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Alvarenga P, Park JY, Pinto R, Parente D, Lajkosz K, Westergard S, Ghai S, Kim R, Kulkarni S, Au F, Chamadoira J, Freitas V. Decoding the Prevalent High-Risk Breast Cancers: Demographics, Pathological, Imaging Insights, and Long-Term Outcome. Can Assoc Radiol J 2024:8465371241253254. [PMID: 38795027 DOI: 10.1177/08465371241253254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
Objective: To investigate the features and outcomes of breast cancer in high-risk subgroups. Materials and Methods: REB approved an observational study of women diagnosed with breast cancer from 2010 to 2019. Three radiologists, using the BI-RADS lexicon, blindly reviewed mammogram and MRI screenings without a washout period. Consensus was reached with 2 additional reviewers. Inter-rater agreement was measured by Fleiss Kappa. Statistical analysis included Mann-Whitney U, Chi-square tests for cohort analysis, and Kaplan-Meier for survival rates, with a Cox model for comparative analysis using gene mutation as a reference. Results: The study included 140 high-risk women, finding 155 malignant lesions. Significant age differences noted: chest radiation therapy (median age 44, IQR: 37.0-46.2), gene mutation (median age 49, IQR: 39.8-58.0), and familial risk (median age 51, IQR: 44.5-56.0) (P = .007). Gene mutation carriers had smaller (P = .01), higher-grade tumours (P = .002), and more triple-negative ER- (P = .02), PR- (P = .002), and HER2- (P = .02) cases. MRI outperformed mammography in all subgroups. Substantial to near-perfect inter-rater agreement observed. Over 10 years, no deaths occurred in chest radiation group, with no significant survival difference between gene mutation and familial risk groups, HR = 0.93 (95% CI: 0.27, 3.26), P = .92. Conclusion: The study highlights the importance of age and specific tumour characteristics in identifying high-risk breast cancer subgroups. MRI is confirmed as an effective screening tool. Despite the aggressive nature of cancers in gene mutation carriers, early detection is crucial for survival outcomes. These insights, while necessitating further validation with larger studies, advocate for a move toward personalized medical care, strengthening the existing healthcare guidelines.
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Affiliation(s)
- Pedro Alvarenga
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Renata Pinto
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shelley Westergard
- Average and High-Risk Ontario Breast Screening Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Sandeep Ghai
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Raymond Kim
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Sinai Health System, Hospital for Sick Children, Ontario Institute for Cancer Research, University of Toronto, Toronto, ON, Canada
| | - Supriya Kulkarni
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Frederick Au
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Juliana Chamadoira
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Vivianne Freitas
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Pawlak ME, Rudnicki W, Borkowska A, Skubisz K, Rydzyk R, Łuczyńska E. Comparative Analysis of Diagnostic Performance of Automatic Breast Ultrasound, Full-Field Digital Mammography and Contrast-Enhanced Mammography in Relation to Breast Composition. Biomedicines 2023; 11:3226. [PMID: 38137447 PMCID: PMC10741119 DOI: 10.3390/biomedicines11123226] [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: 10/25/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
This single center study includes a comparative analysis of the diagnostic performance of full-field digital mammography (FFDM), contrast-enhanced mammography (CEM) and automatic breast ultrasound (ABUS) in the group of patients with breast American College of Radiology (ACR) categories C and D as well as A and B with FFDM. The study involved 297 patients who underwent ABUS and FFDM. Breast types C and D were determined in 40% of patients with FFDM and low- energy CEM. CEM was performed on 76 patients. Focal lesions were found in 131 patients, of which 115 were histopathologically verified. The number of lesions detected in patients with multiple lesions were 40 from 48 with ABUS, 13 with FFDM and 21 with CEM. Compliance in determining the number of foci was 82% for FFDM and 91% for both CEM and ABUS. In breast types C and D, 72% of all lesions were found with ABUS, 56% with CEM and 29% with FFDM (p = 0.008, p = 0.000); all invasive cancers were diagnosed with ABUS, 83% with CEM and 59% with FFDM (p = 0.000, p = 0.023); 100% DCIS were diagnosed with ABUS, 93% with CEM and 59% with FFDM. The size of lesions from histopathology in breast ACR categories A and B was 14-26 mm, while in breast categories C and D was 11-37 mm. In breast categories C and D, sensitivity of ABUS, FFDM and CEM was, respectively, 78.05, 85.37, 92.68; specificity: 40, 13.33, 8.33; PPV (positive predictive value): 78.05, 72.92, 77.55; NPV (negative predictive value): 40, 25, 25, accuracy: 67.86, 66.07, 73.58. In breast categories A and B, sensitivity of ABUS, FFDM and CEM was, respectively, 81.25, 93.75, 93.48; specificity: 18.18, 18.18, 16.67; PPV: 81.25, 83.33, 89.58; NPV: 18.18, 40, 25; accuracy: 69.49, 79.66, 84.62. The sensitivity of the combination of FFDM and ABUS was 100 for all types of breast categories; the accuracy was 75 in breast types C and D and 81.36 in breast types A and B. The study confirms the predominance of C and D breast anatomy types and the low diagnostic performance of FFDM within that group and indicates ABUS and CEM as potential additive methods in breast cancer diagnostics.
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Affiliation(s)
- Marta Ewa Pawlak
- Diagnostic Imaging Department, University Hospital in Cracow, 30-688 Cracow, Poland;
| | - Wojciech Rudnicki
- Department of Electroradiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (W.R.); (A.B.); (K.S.)
| | - Anna Borkowska
- Department of Electroradiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (W.R.); (A.B.); (K.S.)
| | - Karolina Skubisz
- Department of Electroradiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (W.R.); (A.B.); (K.S.)
| | - Rafał Rydzyk
- Diagnostic Imaging Department, 5th Military Clinical Hospital in Krakow, 30-901 Cracow, Poland
| | - Elżbieta Łuczyńska
- Department of Electroradiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (W.R.); (A.B.); (K.S.)
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Berg WA, Bandos AI, Sava MG. Analytic Hierarchy Process Analysis of Patient Preferences for Contrast-Enhanced Mammography Versus MRI as Supplemental Screening Options for Breast Cancer. J Am Coll Radiol 2023; 20:758-768. [PMID: 37394083 DOI: 10.1016/j.jacr.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To guide implementation of supplemental breast screening by assessing patient preferences for contrast-enhanced mammography (CEM) versus MRI using analytic hierarchy process (AHP) methodology. METHODS In an institutional review board-approved, HIPAA-compliant protocol, from March 23 to June 3, 2022, we contacted 579 women who had both CEM screening and MRI. Women were e-mailed an invitation to complete an online survey developed using an AHP-based model to elicit preferences for CEM or MRI. Methods for categorical data analysis were used to evaluate factors affecting preferences, under the Bonferroni correction for multiplicity. RESULTS Complete responses were received from 222 (38.3%) women; the 189 women with a personal history of breast cancer had a mean age 61.8 years, and the 34 women without a personal history of breast cancer had a mean age of 53.6 years. Of 222 respondents, 157 (70.7%, confidence interval [CI]: 64.7-76.7) were determined to prefer CEM to MRI. Breast positioning was the most important criterion for 74 of 222 (33.3%) respondents, with claustrophobia, intravenous line placement, and overall stress most important for 38, 37, and 39 women (17.1%, 16.7%, and 17.6%), respectively, and noise level, contrast injection, and indifference being emphasized least frequently (by 10 [4.5%], 11 [5.0%], and 13 [5.9%] women, respectively). CEM preference was most prevalent (MRI least prevalent) for respondents emphasizing claustrophobia (37 of 38 [97%], CI: 86.2-99.9); CEM preference was least prevalent (MRI most prevalent) for respondents emphasizing breast positioning (40 of 74 [54%], CI: 42.1-65.7). CONCLUSIONS AHP-based modeling reveals strong patient preferences for CEM over MRI, with claustrophobia favoring preference for CEM and breast positioning relatively favoring preference for MRI. Our results should help guide implementation of screening CEM and MRI.
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Affiliation(s)
- Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania; ACR and the Society of Breast Imaging, Honorary Fellow of the Austrian Roentgen Society, and voluntary Chief Scientific Advisor to DenseBreast-info website.
| | - Andriy I Bandos
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - M Gabriela Sava
- Wilbur O. and Ann Powers College of Business, Clemson University, Clemson, South Carolina; current affiliation: Department of Applied Statistics and Operations Research, Allen W. and Carol M. Schmidhorst College of Business, Bowling Green State University, Bowling Green, Ohio
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Wehbe A, Gonte MR, O'Neill SC, Amit‐Yousif A, Purrington K, Manning M, Simon MS. Predictors of nonadherence to breast cancer screening guidelines in a United States urban comprehensive cancer center. Cancer Med 2023; 12:15482-15491. [PMID: 37329206 PMCID: PMC10417068 DOI: 10.1002/cam4.6182] [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: 12/08/2022] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND This study aimed to identify predictors of nonadherence to breast cancer screening guidelines in an urban screening clinic among high- and average-risk women in the United States. METHODS We reviewed records of 6090 women who received ≥2 screening mammograms over 2 years at the Karmanos Cancer Institute to examine how breast cancer risk and breast density were associated with guideline-concordant screening. Incongruent screening was defined as receiving supplemental imaging between screening mammograms for average-risk women, and as not receiving recommended supplemental imaging for high-risk women. We used t-tests and chi-square tests to examine bivariate associations with guideline-congruent screening, and probit regression to regress guideline-congruence unto breast cancer risk, breast density, and their interaction, controlling for age and race. RESULTS Incongruent screening was more likely among high- versus average-risk women (97.7% vs. 0.9%, p < 0.01). Among average-risk women, incongruent screening was more likely among those with dense versus nondense breasts (2.0% vs. 0.1%, p < 0.01). Among high-risk women, incongruent screening was more likely among those with nondense versus dense breasts (99.5% vs. 95.2%, p < 0.01). The significant main effects of density and high-risk on increased incongruent screening were qualified by a density by high-risk interaction, showing a weaker association between risk and incongruent screening among women with dense breasts (simple slope = 3.71, p < 0.01) versus nondense breasts (simple slope = 5.79, p < 0.01). Age and race were not associated with incongruent screening. CONCLUSIONS Lack of adherence to evidence-based screening guidelines has led to underutilization of supplementary imaging for high-risk women and potential overutilization for women with dense breasts without other risk factors.
