-inferiority of CESM to CE-MRI as a locoregional staging technique. The input data of this analysis can be updated when such results become available.
Collapse
Affiliation(s)
- S L Savaridas
- School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
| | - H Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| |
Collapse
|
45
|
Yang ML, Bhimani C, Roth R, Germaine P. Contrast enhanced mammography: focus on frequently encountered benign and malignant diagnoses. Cancer Imaging 2023; 23:10. [PMID: 36691077 PMCID: PMC9872331 DOI: 10.1186/s40644-023-00526-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.
Collapse
Affiliation(s)
- Mindy L. Yang
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
- Present address: SimonMed Imaging, 6900 E Camelback Road, Suite 700, Scottsdale, AZ 85251 USA
| | - Chandni Bhimani
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
- Present address: Atlantic Medical Imaging, Bayport One Office Building, 8025 Black Horse Pike, Suite 300, West Atlantic City, NJ 08232 USA
| | - Robyn Roth
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| | - Pauline Germaine
- Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| |
Collapse
|
46
|
Neeter LM, Robbe MQ, van Nijnatten TJ, Jochelson MS, Raat H, Wildberger JE, Smidt ML, Nelemans PJ, Lobbes MB. Comparing the Diagnostic Performance of Contrast-Enhanced Mammography and Breast MRI: a Systematic Review and Meta-Analysis. J Cancer 2023; 14:174-182. [PMID: 36605487 PMCID: PMC9809339 DOI: 10.7150/jca.79747] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/03/2022] [Indexed: 01/04/2023] Open
Abstract
Background: To provide a systematic review and meta-analysis that evaluates the diagnostic accuracy of contrast-enhanced mammography (CEM) compared to standard contrast-enhanced breast magnetic resonance imaging (breast MRI). Like breast MRI, CEM enables tumour visualization by contrast accumulation. CEM seems to be a viable substitute for breast MRI. Methods: This systematic search assessed the diagnostic accuracy of these techniques in women with suspicious breast lesions on prior imaging or physical examination, who have undergone both breast MRI and CEM. CEM had to be performed on a commercially available system. The MRI sequence parameters had to be described sufficiently to ensure that standard breast MRI sequence protocols were used. Pooled values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR), were estimated using bivariate mixed-effects logistic regression modeling. Hierarchical summary receiver operating characteristic curves for CEM and breast MRI were also constructed. Results: Six studies (607 patients with 775 lesions) met the predefined inclusion criteria. Pooled sensitivity was 96% for CEM and 97% for breast MRI. Pooled specificity was 77% for both modalities. DOR was 79.5 for CEM and 122.9 for breast MRI. Between-study heterogeneity expressed as the I2 -index was substantial with values over 80%. Conclusion: Pooled sensitivity was high for both CEM and breast MRI, with moderate specificity. The pooled DOR estimates, however, indicate higher overall diagnostic performance of breast MRI compared to CEM. Nonetheless, current scientific evidence is too limited to prematurely discard CEM as an alternative for breast MRI.
Collapse
Affiliation(s)
- Lidewij M.F.H. Neeter
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - M.M. Quirien. Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Thiemo J.A. van Nijnatten
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Maxine S. Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - H.P.J. Raat
- Department of Medical Imaging, Laurentius hospital, Mgr. Driessenstrtaat 6, 6040AX Roermond, the Netherlands
| | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Marjolein L. Smidt
- Department of Surgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Patty J. Nelemans
- Department of Epidemiology, Maastricht University, P. Debyelaan 1, 6229 HA Maastricht, the Netherlands
| | - Marc B.I. Lobbes
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands
| |
Collapse
|
47
|
Emory T, Hoven N, Nelson M, Church AL, Rubin N, Kuehn-Hajder J. Diagnostic Contrast-Enhanced Mammography Performed Immediately Prior to Same-Day Biopsy: An Analysis of Index Lesion Enhancement Compared to Histopathology and Follow-up in Patients With Suspicious Ultrasound Findings. JOURNAL OF BREAST IMAGING 2023; 5:40-47. [PMID: 36778652 PMCID: PMC9901423 DOI: 10.1093/jbi/wbac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Indexed: 01/03/2023]
Abstract
Objective To measure the diagnostic performance of contrast-enhanced mammography (CEM) for the index lesion when it is performed the same day prior to biopsy in patients with suspicious findings at US. Methods This IRB-approved retrospective study compared radiologist original reports of the presence or absence of index lesion enhancement on CEM to biopsy results and follow-up. The most suspicious lesion or the larger of equally suspicious lesions recommended for biopsy by US after a diagnostic workup including mammography was considered the index lesion. CEM exams were performed the same day, immediately prior to the scheduled biopsy, as requested by the radiologist recommending the biopsy. Numeric variables were summarized with means and standard deviations, or medians and the minimum and maximum, where appropriate. Results Biopsy demonstrated cancer in 64.7% (200/309) of index lesions. Of these, 197/200 demonstrated enhancement for a sensitivity of 98.5% (95% CI: 95.7%-99.7%) (197/200) and the negative predictive value of CEM for non-enhancing index lesions was 95.1% (58/61; 95% CI: 86.1%-98.4%). The three false negative exams were two grade 1 ER+ HER2- invasive ductal cancers that were 6 mm and 7 mm in size, and a 3-mm grade 2 ductal carcinoma in situ in a complex cystic and solid mass. False positive exams made up 20.6% (51/248) of the positive exams. Conclusion Diagnostic CEM showed high sensitivity and specificity for cancer in lesions with suspicious US findings. CEM may reduce the need for some biopsies, and negative CEM may support a true negative biopsy result.
