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Wu H, Jiang Y, Tian H, Ye X, Cui C, Shi S, Chen M, Ding Z, Li S, Huang Z, Luo Y, Peng Q, Xu J, Dong F. Sonography-based multimodal information platform for identifying the surgical pathology of ductal carcinoma in situ. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108039. [PMID: 38266556 DOI: 10.1016/j.cmpb.2024.108039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The risk of ductal carcinoma in situ (DCIS) identified by biopsy often increases during surgery. Therefore, confirming the DCIS grade preoperatively is necessary for clinical decision-making. PURPOSE To train a three-classification deep learning (DL) model based on ultrasound (US), combining clinical data, mammography (MG), US, and core needle biopsy (CNB) pathology to predict low-grade DCIS, intermediate-to-high-grade DCIS, and upstaged DCIS. MATERIALS AND METHODS Data of 733 patients with 754 DCIS cases confirmed by biopsy were retrospectively collected from May 2013 to June 2022 (N1), and other data (N2) were confirmed by biopsy as low-grade DCIS. The lesions were randomly divided into training (n=471), validation (n=142), and test (n = 141) sets to establish the DCIS-Net. Information on the DCIS-Net, clinical (age and sign), US (size, calcifications, type, breast imaging reporting and data system [BI-RADS]), MG (microcalcifications, BI-RADS), and CNB pathology (nuclear grade, architectural features, and immunohistochemistry) were collected. Logistic regression and random forest analyses were conducted to develop Multimodal DCIS-Net to calculate the specificity, sensitivity, accuracy, receiver operating characteristic curve, and area under the curve (AUC). RESULTS In the test set of N1, the accuracy and AUC of the multimodal DCIS-Net were 0.752-0.766 and 0.859-0.907 in the three-classification task, respectively. The accuracy and AUC for discriminating DCIS from upstaged DCIS were 0.751-0.780 and 0.829-0.861, respectively. In the test set of N2, the accuracy and AUC of discriminating low-grade DCIS from upstaged low-grade DCIS were 0.769-0.987 and 0.818-0.939, respectively. DL was ranked from one to five in the importance of features in the multimodal-DCIS-Net. CONCLUSION By developing the DCIS-Net and integrating it with multimodal information, diagnosing low-grade DCIS, intermediate-to high-grade DCIS, and upstaged DCIS is possible. It can also be used to distinguish DCIS from upstaged DCIS and low-grade DCIS from upstaged low-grade DCIS, which could pave the way for the DCIS clinical workflow.
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Affiliation(s)
- Huaiyu Wu
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Yitao Jiang
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China; Research and Development Department, Microport Prophecy, Shanghai 201203, China
| | - Hongtian Tian
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Xiuqin Ye
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Chen Cui
- Research and Development Department, Illuminate, LLC, Shenzhen, Guangdong 518000, China
| | - Siyuan Shi
- Research and Development Department, Illuminate, LLC, Shenzhen, Guangdong 518000, China
| | - Ming Chen
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Zhimin Ding
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Shiyu Li
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Zhibin Huang
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Yuwei Luo
- Department of Breast Surgery, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China; Department of General Surgery, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China
| | - Quanzhou Peng
- Department of Pathology, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Jinan University, Shenzhen 518020, Guangdong, China.