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Affiliation(s)
- Alexandra Wehbe
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Madeleine R. Gonte
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Suzanne C. O'Neill
- Department of Oncology, Lombardi Cancer CenterGeorgetown UniversityWashingtonDCUSA
| | - Alit Amit‐Yousif
- Center for Breast HealthOakland Macomb Obstetrics and GynecologyRochester HillsMichiganUSA
| | - Kristen Purrington
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
| | - Mark Manning
- Department of PsychologyOakland UniversityRochesterMichiganUSA
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Michael S. Simon
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
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Alikhassi A, Li X, Au F, Kulkarni S, Ghai S, Allison G, Freitas V. False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features. Breast Cancer Res Treat 2023; 198:321-334. [PMID: 36740611 DOI: 10.1007/s10549-023-06861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care. MATERIALS AND METHODS A retrospective multi-institutional study of imaging studies and patient's chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions' frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis. RESULTS Two hundred nineteen women (median age 49 years; range 26-85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02-1.08; p = 0.0015), irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6-78.4; p = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40-7.40; p = 0.0058). For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02-0.76; p = 0.024). CONCLUSION Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright mass lesion showed significant association with false-positive result. It may impact the patient's management with a suggestion of follow-up rather than interventional procedure when these demographic and imaging parameters are present, consequently decreasing the patient's anxiety and health care costs.
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Affiliation(s)
- Afsaneh Alikhassi
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Xuan Li
- Department of Biostatistics-Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 10Th Floor, Room 10-509, Toronto, ON, M5G 2M9, Canada
| | - Frederick Au
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Grant Allison
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Hussein H, Abbas E, Keshavarzi S, Fazelzad R, Bukhanov K, Kulkarni S, Au F, Ghai S, Alabousi A, Freitas V. Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis. Radiology 2023; 306:e221785. [PMID: 36719288 DOI: 10.1148/radiol.221785] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background The best supplemental breast cancer screening modality in women at average risk or intermediate risk for breast cancer with dense breast and negative mammogram remains to be determined. Purpose To conduct systematic review and meta-analysis comparing clinical outcomes of the most common available supplemental screening modalities in women at average risk or intermediate risk for breast cancer in patients with dense breasts and mammography with negative findings. Materials and Methods A comprehensive search was conducted until March 12, 2020, in Medline, Epub Ahead of Print and In-Process and Other Non-Indexed Citations; Embase Classic and Embase; Cochrane Central Register of Controlled Trials; and Cochrane Database of Systematic Reviews, for Randomized Controlled Trials and Prospective Observational Studies. Incremental cancer detection rate (CDR); positive predictive value of recall (PPV1); positive predictive value of biopsies performed (PPV3); and interval CDRs of supplemental imaging modalities, digital breast tomosynthesis, handheld US, automated breast US, and MRI in non-high-risk patients with dense breasts and mammography negative for cancer were reviewed. Data metrics and risk of bias were assessed. Random-effects meta-analysis and two-sided metaregression analyses comparing each imaging modality metrics were performed (PROSPERO; CRD42018080402). Results Twenty-two studies reporting 261 233 screened patients were included. Of 132 166 screened patients with dense breast and mammography negative for cancer who met inclusion criteria, a total of 541 cancers missed at mammography were detected with these supplemental modalities. Metaregression models showed that MRI was superior to other supplemental modalities in CDR (incremental CDR, 1.52 per 1000 screenings; 95% CI: 0.74, 2.33; P < .001), including invasive CDR (invasive CDR, 1.31 per 1000 screenings; 95% CI: 0.57, 2.06; P < .001), and in situ disease (rate of ductal carcinoma in situ, 1.91 per 1000 screenings; 95% CI: 0.10, 3.72; P < .04). No differences in PPV1 and PPV3 were identified. The limited number of studies prevented assessment of interval cancer metrics. Excluding MRI, no statistically significant difference in any metrics were identified among the remaining imaging modalities. Conclusion The pooled data showed that MRI was the best supplemental imaging modality in women at average risk or intermediate risk for breast cancer with dense breasts and mammography negative for cancer. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Hooley and Butler in this issue.
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Affiliation(s)
- Heba Hussein
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Engy Abbas
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Sareh Keshavarzi
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Rouhi Fazelzad
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Karina Bukhanov
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Supriya Kulkarni
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Frederick Au
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Sandeep Ghai
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Abdullah Alabousi
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Vivianne Freitas
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
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Lei H, Zhang M, Zhang L, Hemminki K, Wang XJ, Chen T. Overview on population screening for carriers with germline BRCA mutation in China. Front Oncol 2022; 12:1002360. [PMID: 36439508 PMCID: PMC9682265 DOI: 10.3389/fonc.2022.1002360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/01/2023] Open
Abstract
Carriers with BRCA1/2 germline pathogenic variants are associated with a high risk of breast and ovarian cancers (also pancreatic and prostate cancers). While the spectrum on germline BRCA mutations among the Chinese population shows ethnic specificity, the identification of carriers with germline BRCA mutation before cancer onset is the most effective approach to protect them. This review focused on the current status of BRCA1/2 screening, the surveillance and prevention measures, and discussed the issues and potential impact of BRCA1/2 population screening in China. We conducted literature research on databases PubMed and Google Scholar, as well as Chinese databases CNKI and Wangfang Med Online database (up to 31 March 2022). Latest publications on germline BRCA1/2 prevalence, spectrum, genetic screening as well as carrier counseling, surveillance and prevention were captured where available. While overall 15,256 records were retrieved, 72 publications using germline BRCA1/2 testing were finally retained for further analyses. Germline BRCA1/2 mutations are common in Chinese patients with hereditary breast, ovarian, prostate and pancreatic cancers. Within previous studies, a unique BRCA mutation spectrum in China was revealed. Next-generation sequencing panel was considered as the most common method for BRCA1/2 screening. Regular surveillance and preventive surgeries were tailored to carriers with mutated-BRCA1/2. We recommend that all Chinese diagnosed with breast, ovarian, pancreatic or prostate cancers and also healthy family members, shall undergo BRCA1/2 gene test to provide risk assessment. Subsequently, timely preventive measures for mutation carriers are recommended after authentic genetic counseling.
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Affiliation(s)
- Huijun Lei
- Department of Cancer Prevention/Zhejiang Cancer Institute, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Min Zhang
- School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Luyao Zhang
- Department of Cancer Epidemiology and Prevention, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czechia
- Division of Cancer Epidemiology, German Cancer Research Center Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Xiao-jia Wang
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Tianhui Chen
- Department of Cancer Prevention/Zhejiang Cancer Institute, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
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8
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Mighton C, Shickh S, Aguda V, Krishnapillai S, Adi-Wauran E, Bombard Y. From the patient to the population: Use of genomics for population screening. Front Genet 2022; 13:893832. [PMID: 36353115 PMCID: PMC9637971 DOI: 10.3389/fgene.2022.893832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/26/2022] [Indexed: 10/22/2023] Open
Abstract
Genomic medicine is expanding from a focus on diagnosis at the patient level to prevention at the population level given the ongoing under-ascertainment of high-risk and actionable genetic conditions using current strategies, particularly hereditary breast and ovarian cancer (HBOC), Lynch Syndrome (LS) and familial hypercholesterolemia (FH). The availability of large-scale next-generation sequencing strategies and preventive options for these conditions makes it increasingly feasible to screen pre-symptomatic individuals through public health-based approaches, rather than restricting testing to high-risk groups. This raises anew, and with urgency, questions about the limits of screening as well as the moral authority and capacity to screen for genetic conditions at a population level. We aimed to answer some of these critical questions by using the WHO Wilson and Jungner criteria to guide a synthesis of current evidence on population genomic screening for HBOC, LS, and FH.
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Affiliation(s)
- Chloe Mighton
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vernie Aguda
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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9
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Breast-Specific Gamma Imaging: An Added Value in the Diagnosis of Breast Cancer, a Systematic Review. Cancers (Basel) 2022; 14:cancers14194619. [PMID: 36230540 PMCID: PMC9559460 DOI: 10.3390/cancers14194619] [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: 08/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Breast-specific gamma imaging represents an emergent instrument for breast cancer detection. We selected on Medline articles published from 1995 to 2022 that compare various imaging modalities with breast-specific gamma imaging. The aim of this paper was to assess if this imaging method is a more valuable choice in detecting breast malignant lesions compared to morphological counterparts such mammography, ultrasound, and magnetic resonance imaging in terms of specificity, sensibility and positive and negative predictive value. At the cost of a major radiology burden, breast-specific gamma imaging is more specific, with a sensibility comparable to magnetic resonance imaging and higher than ultrasonography and mammography. Abstract Purpose: Breast cancer is the most common solid tumor and the second highest cause of death in the United States. Detection and diagnosis of breast tumors includes various imaging modalities, such as mammography (MMG), ultrasound (US), and contrast-enhancement MRI. Breast-specific gamma imaging (BSGI) is an emerging tool, whereas morphological imaging has the disadvantage of a higher absorbed dose. Our aim was to assess if this imaging method is a more valuable choice in detecting breast malignant lesions compared to morphological counterparts. Methods: research on Medline from 1995 to June 2022 was conducted. Studies that compared at least one anatomical imaging modality with BSGI were screened and assessed through QUADAS2 for risk of bias and applicability concerns assessment. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) were reported. Results: A total of 15 studies compared BSGI with MMG, US, and MRI. BSGI sensitivity was similar to MRI, but specificity was higher. Specificity was always higher than MMG and US. BSGI had higher PPV and NPV. When used for the evaluation of a suspected breast lesion, the overall sensitivity was better than the examined overall sensitivity when BSGI was excluded. Risk of bias and applicability concerns domain showed mainly low risk of bias. Conclusion: BSGI is a valuable imaging modality with similar sensitivity to MRI but higher specificity, although at the cost of higher radiation burden.
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Forrai G, Kovács E, Ambrózay É, Barta M, Borbély K, Lengyel Z, Ormándi K, Péntek Z, Tünde T, Sebő É. Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610382. [PMID: 35755417 PMCID: PMC9214693 DOI: 10.3389/pore.2022.1610382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.
