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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.
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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
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Yang X, Lu Z, Tan X, Shao L, Shi J, Dou W, Sun Z. Evaluating the added value of synthetic magnetic resonance imaging in predicting sentinel lymph node status in breast cancer. Quant Imaging Med Surg 2024; 14:3789-3802. [PMID: 38846281 PMCID: PMC11151255 DOI: 10.21037/qims-24-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/29/2024] [Indexed: 06/09/2024]
Abstract
Background The noninvasive prediction of sentinel lymph node (SLN) metastasis using quantitative magnetic resonance imaging (MRI), particularly with synthetic MRI (syMRI), is an emerging field. This study aimed to explore the potential added benefits of syMRI over conventional MRI and diffusion-weighted imaging (DWI) in predicting metastases in SLNs. Methods This retrospective study consecutively enrolled 101 patients who were diagnosed with breast cancer (BC) and underwent SLN biopsy from December 2022 to October 2023 at the Affiliated Hospital of Jiangnan University. These patients underwent preoperative MRI including conventional MRI, DWI, and syMRI and were categorized into two groups according to the postoperative pathological results: those with and without metastatic SLNs. MRI morphological features, DWI, and syMRI-derived quantitative parameters of breast tumors were statistically compared between these two groups. Binary logistic regression was used to separately develop predictive models for determining the presence of SLN involvement, with variables that exhibited significant differences being incorporated. The performance of each model was evaluated through receiver operating characteristic (ROC) curve analysis, including the area under the curve (AUC), sensitivity, and specificity. Results Compared to the group of 54 patients with BC but no metastatic SLNs, the group of 47 patients with BC and metastatic SLNs had a significantly larger maximum axis diameter [metastatic SLNs: median 2.40 cm, interquartile range (IQR) 1.50-3.00 cm; no metastatic SLNs: median 1.80 cm, IQR 1.37-2.50 cm; P=0.03], a higher proton density (PD) (78.44±11.92 vs. 69.20±10.63 pu; P<0.001), and a lower apparent diffusion coefficient (ADC) (metastatic SLNs: median 0.91×10-3 mm2/s, IQR 0.79-1.01 mm2/s; no metastatic SLNs: median 1.02×10-3 mm2/s, IQR 0.92-1.12 mm2/s; P=0.001). Moreover, the prediction model with maximum axis diameter and ADC yielded an AUC of 0.71 [95% confidence interval (CI): 0.618-0.802], with a sensitivity of 78.72% and a specificity of 51.85%; After addition of syMRI-derived PD to the prediction model, the AUC increased significantly to 0.86 (AUC: 0.86 vs. 0.71; 95% CI: 0.778-0.922; P=0.002), with a sensitivity of 80.85% and a specificity of 81.50%. Conclusions Combined with conventional MRI and DWI, syMRI can offer additional value in enhancing the predictive performance of determining SLN status before surgery in patients with BC.
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Affiliation(s)
- Xiao Yang
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhou Lu
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiaoying Tan
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lin Shao
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jie Shi
- GE Healthcare, MR Research China, Beijing, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Zongqiong Sun
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, China
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Ripaud E, Jailin C, Quintana GI, Milioni de Carvalho P, Sanchez de la Rosa R, Vancamberg L. Deep-learning model for background parenchymal enhancement classification in contrast-enhanced mammography. Phys Med Biol 2024; 69:115013. [PMID: 38657641 DOI: 10.1088/1361-6560/ad42ff] [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: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 04/26/2024]
Abstract
Background.Breast background parenchymal enhancement (BPE) is correlated with the risk of breast cancer. BPE level is currently assessed by radiologists in contrast-enhanced mammography (CEM) using 4 classes: minimal, mild, moderate and marked, as described inbreast imaging reporting and data system(BI-RADS). However, BPE classification remains subject to intra- and inter-reader variability. Fully automated methods to assess BPE level have already been developed in breast contrast-enhanced MRI (CE-MRI) and have been shown to provide accurate and repeatable BPE level classification. However, to our knowledge, no BPE level classification tool is available in the literature for CEM.Materials and methods.A BPE level classification tool based on deep learning has been trained and optimized on 7012 CEM image pairs (low-energy and recombined images) and evaluated on a dataset of 1013 image pairs. The impact of image resolution, backbone architecture and loss function were analyzed, as well as the influence of lesion presence and type on BPE assessment. The evaluation of the model performance was conducted using different metrics including 4-class balanced accuracy and mean absolute error. The results of the optimized model for a binary classification: minimal/mild versus moderate/marked, were also investigated.Results.The optimized model achieved a 4-class balanced accuracy of 71.5% (95% CI: 71.2-71.9) with 98.8% of classification errors between adjacent classes. For binary classification, the accuracy reached 93.0%. A slight decrease in model accuracy is observed in the presence of lesions, but it is not statistically significant, suggesting that our model is robust to the presence of lesions in the image for a classification task. Visual assessment also confirms that the model is more affected by non-mass enhancements than by mass-like enhancements.Conclusion.The proposed BPE classification tool for CEM achieves similar results than what is published in the literature for CE-MRI.
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Murakami W, Mortazavi S, Yu T, Kathuria-Prakash N, Yan R, Fischer C, McCann KE, Lee-Felker S, Sung K. Clinical Significance of Background Parenchymal Enhancement in Breast Cancer Risk Stratification. J Magn Reson Imaging 2024; 59:1742-1757. [PMID: 37724902 DOI: 10.1002/jmri.29015] [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: 08/13/2022] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Background parenchymal enhancement (BPE) is an established breast cancer risk factor. However, the relationship between BPE levels and breast cancer risk stratification remains unclear. PURPOSE To evaluate the clinical relationship between BPE levels and breast cancer risk with covariate adjustments for age, ethnicity, and hormonal status. STUDY TYPE Retrospective. POPULATION 954 screening breast MRI datasets representing 721 women divided into four cohorts: women with pathogenic germline breast cancer (BRCA) mutations (Group 1, N = 211), women with non-BRCA germline mutations (Group 2, N = 60), women without high-risk germline mutations but with a lifetime breast cancer risk of ≥20% using the Tyrer-Cuzick model (Group 3, N = 362), and women with <20% lifetime risk (Group 4, N = 88). FIELD STRENGTH/SEQUENCE 3 T/axial non-fat-saturated T1, short tau inversion recovery, fat-saturated pre-contrast, and post-contrast T1-weighted images. ASSESSMENT Data on age, body mass index, ethnicity, menopausal status, genetic predisposition, and hormonal therapy use were collected. BPE levels were evaluated by two breast fellowship-trained radiologists independently in accordance with BI-RADS, with a third breast fellowship-trained radiologist resolving any discordance. STATISTICAL TESTS Propensity score matching (PSM) was utilized to adjust covariates, including age, ethnicity, menopausal status, hormonal treatments, and prior bilateral oophorectomy. The Mann-Whitney U test, chi-squared test, and univariate and multiple logistic regression analysis were performed, with an odds ratio (OR) and corresponding 95% confidence interval. Weighted Kappa statistic was used to assess inter-reader variation. A P value <0.05 indicated a significant result. RESULTS In the assessment of BPE, there was substantial agreement between the two interpreting radiologists (κ = 0.74). Patient demographics were not significantly different between patient groups after PSM. The BPE of Group 1 was significantly lower than that of Group 4 and Group 3 among premenopausal women. In estimating the BPE level, the OR of gene mutations was 0.35. DATA CONCLUSION Adjusting for potential confounders, the BPE level of premenopausal women with BRCA mutations was significantly lower than that of non-high-risk women. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wakana Murakami
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Radiology, Showa University, School of Medicine, Tokyo, Japan
| | - Shabnam Mortazavi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Tiffany Yu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Nikhita Kathuria-Prakash
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Ran Yan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California, USA
| | - Cheryce Fischer
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kelly E McCann
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Stephanie Lee-Felker
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, California, USA
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Goh Y, Quek ST, Pillay P, Chou CP. Evaluation of architectural distortion with contrast-enhanced mammography. Clin Radiol 2024; 79:163-169. [PMID: 38114374 DOI: 10.1016/j.crad.2023.11.021] [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: 03/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.
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Affiliation(s)
- Y Goh
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - S T Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - P Pillay
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd 119074, Singapore
| | - C-P Chou
- Kaohsiung Veterans General Hospital, Radiology Department, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan, ROC.
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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 2024:10.1007/s00330-023-10574-7. [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] [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.
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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
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Fischer U, Diekmann F, Helbich T, Preibsch H, Püsken M, Wenkel E, Wienbeck S, Fallenberg EM. [Use of contrast-enhanced mammography for diagnosis of breast cancer]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:916-924. [PMID: 37889284 PMCID: PMC10692004 DOI: 10.1007/s00117-023-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is an imaging method that is able to improve visualization of intramammary tumors after peripheral venous administration of an iodine-containing contrast medium (ICM). OBJECTIVES AND METHODS The current significance of CEM is discussed. RESULTS Studies were able to show an advantage of CEM in the diagnosis of breast cancer compared to mammography, especially for women with dense breasts. Indications for CEM currently depend on the availability of magnetic resonance imaging (MRI). If MRI is available, CEM is indicated in those cases when MRI cannot be performed. Use of CEM for breast cancer screening is currently viewed critically. This view can change when results and updated assessments of large CEM studies in Europe and USA become available. Patients must be informed about the use of an ICM. As ICM administration for CEM is carried out in a similar manner to established imaging methods, the authors expect the use of ICM for CEM to be unproblematic as long as general contraindications are adhered to. CONCLUSIONS In the future, CEM could have greater importance for the diagnosis of breast cancer, as this imaging method has diagnostic advantages compared to conventional mammography. A great advantage of CEM is its availability. For those who use breast MRI, CEM is helpful when MRI is not feasible due to contraindications or other reasons.