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Nguyen DL, Greenwood HI, Rahbar H, Grimm LJ. Evolving Treatment Paradigms for Low-Risk Ductal Carcinoma In Situ: Imaging Needs. AJR Am J Roentgenol 2024; 222:e2330503. [PMID: 38090808 DOI: 10.2214/ajr.23.30503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
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Affiliation(s)
- Derek L Nguyen
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
| | - Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Lars J Grimm
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
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Huang Z, Yang K, Tian H, Wu H, Tang S, Cui C, Shi S, Jiang Y, Chen J, Xu J, Dong F. A validation of an entropy-based artificial intelligence for ultrasound data in breast tumors. BMC Med Inform Decis Mak 2024; 24:1. [PMID: 38166852 PMCID: PMC10759705 DOI: 10.1186/s12911-023-02404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The application of artificial intelligence (AI) in the ultrasound (US) diagnosis of breast cancer (BCa) is increasingly prevalent. However, the impact of US-probe frequencies on the diagnostic efficacy of AI models has not been clearly established. OBJECTIVES To explore the impact of using US-video of variable frequencies on the diagnostic efficacy of AI in breast US screening. METHODS This study utilized different frequency US-probes (L14: frequency range: 3.0-14.0 MHz, central frequency 9 MHz, L9: frequency range: 2.5-9.0 MHz, central frequency 6.5 MHz and L13: frequency range: 3.6-13.5 MHz, central frequency 8 MHz, L7: frequency range: 3-7 MHz, central frequency 4.0 MHz, linear arrays) to collect breast-video and applied an entropy-based deep learning approach for evaluation. We analyzed the average two-dimensional image entropy (2-DIE) of these videos and the performance of AI models in processing videos from these different frequencies to assess how probe frequency affects AI diagnostic performance. RESULTS The study found that in testing set 1, L9 was higher than L14 in average 2-DIE; in testing set 2, L13 was higher in average 2-DIE than L7. The diagnostic efficacy of US-data, utilized in AI model analysis, varied across different frequencies (AUC: L9 > L14: 0.849 vs. 0.784; L13 > L7: 0.920 vs. 0.887). CONCLUSION This study indicate that US-data acquired using probes with varying frequencies exhibit diverse average 2-DIE values, and datasets characterized by higher average 2-DIE demonstrate enhanced diagnostic outcomes in AI-driven BCa diagnosis. Unlike other studies, our research emphasizes the importance of US-probe frequency selection on AI model diagnostic performance, rather than focusing solely on the AI algorithms themselves. These insights offer a new perspective for early BCa screening and diagnosis and are of significant for future choices of US equipment and optimization of AI algorithms.
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Affiliation(s)
- Zhibin Huang
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Keen Yang
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Hongtian Tian
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Huaiyu Wu
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Shuzhen Tang
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Chen Cui
- Research and development department, Illuminate, LLC, 518000, Shenzhen, Guangdong, China
| | - Siyuan Shi
- Research and development department, Illuminate, LLC, 518000, Shenzhen, Guangdong, China
| | - Yitao Jiang
- Research and development department, Illuminate, LLC, 518000, Shenzhen, Guangdong, China
| | - Jing Chen
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Jinfeng Xu
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China.
- Shenzhen People's Hospital, 518020, Shenzhen, China.
| | - Fajin Dong
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China.
- Shenzhen People's Hospital, 518020, Shenzhen, China.
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Kayadibi Y, Deger E, Kurt SA, Ucar AK, Adaletli I, Ozturk T, Kocael CP, Velidedeoglu M, Icten GE. The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2295-2306. [PMID: 37146224 DOI: 10.1002/jum.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). MATERIAL AND METHODS Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. RESULTS Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). CONCLUSION Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.
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Affiliation(s)
- Yasemin Kayadibi
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Enes Deger
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seda Aladag Kurt
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tulin Ozturk
- Cerrahpasa Medical Faculty, Department of Pathology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Pinar Kocael
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Ito T, Ueno E, Endo T, Omoto K, Kuwajima A, Taniguchi N, Tsunoda H, Tohno E, Hashimoto H, Fujimoto Y, Watanabe T. The Japan Society of Ultrasonics in Medicine guidelines on non-mass abnormalities of the breast. J Med Ultrason (2001) 2023; 50:331-339. [PMID: 37261555 PMCID: PMC10354171 DOI: 10.1007/s10396-023-01308-9] [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: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 06/02/2023]
Abstract
It is possible to appropriately diagnose non-mass abnormalities by elucidating ultrasound non-mass abnormality findings and sharing the concept. If non-mass abnormalities can be diagnosed early, the number of curable cases could increase, leading to fewer breast cancer deaths. The Japan Society of Ultrasonics in Medicine (JSUM) Terminology/Diagnostic Criteria Committee has classified non-mass abnormalities into five subtypes: hypoechoic area in the mammary gland, abnormalities of the ducts, architectural distortion, multiple small cysts, and echogenic foci without a hypoechoic area. We herein define the findings for each of these subtypes and present a summary of the JSUM guidelines on non-mass abnormalities of the breast generated based on those findings.