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Affiliation(s)
- Gábor Forrai
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | - Eszter Kovács
- GÉ-RAD Kft., Budapest, Hungary
- Duna Medical Center, Budapest, Hungary
| | | | | | - Katalin Borbély
- National Institute of Oncology, Budapest, Hungary
- Ministry of Human Capacities, Budapest, Hungary
| | | | | | | | - Tasnádi Tünde
- Dr Réthy Pál Member Hospital of Békés County Central Hospital, Békéscsaba, Hungary
| | - Éva Sebő
- Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
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11
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Freitas V, Li X, Amitai Y, Au F, Kulkarni S, Ghai S, Mulligan AM, Bromley M, Siepmann T. Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer. Radiology 2022; 304:297-307. [PMID: 35471109 DOI: 10.1148/radiol.212361] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The diagnostic value of screening the contralateral breast with MRI in patients with newly diagnosed breast cancer is poorly understood. Purpose To assess the impact of MRI for screening the contralateral breast on long-term outcomes in patients with newly diagnosed breast cancer and to determine whether subgroups with unfavorable prognoses would benefit from MRI in terms of survival. Materials and Methods Data on consecutive patients with newly diagnosed breast cancer seen from January 2008 to December 2010 were reviewed retrospectively. Patients with neoadjuvant chemotherapy, previous breast cancer, distant metastasis, absence of contralateral mammography at diagnosis, and no planned surgical treatment were excluded. Groups that did and did not undergo preoperative MRI were compared. Survival analysis was performed using the Kaplan-Meier method for propensity score-matched groups to estimate cause-specific survival (CSS) and overall survival (OS). A marginal Cox proportional hazards model was used to evaluate association of MRI and clinicopathologic variables with OS. Results Of 1846 patients, 1199 fulfilled the inclusion criteria. Median follow-up time was 10 years (range, 0-14 years). The 2:1 matched sample comprised 705 patients (470 in the MRI group and 235 in the no-MRI group); median ages at surgery were 59 years (range, 31-87 years) and 64 years (range, 37-92 years), respectively. MRI depicted contralateral synchronous disease more frequently (27 of 470 patients [5.7%] vs five of 235 patients [2.1%]; P = .047) and was associated with a higher OS (hazard ratio [HR], 2.51; 95% CI: 1.25, 5.06; P = .01). No differences were observed between groups in metachronous disease rate (MRI group: 21 of 470 patients [4.5%]; no-MRI group: 10 of 235 patients [4.3%]; P > .99) or CSS (HR, 1.34; 95% CI: 0.56, 3.21; P = .51). MRI benefit was greater in patients with larger tumor sizes (>2 cm) (HR, 2.58; 95% CI: 1.11, 5.99; P = .03) and histologic grade III tumors (HR, 2.94; 95% CI: 1.18, 7.32; P = .02). Conclusion Routine MRI screening of the contralateral breast after first diagnosis of breast cancer improved overall survival; the most pronounced benefit was found in patients with larger primary tumor size and primary tumors of histologic grade III. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Taourel in this issue.
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Affiliation(s)
- Vivianne Freitas
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Xuan Li
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Yoav Amitai
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Frederick Au
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Supriya Kulkarni
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Sandeep Ghai
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Anna Marie Mulligan
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Miluska Bromley
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
| | - Timo Siepmann
- From the Joint Department of Medical Imaging, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Department of Radiology, Tel Aviv University, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv, Israel (Y.A.); Laboratory Medicine Program, University of Toronto, University Health Network, Toronto General Hospital Site, Toronto, Canada (A.M.M.); Department of Plastic and Reconstructive Surgery, Universidad Científica del Sur, Lima, Peru (M.B.); and Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav, Carus Technische Universität Dresden, Dresden, Germany (T.S.)
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12
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Son D, Phillips J, Mehta TS, Mehta R, Brook A, Dialani VM. Patient preferences regarding use of contrast-enhanced imaging for breast cancer screening. Acad Radiol 2022; 29 Suppl 1:S229-S238. [PMID: 33846061 DOI: 10.1016/j.acra.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Our purpose is to understand patient preferences towards contrast-enhanced imaging such as CEM or MRI for breast cancer screening. METHODS AND MATERIALS An anonymous survey was offered to all patients having screening mammography at a single academic institution from December 27 th 2019 to March 6 th 2020. Survey questions related to: (1) patients' background experiences (2) patients' concern for aspects of MRI and CEM measured using a 5-point Likert scale, and (3) financial considerations. RESULTS 75% (1011/1349) patients completed the survey. 53.0% reported dense breasts and of those, 47.6% had additional screening. 49.6% had experienced a callback, 29.0% had a benign biopsy, and 13.7% had prior CEM/MRI. 34.7% were satisfied with mammography for screening. A majority were neutral or not concerned with radiation exposure, contrast allergy, IV line placement, claustrophobia, and false positive exams. 54.7% were willing to pay at least $250-500 for screening MRI. Those reporting dense breasts were less satisfied with mammography for screening (p<0.001) and willing to pay more for MRI (p<0.001). If patients had prior CEM/MRI, there was less concern for an allergic reaction (p<0.001), IV placement (p=0.025), and claustrophobia (p=0.006). There was less concern for false positives if they had a prior benign biopsy (p=0.029) or prior CEM/MRI (p=0.005) and less concern for IV placement if they had dense breasts (p=0.007) or a previous callback (p=0.013). CONCLUSION The screening population may accept CEM or MRI as a screening exam despite its risks and cost, especially patients with dense breasts and patients who have had prior CEM/MRI.
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13
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Comparing breast cancer imaging characteristics of CHEK2 with BRCA1 and BRCA2 gene mutation carriers. Eur J Radiol 2021; 146:110074. [PMID: 34902667 DOI: 10.1016/j.ejrad.2021.110074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Breast cancer gene (BRCA) 1 and 2 mutations are frequently studied gene mutations (GM); the incidence of checkpoint kinase 2 (CHEK2) is increasing. We describe the imaging features of breast cancer (BC) in CHEK2 mutations, compared to BRCA 1 and 2 using mammography, ultrasound (US) and magnetic resonance imaging (MRI). METHOD Inclusion criteria were primary BC in GM carriers, treated in the same hospital. Age at diagnosis, histology, hormone receptor and human epidermal growth factor receptor 2 (HER2) status were retrieved. Mammography descriptors were mass, asymmetry and suspicious microcalcifications. The enhancement pattern (MRI), shape and border, architectural distortion, the presence of a hyperechoic rim and cystic complex structure (US) were documented. Analyses were performed using SAS software (version 9.4). Fishers' exact test was used to test associations between two categorical variables. RESULTS In 191 women, 233 malignant lesions were diagnosed (78 in BRCA1, 109 in BRCA2, 46 in CHEK2). In CHEK2 carriers, mammographically, suspicious microcalcifications (54%) were more prevalent (BRCA2 (48%) and BRCA1 carriers (33%)) (p-value = 0.057) compared to mass lesions (35%). On US, lesions were most frequently ill-defined (86%) (p = 0.579) and irregular (94.5%) (p = 0.098) compared to BRCA2 (77% and 80% resp.) and BRCA1 carriers (71% and 72% resp.). On MRI, mass lesions showed a type 3 curve in CHEK2 (67%) compared to BRCA1 (36%) and BRCA2 (50%) (p = 0.056). CONCLUSIONS Malignant radiological characteristics of breast cancer, more specifically suspicious microcalcifications, were more frequently seen in CHEK2 and BRCA2 compared to BRCA1 mutation carriers (without a significant difference) indicating the importance of mammography in follow-up of CHEK2 carriers.
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14
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Brown A, Lourenco AP, Niell BL, Cronin B, Dibble EH, DiNome ML, Goel MS, Hansen J, Heller SL, Jochelson MS, Karrington B, Klein KA, Mehta TS, Newell MS, Schechter L, Stuckey AR, Swain ME, Tseng J, Tuscano DS, Moy L. ACR Appropriateness Criteria® Transgender Breast Cancer Screening. J Am Coll Radiol 2021; 18:S502-S515. [PMID: 34794604 DOI: 10.1016/j.jacr.2021.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Abstract
Breast cancer screening recommendations for transgender and gender nonconforming individuals are based on the sex assigned at birth, risk factors, and use of exogenous hormones. Insufficient evidence exists to determine whether transgender people undergoing hormone therapy have an overall lower, average, or higher risk of developing breast cancer compared to birth-sex controls. Furthermore, there are no longitudinal studies evaluating the efficacy of breast cancer screening in the transgender population. In the absence of definitive data, current evidence is based on data extrapolated from cisgender studies and a limited number of cohort studies and case reports published on the transgender community. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Ann Brown
- University of Cincinnati, Cincinnati, Ohio.