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Affiliation(s)
- Uwe Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen, Deutschland.
| | - Felix Diekmann
- Institut für Radiologische Diagnostik, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Thomas Helbich
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Pädiatrische Radiologie, Medizinische Universität Wien/AKH WIEN, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Heike Preibsch
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Michael Püsken
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Evelyn Wenkel
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Radiologie München, München, Deutschland
| | - Susanne Wienbeck
- Radiologie Schwarzer Bär MVZ, Schwarzer Bär 8, 30449, Hannover, Deutschland
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Eva Maria Fallenberg
- Institut für diagnostische und interventionelle Radiologie, School of Medicine & Klinikum rechts der Isar Technische Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland
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Phillips J, Mehta TS, Portnow LH, Fishman MDC, Zhang Z, Pisano ED. Comparison of Contrast-enhanced Mammography with MRI Utilizing an Enriched Reader Study: A Breast Cancer Study (CONTRRAST Trial). Radiology 2023; 309:e230530. [PMID: 37962503 DOI: 10.1148/radiol.230530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Despite growing interest in using contrast-enhanced mammography (CEM) for breast cancer screening as an alternative to breast MRI, limited literature is available. Purpose To determine whether CEM is noninferior to breast MRI or abbreviated breast MRI (AB MRI) and superior to two-dimensional mammography in an asymptomatic population simulating those who would present for screening and then undergo diagnostic work-up. Materials and Methods This enriched reader study used CEM and MRI data prospectively collected from asymptomatic individuals at a single institution from December 2014 to March 2020. Case sets were obtained at screening, as part of work-up for a screening-detected finding, or before biopsy of a screening-detected abnormality. All images were anonymized and randomized, and all 12 radiologists interpreted them. For CEM interpretation, readers were first shown low-energy images as a surrogate for digital mammography and asked to give a forced Breast Imaging Reporting and Data System score for up to three abnormalities. The highest score was used as the case score. Readers then reviewed the full CEM examination and scored it similarly. After a minimum 1-month washout, the readers similarly interpreted AB MRI and full MRI examinations. Receiver operating characteristic analysis, powered to test CEM noninferiority to full MRI, was performed. Results The study included 132 case sets (14 negative, 74 benign, and 44 malignant; all female participants; mean age, 54 years ± 12 [SD]). The mean areas under the receiver operating characteristic curve (AUCs) for digital mammography, CEM, AB MRI, and full MRI were 0.79, 0.91, 0.89, and 0.91, respectively. CEM was superior to digital mammography (P < .001). No evidence of a difference in AUC was found between CEM and AB MRI and MRI. Conclusion In an asymptomatic study sample, CEM was noninferior to full MRI and AB MRI and was superior to digital mammography. Clinical trial registration no. NCT03482557 and NCT02275871 © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Jordana Phillips
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Tejas S Mehta
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Leah H Portnow
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Michael D C Fishman
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Zheng Zhang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Etta D Pisano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
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Li L, Gao Y, Zhang Y, Yang R, Ouyang Z, Guo R, Yu H, Shi X, Cao X. A Biomimetic Nanogel System Restores Macrophage Phagocytosis for Magnetic Resonance Imaging-Guided Synergistic Chemoimmunotherapy of Breast Cancer. Adv Healthc Mater 2023; 12:e2300967. [PMID: 37470683 DOI: 10.1002/adhm.202300967] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
Novel strategies to facilitate tumor-specific drug delivery and restore immune attacks remain to be developed to overcome the current limitations of chemotherapy. Herein, a cancer cell membrane (CM)-camouflaged and ultrasmall iron oxide nanoparticles (USIO NPs)-loaded polyethylenimine nanogel (NG) system is reported to co-deliver docetaxel (DTX) and CD47 siRNA (siCD47). The prepared co-delivery system exhibits good colloidal stability, biocompatibility, and r1 relaxivity (1.35 mM-1 s-1 ) and enables redox-responsive release of the loaded DTX in the tumor microenvironment. The NG system realizes homologous targeting delivery of DTX and siCD47 to murine breast cancer cells (4T1 cells) for efficient chemotherapy and gene silencing; thus, inducing immunogenic cell death (ICD) and restoring macrophage phagocytic effect through downregulation of "don't eat me" signals on cancer cells. Likewise, the co-delivery system can also act on macrophages to promote their M1 polarization, which can be combined with DTX-mediated ICD and antibody-mediated immune checkpoint blockade to generate effector T cells for robust chemoimmunotherapy. Further, the USIO NPs-incorporated NG system also allows for magnetic resonance imaging of tumors. The developed biomimetic NG system acting on both cancer cells and macrophages holds a promising potential for macrophage phagocytosis-restored chemoimmunotherapy.
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Affiliation(s)
- Lulu Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Yue Gao
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Yiming Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Rui Yang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Zhijun Ouyang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Rui Guo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Hongwei Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xiangyang Shi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Xueyan Cao
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
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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.
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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.)
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11
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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 2023:20220051. [PMID: 37227804 PMCID: PMC10392639 DOI: 10.1259/bjr.20220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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.
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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
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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12
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Lin F, Li Q, Wang Z, Shi Y, Ma H, Zhang H, Zhang K, Yang P, Zhang R, Duan S, Gu Y, Mao N, Xie H. Intratumoral and peritumoral radiomics for preoperatively predicting the axillary non-sentinel lymph node metastasis in breast cancer on the basis of contrast-enhanced mammography: a multicenter study. Br J Radiol 2023; 96:20220068. [PMID: 36542866 PMCID: PMC9975381 DOI: 10.1259/bjr.20220068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To develop and test a contrast-enhanced mammography (CEM)-based radiomics model using intratumoral and peritumoral regions to predict non-sentinel lymph node (NSLN) metastasis in breast cancer before surgery. METHODS This multicenter study included 365 breast cancer patients with sentinel lymph node metastasis. Intratumoral regions of interest (ROIs) were manually delineated, and peritumoral ROIs (5 and 10 mm) were automatically obtained. Five models, including intratumoral model, peritumoral (5 and 10 mm) models, and intratumoral+peritumoral (5 and 10 mm) models, were constructed by support vector machine classifier on the basis of optimal features selected by variance threshold, SelectKbest, and least absolute shrinkage and selection operator algorithms. The predictive performance of radiomics models was evaluated by receiver operating characteristic curves. An external testing set was used to test the model. The Memorial Sloan Kettering Cancer Center (MSKCC) model was used to compare the predictive performance with radiomics model. RESULTS The intratumoral ROI and intratumoral+peritumoral 10-mm ROI-based radiomics model achieved the best performance with an area under the curve (AUC) of 0.8000 (95% confidence interval [CI]: 0.6871-0.8266) in the internal testing set. In the external testing set, the AUC of radiomics model was 0.7567 (95% CI: 0.6717-0.8678), higher than that of MSKCC model (AUC = 0.6681, 95% CI: 0.5148-0.8213) (p = 0.361). CONCLUSIONS The intratumoral and peritumoral radiomics based on CEM had an acceptable predictive performance in predicting NSLN metastasis in breast cancer, which could be seen as a supplementary predicting tool to help clinicians make appropriate surgical plans. ADVANCES IN KNOWLEDGE The intratumoral and peritumoral CEM-based radiomics model could noninvasively predict NSLN metastasis in breast cancer patients before surgery.
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Affiliation(s)
- Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Qin Li
- Department of Radiology, WeiFang Traditional Chinese Hospital, Weifang, China
| | - Zhongyi Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Haicheng Zhang
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Kun Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Ping Yang
- Department of Pathology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Ran Zhang
- Huiying Medical Technology, Beijing, China
| | | | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
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13
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Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study. AJR Am J Roentgenol 2022; 219:884-894. [PMID: 35731101 DOI: 10.2214/ajr.22.27756] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Contrast-enhanced mammography (CEM) is rapidly expanding as a credible alternative to MRI in various clinical settings. OBJECTIVE. The purpose of this study was to compare CEM and MRI for neoadjuvant therapy (NAT) response assessment in patients with breast cancer. METHODS. This prospective study included 51 patients (mean age, 46 ± 11 [SD] years) with biopsy-proven breast cancer who were candidates for NAT from May 2015 to April 2018. Patients underwent both CEM and MRI before, during, and after NAT (pre-NAT, mid-NAT, and post-NAT, respectively). Post-NAT CEM included a 6-minute delayed acquisition. One breast radiologist with experience in CEM reviewed CEM examinations; one breast radiologist with experience in MRI reviewed MRI examinations. The radiologists assessed for the presence of an enhancing lesion; if an enhancing lesion was detected, its size was measured. RECIST version 1.1 response assessment categories were derived. Pathologic complete response (pCR) was defined as absence of both invasive cancer and ductal carcinoma in situ (DCIS). RESULTS. Of 51 patients, 16 achieved pCR. CEM yielded systematically lower size measurements compared with MRI (mean difference, -0.2 mm for pre-NAT, -0.7 mm for mid-NAT, and -0.3 mm for post-NAT). All post-NAT imaging tests yielded systematically larger size measurements compared with pathology (mean difference, 0.8 mm for CEM, 1.2 mm for MRI, and 1.9 mm for delayed CEM). Of 12 patients with residual DCIS, an enhancing lesion was detected in seven on post-NAT CEM, eight on post-NAT MRI, and nine on post-NAT delayed CEM. Agreement of RECIST response categories between CEM and MRI, expressed as kappa coefficient, was 0.791 at mid-NAT and 0.871 at post-NAT. For detecting pCR by post-NAT imaging, sensitivity and specificity were 81% and 83% for CEM, 100% and 86% for MRI, and 81% and 89% for delayed CEM. Sensitivity was significantly higher for MRI than CEM (p = .001) and delayed CEM (p = .002); remaining comparisons were not significant (p > .05). CONCLUSION. After NAT for breast cancer, CEM and MRI yielded comparable assessments of lesion size (both slightly overestimated vs pathology) and RECIST categories and showed no significant difference in specificity for pCR. MRI had higher sensitivity for pCR. Delayed CEM acquisition may help detect residual DCIS. CLINICAL IMPACT. Although MRI remains the preferred test for NAT response monitoring, the findings support CEM as a useful alternative when MRI is contraindicated or not tolerated.