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Affiliation(s)
- Toshikazu Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
| | - Ei Ueno
- Tsukuba International Breast Clinic, Ibaraki, Japan
| | - Tokiko Endo
- Department of Breast Surgery, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan
| | - Kiyoka Omoto
- Department of Laboratory Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akira Kuwajima
- Department of Health Check-Up, PL Tokyo Health Control Center, Tokyo, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroko Tsunoda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, Ibaraki, Japan
| | - Hideyuki Hashimoto
- Medical Department, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | | | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Miyagi, Japan
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Watanabe T. Features of ductal carcinoma in situ ultrasound images. J Med Ultrason (2001) 2023; 50:347-350. [PMID: 37369884 PMCID: PMC10354177 DOI: 10.1007/s10396-023-01334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Ultrasound images of ductal carcinoma in situ (DCIS) show a wide range of variations from mass to non-mass lesions. This article describes the characteristics of ultrasound images of DCIS based on the BC-02 study conducted by The Japanese Association of Breast and Thyroid Sonology (JABTS). In the BC-02 study, ultrasound images of 705 DCIS cases were classified by imaging findings. The results showed that non-mass abnormalities accounted for 60% of all lesions and masses for 40%. Looking at each subclassification, hypoechoic areas in the mammary gland were the most common (50% of the total), followed by solid masses (31%), mixed masses (9%), and abnormalities of the ducts (8%). These four classifications accounted for 98% of the total. Echogenic foci without a hypoechoic area, architectural distortion, and clustered microcysts were very rare, accounting for about 1% of the total. The ultrasound images of DCIS were characterized by a wide range of variations from masses to non-masses abnormalities, with hypoechoic areas in the mammary gland being the most common, followed by solid masses.
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Affiliation(s)
- Takanori Watanabe
- National Hospital Organization Sendai Medical Center, 2-11-12 Miyaginohara, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
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Wang B, Yang D, Zhang X, Gong X, Xu T, Han J, Ren Y, Zou S, Li L, Wang Y. The diagnostic value of contrast-enhanced ultrasonography in breast ductal abnormalities. Cancer Imaging 2023; 23:25. [PMID: 36899406 PMCID: PMC10007791 DOI: 10.1186/s40644-023-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/25/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Ductal lesions are an important, often overlooked, and poorly understood issue in breast imaging, which have a risk of underlying malignancy ranging from 5 to 23%. Ultrasonography (US), which has largely replaced galactography or ductography, has become an important imaging method to assess patients with ductal lesions. However, it is difficult to distinguish benign from malignant ductal abnormalities only by ultrasonography, most of which are recommended to be at least in subcategory 4A; these require biopsy according to the ACR BI-RADS®atlas 5th Edition-breast ultrasound. Contrast-enhanced ultrasound (CEUS) has been shown to be valuable for differentiating benign from malignant tumors, but its value is unclear in breast ductal lesions. Therefore, the purposes of this study were to explore the characteristics of malignant ductal abnormalities on US and CEUS imaging and the diagnostic value of CEUS in breast ductal abnormalities. METHODS Overall, 82 patients with 82 suspicious ductal lesions were recruited for this prospective study. They were divided into benign and malignant groups according to the pathological results. Morphologic features and quantitative parameters of US and CEUS were analyzed by comparison and multivariate logistic regression to determine the independent risk factors. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS Shape, margin, inner echo, size, microcalcification and blood flow classification on US, wash-in time, enhancement intensity, enhancement mode, enhancement scope, blood perfusion defects, peripheral high enhancement and boundary on CEUS were identified as features correlated with malignant ductal lesions. However, multivariate logistic regression showed that only microcalcification (OR = 8.96, P = 0.047) and enhancement scope (enlarged, OR = 27.42, P = 0.018) were independent risk factors for predicting malignant ductal lesions. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the ROC curve of microcalcifications combined with an enlarged enhancement scope were 0.895, 0.886, 0.872, 0.907, 0.890, and 0.92, respectively. CONCLUSIONS Microcalcification and enlarged enhancement scope are independent factors for predicting malignant ductal lesions. The combined diagnosis can greatly improve the diagnostic performance, indicating that CEUS can be useful in the differentiation of benign and malignant lesions to formulate more appropriate management for ductal lesions.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Di Yang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuan Zhang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - XuanTong Gong
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tong Xu
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Han
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - YinPeng Ren
- Department of Breast Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - ShuangMei Zou
- Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yong Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Gao L, Lai X, Zhang J, Jiang Y, Li J. Sonographic prediction of intraductal papillary carcinoma with partially cystic breast lesions. BMC Med Imaging 2023; 23:3. [PMID: 36609236 PMCID: PMC9817258 DOI: 10.1186/s12880-022-00934-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/10/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intraductal papillary carcinoma (IDPC) is a rare but fatal disease. Preoperative ultrasound diagnosis of IDPC remains challenging and meaningful. The aim of the study was to determine an effective ultrasound model to predict intraductal papillary carcinoma (IDPC) in patients with partially cystic breast lesions on ultrasound. METHODS We reviewed female patients with breast nodules who underwent biopsy or surgery between 2004 and 2019, and pathological results were used as the reference standard. We finally included 21 IDPC patients with partially cystic lesions on preoperative ultrasound matched to 40 patients with intraductal papilloma. The association of ultrasound features with IDPC was analysed. RESULTS Posterior echo enhancement (P < 0.001), tumour size (P = 0.002), irregular shape (P = 0.003), wide base (P = 0.003), solid-mainly component (P = 0.013), rich Doppler flow (P < 0.001) and multiple lesions (P = 0.044) were associated with IDPC by univariate analysis. Based on univariate analysis, variables were included in the regression analysis to obtain independent factors. The regression analysis showed that microcalcification, multiple lesions, posterior echo enhancement, wide base of solid components and rich colour Doppler flow were predictors for IDPC (P < 0.001). The collective model of the independent factors (microcalcification, multiple lesions, posterior echo enhancement, wide base of solid components and rich colour Doppler flow) could predict IDPC with an area under the curve (AUC) of 0.99 (95% CI 0.95-1.00). The collective model had a better net benefit demonstrated by the decision curve. CONCLUSION Ultrasonic features may be an applicable model for predicting IDPC with partially cystic breast lesions on ultrasound and has a better potential to facilitate decision-making preoperatively.