| | - Ana P Lourenco
- Panel Chair, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair; and Section Chief, Breast Imaging and Lead Interpreting Physician, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Chair, ACR Commission on Breast Imaging Government Relations Committee; Panel Member, NCCN Breast Cancer Screening and Diagnosis Panel; Radiomics Chair, ECOG-ACRIN EA1202 DCIS DUET TRIAL; and Member, ACR and SBI Screening Leadership Group
| | - Beth Cronin
- Women and Infants Hospital, Providence, Rhode Island; RI Section Chair, for American College of Obstetrics and Gynecology; and Primary care physician-obstetrician/gynecologist
| | | | - Maggie L DiNome
- Chief, Breast Surgey and Director, Breast Health UCLA Medical Center, Los Angeles, California; and Society of Surgical Oncology
| | - Mita Sanghavi Goel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; American College of Physicians
| | - Juliana Hansen
- Oregon Health and Science University, Portland, Oregon; and Board Member, American Society of Plastic Surgeons
| | | | - Maxine S Jochelson
- Director, Imaging, Evelyn Lauder Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Tejas S Mehta
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; BIDMC Trustee Advisory Board; Tufts University School of Medicine Board of Advisors; and Mass Radiology Society - Breast Imaging Committee
| | - Mary S Newell
- Interim Division Director, Breast Imaging, Emory University Hospital, Atlanta, Georgia; Governor, ABR; Board Member and SBI Chair, ACR BI-RADS; and Chair, ACR PP/TS
| | - Loren Schechter
- Weiss Memorial Hospital, Chicago, Illinois; and Treasurer and Member of the Executive Committee, World Professional Association for Transgender Health
| | - Ashley R Stuckey
- Women and Infants Hospital, Providence, Rhode Island; American College of Obstetricians and Gynecologists
| | - Mary E Swain
- Radiology Associates of Tallahassee, Tallahassee, Florida
| | - Jennifer Tseng
- The University of Chicago Medicine, Chicago, Illinois; and Editorial Board, American Board of Surgery SCORE; Editor, Journal of Surgical Education; Training Committee, Society of Surgical Oncology; American College of Surgeons
| | | | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair, ACR PP/TS; Chair, ACR NMD Registry; Senior Deputy Editor, Radiology; and Advisory Board, iCAD and Lunit
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15
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Weinstein SP, Slanetz PJ, Lewin AA, Battaglia T, Chagpar AB, Dayaratna S, Dibble EH, Goel MS, Hayward JH, Kubicky CD, Le-Petross HT, Newell MS, Sanford MF, Scheel JR, Vincoff NS, Yao K, Moy L. ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. J Am Coll Radiol 2021; 18:S456-S473. [PMID: 34794600 DOI: 10.1016/j.jacr.2021.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Abstract
Mammography remains the only validated screening tool for breast cancer, however, there are limitations to mammography. One of the limitations of mammography is the variable sensitivity based on breast density. Supplemental screening may be considered based on the patient's risk level and breast density. For average-risk women with nondense breasts, the sensitivity of digital breast tomosynthesis (DBT) screening is high; additional supplemental screening is not warranted in this population. For average-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhanced mammography, screening ultrasound (US), breast MRI, or abbreviated breast MRI. In intermediate-risk women, there is emerging evidence suggesting that women in this population may benefit from breast MRI or abbreviated breast MRI. In intermediate-risk women with dense breasts, given the decreased sensitivity of mammography/DBT, this population may benefit from additional supplemental screening with contrast-enhancedmammography or screening US. There is strong evidence supporting screening high-risk women with breast MRI regardless of breast density. Contrast-enhanced mammography, whole breast screening US, or abbreviated breast MRI may be also considered. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Susan P Weinstein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Priscilla J Slanetz
- Panel Chair, Boston University School of Medicine, Boston, Massachusetts; and President, Massachusetts Radiological Society
| | - Alana A Lewin
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Tracy Battaglia
- Director, Womens Health Unit, Associate Director, Belkin Breast Health Center, Boston Medical Center and Boston University School of Medicine and Public Health, Boston, Massachusetts; and Chair, National Navigation Roundtable
| | - Anees B Chagpar
- Yale School of Medicine, New Haven, Connecticut; Society of Surgical Oncology
| | - Sandra Dayaratna
- Thomas Jefferson University Hospital, Robbinsville, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Mita Sanghavi Goel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; American College of Physicians
| | | | | | - Huong T Le-Petross
- The University of Texas MD Anderson Cancer Center, Houston, Texas; and Breast Imaging Lead in Prevention, Breast Committee, DI Committee of the Alliance
| | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; Governor, ABR; and Board Member, SBI
| | | | - John R Scheel
- Fellowship Director, University of Washington, Seattle, Washington
| | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Katherine Yao
- NorthShore University HealthSystem, Evanston, Illinois; Vice Chair, National Accreditation Program for Breast Centers; and American College of Surgeons
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair, ACR NMD Registry; Senior Deputy Editor, Radiology; and Advisory Board, iCAD and Lunit
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Kim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol 2021; 19:290. [PMID: 34579740 PMCID: PMC8477561 DOI: 10.1186/s12957-021-02403-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). METHODS The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. RESULTS A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7-2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. CONCLUSION AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.
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Affiliation(s)
- Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, Division of Breast and Thyroid Surgical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
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Bhushan A, Gonsalves A, Menon JU. Current State of Breast Cancer Diagnosis, Treatment, and Theranostics. Pharmaceutics 2021; 13:723. [PMID: 34069059 PMCID: PMC8156889 DOI: 10.3390/pharmaceutics13050723] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is one of the leading causes of cancer-related morbidity and mortality in women worldwide. Early diagnosis and effective treatment of all types of cancers are crucial for a positive prognosis. Patients with small tumor sizes at the time of their diagnosis have a significantly higher survival rate and a significantly reduced probability of the cancer being fatal. Therefore, many novel technologies are being developed for early detection of primary tumors, as well as distant metastases and recurrent disease, for effective breast cancer management. Theranostics has emerged as a new paradigm for the simultaneous diagnosis, imaging, and treatment of cancers. It has the potential to provide timely and improved patient care via personalized therapy. In nanotheranostics, cell-specific targeting moieties, imaging agents, and therapeutic agents can be embedded within a single formulation for effective treatment. In this review, we will highlight the different diagnosis techniques and treatment strategies for breast cancer management and explore recent advances in breast cancer theranostics. Our main focus will be to summarize recent trends and technologies in breast cancer diagnosis and treatment as reported in recent research papers and patents and discuss future perspectives for effective breast cancer therapy.
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Affiliation(s)
- Arya Bhushan
- Ladue Horton Watkins High School, St. Louis, MO 63124, USA;
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
| | - Andrea Gonsalves
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
| | - Jyothi U. Menon
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
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Sudhir R, Sannapareddy K, Potlapalli A, Krishnamurthy PB, Buddha S, Koppula V. Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast. Br J Radiol 2021; 94:20201046. [PMID: 33242249 DOI: 10.1259/bjr.20201046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard. METHODS It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis. RESULTS This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24-72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG. CONCLUSION CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast. ADVANCES IN KNOWLEDGE CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.
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Affiliation(s)
- Rashmi Sudhir
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Kamala Sannapareddy
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Alekya Potlapalli
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Suryakala Buddha
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Veeraiah Koppula
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
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De Cataldo C, Bruno F, Palumbo P, Di Sibio A, Arrigoni F, Clemente A, Bafile A, Gravina GL, Cappabianca S, Barile A, Splendiani A, Masciocchi C, Di Cesare E. Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review. Gland Surg 2021; 9:2225-2234. [PMID: 33447575 DOI: 10.21037/gs-20-546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The presence of axillary lymph nodes metastases in breast cancer is the most significant prognostic factor, with a great impact on morbidity, disease-related survival and management of oncological therapies; for this reason, adequate imaging evaluation is strictly necessary. Physical examination is not enough sensitive to assess breast cancer nodal status; axillary ultrasonography (US) is commonly used to detect suspected or occult nodal metastasis, providing exclusively morphological evaluation, with low sensitivity and positive predictive value. Currently, sentinel lymph node biopsy (SLNB) and/or axillary dissection are the milestone for the diagnostic assessment of axillary lymph node metastases, although its related morbidity. The impact of magnetic resonance imaging (MRI) in the detection of nodal metastases has been widely investigated, as it continues to represent the most promising imaging modality in the breast cancer management. In particular, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values represent additional reliable non-contrast sequences, able to improve the diagnostic accuracy of breast cancer MRI evaluation. Several studies largely demonstrated the usefulness of implementing DWI/ADC MRI in the characterization of breast lesions. Herein, in the light of our clinical experience, we perform a review of the literature regarding the diagnostic performance and accuracy of ADC value as potential pre-operative tool to define metastatic involvement of nodal structures in breast cancer patients. For the purpose of this review, PubMed, Web of Science, and SCOPUS electronic databases were searched with different combinations of "axillary lymph node", "breast cancer", "MRI/ADC", "breast MRI" keywords. All original articles, reviews and metanalyses were included.
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Affiliation(s)
- Camilla De Cataldo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alfredo Clemente
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Giovanni Luca Gravina
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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20
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Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Goggins M, Hutton ML, Karlan BY, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pederson HJ, Reiser G, Senter-Jamieson L, Shannon KM, Shatsky R, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Yurgelun MB, Darlow SD, Dwyer MA. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:77-102. [DOI: 10.6004/jnccn.2021.0001] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic or likely pathogenic variants associated with increased risk of breast, ovarian, and pancreatic cancer and recommended approaches to genetic testing/counseling and management strategies in individuals with these pathogenic or likely pathogenic variants. This manuscript focuses on cancer risk and risk management for BRCA-related breast/ovarian cancer syndrome and Li-Fraumeni syndrome. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. There is also evidence that risks of prostate cancer and pancreatic cancer are elevated in these carriers. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Michael P. Berry
- 3St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Michael Goggins
- 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Seema Khan
- 12Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Holly J. Pederson
- 22Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Hizukuri A, Nakayama R, Nara M, Suzuki M, Namba K. Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses on Breast DCE-MRI Images Using Deep Convolutional Neural Network with Bayesian Optimization. J Digit Imaging 2020; 34:116-123. [PMID: 33159279 DOI: 10.1007/s10278-020-00394-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 01/23/2023] Open
Abstract
Although magnetic resonance imaging (MRI) has a higher sensitivity of early breast cancer than mammography, the specificity is lower. The purpose of this study was to develop a computer-aided diagnosis (CAD) scheme for distinguishing between benign and malignant breast masses on dynamic contrast material-enhanced MRI (DCE-MRI) by using a deep convolutional neural network (DCNN) with Bayesian optimization. Our database consisted of 56 DCE-MRI examinations for 56 patients, each of which contained five sequential phase images. It included 26 benign and 30 malignant masses. In this study, we first determined a baseline DCNN model from well-known DCNN models in terms of classification performance. The optimum architecture of the DCNN model was determined by changing the hyperparameters of the baseline DCNN model such as the number of layers, the filter size, and the number of filters using Bayesian optimization. As the input of the proposed DCNN model, rectangular regions of interest which include an entire mass were selected from each of DCE-MRI images by an experienced radiologist. Three-fold cross validation method was used for training and testing of the proposed DCNN model. The classification accuracy, the sensitivity, the specificity, the positive predictive value, and the negative predictive value were 92.9% (52/56), 93.3% (28/30), 92.3% (24/26), 93.3% (28/30), and 92.3% (24/26), respectively. These results were substantially greater than those with the conventional method based on handcrafted features and a classifier. The proposed DCNN model achieved high classification performance and would be useful in differential diagnoses of masses in breast DCE-MRI images as a diagnostic aid.