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14
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Coffey K, Jochelson MS. Contrast-enhanced mammography in breast cancer screening. Eur J Radiol 2022; 156:110513. [PMID: 36108478 PMCID: PMC10680079 DOI: 10.1016/j.ejrad.2022.110513] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023]
Abstract
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
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15
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Vasselli F, Fabi A, Ferranti FR, Barba M, Botti C, Vidiri A, Tommasin S. How Dual-Energy Contrast-Enhanced Spectral Mammography Can Provide Useful Clinical Information About Prognostic Factors in Breast Cancer Patients: A Systematic Review of Literature. Front Oncol 2022; 12:859838. [PMID: 35941874 PMCID: PMC9355886 DOI: 10.3389/fonc.2022.859838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In the past decade, a new technique derived from full-field digital mammography has been developed, named contrast-enhanced spectral mammography (CESM). The aim of this study was to define the association between CESM findings and usual prognostic factors, such as estrogen receptors, progesterone receptors, HER2, and Ki67, in order to offer an updated overview of the state of the art for the early differential diagnosis of breast cancer and following personalized treatments. Materials and Methods According to the PRISMA guidelines, two electronic databases (PubMed and Scopus) were investigated, using the following keywords: breast cancer AND (CESM OR contrast enhanced spectral mammography OR contrast enhanced dual energy mammography) AND (receptors OR prognostic factors OR HER2 OR progesterone OR estrogen OR Ki67). The search was concluded in August 2021. No restriction was applied to publication dates. Results We obtained 28 articles from the research in PubMed and 114 articles from Scopus. After the removal of six replicas that were counted only once, out of 136 articles, 37 articles were reviews. Eight articles alone have tackled the relation between CESM imaging and ER, PR, HER2, and Ki67. When comparing radiological characterization of the lesions obtained by either CESM or contrast-enhanced MRI, they have a similar association with the proliferation of tumoral cells, as expressed by Ki-67. In CESM-enhanced lesions, the expression was found to be 100% for ER and 77.4% for PR, while moderate or high HER2 positivity was found in lesions with non-mass enhancement and with mass closely associated with a non-mass enhancement component. Conversely, the non-enhancing breast cancer lesions were not associated with any prognostic factor, such as ER, PR, HER2, and Ki67, which may be associated with the probability of showing enhancement. Radiomics on CESM images has the potential for non-invasive characterization of potentially heterogeneous tumors with different hormone receptor status. Conclusions CESM enhancement is associated with the proliferation of tumoral cells, as well as to the expression of estrogen and progesterone receptors. As CESM is a relatively young imaging technique, a few related works were found; this may be due to the “off-label” modality. In the next few years, the role of CESM in breast cancer diagnostics will be more thoroughly investigated.
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Affiliation(s)
- Federica Vasselli
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Romana Ferranti
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Division of Breast Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Antonello Vidiri,
| | - Silvia Tommasin
- Human Neuroscience Department, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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16
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Montrognon F, Clatot F, Berghian A, Douvrin F, Quieffin F, Defta D, Buquet A, Ferret M, Lequesne J, Leheurteur M, Fontanilles M, Georgescu D, Callonnec F. Impact of preoperative staging with contrast-enhanced mammography for localized breast cancer management. Br J Radiol 2022; 95:20210765. [PMID: 35195454 PMCID: PMC10996426 DOI: 10.1259/bjr.20210765] [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: 06/23/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A precise evaluation of the disease extent is mandatory before surgery for early breast cancer (EBC). Contrast-enhanced mammography (CEDM) is a recent technique that may help define adequate surgery. METHODS This retrospective study included consecutive patients referred to a cancer center between November 2016 and July 2017 for biopsy-confirmed invasive EBC management. The primary objective was to evaluate the rate of surgical changes after incorporating the results of the preoperative staging examination, including CEDM. RESULTS A total of 231 patients were screened for inclusion, and 132 patients were included, corresponding to 134 lesions. The first surgical plan was modified for 33 patients (25%), which represented 34 lesions. For 8 patients (6%), the surgery was cancelled in preference for neoadjuvant chemotherapy; for 16 patients (12.1%), the primary tumor procedure was enlarged; and for 23 patients (17.4%) the lymph node management was modified. Surgery was changed only due to the CEDM results for 24 patients (18.5%) and consisted of a more invasive procedure due to a more extended, multifocal or multicentric lesion than seen on the standard imaging. Anatomopathological surgery piece findings were well correlated with contrast-enhanced mammography results. Overall, there was no increase in the delay between the planned date of surgery and the effective surgical procedure (median 0 days). CONCLUSION CEDM added to preoperative staging helped define better surgical management without increasing delay in the surgical procedure. ADVANCES IN KNOWLEDGE CEDM is a reliable technique that should be considered as part of preoperative staging for EBC.
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Affiliation(s)
- Fanny Montrognon
- Department of Radiology, University Hospital
Center, Rouen,
France
| | - Florian Clatot
- Department of Medical Oncology, Henri Becquerel
Center, Rouen,
France
| | - Anca Berghian
- Department of Anatomopathology, Henri Becquerel
Center, Rouen,
France
| | | | | | - Diana Defta
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Anaïs Buquet
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Martine Ferret
- Department of Radiology, Henri Becquerel Center,
Rouen, France
| | - Justine Lequesne
- Department of Clinical Research, Henri Becquerel
Center, Rouen,
France
| | | | | | - Dragos Georgescu
- Department of Gynecology and Breast surgery, Henri Becquerel
Center, Rouen,
France
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17
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Jing X, Wielema M, Cornelissen LJ, van Gent M, Iwema WM, Zheng S, Sijens PE, Oudkerk M, Dorrius MD, van Ooijen PMA. Using deep learning to safely exclude lesions with only ultrafast breast MRI to shorten acquisition and reading time. Eur Radiol 2022; 32:8706-8715. [PMID: 35614363 DOI: 10.1007/s00330-022-08863-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the feasibility of automatically identifying normal scans in ultrafast breast MRI with artificial intelligence (AI) to increase efficiency and reduce workload. METHODS In this retrospective analysis, 837 breast MRI examinations performed on 438 women from April 2016 to October 2019 were included. The left and right breasts in each examination were labelled normal (without suspicious lesions) or abnormal (with suspicious lesions) based on final interpretation. Maximum intensity projection (MIP) images of each breast were then used to train a deep learning model. A high sensitivity threshold was calculated based on the detection trade - off (DET) curve on the validation set. The performance of the model was evaluated by receiver operating characteristic analysis of the independent test set. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with the high sensitivity threshold were calculated. RESULTS The independent test set consisted of 178 examinations of 149 patients (mean age, 44 years ± 14 [standard deviation]). The trained model achieved an AUC of 0.81 (95% CI: 0.75-0.88) on the independent test set. Applying a threshold of 0.25 yielded a sensitivity of 98% (95% CI: 90%; 100%), an NPV of 98% (95% CI: 89%; 100%), a workload reduction of 15.7%, and a scan time reduction of 16.6%. CONCLUSION This deep learning model has a high potential to help identify normal scans in ultrafast breast MRI and thereby reduce radiologists' workload and scan time. KEY POINTS • Deep learning in TWIST may eliminate the necessity of additional sequences for identifying normal breasts during MRI screening. • Workload and scanning time reductions of 15.7% and 16.6%, respectively, could be achieved with the cost of 1 (1 of 55) false negative prediction.
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Affiliation(s)
- Xueping Jing
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Mirjam Wielema
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Ludo J Cornelissen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Margo van Gent
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Willie M Iwema
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
| | - Sunyi Zheng
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Paul E Sijens
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen and Institute of Diagnostic Accuracy, Wiersmastraat 5, 9713, GH, Groningen, The Netherlands
| | - Monique D Dorrius
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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18
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Gennaro G, Baldan E, Bezzon E, Caumo F. Artifact reduction in contrast-enhanced mammography. Insights Imaging 2022; 13:90. [PMID: 35554734 PMCID: PMC9098782 DOI: 10.1186/s13244-022-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions. METHODS A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as "Absent", "Weak", "Medium", "Strong" in each artifact intensity category were compared between the two algorithms. P-values lower than 0.05 were considered statistically significant. RESULTS The NEW algorithm succeeded in eliminating 84.5% of breast-in-breast artifacts, 84.2% of ripple artifacts, and 56.9% of skinfold enhancement artifacts versus STD DES images, and reduced the artifact intensity in 12.1%, 13.0%, and 28.8% of the images, respectively. The visibility of lesion contrast uptake was the same with the STD and the NEW algorithms. CONCLUSION The new dual-energy subtraction algorithm demonstrated to be effective in reducing/eliminating CEM-related artifacts while preserving lesion contrast enhancement.