Collapse
Affiliation(s)
- Tim Emory
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Noelle Hoven
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Michael Nelson
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - An L Church
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Nathan Rubin
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | | |
Collapse
|
48
|
Pires-Gonçalves L, Henriques Abreu M, Ferrão A, Guimarães Dos Santos A, Aguiar AT, Gouvêa M, Henrique R. Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer. Acta Radiol 2022; 64:1816-1822. [PMID: 36575580 DOI: 10.1177/02841851221144021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.
Collapse
Affiliation(s)
- Lígia Pires-Gonçalves
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Anabela Ferrão
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | | | - Ana Teresa Aguiar
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Margarida Gouvêa
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| |
Collapse
|
49
|
Li X, Cui J, Song J, Jia M, Zou Z, Ding G, Zheng Y. Contextual Features and Information Bottleneck-Based Multi-Input Network for Breast Cancer Classification from Contrast-Enhanced Spectral Mammography. Diagnostics (Basel) 2022; 12:3133. [PMID: 36553140 PMCID: PMC9777091 DOI: 10.3390/diagnostics12123133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
In computer-aided diagnosis methods for breast cancer, deep learning has been shown to be an effective method to distinguish whether lesions are present in tissues. However, traditional methods only classify masses as benign or malignant, according to their presence or absence, without considering the contextual features between them and their adjacent tissues. Furthermore, for contrast-enhanced spectral mammography, the existing studies have only performed feature extraction on a single image per breast. In this paper, we propose a multi-input deep learning network for automatic breast cancer classification. Specifically, we simultaneously input four images of each breast with different feature information into the network. Then, we processed the feature maps in both horizontal and vertical directions, preserving the pixel-level contextual information within the neighborhood of the tumor during the pooling operation. Furthermore, we designed a novel loss function according to the information bottleneck theory to optimize our multi-input network and ensure that the common information in the multiple input images could be fully utilized. Our experiments on 488 images (256 benign and 232 malignant images) from 122 patients show that the method's accuracy, precision, sensitivity, specificity, and f1-score values are 0.8806, 0.8803, 0.8810, 0.8801, and 0.8806, respectively. The qualitative, quantitative, and ablation experiment results show that our method significantly improves the accuracy of breast cancer classification and reduces the false positive rate of diagnosis. It can reduce misdiagnosis rates and unnecessary biopsies, helping doctors determine accurate clinical diagnoses of breast cancer from multiple CESM images.
Collapse
Affiliation(s)
- Xinmeng Li
- School of Information Science and Engineering, Shandong Normal University, Jinan 250358, China
| | - Jia Cui
- School of Information Science and Engineering, Shandong Normal University, Jinan 250358, China
| | - Jingqi Song
- School of Information Science and Engineering, Shandong Normal University, Jinan 250358, China
| | - Mingyu Jia
- School of Information Science and Engineering, Shandong Normal University, Jinan 250358, China
| | - Zhenxing Zou
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264001, China
| | - Guocheng Ding
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264001, China
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Jinan 250358, China
| |
Collapse
|
50
|
Phillips J, U Achibiri J, Kim G, Quintana LM, J Mehta R, S Mehta T. Characterization of True and False Positive Findings on Contrast-Enhanced Mammography. Acad Radiol 2022; 29:1672-1681. [PMID: 35190261 DOI: 10.1016/j.acra.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this paper is to characterize true and false positive findings on contrast-enhanced mammography (CEM) and correlate enhancement pattern and method of detection with pathology outcomes. MATERIALS AND METHODS This was an IRB-approved retrospective review of diagnostic CEM performed from December 2015 through December 2019 for which biopsy was recommended. Background parenchymal enhancement, tissue density, finding features, pathologic/clinical outcomes, and method of detection were captured. CEM includes low-energy images (LE), similar to standard 2D mammography, and recombined images (RI) that show enhancement. 'MG-detected' findings were identified on mammography or LE. 'RI-detected' findings were identified due to enhancement on RI. The positive predictive value (PPV2) was calculated on a per-case and a per-finding level. Comparisons were performed using Pearson chi-square and Fisher exact tests. RESULTS One hundred sixty CEM cases with 220 findings were evaluated with a case PPV2 of 58.1%. 32.3% (71/220) of lesions were RI-detected. The PPV2 of RI-detected enhancement was 40.8% with subanalysis revealing PPV2 of 22.2%, 32%, and 51.4% for foci, NME, and masses, respectively. The PPV2 of MG-detected enhancement was 73.5% with subanalysis revealing PPV2 of 50%, 54.1%, and 83.8% for foci, NME, and masses, respectively. There were 100 false positives findings, 42 of which were RI-detected. CONCLUSION PPV2 of diagnostic CEM is within the range of other diagnostic breast imaging exams. However false positives remain a challenge, especially for RI-detected findings. Additional efforts to improve specificity of RI-detected findings are worthwhile.
Collapse
Affiliation(s)
- Jordana Phillips
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Janeiro U Achibiri
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Geunwon Kim
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Liza M Quintana
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| |
Collapse
|