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Affiliation(s)
- Akiyoshi Hizukuri
- Department of Electronic and Computer Engineering, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577,, Japan.
| | - Ryohei Nakayama
- Department of Electronic and Computer Engineering, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577,, Japan
| | - Mayumi Nara
- Department of Breast Surgery, Hokuto Hospital, 7-5 Kisen, Inada-cho, Obihiro-shi, Hokkaido, 080-0833,, Japan
| | - Megumi Suzuki
- Department of Breast Surgery, Hokuto Hospital, 7-5 Kisen, Inada-cho, Obihiro-shi, Hokkaido, 080-0833,, Japan
| | - Kiyoshi Namba
- Department of Breast Surgery, Hokuto Hospital, 7-5 Kisen, Inada-cho, Obihiro-shi, Hokkaido, 080-0833,, Japan
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Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Plaza MJ, Perea E, Sanchez-Gonzalez MA. Abbreviated Screening Breast MRI in Women at Higher-than-Average Risk for Breast Cancer with Prior Normal Full Protocol MRI. JOURNAL OF BREAST IMAGING 2020; 2:343-351. [PMID: 38424958 DOI: 10.1093/jbi/wbaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare the performance of abbreviated screening breast MRI (ABMR) versus full protocol MRI (FPMR) in women at higher-than-average risk for breast cancer with a prior normal FPMR. METHODS ABMR was performed on higher-than-average-risk women who had a prior normal FPMR. ABMR protocol consisted of short inversion time inversion recovery imaging, precontrast, and two early postcontrast sequences acquired in under 10 minutes. Retrospective review of ABMR examinations performed from July 2016 to July 2018 was compared with a control group who underwent routine screening with FPMR who had a prior normal FPMR performed from July 2014 to June 2016. Screening outcome metrics were calculated and compared, adjusting for differences in patient demographics. RESULTS The study cohort included 481 ABMR examinations, while the control group included 440 FPMR studies. There was no significant difference in the abnormal interpretation rate (AIR) or cancer detection rate (CDR) for the ABMR versus the FPMR group (AIR 6.0% vs 6.8% respectively, odds ratio (OR) 0.91, 95% confidence interval (CI): 0.53-1.5, P = 0.73; CDR 8.3 vs 11 cancers detected per 1000 examinations respectively, OR 0.73, 95% CI: 0.20-2.7, P = 0.64). The PPV2 and PPV3 for the ABMR group was 19% and 21% versus 16% and 16% for the FPMR group, with no statistical difference. Sensitivity was 100% in each group with no interval cancers. There was no difference in specificity between the ABMR and FPMR groups, 93% versus 94%, respectively (P = 0.73). CONCLUSION ABMR may be used to screen higher-than-average-risk women with a prior normal FPMR as outcome metrics are equivalent to FPMR.
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Affiliation(s)
| | - Elizabeth Perea
- Ponce Health Sciences University School of Medicine, Department of Graduate Medical Education, MD Program, Ponce, Puerto Rico
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Dynamic contrast-enhanced magnetic resonance imaging for risk-stratified screening in women with BRCA mutations or high familial risk for breast cancer: are we there yet? Breast Cancer Res Treat 2020; 183:243-250. [PMID: 32621252 DOI: 10.1007/s10549-020-05759-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Women at an elevated lifetime risk for breast cancer (BC), including carriers of pathogenic mutations in BC predisposition genes, are recommended intensified BC screening that includes annual mammography (MG) and annual breast MRI. Controversy exists regarding the clinical utility of MRI as a screening tool in high-risk women. This paper is intended to review recent advances and remaining areas of uncertainty in order to further facilitate the incorporation of breast MRI into an intensified BC screening protocol for women at high familial risk and BRCA carriers. METHODS A multidisciplinary team of medical oncologists and a radiologist specializing in the treatment of BC and high-risk patients searched PubMed to identify studies deemed to have the highest scientific value. Since none of the initial MRI studies were randomized, meta-analyses examining breast MRI screening in high-risk women were prioritized for inclusion. RESULTS Breast MRI performs well in high-risk women, including mutation carriers. Breast MRI screening allows for the detection of early stage, likely curable invasive BC. It is mandatory that radiologists receive appropriate MRI training to reduce false positives and unnecessary biopsies. MRI screening is cost-effective in the highest risk patients and new clinical trials are open examining abbreviated and ultra-fast MRI techniques as a tool to drive down costs and improve specificity. CONCLUSIONS As breast MRI is recommended as part of an intensified screening program in addition to mammography for high-risk women, it important that health care providers understand the benefits and limitations of this screening modality for high-risk women, as well as areas for further investigation.
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Alonso Roca S, Delgado Laguna A, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): Pros and cons of MRI screening. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Preliminary study on discriminating HER2 2+ amplification status of breast cancers based on texture features semi-automatically derived from pre-, post-contrast, and subtraction images of DCE-MRI. PLoS One 2020; 15:e0234800. [PMID: 32555662 PMCID: PMC7299320 DOI: 10.1371/journal.pone.0234800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/02/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate whether texture features extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are associated with human epidermal growth factor receptor type 2 (HER2) 2+ status of breast cancer. Materials and methods 92 MRI cases including 52 HER2 2+ positive and 40 negative patients confirmed by fluorescence in situ hybridization were retrospectively selected. The lesion area was semi-automatically delineated, and a total of 488 texture features were respectively extracted from precontrast, postcontrast, and subtraction images. The Student’s t-test or Mann-Whitney U test was performed to identify statistically significant features between different HER2 2+ amplification groups. Least absolute shrinkage and selection operator (LASSO) was used to search for the optimal feature subsets. Three machine learning classifiers, logistic regression analysis (LRA), quadratic discriminant analysis (QDA), and support vector machine (SVM), were used with a leave-one-out cross validation method to establish the classification models of HER2 2+ status. Classification performance was evaluated by receiver operating characteristic (ROC) analysis. Results Based on the texture analysis with SVM model, the areas under the ROC curve (AUCs) were 0.890 for subtraction images, 0.736 for postcontrast images, and 0.672 for precontrast images, respectively. For LRA model, the AUCs were 0.884, 0.733, and 0.623, respectively. For QDA model, the AUCs were 0.831, 0.726, and 0.568, respectively. LRA and the SVM model with subtraction images reached significantly better performance than the QDA model (P = 0.0227 and P = 0.0088, respectively). Conclusion Texture features of breast cancer extracted from DCE-MRI are associated with HER2 2+ status. Additional studies are necessary to confirm the present preliminary findings.
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, López Ruiz A. Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. RADIOLOGIA 2020; 62:417-433. [PMID: 32527577 DOI: 10.1016/j.rx.2020.04.009] [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] [Received: 03/28/2019] [Revised: 03/12/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies», such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies» in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - A López Ruiz
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening. RADIOLOGIA 2020; 62:252-265. [PMID: 32241593 DOI: 10.1016/j.rx.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/23/2019] [Accepted: 01/30/2020] [Indexed: 12/31/2022]
Abstract
Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - S Santamaría Jareño
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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MRI-guided vacuum-assisted breast biopsy: experience of a single tertiary referral cancer centre and prospects for the future. Med Oncol 2020; 37:36. [PMID: 32221708 DOI: 10.1007/s12032-020-01358-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/02/2020] [Indexed: 01/11/2023]
Abstract
MRI-guided vacuum-assisted breast biopsy (VABB) is used for suspicious breast cancer (BC) lesions which are detectable only with MRI: because the high sensitivity but limited specificity of breast MRI it is a fundamental tool in breast imaging divisions. We analyse our experience of MRI-guided VABB and critically discuss the potentialities of diffusion-weighted imaging (DWI) and artificial intelligence (AI) in this matter. We retrospectively analysed a population of consecutive women underwent VABB at our tertiary referral BC centre from 01/2011 to 01/2019. Reference standard was histological diagnosis or at least 1-year negative follow-up. McNemar, Mann-Whitney and χ2 tests at 95% level of significance were used as statistical exams. 217 women (mean age = 52, 18-72 years) underwent MRI-guided VABB; 11 were excluded and 208 MRI-guided VABB lesions were performed: 34/208 invasive carcinomas, 32/208 DCIS, 8/208 LCIS, 3/208 high-risk lesions and 131/208 benign lesions were reported. Accuracy of MRI-guided VABB was 97%. The predictive features for malignancy were mass with irregular shape (OR 8.4; 95% CI 0.59-31.6), size of the lesion (OR 4.4; 95% CI 1.69-9.7) and mass with irregular/spiculated margins (OR 5.4; 95% CI 6.8-31.1). Six-month follow-up showed 4 false-negative cases (1.9%). Invasive BC showed a statistically significant higher hyperintense signal at DWI compared to benign lesions (p = 0.03). No major complications occurred. MR-guided VABB showed high accuracy. Benign-concordant lesions should be followed up with breast MRI in 6-12 months due to the risk of false-negative results. DWI and AI applications showed potential benefit as support tools for radiologists.
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Fusco R, Raiano N, Raiano C, Maio F, Vallone P, Mattace Raso M, Setola SV, Granata V, Rubulotta MR, Barretta ML, Petrosino T, Petrillo A. Evaluation of average glandular dose and investigation of the relationship with compressed breast thickness in dual energy contrast enhanced digital mammography and digital breast tomosynthesis. Eur J Radiol 2020; 126:108912. [PMID: 32151787 DOI: 10.1016/j.ejrad.2020.108912] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To quantitatively assess the dose of Dual energy contrast enhanced digital mammography (CEDM) and digital breast tomosynthesis (DBT) and to investigate the relationship between average absorbed glandular dose (AGD), compressed breast thickness (CBT) and compression force (CF). MATERIALS AND METHODS All CEDM and DBT examinations were performed in cranio-caudal (CC) and medio-lateral oblique (MLO) view. Exposure parameters of 135 mammographic procedures that using AEC (automatic exposure control) mode were recorded. AGDs were calculated. Kruskal Wallis test was performed. RESULTS CBT population ranged from 23 to 94 mm with a thickness median value of 52 mm in CC view and of 57 mm in MLO views. CEDM AGD median value was significatively lower than DBT AGD in each views (p << 0.01). AGD showed a positive correlation and linear regression with CBT for both CEDM and DBT while CF did not show a correlation and linear regression with AGD. The highest values were found for MLO view: R2 of 0.74 for CEDM and R2 of 0.61 for DBT. Kruskal Wallis test shows that there was a difference statistically significant between AGD values of CEDM and DBT in CC view respect to MLO views (p < 0.01). CONCLUSIONS Dose values of both techniques meet the recommendations for maximum dose in mammography. The results of the present study indicated that there was significant difference between AGD for CEDM and DBT exposure in different views (AGD in CC views had the lowest value) and that CBT could influence the AGD while CF was not correlated to AGD.
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Affiliation(s)
- Roberta Fusco
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Nicola Raiano
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Concetta Raiano
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Francesca Maio
- Radiology Division, "UNIVERSITA' DEGLI STUDI DI NAPOLI FEDERICO II", Via Pansini, Naples, Italy
| | - Paolo Vallone
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Mauro Mattace Raso
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Sergio Venanzio Setola
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Vincenza Granata
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Maria Rosaria Rubulotta
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Maria Lusia Barretta
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Teresa Petrosino
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA", Via Mariano Semmola, Naples, Italy.