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Affiliation(s)
- Gisella Gennaro
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy.
| | - Enrica Baldan
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Elisabetta Bezzon
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Francesca Caumo
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
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19
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Sun Y, Wang S, Liu Z, You C, Li R, Mao N, Duan S, Lynn HS, Gu Y. Identifying factors that may influence the classification performance of radiomics models using contrast-enhanced mammography (CEM) images. Cancer Imaging 2022; 22:22. [PMID: 35550658 PMCID: PMC9101829 DOI: 10.1186/s40644-022-00460-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radiomics plays an important role in the field of oncology. Few studies have focused on the identification of factors that may influence the classification performance of radiomics models. The goal of this study was to use contrast-enhanced mammography (CEM) images to identify factors that may potentially influence the performance of radiomics models in diagnosing breast lesions. Methods A total of 157 women with 161 breast lesions were included. Least absolute shrinkage and selection operator (LASSO) regression and the random forest (RF) algorithm were employed to construct radiomics models. The classification result for each lesion was obtained by using 100 rounds of five-fold cross-validation. The image features interpreted by the radiologists were used in the exploratory factor analyses. Univariate and multivariate analyses were performed to determine the association between the image features and misclassification. Additional exploratory analyses were performed to examine the findings. Results Among the lesions misclassified by both LASSO and RF ≥ 20% of the iterations in the cross-validation and those misclassified by both algorithms ≤5% of the iterations, univariate analysis showed that larger lesion size and the presence of rim artifacts and/or ripple artifacts were associated with more misclassifications among benign lesions, and smaller lesion size was associated with more misclassifications among malignant lesions (all p < 0.050). Multivariate analysis showed that smaller lesion size (odds ratio [OR] = 0.699, p = 0.002) and the presence of air trapping artifacts (OR = 35.568, p = 0.025) were factors that may lead to misclassification among malignant lesions. Additional exploratory analyses showed that benign lesions with rim artifacts and small malignant lesions (< 20 mm) with air trapping artifacts were misclassified by approximately 50% more in rate compared with benign and malignant lesions without these factors. Conclusions Lesion size and artifacts in CEM images may affect the diagnostic performance of radiomics models. The classification results for lesions presenting with certain factors may be less reliable. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00460-8.
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Affiliation(s)
- Yuqi Sun
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Simin Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ziang Liu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ruimin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong, 264000, China
| | - Shaofeng Duan
- GE Healthcare China, No. 1 Huatuo Road, Shanghai, 210000, China
| | - Henry S Lynn
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China.
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20
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Ma Y, Liu A, Zhang Y, Zhu Y, Wang Y, Zhao M, Liang Z, Qu Z, Yin L, Lu H, Ye Z. Comparison of background parenchymal enhancement (BPE) on contrast-enhanced cone-beam breast CT (CE-CBBCT) and breast MRI. Eur Radiol 2022; 32:5773-5782. [PMID: 35320411 DOI: 10.1007/s00330-022-08699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the background parenchymal enhancement (BPE) levels on contrast-enhanced cone-beam breast CT (CE-CBBCT) and MRI, evaluate inter-reader reliability, and analyze the relationship between clinical factors and BPE level on CE-CBBCT. METHODS In this retrospective study, patients who underwent both CE-CBBCT and MRI were analyzed. BPE levels on CE-CBBCT and MRI were assessed by five specialists independently in random fashion, with a wash-out period of 4 weeks. Weighted kappa was used to analyze the agreement between CE-CBBCT and MRI, and intraclass correlation coefficient (ICC) was used to evaluate the inter-reader reliability for each modality. The association between BPE level on CE-CBBCT and clinical factors was evaluated by univariate and multivariate logistic regression. RESULTS A total of 221 patients from January 2017 to April 2021 were enrolled. CE-CBBCT showed substantial agreement (weighted kappa = 0.690) with MRI for BPE evaluation, with good degree of inter-reader reliability on both CE-CBBCT (ICC = 0.712) and MRI (ICC = 0.757). Based on majority reports, BPE levels on CE-CBBCT were lower than MRI (p < 0.001). BPE level on CE-CBBCT was significantly associated with menstrual status (odds ratio, OR = 0.125), breast density (OR = 2.308), and previously treated breast cancer (OR = 0.052) (all p < 0.05). BPE level for premenopausal patients was associated with menstrual cycle, with lower BPE level for the 2nd week of menstrual cycle (OR = 0.246). CONCLUSIONS CE-CBBCT showed substantial agreement and comparable inter-reader reliability with MRI for BPE evaluation, indicating that the corresponding BI-RADS lexicons could be used to describe BPE level on CE-CBBCT. The 2nd week of menstrual cycle timing is suggested as the optimal examination period for CE-CBBCT. KEY POINTS • CE-CBBCT showed substantial agreement and comparable inter-reader reliability with MRI for BPE evaluation. • Menstrual status, breast density, and previously treated breast cancer were associated with the BPE level on CE-CBBCT images. • The 2ndweek of the menstrual cycle is suggested as the optimal examination period for CE-CBBCT.
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Affiliation(s)
- Yue Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Aidi Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yueqiang Zhu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yafei Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Mengran Zhao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhiran Liang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhiye Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Lu Yin
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China.
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Ferranti FR, Vasselli F, Barba M, Sperati F, Terrenato I, Graziano F, Vici P, Botti C, Vidiri A. Diagnostic Accuracy of Contrast-Enhanced, Spectral Mammography (CESM) and 3T Magnetic Resonance Compared to Full-Field Digital Mammography plus Ultrasound in Breast Lesions: Results of a (Pilot) Open-Label, Single-Centre Prospective Study. Cancers (Basel) 2022; 14:cancers14051351. [PMID: 35267659 PMCID: PMC8909837 DOI: 10.3390/cancers14051351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: To assess the diagnostic accuracy of CESM and 3T MRI compared to full-field digital mammography (FFDM), plus US, in the evaluation of advanced breast lesions. Materials and Methods: Consenting women with suspicious findings underwent FFDM, US, CESM and 3T MRI. Breast lesions were histologically assessed, with histology being the gold standard. Two experienced breast radiologists, blinded to cancer status, read the images. Diagnostic accuracy of (1) CESM as an adjunct to FFDM and US, and (2) 3T MRI as an adjunct to CESM compared to FFDM and US, was assessed. Measures of accuracy were sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: There were 118 patients included along with 142 histologically characterized lesions. K agreement values were 0.69, 0.68, 0.63 and 0.56 for concordance between the gold standard and FFDM, FFDM + US, CESM and MRI, respectively (p < 0.001, for all). K concordance for CESM was 0.81 with FFDM + US and 0.73 with MRI (p value < 0.001 for all). Conclusions: CESM may represent a valuable alternative and/or an integrating technique to MRI in the evaluation of breast cancer patients.
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Affiliation(s)
- Francesca Romana Ferranti
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
| | - Federica Vasselli
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
- Correspondence: (M.B.); (A.V.); Tel.: +39-0652665419 (M.B.); +39-0652662731 (A.V.)
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.S.); (I.T.)
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.S.); (I.T.)
| | - Franco Graziano
- Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.G.); (C.B.)
| | - Patrizia Vici
- Sperimentazioni di Fase IV, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Claudio Botti
- Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.G.); (C.B.)
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
- Correspondence: (M.B.); (A.V.); Tel.: +39-0652665419 (M.B.); +39-0652662731 (A.V.)
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22
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Yuen S, Monzawa S, Gose A, Yanai S, Yata Y, Matsumoto H, Ichinose Y, Tashiro T, Yamagami K. Impact of background parenchymal enhancement levels on the diagnosis of contrast-enhanced digital mammography in evaluations of breast cancer: comparison with contrast-enhanced breast MRI. Breast Cancer 2022; 29:677-687. [DOI: 10.1007/s12282-022-01345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
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Bauer E, Levy MS, Domachevsky L, Anaby D, Nissan N. Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: A state-of-the-art review. Clin Imaging 2021; 83:41-50. [PMID: 34953310 DOI: 10.1016/j.clinimag.2021.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/20/2022]
Abstract
Within the past decade, background parenchymal enhancement (BPE) and background parenchymal uptake (BPU) have emerged as novel imaging-derived biomarkers in the diagnosis and treatment monitoring of breast cancer. Growing evidence supports the role of breast parenchyma vascularity and metabolic activity as probable risk factors for breast cancer development. Furthermore, in the presence of a newly-diagnosed breast cancer, added clinically-relevant data was surprisingly found in the respective imaging properties of the non-affected contralateral breast. Evaluation of the contralateral BPE and BPU have been found to be especially instrumental in predicting the prognosis of a patient with breast cancer and even anticipating their response to neoadjuvant chemotherapy. Simultaneously, further research has found a link between these two biomarkers, even though they represent different physical properties. The aim of this review is to provide an up to date summary of the current clinical applications of BPE and BPU as breast cancer imaging biomarkers with the hope that it propels their further usage in clinical practice.