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Affiliation(s)
- Luying Gao
- grid.506261.60000 0001 0706 7839Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dongdansantiao, Beijing, 100730 China
| | - Xingjian Lai
- grid.506261.60000 0001 0706 7839Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dongdansantiao, Beijing, 100730 China
| | - Jing Zhang
- grid.506261.60000 0001 0706 7839Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dongdansantiao, Beijing, 100730 China
| | - Yuxin Jiang
- grid.506261.60000 0001 0706 7839Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dongdansantiao, Beijing, 100730 China
| | - Jianchu Li
- grid.506261.60000 0001 0706 7839Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dongdansantiao, Beijing, 100730 China
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Guo W, Wang T, Li F, Jia C, Zheng S, Zhang X, Bai M. Non-mass Breast Lesions: Could Multimodal Ultrasound Imaging Be Helpful for Their Diagnosis? Diagnostics (Basel) 2022; 12:diagnostics12122923. [PMID: 36552930 PMCID: PMC9777234 DOI: 10.3390/diagnostics12122923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To develop a prediction model for discriminating malignant from benign breast non-mass-like lesions (NMLs) using conventional ultrasound (US), strain elastography (SE) of US elastography and contrast-enhanced ultrasound (CEUS). Methods: A total of 101 NMLs from 100 patients detected by conventional US were enrolled in this retrospective study. The characteristics of NMLs in conventional US, SE and CEUS were compared between malignant and benign NMLs. Histopathological results were used as the reference standard. Binary logistic regression analysis was performed to identify the independent risk factors. A multimodal method to evaluate NMLs based on logistic regression was developed. The diagnostic performance of conventional US, US + SE, US + CEUS and the combination of these modalities was evaluated and compared. Results: Among the 101 lesions, 50 (49.5%) were benign and 51 (50.5%) were malignant. Age ≥45 y, microcalcifications in the lesion, elasticity score >3, earlier enhancement time and hyper-enhancement were independent diagnostic indicators included to establish the multimodal prediction method. The area under the receiver operating characteristic curve (AUC) of US + SE + CEUS was significantly higher than that of US (p < 0.0001) and US + SE (p < 0.0001), but there was no significant difference between the AUC of US + SE + CEUS and the AUC of US + CEUS (p = 0.216). Conclusion: US + SE + CEUS and US + CEUS could significantly improve the diagnostic efficiency and accuracy of conventional US in the diagnosis of NMLs.