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Burk KS, Edmonds CE, Mercaldo SF, Lehman CD, Sippo DA. The Effect of Prior Comparison MRI on Interpretive Performance of Screening Breast MRI. JOURNAL OF BREAST IMAGING 2020; 2:36-42. [PMID: 38425000 DOI: 10.1093/jbi/wbz076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the effect of prior comparison MRI on interpretive performance of screening breast MRI. METHODS After institutional review board approval, all screening breast MRI examinations performed from January 2011 through December 2014 were retrospectively reviewed. Screening performance metrics were estimated and compared for exams with and without a prior comparison MRI, using logistic regression models to adjust for age and screening indication (BRCA mutation or thoracic radiation versus breast cancer history versus high-risk lesion history versus breast cancer family history). RESULTS Most exams, 4509 (87%), had a prior comparison MRI (incidence round), while 661 (13%) did not (prevalence round). Abnormal interpretation rate (6% vs 20%, P < 0.01), biopsy rate (3% vs 9%, P < 0.01), and false-positive biopsy recommendation rate per 1000 exams (21 vs 71, P < 0.01) were significantly lower in the incidence rounds compared to the prevalence rounds, while specificity was significantly higher (95% vs 81%, P < 0.01). There was no difference in cancer detection rate (CDR) per 1000 exams (12 vs 20, P = 0.1), positive predictive value of biopsies performed (PPV3) (35% vs 23%, P = 0.1), or sensitivity (86% vs 76%, P = 0.4). CONCLUSION Presence of a prior comparison significantly improves incidence round screening breast MRI examination performance compared with prevalence round screening. Consideration should be given to updating the BI-RADS breast MRI screening benchmarks and auditing prevalence and incidence round examinations separately.
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Affiliation(s)
- Kristine S Burk
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Sarah F Mercaldo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Dorothy A Sippo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
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Petrillo A, Fusco R, Vallone P, Filice S, Granata V, Petrosino T, Rosaria Rubulotta M, Setola SV, Mattace Raso M, Maio F, Raiano C, Siani C, Di Bonito M, Botti G. Digital breast tomosynthesis and contrast-enhanced dual-energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification. Breast J 2019; 26:860-872. [PMID: 31886607 DOI: 10.1111/tbj.13739] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022]
Abstract
To compare diagnostic performance of contrast-enhanced dual-energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast-enhanced MRI (DCE-MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3-5 at imaging or clinically suspicious). CEDM, DBT, and DCE-MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two-dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE-MRI. DCE-MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE-MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE-MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE-MRI. Dynamic information obtained by time-intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.
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Affiliation(s)
- Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Roberta Fusco
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paolo Vallone
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Salvatore Filice
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Teresa Petrosino
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Mauro Mattace Raso
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesca Maio
- Radiology Division, "Universita' Degli Studi di Napoli Federico II", Naples, Italy
| | - Concetta Raiano
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Claudio Siani
- Senology Surgical Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Maurizio Di Bonito
- Pathology Division, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gerardo Botti
- Scientific Director, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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Luo J, Hippe DS, Rahbar H, Parsian S, Rendi MH, Partridge SC. Diffusion tensor imaging for characterizing tumor microstructure and improving diagnostic performance on breast MRI: a prospective observational study. Breast Cancer Res 2019; 21:102. [PMID: 31484577 PMCID: PMC6727336 DOI: 10.1186/s13058-019-1183-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) can increase breast MRI diagnostic specificity due to the tendency of malignancies to restrict diffusion. Diffusion tensor imaging (DTI) provides further information over conventional DWI regarding diffusion directionality and anisotropy. Our study evaluates DTI features of suspicious breast lesions detected on MRI to determine the added diagnostic value of DTI for breast imaging. Methods With IRB approval, we prospectively enrolled patients over a 3-year period who had suspicious (BI-RADS category 4 or 5) MRI-detected breast lesions with histopathological results. Patients underwent multiparametric 3 T MRI with dynamic contrast-enhanced (DCE) and DTI sequences. Clinical factors (age, menopausal status, breast density, clinical indication, background parenchymal enhancement) and DCE-MRI lesion parameters (size, type, presence of washout, BI-RADS category) were recorded prospectively by interpreting radiologists. DTI parameters (apparent diffusion coefficient [ADC], fractional anisotropy [FA], axial diffusivity [λ1], radial diffusivity [(λ2 + λ3)/2], and empirical difference [λ1 − λ3]) were measured retrospectively. Generalized estimating equations (GEE) and least absolute shrinkage and selection operator (LASSO) methods were used for univariate and multivariate logistic regression, respectively. Diagnostic performance was internally validated using the area under the curve (AUC) with bootstrap adjustment. Results The study included 238 suspicious breast lesions (95 malignant, 143 benign) in 194 women. In univariate analysis, lower ADC, axial diffusivity, and radial diffusivity were associated with malignancy (OR = 0.37–0.42 per 1-SD increase, p < 0.001 for each), as was higher FA (OR = 1.45, p = 0.007). In multivariate analysis, LASSO selected only ADC (OR = 0.41) as a predictor for a DTI-only model, while both ADC (OR = 0.41) and FA (OR = 0.88) were selected for a model combining clinical and imaging parameters. Post-hoc analysis revealed varying association of FA with malignancy depending on the lesion type. The combined model (AUC = 0.81) had a significantly better performance than Clinical/DCE-MRI-only (AUC = 0.76, p < 0.001) and DTI-only (AUC = 0.75, p = 0.002) models. Conclusions DTI significantly improves diagnostic performance in multivariate modeling. ADC is the most important diffusion parameter for distinguishing benign and malignant breast lesions, while anisotropy measures may help further characterize tumor microstructure and microenvironment.
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Affiliation(s)
- Jing Luo
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Sana Parsian
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Mara H Rendi
- Department of Pathology, University of Washington School of Medicine, 1959 NE Pacific St. Box 356100, Seattle, WA, 98195, USA
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA. .,Department of Radiology, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, LG2-200, PO Box 19023, Seattle, WA, 98109, USA.
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Renzulli M, Zanotti S, Clemente A, Mineo G, Tovoli F, Reginelli A, Barile A, Cappabianca S, Taffurelli M, Golfieri R. Hereditary breast cancer: screening and risk reducing surgery. Gland Surg 2019; 8:S142-S149. [PMID: 31559181 PMCID: PMC6755941 DOI: 10.21037/gs.2019.04.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The screening modalities for women at high risk for breast cancer has received an increasing role during the last years. The aim of this study was to evaluate the performance of our screening program comparing the diagnostic sensitivity of clinical breast examination, mammography, ultrasonography (US) and magnetic resonance imaging (MRI). METHODS Clinical Breast examination, mammography, US and MRI for each patient with BRCA1 and BRCA2 mutation who underwent breast surgery in our Institution from October 2008 to April 2016 were retrospectively evaluated. The diagnostic accuracy for MRI and for the other surveillance tests in identifying early breast cancer were assessed. RESULTS Twenty-six female patients with genetic mutation underwent breast surgery. Twenty-two out of 26 (85%) developed cancer during the dedicated screening protocol whereas 4 women who underwent surgery did not have cancer. Imaging was able to detect cancer in all 22 patients (per patient sensibility of 100%), identifying all 35 neoplastic lesions (per lesion sensibility of 100%). The combination of Clinical Breast Examination, US and mammography aided the cancer diagnosis in 14 (64%) of patients with a sensitivity of 64% and specificity of 100%. MRI identified all the cancers, with sensibility and specificity of 100%. Moreover, in 8 (36%) of the 22 patients who developed breast cancers, the cancers were detected only by MRI, revealing a significant superiority respect to the other surveillance modalities (P<0.05). CONCLUSIONS MRI demonstrated to be the best imaging modality in detection of breast cancer even for lesion <1 cm. Prophylactic mastectomy is the most effective risk reduction strategy in women at high risk, contributing to the reduction of anxiety related to the condition of a carrier.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Zanotti
- Breast Unit, Department of Woman, Child and Urological Diseases, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Giangaspare Mineo
- Radiology Unit, Department of Diagnostic Medicine and Prevention, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, S. Salvatore Hospital, L’Aquila, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Mario Taffurelli
- Breast Unit, Department of Woman, Child and Urological Diseases, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna, Italy
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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: 91] [Impact Index Per Article: 18.2] [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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Jiang Z, Song L, Lu H, Yin J. The Potential Use of DCE-MRI Texture Analysis to Predict HER2 2+ Status. Front Oncol 2019; 9:242. [PMID: 31032222 PMCID: PMC6473324 DOI: 10.3389/fonc.2019.00242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose: To evaluate the ability of texture analysis of breast dynamic contrast enhancement-magnetic resonance (DCE-MR) images in differentiating human epidermal growth factor receptor 2 (HER2) 2+ status of breast tumors. Methods: A total of 73 cases were retrospectively selected. HER2 2+ status was confirmed by fluorescence in situ hybridization. For each case, 279 textural features were derived. A student's t-test or Mann-Whitney U test was used to select features with statistically significant differences between HER2 2+ positive and negative groups. A principal component analysis was applied to eliminate feature correlation. Three machine learning classifiers, logistic regression (LR), quadratic discriminant analysis (QDA), and a support vector machine (SVM), were trained and tested using a leave-one-out cross-validation method. The area under a receiver operating characteristic curve (AUC) was measured to assess the classifier's performance. Results: The AUCs for the different classifiers were satisfactory, ranging from 0.808 to 0.865. The classification methods derived with LR and SVM demonstrated similarly high performances, and the accuracy levels were 81.06 and 81.18%, respectively. The AUC for the classifier derived with SVM was the highest (0.865), and a marked specificity (88.90%) was presented. For the classifier with LR, the AUC was 0.851, and the corresponding sensitivity (94.44%) was the highest. Conclusion: The texture analysis for breast DCE-MRI proposed in this study demonstrated potential utility in HER2 2+ status discrimination.