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Affiliation(s)
- Ethan Bauer
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Miri Sklair Levy
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Noam Nissan
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
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Breast cancer in dense breasts: comparative diagnostic merits of contrast-enhanced mammography and diffusion-weighted breast MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00442-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
The study was done to compare the value of contrast-enhanced mammography and diffusion-weighted breast MRI in dense breast screening and accurate detection of the breast cancer with correlation of the findings to the histopathological results.
The study included 32 female patients having suspicious breast lesions and underwent digital mammography then scheduled for CESM and MRI DW imaging technique. The imaging findings were correlated to the histopathological findings.
Results
The study was conducted on 40 breast lesions in 32 female patients having dense breasts; they were classified by the digital mammography into ACR C (59.4%) and ACR D (40.6%). By CESM, there were twenty three lesions (57.5%) as mass lesions and thirteen lesions (32.5%) as non-mass lesions. Four lesions (10%) showed no contrast enhancement. According to the lesion characteristics in diffusion-weighted imaging, the breast lesions were classified into thirty three lesions (82.5%) with restricted diffusion and seven lesions (17.5%) with non-restricted diffusion. The study showed a cutoff ADC value to detect the malignant lesions in the dense breasts ≤ 1.1 × 10-3 s/mm2 at b value of 1000 s/mm2 with a sensitivity of 96.77%, specificity of 66.67%, PPV of 96.77%, NPV of 55.55%, and an overall total accuracy of 92.5%.
On comparing the diagnostic accuracy of the CESM to that of the DW MRI, the sensitivity of DW MRI (96.77%) was higher than that of CESM (90.32%). The specificity of DW MRI (66.67%) was higher than that of CESM (33.33%). Total accuracy of DW MRI was higher than that of CESM; they were 90% and 77.5%, respectively. Also, PPV and NPV of DW MRI were 90.91 and 85.71% as compared with 82.35 and 50.00% in CESM, respectively. When comparing the sensitivity of CESM to DW MRI in the detection of multiple breast lesions, they were 88.8 and 100%, respectively.
Conclusion
CESM is a useful technique in identification of hidden lesions in mammographically dense breasts. DW MRI is a fast, unenhanced modality that can be used as a breast cancer screening modality. CESM and DWI demonstrated good overall diagnostic accuracy in dense breast patients; however, DW MRI has a higher diagnostic accuracy than CESM for the detection of malignant breast lesions and their multiplicity.
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Hannsun G, Saponaro S, Sylvan P, Elmi A. Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls.
Recent Findings
Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed.
Summary
CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.
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Liguori A, Depretto C, Ciniselli CM, Citterio A, Boffelli G, Verderio P, Scaperrotta GP. Contrast-enhanced digital mammography and magnetic resonance imaging: reproducibility compared to pathologic anatomy. TUMORI JOURNAL 2021; 108:563-571. [PMID: 34628982 DOI: 10.1177/03008916211050124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare the reproducibility between contrast-enhanced digital mammography (CEDM) and magnetic resonance imaging (MRI) with the postsurgical pathologic examination. In addition, the applicability of the Breast Imaging-Reporting and Data System (BI-RADS) lexicon of MRI to CEDM was evaluated for mass lesions. METHODS A total of 62 patients with a histologically proven diagnosis of breast cancer were included in this study, for a total of 67 lesions. Fifty-nine patients underwent both methods. The reproducibility between MRI vs CEDM and the reference standard (postoperative pathology) was assessed by considering the lesion and breast size as pivotal variables. Reproducibility was evaluated by computing the concordance correlation coefficient (CCC). Bland-Altman plots were used to depict the observed pattern of agreement as well as to estimate the associated bias. Furthermore, the pattern of agreement between the investigated methods with regard to the breast lesion characterization (i.e. mass/nonmass; shape; margins; internal enhanced characteristics) was assessed by computing the Cohen kappa and its 95% confidence interval (CI). RESULTS The reproducibility between MRI and the reference standard and between CEDM and the reference standard showed substantial agreement, with a CCC value of 0.956 (95% CI, 0.931-0.972) and 0.950 (95% CI, 0.920-0.969), respectively. By looking at the Bland-Altman analysis, bias values of 2.344 and 1.875 mm were observed for MRI and CEDM vs reference evaluation, respectively. The agreement between MRI and CEDM is substantial with a CCC value of 0.969 (95% CI, 0.949-0.981). The Bland-Altman analysis showed bias values of -0.469 mm when comparing CEDM vs MRI. Following the Landis and Koch classification criteria, moderate agreement was observed between the two methods in describing BI-RADS descriptors of mass lesions. CONCLUSION CEDM is able to measure and describe tumor masses comparably to MRI and can be used for surgical planning.
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Affiliation(s)
- Alessandro Liguori
- Breast Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy.,Breast Radiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Mangiagalli Center, Milano, Lombardia, Italy
| | - Catherine Depretto
- Breast Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Chiara Maura Ciniselli
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Citterio
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giulia Boffelli
- Radiology Piazza OMS 1, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Verderio
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Steinhof-Radwańska K, Lorek A, Holecki M, Barczyk-Gutkowska A, Grażyńska A, Szczudło-Chraścina J, Bożek O, Habas J, Szyluk K, Niemiec P, Gisterek I. Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer. Curr Oncol 2021; 28:4016-4030. [PMID: 34677259 PMCID: PMC8534697 DOI: 10.3390/curroncol28050341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The multifocality and multicentrality of breast cancer (MFMCC) are the significant aspects that determine a specialist's choice between applying breast-conserving therapy (BCT) or performing a mastectomy. This study aimed to assess the usefulness of mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in women diagnosed with breast cancer before qualifying for surgical intervention to visualize other (additional) cancer foci. METHODS The study included 60 breast cancer cases out of 630 patients initially who underwent surgery due to breast cancer from January 2015 to April 2019. MG, CESM, and MRI were compared with each other in terms of the presence of MFMCC and assessed for compliance with the postoperative histopathological examination (HP). RESULTS Histopathological examination confirmed the presence of MFMCC in 33/60 (55%) patients. The sensitivity of MG in detecting MFMCC was 50%, and its specificity was 95.83%. For CESM, the sensitivity was 85.29%, and the specificity was 96.15%. For MRI, all the above-mentioned parameters were higher as follows: sensitivity-91.18%; specificity-92.31%. CONCLUSIONS In patients with MFMCC, both CESM and MRI are highly sensitive in the detection of additional cancer foci. Both CESM and MRI change the extent of surgical intervention in every fourth patient.
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Affiliation(s)
- Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Michał Holecki
- Department of Internal, Autoimmune and Metabolic Diseases, Faculty of Medical Science, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Anna Grażyńska
- Students’ Scientific Society Department of Nuclear Medicine and Diagnostic Imaging, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, University Clinical Center Prof. K. Gibiński, 40-752 Katowice, Poland;
| | | | - Oskar Bożek
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (A.B.-G.); (O.B.)
| | - Justyna Habas
- Faculty of Pharmaceutical Sciences, Medical University of Silesia in Sosnowiec, 41-200 Sosnowiec, Poland;
| | - Karol Szyluk
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland;
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Iwona Gisterek
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-515 Katowice, Poland;
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Gilbert FJ, Hickman SE, Baxter GC, Allajbeu I, James J, Caraco C, Vinnicombe S. Opportunities in cancer imaging: risk-adapted breast imaging in screening. Clin Radiol 2021; 76:763-773. [PMID: 33820637 DOI: 10.1016/j.crad.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S E Hickman
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - G C Baxter
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - I Allajbeu
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J James
- Nottingham Breast Institute, City Hospital, Nottingham, UK
| | - C Caraco
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - S Vinnicombe
- Thirlestaine Breast Centre, Cheltenham, UK; Ninewells Hospital and Medical School, University of Dundee, UK
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Quantitative Breast Density in Contrast-Enhanced Mammography. J Clin Med 2021; 10:jcm10153309. [PMID: 34362092 PMCID: PMC8348046 DOI: 10.3390/jcm10153309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Contrast-enhanced mammography (CEM) demonstrates a potential role in personalized screening models, in particular for women at increased risk and women with dense breasts. In this study, volumetric breast density (VBD) measured in CEM images was compared with VBD obtained from digital mammography (DM) or tomosynthesis (DBT) images. A total of 150 women who underwent CEM between March 2019 and December 2020, having at least a DM/DBT study performed before/after CEM, were included. Low-energy CEM (LE-CEM) and DM/DBT images were processed with automatic software to obtain the VBD. VBDs from the paired datasets were compared by Wilcoxon tests. A multivariate regression model was applied to analyze the relationship between VBD differences and multiple independent variables certainly or potentially affecting VBD. Median VBD was comparable for LE-CEM and DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (p = 0.5855). VBD differences between LE-CEM and DM were associated with significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance, i.e., variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761). Volumetric breast density was obtained from low-energy contrast-enhanced spectral mammography and was not significantly different from volumetric breast density measured from standard mammograms.