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Affiliation(s)
- Wenjuan Guo
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Tong Wang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Siqi Zheng
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- Correspondence:
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10
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Loudig O, Mitchell MI, Ben-Dov IZ, Liu C, Fineberg S. MiRNA expression deregulation correlates with the Oncotype DX ® DCIS score. BREAST CANCER RESEARCH : BCR 2022; 24:62. [PMID: 36096802 PMCID: PMC9469592 DOI: 10.1186/s13058-022-01558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
Background Current clinical criteria do not discriminate well between women who will or those who will not develop ipsilateral invasive breast cancer (IBC), or a DCIS recurrence after a ductal carcinoma in situ (DCIS) diagnosis. The 12-gene Oncotype DX® DCIS assay (RT qPCR gene-based scoring system) was established and shown to predict the risk of subsequent ipsilateral IBC or DCIS recurrence. Recent studies have shown that microRNA (miRNA) expression deregulation can contribute to the development of IBC, but very few have evaluated miRNA deregulation in DCIS lesions. In this study, we sought to determine whether specific miRNA expression changes may correlate with Oncotype DX® DCIS scores. Methods For this study, we used archived formalin-fixed, paraffin-embedded (FFPE) specimens from 41 women diagnosed with DCIS between 2012 and 2018. The DCIS lesions were stratified into low (n = 26), intermediate (n = 10), and high (n = 5) risk score groups using the Oncotype DX® DCIS assay. Total RNA was extracted from DCIS lesions by macro-dissection of unstained FFPE sections, and next-generation small-RNA sequencing was performed. We evaluated the correlation between miRNA expression data and Oncotype score, as well as patient age. RT-qPCR validations were performed to validate the topmost differentially expressed miRNAs identified between the different risk score groups. Results MiRNA sequencing of 32 FFPE DCIS specimens from the three different risk group scores identified a correlation between expression deregulation of 17 miRNAs and Oncotype scores. Our analyses also revealed a correlation between the expression deregulation of 9 miRNAs and the patient’s age. Based on these results, a total of 15 miRNAs were selected for RT-qPCR validation. Of these, miR-190b (p = 0.043), miR-135a (p = 0.05), miR-205 (p = 0.00056), miR-30c (p = 0.011), and miR-744 (p = 0.038) showed a decreased expression in the intermediate/high Oncotype group when compared to the low-risk score group. A composite risk score was established using these 5 miRNAs and indicated a significant association between miRNA expression deregulation and the Oncotype DX® DCIS Score (p < 0.0021), between high/intermediate and low risk groups. Conclusions Our analyses identified a subset of 5 miRNAs able to discriminate between Oncotype DX® DCIS score subgroups. Together, our data suggest that miRNA expression analysis may add value to the predictive and prognostic evaluation of DCIS lesions. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-022-01558-4.
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Affiliation(s)
- Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA.
| | - Megan I Mitchell
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah Medical Center, 91120, Jerusalem, Israel
| | - Christina Liu
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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11
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Escalating de-escalation in breast cancer treatment. Breast Cancer Res Treat 2022; 195:85-90. [PMID: 35902432 DOI: 10.1007/s10549-022-06685-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/08/2022] [Indexed: 12/17/2022]
Abstract
Efforts have continually been made to de-escalate treatment for breast cancer, with the goal of balancing oncologic outcomes with complications and patient quality of life. In the early 2000s, two landmark studies firmly established that conservative treatment approaches for breast cancer can be safe and effective. More recently, neoadjuvant chemotherapy has gained momentum as a potential standard of care for breast cancer. An important question has thus arisen: Can neoadjuvant approaches themselves be de-escalated to further minimize adverse treatment effects while maintaining oncological outcomes? In this editorial, we look at the available evidence and assess current trends in treatment de-escalation for women with breast cancer.
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12
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Hanna M. Pathologic Nipple Discharge: Rare Imaging Presentation. Cureus 2022; 14:e23005. [PMID: 35415047 PMCID: PMC8994012 DOI: 10.7759/cureus.23005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/05/2022] Open
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13
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Komarla R, Gilliland L, Piraner M, Seidel R, Clifford K, Kunjummen J. Imaging and pathologic features of non-calcified ductal carcinoma in situ: can sonography predict upgrade? Br J Radiol 2022; 95:20211013. [PMID: 34870448 PMCID: PMC8822564 DOI: 10.1259/bjr.20211013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the imaging and pathologic features and upgrade rate of non-calcified ductal carcinoma in situ (NCDCIS). The study tested the hypothesis that lesions with sonographic findings have higher upgrade rate compared to lesions seen on mammography or MRI only. METHODS This retrospective study included patients with ductal carcinoma in situ (DCIS) diagnosed by image-guided core breast biopsy from December 2009 to April 2018. Patients with microcalcifications on mammography or concurrent ipsilateral cancer on core biopsy were excluded. An upgrade was defined as surgical pathology showing microinvasive or invasive cancer. RESULTS A total of 71 lesions constituted the study cohort. 62% of cases (44/71) had a mammographic finding, and 38% (27/71) of mammographically occult lesions had findings on either ultrasound, MRI, or both. Of the 67 cases that underwent sonography, a mass was noted in 56/67 (83.6%) cases and no sonographic correlate was identified in 11/67 (16.4%) cases. 21% (15/71) of lesions were upgraded on final surgical pathology. The upgrade rate of patients with sonographic correlate was 27% (15/56) vs with mammographic findings only was 0% (0/11). CONCLUSION DCIS should be considered in the differential diagnosis of architectural distortion, asymmetries, focal asymmetries, and masses, even in the absence of microcalcifications. NCDCIS diagnosed by ultrasound may be an independent risk factor for upgrade. ADVANCES IN KNOWLEDGE Radiologists must be aware of imaging features of DCIS and consider increased upgrade rate when NCDCIS is diagnosed by ultrasound.