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Affiliation(s)
- Zejun Jiang
- Shengjing Hospital of China Medical University, Shenyang, China.,School of Sino-Dutch Biomedical and Information Engineering, Northeastern University, Shenyang, China
| | - Lirong Song
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Hecheng Lu
- School of Sino-Dutch Biomedical and Information Engineering, Northeastern University, Shenyang, China
| | - Jiandong Yin
- Shengjing Hospital of China Medical University, Shenyang, China
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Metcalfe K, Eisen A, Senter L, Armel S, Bordeleau L, Meschino WS, Pal T, Lynch HT, Tung NM, Kwong A, Ainsworth P, Karlan B, Moller P, Eng C, Weitzel JN, Sun P, Lubinski J, Narod SA. International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation. Br J Cancer 2019; 121:15-21. [PMID: 30971774 PMCID: PMC6738089 DOI: 10.1038/s41416-019-0446-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Women with a BRCA1 or BRCA2 mutation face high risks of breast and ovarian cancer. In the current study, we report on uptake of cancer screening and risk-reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017). METHODS Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered. RESULTS Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy and 64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country. CONCLUSION For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.
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Affiliation(s)
- Kelly Metcalfe
- Women's College Research Institute, Toronto, ON, Canada.,Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Leigha Senter
- Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan Armel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | | | - Tuya Pal
- Vanderbilt-Ingram Cancer Center/Vanderbilt University Medical Center, Nashville, TN, USA
| | - Henry T Lynch
- Hereditary Cancer Center, Creighton University School of Medicine, Omaha, NE, USA
| | - Nadine M Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR.,Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.,Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong SAR
| | - Peter Ainsworth
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Beth Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Pal Moller
- Research Group Inherited Cancer, Department of Medical, Genetics, Oslo University Hospital, Oslo, Norway.,Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Oslo, Norway.,Center for Hereditary Tumors, HELIOS-Klinikum Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Charis Eng
- Genomic Medicine Institute, Center for Personalised Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ping Sun
- Women's College Research Institute, Toronto, ON, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A Narod
- Women's College Research Institute, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Guindalini RSC, Zheng Y, Abe H, Whitaker K, Yoshimatsu TF, Walsh T, Schacht D, Kulkarni K, Sheth D, Verp MS, Bradbury AR, Churpek J, Obeid E, Mueller J, Khramtsova G, Liu F, Raoul A, Cao H, Romero IL, Hong S, Livingston R, Jaskowiak N, Wang X, Debiasi M, Pritchard CC, King MC, Karczmar G, Newstead GM, Huo D, Olopade OI. Intensive Surveillance with Biannual Dynamic Contrast-Enhanced Magnetic Resonance Imaging Downstages Breast Cancer in BRCA1 Mutation Carriers. Clin Cancer Res 2019; 25:1786-1794. [PMID: 30154229 PMCID: PMC6395536 DOI: 10.1158/1078-0432.ccr-18-0200] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To establish a cohort of high-risk women undergoing intensive surveillance for breast cancer.Experimental Design: We performed dynamic contrast-enhanced MRI every 6 months in conjunction with annual mammography (MG). Eligible participants had a cumulative lifetime breast cancer risk ≥20% and/or tested positive for a pathogenic mutation in a known breast cancer susceptibility gene. RESULTS Between 2004 and 2016, we prospectively enrolled 295 women, including 157 mutation carriers (75 BRCA1, 61 BRCA2); participants' mean age at entry was 43.3 years. Seventeen cancers were later diagnosed: 4 ductal carcinoma in situ (DCIS) and 13 early-stage invasive breast cancers. Fifteen cancers occurred in mutation carriers (11 BRCA1, 3 BRCA2, 1 CDH1). Median size of the invasive cancers was 0.61 cm. No patients had lymph node metastasis at time of diagnosis, and no interval invasive cancers occurred. The sensitivity of biannual MRI alone was 88.2% and annual MG plus biannual MRI was 94.1%. The cancer detection rate of biannual MRI alone was 0.7% per 100 screening episodes, which is similar to the cancer detection rate of 0.7% per 100 screening episodes for annual MG plus biannual MRI. The number of recalls and biopsies needed to detect one cancer by biannual MRI were 2.8 and 1.7 in BRCA1 carriers, 12.0 and 8.0 in BRCA2 carriers, and 11.7 and 5.0 in non-BRCA1/2 carriers, respectively. CONCLUSIONS Biannual MRI performed well for early detection of invasive breast cancer in genomically stratified high-risk women. No benefit was associated with annual MG screening plus biannual MRI screening.See related commentary by Kuhl and Schrading, p. 1693.
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Affiliation(s)
- Rodrigo Santa Cruz Guindalini
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
- CLION, CAM Group, Salvador, Bahia, Brazil
- Department of Radiology and Oncology, The State of Sao Paulo Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, São Paulo, Brazil
| | - Yonglan Zheng
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Hiroyuki Abe
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Kristen Whitaker
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Toshio F Yoshimatsu
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Tom Walsh
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
| | - David Schacht
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Kirti Kulkarni
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Deepa Sheth
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Marion S Verp
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Angela R Bradbury
- Department of Medicine, Division of Hematology-Oncology, and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane Churpek
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey Mueller
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Galina Khramtsova
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Fang Liu
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Akila Raoul
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Hongyuan Cao
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Iris L Romero
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Susan Hong
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
- University of Illinois Cancer Center, University of Illinois - Chicago, Chicago, Illinois
| | - Robert Livingston
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nora Jaskowiak
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Xiaoming Wang
- Computation Institute, The University of Chicago, Chicago, Illinois
| | - Marcio Debiasi
- PUCRS School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Rio Grande do Sul, Brazil
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Mary-Claire King
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington
| | - Gregory Karczmar
- Department of Radiology, The University of Chicago, Chicago, Illinois.
| | | | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois.
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois.
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The clinical impact of MRI screening for BRCA mutation carriers: the first report in Japan. Breast Cancer 2019; 26:552-561. [PMID: 30820924 PMCID: PMC6694035 DOI: 10.1007/s12282-019-00955-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/14/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is no consensus on the appropriate surveillance for high-risk women with breast cancer in Japan. We investigated their imaging features and pathological characteristics to build a proper surveillance system for asymptomatic high-risk individuals in the future. METHODS We retrospectively reviewed 93 female (median age 43 years) BRCA1 and BRCA2 mutation carriers from our institutional clinical database from 2011 to 2017. The study population was composed of 112 breast cancers. Mammography and MRI were reviewed by examiners blinded to patients' clinical history. Final surgical or biopsy histopathology served as the reference standard in all the patients. RESULTS Fifty-nine breast cancers met selection criteria; of these, 30 were BRCA1-associated tumors, and 29 were BRCA2-associated tumors. Invasive ductal carcinoma was the most prevalent type in both BRCA1 and BRCA2. There were statistically significant differences in phenotype, nuclear grade, and Ki-67 labeling index between BRCA1 and BRCA2 mutation carriers. Additionally, imaging findings on mammography and MRI were statistically different. Tumors in BRCA2 carriers demonstrated mammographic calcifications more frequently, while those in BRCA1 carriers demonstrated a mass or architectural distortion (P < 0.001). Enhancement pattern on MRI also significantly differed between the two subgroups (P = 0.006). The size of MRI-detected lesions was statistically smaller than the size of those detected by other modalities (P = 0.004). CONCLUSIONS The imaging and histological characteristics of BRCA1/2 mutation carriers were consistent with other countries' studies. MRI-detected lesions were significantly smaller than lesions detected by non-MRI modality. All lesions in BRCA1 mutation carriers could be detected by MRI.
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Performance of Screening Breast MRI After Negative Full-Field Digital Mammography Versus After Negative Digital Breast Tomosynthesis in Women at Higher Than Average Risk for Breast Cancer. AJR Am J Roentgenol 2019; 212:271-279. [DOI: 10.2214/ajr.18.19916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Rahbar H, Zhang Z, Chenevert TL, Romanoff J, Kitsch AE, Hanna LG, Harvey SM, Moy L, DeMartini WB, Dogan B, Yang WT, Wang LC, Joe BN, Oh KY, Neal CH, McDonald ES, Schnall MD, Lehman CD, Comstock CE, Partridge SC. Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702). Clin Cancer Res 2019; 25:1756-1765. [PMID: 30647080 DOI: 10.1158/1078-0432.ccr-18-2967] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives.Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. RESULTS Of 107 women enrolled, 67 patients (median age 49, range 24-75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n = 63) or 5 (n = 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm2/s) than benign lesions [1.21 × 10-3 vs.1.47 × 10-3; P < 0.0001; area under ROC curve = 0.75; 95% confidence interval (CI) 0.65-0.84]. In centralized analysis, application of an ADC threshold (1.53 × 10-3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%-31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 × 10-3 mm2/s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. CONCLUSIONS DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.
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Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Seattle, Washington.
| | - Zheng Zhang
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Averi E Kitsch
- University of Washington School of Medicine, Seattle, Washington
| | - Lucy G Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara M Harvey
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Linda Moy
- New York University School of Medicine, New York, New York
| | - Wendy B DeMartini
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Wei T Yang
- MD Anderson Cancer Center, Houston, Texas
| | - Lilian C Wang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bonnie N Joe
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Karen Y Oh
- Oregon Health Sciences University, Portland, Oregon
| | - Colleen H Neal
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth S McDonald
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Constance D Lehman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Ismail HM, Pretty CG, Signal MK, Haggers M, Chase JG. Attributes, Performance, and Gaps in Current & Emerging Breast Cancer Screening Technologies. Curr Med Imaging 2019; 15:122-131. [DOI: 10.2174/1573405613666170825115032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 08/15/2017] [Accepted: 08/22/2017] [Indexed: 01/29/2023]
Abstract
Background:Early detection of breast cancer, combined with effective treatment, can reduce mortality. Millions of women are diagnosed with breast cancer and many die every year globally. Numerous early detection screening tests have been employed. A wide range of current breast cancer screening methods are reviewed based on a series of searchers focused on clinical testing and performance. </P><P> Discussion: The key factors evaluated centre around the trade-offs between accuracy (sensitivity and specificity), operator dependence of results, invasiveness, comfort, time required, and cost. All of these factors affect the quality of the screen, access/eligibility, and/or compliance to screening programs by eligible women. This survey article provides an overview of the working principles, benefits, limitations, performance, and cost of current breast cancer detection techniques. It is based on an extensive literature review focusing on published works reporting the main performance, cost, and comfort/compliance metrics considered.Conclusion:Due to limitations and drawbacks of existing breast cancer screening methods there is a need for better screening methods. Emerging, non-invasive methods offer promise to mitigate the issues particularly around comfort/pain and radiation dose, which would improve compliance and enable all ages to be screened regularly. However, these methods must still undergo significant validation testing to prove they can provide realistic screening alternatives to the current accepted standards.