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Differentiating Breast Tumors from Background Parenchymal Enhancement at Contrast-Enhanced Mammography: The Role of Radiomics-A Pilot Reader Study. Diagnostics (Basel) 2021; 11:diagnostics11071248. [PMID: 34359332 PMCID: PMC8305277 DOI: 10.3390/diagnostics11071248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background: The purpose of this study was to assess the effectiveness of the radiomic analysis of contrast-enhanced spectral mammography (CESM) in discriminating between breast cancers and background parenchymal enhancement (BPE). Methods: This retrospective study included 38 patients that underwent CESM examinations for clinical purposes between January 2019–December 2020. A total of 57 malignant breast lesions and 23 CESM examinations with 31 regions of BPE were assessed through radiomic analysis using MaZda software. The parameters that demonstrated to be independent predictors for breast malignancy were exported into the B11 program and a k-nearest neighbor classifier (k-NN) was trained on the initial groups of patients and was tested using a validation group. Histopathology results obtained after surgery were considered the gold standard. Results: Radiomic analysis found WavEnLL_s_2 parameter as an independent predictor for breast malignancies with a sensitivity of 68.42% and a specificity of 83.87%. The prediction model that included CH1D6SumAverg, CN4D6Correlat, Kurtosis, Perc01, Perc10, Skewness, and WavEnLL_s_2 parameters had a sensitivity of 73.68% and a specificity of 80.65%. Higher values were obtained of WavEnLL_s_2 and the prediction model for tumors than for BPEs. The comparison between the ROC curves provided by the WaveEnLL_s_2 and the entire prediction model did not show statistically significant results (p = 0.0943). The k-NN classifier based on the parameter WavEnLL_s_2 had a sensitivity and specificity on training and validating groups of 71.93% and 45.16% vs. 60% and 44.44%, respectively. Conclusion: Radiomic analysis has the potential to differentiate CESM between malignant lesions and BPE. Further quantitative insight into parenchymal enhancement patterns should be performed to facilitate the role of BPE in personalized clinical decision-making and risk assessment.
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de Kermadec E, Thomassin I, Daraï E, Kolanska K, Chabbert-Buffet N. [Impact of the menstrual cycle on the quality of interpretation of the MRI result in the follow-up of women at genetic risk for breast]. ACTA ACUST UNITED AC 2021; 49:923-929. [PMID: 33771738 DOI: 10.1016/j.gofs.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast MRI is used as a reference for screening breast cancer among women with a genetic high risk. Its sensitivity and specificity might decrease because of the background parenchymal enhancement. Therefore, it is recommended to plan the MRI between the 7th and the 14th day of the menstrual cycle despite of the burden of this organization. Our aim was to evaluate the interpretation (performance) of the MRI performance when it was done out of this period. METHODS We analyzed the MRI done in the Tenon Hospital among patients with a genetic high risk, without a history of breast cancer, between 2006 and 2016. We analyzed the rate of enhancement hindering the interpretation (EH) - that is to say grade III and IV -, the rate of additional explorations (MRI and biopsy), and the occurrence of interval events in 2 groups according to the programming of the examination: appropriate programming (D7-D14) and inappropriate programming (outside this period). RESULTS In total, 126 MRI were analyzed, done in a population of 62 women with a genetic predisposition to Breast Cancer (BRCA 1 or 2: 91%, others: 9%), median age was 34.5 years old. 84 were in appropriate programming and 42 were in an inappropriate one. The rate of EH was comparable between the two groups (respectively 31% and 35.7%, P=1), as well as the rate of additional explorations (respectively 31% and 45%, P=0.11). CONCLUSION Our results suggest that the programming of screening MRI could be simplified among patients with a genetic predisposition of breast cancer.
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Affiliation(s)
- E de Kermadec
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - I Thomassin
- Réseau sein a risque, AP-HP, Paris, France; Service de radiologie, centre d'imagerie de la femme, Sorbonne Université site TENON, AP-HP, Paris, France
| | - E Daraï
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - K Kolanska
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France.
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Berg WA, Bandos AI, Zuley ML, Waheed UX. Training Radiologists to Interpret Contrast-enhanced Mammography: Toward a Standardized Lexicon. JOURNAL OF BREAST IMAGING 2021; 3:176-189. [PMID: 38424825 DOI: 10.1093/jbi/wbaa115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/05/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Using terms adapted from the BI-RADS Mammography and MRI lexicons, we trained radiologists to interpret contrast-enhanced mammography (CEM) and assessed reliability of their description and assessment. METHODS A 60-minute presentation on CEM and terminology was reviewed independently by 21 breast imaging radiologist observers. For 21 CEM exams with 31 marked findings, observers recorded background parenchymal enhancement (BPE) (minimal, mild, moderate, marked), lesion type (oval/round or irregular mass, or non-mass enhancement), intensity of enhancement (none, weak, medium, strong), enhancement quality (none, homogeneous, heterogeneous, rim), and BI-RADS assessment category (2, 3, 4A, 4B, 4C, 5). "Expert" consensus of 3 other radiologists experienced in CEM was developed. Kappa statistic was used to assess agreement between radiologists and expert consensus, and between radiologists themselves, on imaging feature categories and final assessments. Reproducibility of specific feature descriptors was assessed as fraction of consensus-concordant responses. RESULTS Radiologists demonstrated moderate agreement for BPE, (mean kappa, 0.43; range, 0.05-0.69), and lowest reproducibility for "minimal." Agreement was substantial for lesion type (mean kappa, 0.70; range, 0.47-0.93), moderate for intensity of enhancement (mean kappa, 0.57; range, 0.44-0.76), and moderate for enhancement quality (mean kappa, 0.59; range, 0.20-0.78). Agreement on final assessment was fair (mean kappa, 0.26; range, 0.09-0.44), with BI-RADS category 3 the least reproducible. Decision to biopsy (BI-RADS 2-3 vs 4-5) showed moderate agreement with consensus (mean kappa, 0.54; range, -0.06-0.87). CONCLUSION With minimal training, agreement for description of CEM findings by breast imaging radiologists was comparable to other BI-RADS lexicons.
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Affiliation(s)
- Wendie A Berg
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Andriy I Bandos
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA
| | - Margarita L Zuley
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
| | - Uzma X Waheed
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
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Current Status and Future of BI-RADS in Multimodality Imaging, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2020; 216:860-873. [PMID: 33295802 DOI: 10.2214/ajr.20.24894] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BI-RADS is a communication and data tracking system that has evolved since its inception as a brief mammography lexicon and reporting guide into a robust structured reporting platform and comprehensive quality assurance tool for mammography, ultrasound, and MRI. Consistent and appropriate use of the BI-RADS lexicon terminology and assessment categories effectively communicates findings, estimates the risk of malignancy, and provides management recommendations to patients and referring clinicians. The impact of BI-RADS currently extends internationally through six language translations. A condensed version has been proposed to facilitate a phased implementation of BI-RADS in resource-constrained regions. The primary advance of the 5th edition of BI-RADS is harmonization of the lexicon terms across mammography, ultrasound, and MRI. Harmonization has also been achieved across these modalities for the reporting structure, assessment categories, management recommendations, and data tracking system. Areas for improvement relate to certain common findings that lack lexicon descriptors and a need for further clarification of proper use of category 3. BI-RADS is anticipated to continue to evolve for application to a range of emerging breast imaging modalities.
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Improving the Diagnostic Accuracy of Breast BI-RADS 4 Microcalcification-Only Lesions Using Contrast-Enhanced Mammography. Clin Breast Cancer 2020; 21:256-262.e2. [PMID: 33243676 DOI: 10.1016/j.clbc.2020.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is a novel breast imaging technique that can provide additional information of breast tissue blood supply. This study aimed to test the possibility of CEM in improving the diagnostic accuracy of Breast Imaging Reporting and Data System (BI-RADS) 4 calcification-only lesions with consideration of morphology and distribution. PATIENTS AND METHODS Data of patients with suspicious malignant calcification-only lesions (BI-RADS 4) on low-energy CEM and proved pathologic diagnoses were retrospectively collected. Two junior radiologists independently reviewed the two sets of CEM images, low-energy images (LE) to describe the calcifications by morphology and distribution type, and recombined images (CE) to record the presence of enhancement. Low-risk and high-risk groups were divided by calcification morphology, distribution, and both, respectively. Positive predictive values and misdiagnosis rates (MDR) were compared between LE-only reading and CE reading. Diagnostic performance was also tested using machine learning method. RESULTS The study included 74 lesions (26 malignant and 48 benign). Positive predictive values were significantly higher and MDRs were significantly lower using CE images than using LE alone for both the low-risk morphology type and low-risk distribution type (P < .05). MDRs were significantly lower when using CE images (18.18%-24.00%) than using LE images alone in low-risk group (76.36%-80.00%) (P < .05). Using a machine learning method, significant improvements in the area under the receiver operating characteristic curve were observed in both low-risk and high-risk groups. CONCLUSION CEM has the potential to aid in the diagnosis of BI-RADS 4 calcification-only lesions; in particular, those presented as low risk in morphology and/or distribution may benefit more.
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Gluskin J, Rossi Saccarelli C, Avendano D, Marino MA, Bitencourt AGV, Pilewskie M, Sevilimedu V, Sung JS, Pinker K, Jochelson MS. Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery. Cancers (Basel) 2020; 12:cancers12123495. [PMID: 33255412 PMCID: PMC7760311 DOI: 10.3390/cancers12123495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer survivors are at risk for recurrence, and the early detection of recurrence improves survival. Therefore, imaging surveillance is performed for women who have breast-conserving surgery. The aim of our retrospective study was to compare routine mammography with contrast-enhanced mammography in the screening (asymptomatic) post-treatment setting. We confirmed that when screening women with breast conservation surgery, contrast-enhanced mammography had a higher cancer detection rate (15.4/1000) and positive predictive value of biopsies (42.9%) than full-field digital mammography (6.2/1000 and 37.5%, respectively). Abstract To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.