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Affiliation(s)
- Hina M. Ismail
- University of Canterbury, Christchurch, Canterbury, New Zealand
| | | | | | - Marcus Haggers
- Tiro Medical Limited, Christchurch, Canterbury, New Zealand
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Cavallo Marincola B, Telesca M, Zaccagna F, Riemer F, Anzidei M, Catalano C, Pediconi F. Can unenhanced MRI of the breast replace contrast-enhanced MRI in assessing response to neoadjuvant chemotherapy? Acta Radiol 2019; 60:35-44. [PMID: 29742918 DOI: 10.1177/0284185118773512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goals of neoadjuvant chemotherapy (NAC) are to reduce tumor volume and to offer a prognostic indicator in assessing treatment response. Contrast-enhanced magnetic resonance imaging (CE-MRI) is an established method for evaluating response to NAC in patients with breast cancer. PURPOSE To validate the role of unenhanced MRI (ue-MRI) compared to CE-MRI for assessing response to NAC in women with breast cancer. MATERIAL AND METHODS Seventy-one patients with ongoing NAC for breast cancer underwent MRI before, during, and at the end of NAC. Ue-MRI was performed with T2-weighted sequences with iterative decomposition of water and fat and diffusion-weighted sequences. CE-MRI was performed using three-dimensional T1-weighted sequences before and after administration of gadobenate dimeglumine. Two blinded observers rated ue-MRI and CE-MRI for the evaluation of tumor response. Statistical analysis was performed to compare lesion size and ADC values changes during therapy, as well as inter-observer agreement. RESULTS There were no statistically significant differences between ue-MRI and CE-MRI sequences for evaluation of lesion size at baseline and after every cycle of treatment ( P > 0.05). The mean tumor ADC values at baseline and across the cycles of NAC were significantly different for the responder group. CONCLUSION Ue-MRI can achieve similar results to CE-MRI for the assessment of tumor response to NAC. ADC values can differentiate responders from non-responders.
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Affiliation(s)
- Beatrice Cavallo Marincola
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marianna Telesca
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fulvio Zaccagna
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Frank Riemer
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Michele Anzidei
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Park JH, Yun BL, Jang M, Ahn HS, Kim SM, Lee SH, Kang E, Kim EK, Park SY. Comparison of the Diagnostic Performance of Synthetic Versus Acquired High b-Value (1500 s/mm2
) Diffusion-Weighted MRI in Women With Breast Cancers. J Magn Reson Imaging 2018; 49:857-863. [DOI: 10.1002/jmri.26259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/26/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jung Hyun Park
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Bo La Yun
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Mijung Jang
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Hye Shin Ahn
- Department of Radiology; Chung-Ang University Hospital, Chung-Ang University College of Medicine; Seoul Republic of Korea
| | - Sun Mi Kim
- Department of Radiology; Seoul National University Bundang Hospital; Nam Gyeongi-do Republic of Korea
| | - Soo Hyun Lee
- Department of Radiology; College of Medicine, Chungbuk National University; Cheongju Republic of Korea
| | - Eunyoung Kang
- Department of Surgery; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
| | - So Yeon Park
- Department of Pathology; Seoul National University College of Medicine, Seoul National University Bundang Hospital; Seongnam Republic of Korea
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Papalouka V, Kilburn-Toppin F, Gaskarth M, Gilbert F. MRI-guided breast biopsy: a review of technique, indications, and radiological-pathological correlations. Clin Radiol 2018; 73:908.e17-908.e25. [PMID: 30041954 DOI: 10.1016/j.crad.2018.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
Breast magnetic resonance imaging (MRI) is the technique of choice in detection, local staging, and monitoring of breast cancer; however, breast MRI results in the detection of more indeterminate/suspicious lesions that need to be histopathologically proven to guide patient management than any other breast imaging method. If such abnormalities are not detectable in any of the conventional imaging tools (mammography (MMG) or ultrasound) then an MRI-guided biopsy needs to be performed to obtain a diagnosis. Breast MRI-guided biopsy is a time-consuming and complex procedure that requires specific equipment and experienced, well-trained staff. This review article explores and illustrates the indications, the currently available technologies, and the technique of breast MRI-guided biopsy, and explains the importance of careful imaging review and selection of cases. We correlate the radiological-pathological findings and highlight the impact on patient management in a multidisciplinary setting.
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Affiliation(s)
- V Papalouka
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Kilburn-Toppin
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - M Gaskarth
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Gilbert
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
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Rebolj M, Assi V, Brentnall A, Parmar D, Duffy SW. Addition of ultrasound to mammography in the case of dense breast tissue: systematic review and meta-analysis. Br J Cancer 2018; 118:1559-1570. [PMID: 29736009 PMCID: PMC6008336 DOI: 10.1038/s41416-018-0080-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mammography is less effective in detecting cancer in dense than in fatty breasts. METHODS We undertook a systematic search in PubMed to identify studies on women with dense breasts who underwent screening with mammography supplemented with ultrasound. A meta-analysis was undertaken on the proportion of cancers detected only by ultrasound, out of all screen-detected cancers, and the proportion of women with negative mammography who were referred for assessment following ultrasound screening. RESULTS Twenty-nine studies satisfied our inclusion criteria. The proportion of total cancers detected only by ultrasound was 0.29 (95% CI: 0.27-0.31), consistent with an approximately 40% increase in the detection of cancers compared to mammography. In the studied populations, this translated into an additional 3.8 (95% CI: 3.4-4.2) screen-detected cases per 1000 mammography-negative women. About 13% (32/248) of cancers were in situ from 17 studies with information on this subgroup. Ultrasound approximately doubled the referral for assessment in three studies with these data. CONCLUSIONS Studies have consistently shown an increased detection of breast cancer by supplementary ultrasound screening. An inclusion of supplementary ultrasound into routine screening will need to consider the availability of ultrasound and diagnostic assessment capacities.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Valentina Assi
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adam Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Greenwood HI, Dodelzon K, Katzen JT. Impact of Advancing Technology on Diagnosis and Treatment of Breast Cancer. Surg Clin North Am 2018; 98:703-724. [PMID: 30005769 DOI: 10.1016/j.suc.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response. New image-guided preoperative localizations are available that have increased patient satisfaction and decreased operating room delays.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology, University of California San Francisco, UCSF Medical Center at Mount Zion, 1600 Divisadero Street Room C-250, San Francisco, CA 94115, USA.
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
| | - Janine T Katzen
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
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Hill DA, Haas JS, Wellman R, Hubbard RA, Lee CI, Alford-Teaster J, Wernli KJ, Henderson LM, Stout NK, Tosteson ANA, Kerlikowske K, Onega T. Utilization of breast cancer screening with magnetic resonance imaging in community practice. J Gen Intern Med 2018; 33:275-283. [PMID: 29214373 PMCID: PMC5834962 DOI: 10.1007/s11606-017-4224-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/29/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice. OBJECTIVE To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications. DESIGN Prospective cohort study conducted between 2007 and 2014. PARTICIPANTS In five regional imaging registries participating in the Breast Cancer Surveillance Consortium (BCSC), 348,955 women received a screening mammogram, of whom 1499 underwent screening MRI. MAIN MEASURES Lifetime breast cancer risk (< 20% or ≥ 20%) estimated by family history of two or more first-degree relatives, and Gail model risk estimates. Breast Imaging Reporting and Data System breast density and benign breast diseases also were assessed. Relative risks (RR) for undergoing screening MRI were estimated using Poisson regression. KEY RESULTS Among women with < 20% lifetime risk, which does not meet professional guidelines for supplementary MRI screening, and no first-degree breast cancer family history, screening MRI utilization was elevated among those with extremely dense breasts [RR 2.2; 95% confidence interval (CI) 1.7-2.8] relative to those with scattered fibroglandular densities and among women with atypia (RR 7.4; 95% CI 3.9-14.3.) or lobular carcinoma in situ (RR 33.1; 95% CI 18.0-60.9) relative to women with non-proliferative disease. Approximately 82.9% (95% CI 80.8%-84.7%) of screening MRIs occurred among women who did not meet professional guidelines and 35.5% (95% CI 33.1-37.9%) among women considered at low-to-average breast cancer risk. CONCLUSION Utilization of screening MRI in community settings is not consistent with current professional guidelines and the goal of delivery of high-value care.
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Affiliation(s)
- Deirdre A Hill
- Department of Internal Medicine and Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,Department of Internal Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, 87131-0001, Albuquerque, NM, USA.
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Jennifer Alford-Teaster
- Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anna N A Tosteson
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Management and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology/Biostatistics, University of California, San Francisco, CA, USA
| | - Tracy Onega
- Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Management and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses in Breast DCE-MRI. J Digit Imaging 2018; 29:388-93. [PMID: 26691512 DOI: 10.1007/s10278-015-9856-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Our purpose in this study was to develop a computer-aided diagnosis (CAD) scheme for distinguishing between benign and malignant breast masses in dynamic contrast material-enhanced magnetic resonance imaging (DCE-MRI). Our database consisted 90 DCE-MRI examinations, each of which contained four sequential phase images; this database included 28 benign masses and 62 malignant masses. In our CAD scheme, we first determined 11 objective features of masses by taking into account the image features and the dynamic changes in signal intensity that experienced radiologists commonly use for describing masses in DCE-MRI. Quadratic discriminant analysis (QDA) was employed to distinguish between benign and malignant masses. As the input of the QDA, a combination of four objective features was determined among the 11 objective features according to a stepwise method. These objective features were as follows: (i) the change in signal intensity from 2 to 5 min; (ii) the change in signal intensity from 0 to 2 min; (iii) the irregularity of the shape; and (iv) the smoothness of the margin. Using this approach, the classification accuracy, sensitivity, and specificity were shown to be 85.6 % (77 of 90), 87.1 % (54 of 62), and 82.1 % (23 of 28), respectively. Furthermore, the positive and negative predictive values were 91.5 % (54 of 59) and 74.2 % (23 of 31), respectively. Our CAD scheme therefore exhibits high classification accuracy and is useful in the differential diagnosis of masses in DCE-MRI images.
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Huppe AI, Mehta AK, Brem RF. Molecular Breast Imaging: A Comprehensive Review. Semin Ultrasound CT MR 2018; 39:60-69. [DOI: 10.1053/j.sult.2017.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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