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Affiliation(s)
- Jill Gluskin
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP 01308-050, Brazil
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, 64718 Nuevo Leon, Mexico
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, 64718 Messina, Italy
| | - Almir G. V. Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP 01509-010, Brazil
| | - Melissa Pilewskie
- Department of Surgery, Breast Service, 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;
| | - Janice S. Sung
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Maxine S. Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Correspondence: ; Tel.: +1-646-888-4507
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Nam Y, Park GE, Kang J, Kim SH. Fully Automatic Assessment of Background Parenchymal Enhancement on Breast MRI Using Machine-Learning Models. J Magn Reson Imaging 2020; 53:818-826. [PMID: 33219624 DOI: 10.1002/jmri.27429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Automated measurement and classification models with objectivity and reproducibility are required for accurate evaluation of the breast cancer risk of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE). PURPOSE To develop and evaluate a machine-learning algorithm for breast FGT segmentation and BPE classification. STUDY TYPE Retrospective. POPULATION A total of 794 patients with breast cancer, 594 patients assigned to the development set, and 200 patients to the test set. FIELD STRENGTH/SEQUENCE 3T and 1.5T; T2 -weighted, fat-saturated T1 -weighted (T1 W) with dynamic contrast enhancement (DCE). ASSESSMENT Manual segmentation was performed for the whole breast and FGT regions in the contralateral breast. The BPE region was determined by thresholding using the subtraction of the pre- and postcontrast T1 W images and the segmented FGT mask. Two radiologists independently assessed the categories of FGT and BPE. A deep-learning-based algorithm was designed to segment and measure the volume of whole breast and FGT and classify the grade of BPE. STATISTICAL TESTS Dice similarity coefficients (DSC) and Spearman correlation analysis were used to compare the volumes from the manual and deep-learning-based segmentations. Kappa statistics were used for agreement analysis. Comparison of area under the receiver operating characteristic (ROC) curves (AUC) and F1 scores were calculated to evaluate the performance of BPE classification. RESULTS The mean (±SD) DSC for manual and deep-learning segmentations was 0.85 ± 0.11. The correlation coefficient for FGT volume from manual- and deep-learning-based segmentations was 0.93. Overall accuracy of manual segmentation and deep-learning segmentation in BPE classification task was 66% and 67%, respectively. For binary categorization of BPE grade (minimal/mild vs. moderate/marked), overall accuracy increased to 91.5% in manual segmentation and 90.5% in deep-learning segmentation; the AUC was 0.93 in both methods. DATA CONCLUSION This deep-learning-based algorithm can provide reliable segmentation and classification results for BPE. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yoonho Nam
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Ga Eun Park
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Junghwa Kang
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zamora K, Allen E, Hermecz B. Contrast mammography in clinical practice: Current uses and potential diagnostic dilemmas. Clin Imaging 2020; 71:126-135. [PMID: 33197726 DOI: 10.1016/j.clinimag.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This article will discuss the indications for Contrast Enhanced Spectral Mammography (CESM) with a focus on imaging interpretation including diagnostic dilemmas and pitfalls which may be encountered in practice. CONCLUSION Understanding potential diagnostic dilemmas and pitfalls of CESM allows for enhanced interpretation. The clinical utilization of Contrast Enhanced Spectral Mammography (CESM) has increased significantly over the last few years. CESM demonstrates comparable sensitivity and accuracy to magnetic resonance imaging (MRI) for the evaluation of breast cancer but is less time consuming and less expensive. Because of this, CESM is now being used in lieu of MRI for many diagnostic indicators including the evaluation of abnormal mammographic findings, extent of disease, and response to neoadjuvant therapy. Additionally, ongoing research into the role of CESM in asymptomatic screening for breast cancer is evolving. As this technique becomes more popular, focusing on appropriate technique and interpretation is important. This article reviews the current and potential roles of CESM. It provides examples of CESM utilized for diagnostic indications while highlighting diagnostic dilemmas, pitfalls, and artifacts that may be encountered when interpreting CESM images.
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Affiliation(s)
- Kathryn Zamora
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Allen
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
| | - Brittany Hermecz
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
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Lin F, Wang Z, Zhang K, Yang P, Ma H, Shi Y, Liu M, Wang Q, Cui J, Mao N, Xie H. Contrast-Enhanced Spectral Mammography-Based Radiomics Nomogram for Identifying Benign and Malignant Breast Lesions of Sub-1 cm. Front Oncol 2020; 10:573630. [PMID: 33194677 PMCID: PMC7662120 DOI: 10.3389/fonc.2020.573630] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives To develop a radiomics nomogram that incorporates contrast-enhanced spectral mammography (CESM)-based radiomics features and clinico-radiological variables for identifying benign and malignant breast lesions of sub-1 cm. Methods This retrospective study included 139 patients with the diameter of sub-1 cm on cranial caudal (CC) position of recombined images. Radiomics features were extracted from low-energy and recombined images on CC position. The variance threshold, analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO) algorithms were used to select optimal predictive features. Radiomics signature (Rad-score) was calculated by a linear combination of selected features. The independent predictive factors were identified by ANOVA and multivariate logistic regression. A radiomics nomogram was developed to predict the malignant probability of lesions. The performance and clinical utility of the nomogram was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results Nineteen radiomics features were selected to calculate Rad-score. Breast imaging reporting and data system (BI-RADS) category and age were identified as predictive factors. The radiomics nomogram combined with Rad-score, BI-RADS category, and age showed better performance (area under curves [AUC]: 0.940, 95% confidence interval [CI]: 0.804-0.992) than Rad-score (AUC: 0.868, 95% CI: 0.711-0.958) and clinico-radiological model (AUC: 0.864, 95% CI: 0.706-0.956) in the validation cohort. The calibration curve and DCA showed that the radiomics nomogram had good consistency and clinical utility. Conclusions The radiomics nomogram incorporated with CESM-based radiomics features, BI-RADS category and age could identify benign and malignant breast lesions of sub-1 cm.
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Affiliation(s)
- Fan Lin
- School of Medical Imaging, Binzhou Medical University, Yantai, China.,Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Zhongyi Wang
- School of Medical Imaging, Binzhou Medical University, Yantai, China.,Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Kun Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Ping Yang
- Department of Pathology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Meijie Liu
- School of Medical Imaging, Binzhou Medical University, Yantai, China.,Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Qinglin Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Jingjing Cui
- Collaboration Department, Huiying Medical Technology, Beijing, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, China
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Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clin Imaging 2020; 69:269-279. [PMID: 33032103 DOI: 10.1016/j.clinimag.2020.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
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Affiliation(s)
- Julie Sogani
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
| | - Delia Keating
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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Sorin V, Yagil Y, Shalmon A, Gotlieb M, Faermann R, Halshtok-Neiman O, Sklair-Levy M. Background Parenchymal Enhancement at Contrast-Enhanced Spectral Mammography (CESM) as a Breast Cancer Risk Factor. Acad Radiol 2020; 27:1234-1240. [PMID: 31812577 DOI: 10.1016/j.acra.2019.10.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/13/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the extent of background parenchymal enhancement (BPE) at contrast-enhanced spectral mammography (CESM), association between clinical factors and BPE, and between BPE extent and breast cancer. MATERIALS AND METHODS This study included 516 women who underwent CESM imaging for screening and diagnostic purposes between 2012 and 2015 in a single center. BPE at CESM images was retrospectively, independently and blindly graded by six experienced radiologists using the following scale: minimal, mild, moderate, or marked. Agreement between readers was estimated using Kendall's W coefficient of concordance. Associations between clinical factors and BPE, and between BPE and breast cancer were examined using generalized estimating equations. Association between BPE and breast cancer was assessed for the whole study group, and for the screening population separately. RESULTS Most women underwent CESM for breast cancer screening (424/516, 82.2%). Mean age was 53 years, the majority had dense breasts (50.4-94%, depending on the reviewer), and minimal to mild BPE (75.8-89.9%). A total of 53/516 women had breast cancer. Overall concordance (W) values between the readers were 0.611 for breast density and 0.789 on BPE. Increased breast density and younger age were positive predictors for increased BPE (odds ratio [OR] 4.07, 95% confidence interval [CI] 2.32-7.14, p < 0.001; OR 2.88, 95% CI 1.87-4.42, p < 0.001, respectively). Breast radiation therapy was a negative predictor for BPE (OR 0.13, 95% CI 0.06-0.31, p < 0.001). Women with increased BPE had increased odds for breast cancer (OR 2.24, 95% CI 1.23-4.09, p = 0.008). This result was consistent when screening cases were analyzed separately (OR 6.27, 95% CI 2.38-16.53, p < 0.001). CONCLUSION BPE at CESM was associated with breast density. Women with increased BPE had increased odds for breast cancer, independently of other potential risk factors.
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Affiliation(s)
- Vera Sorin
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Yael Yagil
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Anat Shalmon
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Michael Gotlieb
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Renata Faermann
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Osnat Halshtok-Neiman
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Miri Sklair-Levy
- Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center and to the Sackler School of Medicine, Tel-Aviv University, Israel
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Lo Gullo R, Daimiel I, Rossi Saccarelli C, Bitencourt A, Sevilimedu V, Martinez DF, Jochelson MS, Morris EA, Reiner JS, Pinker K. MRI background parenchymal enhancement, fibroglandular tissue, and mammographic breast density in patients with invasive lobular breast cancer on adjuvant endocrine hormonal treatment: associations with survival. Breast Cancer Res 2020; 22:93. [PMID: 32819432 PMCID: PMC7441557 DOI: 10.1186/s13058-020-01329-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To investigate if baseline and/or changes in contralateral background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) measured on magnetic resonance imaging (MRI) and mammographic breast density (MD) can be used as imaging biomarkers for overall and recurrence-free survival in patients with invasive lobular carcinomas (ILCs) undergoing adjuvant endocrine treatment. METHODS Women who fulfilled the following inclusion criteria were included in this retrospective HIPAA-compliant IRB-approved study: unilateral ILC, pre-treatment breast MRI and/or mammography from 2000 to 2010, adjuvant endocrine treatment, follow-up MRI, and/or mammography 1-2 years after treatment onset. BPE, FGT, and mammographic MD of the contralateral breast were independently graded by four dedicated breast radiologists according to BI-RADS. Associations between the baseline levels and change in levels of BPE, FGT, and MD with overall survival and recurrence-free survival were assessed using Kaplan-Meier survival curves and Cox regression analysis. RESULTS Two hundred ninety-eight patients (average age = 54.1 years, range = 31-79) fulfilled the inclusion criteria. The average follow-up duration was 11.8 years (range = 2-19). Baseline and change in levels of BPE, FGT, and MD were not significantly associated with recurrence-free or overall survival. Recurrence-free and overall survival were affected by histological subtype (p < 0.0001), number of metastatic axillary lymph nodes (p < 0.0001), age (p = 0.01), and adjuvant endocrine treatment duration (p < 0.001). CONCLUSIONS Qualitative evaluation of BPE, FGT, and mammographic MD changes cannot predict which patients are more likely to benefit from adjuvant endocrine treatment.
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Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Isaac Daimiel
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Almir Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Jeffrey S Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging Service, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.
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Factors Associated With Background Parenchymal Enhancement on Contrast-Enhanced Mammography. AJR Am J Roentgenol 2020; 216:340-348. [PMID: 32755162 DOI: 10.2214/ajr.19.22353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine the relationship between background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM) and breast tissue density, menstrual status, endocrine therapy, and risk factors for breast cancer and also to evaluate interreader agreement on classification of BPE on CEM. MATERIALS AND METHODS. Five subspecialty-trained breast radiologists independently and blindly graded tissue density (with fatty tissue and scattered fibroglandular tissue classified as nondense tissue and with heterogeneously dense and extremely dense classified as dense tissue) and BPE (with minimal or mild BPE categorized as low BPE and moderate or marked BPE categorized as high BPE) on CEM examinations performed from 2014 to 2018. Electronic medical charts were reviewed for information on menstrual status, endocrine therapy, history of breast surgery, and other risk factors for breast cancer. Comparisons were performed using the Kruskal-Wallis test, Mann-Whitney test, and Spearman rank correlation. Interreader agreement was estimated using the Fleiss kappa test. RESULTS. A total of 202 patients (mean [± SD] age, 54 ± 10 years; range, 25-84 years) underwent CEM. Tissue density was categorized as fatty in two patients (1%), scattered fibroglandular in 67 patients (33%), heterogeneously dense in 117 patients (58%), and extremely dense in 16 patients (8%). Among the 202 patients, BPE was minimal in 77 (38%), mild in 80 (40%), moderate in 31 (15%), and marked in 14 (7%). Dense breasts, younger age, premenopausal status, no history of endocrine therapy, and no history of breast cancer were significantly associated with high BPE. Among premenopausal patients, no association was found between BPE and time from last menstrual period to CEM. Overall interreader agreement on BPE was moderate (κ = 0.41; 95% CI, 0.40-0.42). Interreader agreement on tissue density was substantial (κ = 0.67; 95% CI, 0.66-0.69). CONCLUSION. Women with dense breasts, premenopausal status, and younger age are more likely to have greater BPE. Targeting CEM to the last menstrual period is not indicated.
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Suter MB, Pesapane F, Agazzi GM, Gagliardi T, Nigro O, Bozzini A, Priolo F, Penco S, Cassano E, Chini C, Squizzato A. Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. Breast 2020; 53:8-17. [PMID: 32540554 PMCID: PMC7375655 DOI: 10.1016/j.breast.2020.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%-91%], with a sensitivity of 85% [95% CI 73%-93%], and a specificity of 77% [95% CI 60%-88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.
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Affiliation(s)
| | - Filippo Pesapane
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Giorgio Maria Agazzi
- University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Tania Gagliardi
- Department of Radiology, Royal Marsden Hospital, London, UK.
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
| | - Anna Bozzini
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Francesca Priolo
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Silvia Penco
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Enrico Cassano
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Claudio Chini
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
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Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon. Ultrasound Q 2020; 36:179-191. [PMID: 32511210 DOI: 10.1097/ruq.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.
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Zhao S, Zhang X, Zhong H, Qin Y, Li Y, Song B, Huang J, Yu J. Background Parenchymal Enhancement on Contrast-Enhanced Spectral Mammography: Influence of Age, Breast Density, Menstruation Status, and Menstrual Cycle Timing. Sci Rep 2020; 10:8608. [PMID: 32451404 PMCID: PMC7248100 DOI: 10.1038/s41598-020-65526-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
To evaluate the relationship of the extent and quantitative intensity of background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM) with age, breast density, menstruation status, and menstrual cycle timing. This retrospective study included women who underwent CESM from July 2017 to March 2019 and who had menstruation status records. BPE category assessment was performed subjectively. BPE intensity was quantitatively measured using regions-of-interest. 208 subjects were included (150 were regular menstrual cycle and 58 were postmenopausal). The breast density was classified as category B in 11 subjects, category C in 231 subjects, and category D in 23 subjects. Subjects based on menstrual cycle timing, 24 at days 1-7, 55 at days 8-14, 48 at days 15-21, and 23 at days 22-28. Both quantitative and categorical analyses show a weak negative correlation between BPE and age in all subjects, but there was no significant correlation in premenopausal patients. Both the BPE pixel intensity value and BPE category was significantly lower in postmenopausal patients than in premenopausal patients, and there was no significant difference in breast density according to BPE. The minimum and maximum pixel values of BPE on days 8-14 of the menstrual cycle was significantly lower than those on days 15-21. There was no correlation between BPE level and menstrual cycle timing. Breast density with category D was more likely to have a lower BPE level than category C. We show here that BPE level is affected by menstruation status and menstrual cycle timing. We suggest that CESM should not be performed on days 15-21 of the menstrual cycle, but on days 8-14.
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Affiliation(s)
- Shuang Zhao
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xueqin Zhang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Huanhuan Zhong
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yan Li
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Juan Huang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
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Radiomics Analysis on Contrast-Enhanced Spectral Mammography Images for Breast Cancer Diagnosis: A Pilot Study. ENTROPY 2019. [PMCID: PMC7514454 DOI: 10.3390/e21111110] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Contrast-enhanced spectral mammography is one of the latest diagnostic tool for breast care; therefore, the literature is poor in radiomics image analysis useful to drive the development of automatic diagnostic support systems. In this work, we propose a preliminary exploratory analysis to evaluate the impact of different sets of textural features in the discrimination of benign and malignant breast lesions. The analysis is performed on 55 ROIs extracted from 51 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) from the breast cancer screening phase between March 2017 and June 2018. We extracted feature sets by calculating statistical measures on original ROIs, gradiented images, Haar decompositions of the same original ROIs, and on gray-level co-occurrence matrices of the each sub-ROI obtained by Haar transform. First, we evaluated the overall impact of each feature set on the diagnosis through a principal component analysis by training a support vector machine classifier. Then, in order to identify a sub-set for each set of features with higher diagnostic power, we developed a feature importance analysis by means of wrapper and embedded methods. Finally, we trained an SVM classifier on each sub-set of previously selected features to compare their classification performances with respect to those of the overall set. We found a sub-set of significant features extracted from the original ROIs with a diagnostic accuracy greater than 80 % . The features extracted from each sub-ROI decomposed by two levels of Haar transform were predictive only when they were all used without any selection, reaching the best mean accuracy of about 80 % . Moreover, most of the significant features calculated by HAAR decompositions and their GLCMs were extracted from recombined CESM images. Our pilot study suggested that textural features could provide complementary information about the characterization of breast lesions. In particular, we found a sub-set of significant features extracted from the original ROIs, gradiented ROI images, and GLCMs calculated from each sub-ROI previously decomposed by the Haar transform.
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sung JS, Lebron L, Keating D, D'Alessio D, Comstock CE, Lee CH, Pike MC, Ayhan M, Moskowitz CS, Morris EA, Jochelson MS. Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer. Radiology 2019; 293:81-88. [PMID: 31453765 DOI: 10.1148/radiol.2019182660] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundContrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than two-dimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting.PurposeTo evaluate the performance of CEDM for breast cancer screening.Materials and MethodsThis retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value were determined.ResultsIn the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%).ConclusionContrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer.© RSNA, 2019.
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Affiliation(s)
- Janice S Sung
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Lizza Lebron
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Delia Keating
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Donna D'Alessio
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Christopher E Comstock
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Carol H Lee
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Malcolm C Pike
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Miranda Ayhan
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Chaya S Moskowitz
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Elizabeth A Morris
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
| | - Maxine S Jochelson
- From the Department of Radiology (J.S.S., L.L., D.K., D.D., C.E.C., C.H.L., M.A., E.A.M., M.S.J.) and Department of Epidemiology and Biostatistics (M.C.P., C.S.M.), Memorial Sloan-Kettering Cancer Center, 300 E 66th St, New York, NY 10065. From the 2017 RSNA Annual Meeting
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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