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Affiliation(s)
- Rohini Komarla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Lawrence Gilliland
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Maria Piraner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Seidel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kelly Clifford
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jean Kunjummen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Goto M, Nakano S, Saito M, Banno H, Ito Y, Ido M, Ando T, Kousaka J, Fujii K, Suzuki K. Evaluation of an MRI/US fusion technique for the detection of non-mass enhancement of breast lesions detected by MRI yet occult on conventional B-mode second-look US. J Med Ultrason (2001) 2022; 49:269-278. [PMID: 35083535 DOI: 10.1007/s10396-021-01175-2] [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: 07/06/2021] [Accepted: 10/08/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to verify the utility of second-look ultrasound (US) using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/US fusion technique, in identifying MRI-detected breast lesions with non-mass enhancement (NME). METHODS Consecutive patients who had one or more NME lesions detected by MRI yet occult on the subsequent second-look US in conventional B (cB)-mode imaging were enrolled in the study between June 2015 and April 2020. Supine MRI of the lesions was performed and, using its data, second-look US using RVS was performed. RESULTS Twenty patients with 21 NME lesions were included. The overall median lesion size on prone MRI was 23 mm (range, 5-63 mm). Supine MRI identified all the 21 NME lesions, and second-look US using RVS successfully detected 18 (86%) of them. RVS-guided biopsy was performed for histopathological evaluation, showing that nine of the 18 lesions were benign and the other nine malignant. Of the nine malignant lesions, two (22%) were invasive cancer and seven (78%) were ductal carcinoma in situ. In four of five patients who underwent prone MRI for preoperative evaluation, the diagnosis was benign and surgery was conducted as originally planned. In the other patient, the diagnosis was malignant and contralateral breast-conserving surgery was added. Three (14%) of the 21 NME lesions had no RVS correlates and were judged to be benign after 24-month follow-up. CONCLUSION The results suggest that second-look US using RVS helps identify MRI-detected NME lesions that are occult on cB-mode second-look US.
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Affiliation(s)
- Manami Goto
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Masayuki Saito
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Hirona Banno
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yukie Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mirai Ido
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
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Stromal computational signatures predict upgrade to invasive carcinoma in mass-forming DCIS: a brief report of 44 cases. Pathol Res Pract 2022; 231:153771. [DOI: 10.1016/j.prp.2022.153771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
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16
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Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology 2021; 302:246-255. [PMID: 34931856 PMCID: PMC8805655 DOI: 10.1148/radiol.211839] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
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Affiliation(s)
- Lars J. Grimm
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Habib Rahbar
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Monica Abdelmalak
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Allison H. Hall
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Marc D. Ryser
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
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17
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Anderson S, Parker E, Rahbar H, Scheel JR. IV Ductal Carcinoma In Situ, Including its Histologic Subtypes and Grades. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Kayadibi Y, Ucar N, Kaya MF, Yildirim E, Bektas S. Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2532-2542. [PMID: 34127332 DOI: 10.1016/j.ultrasmedbio.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann-Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.
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Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul Universitesi-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
| | - Nese Ucar
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Mehmet Fatih Kaya
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Emine Yildirim
- Department of General Surgery, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
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20
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Choe J, Chikarmane SA, Giess CS. Nonmass Findings at Breast US: Definition, Classifications, and Differential Diagnosis. Radiographics 2021; 40:326-335. [PMID: 32125954 DOI: 10.1148/rg.2020190125] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A nonmass finding at US has been described as a discrete identifiable area of altered echotexture compared with that of the surrounding breast tissue that does not conform to a mass shape. Recognizing nonmass findings is important because breast cancer can manifest as such lesions, and US correlate findings for mammographic and breast MRI abnormalities may manifest as nonmass findings. The term nonmass finding is not part of the current Breast Imaging Reporting and Data System US terminology, and no standardized approach to classify and evaluate nonmass findings at US currently exists, despite the various classification systems proposed in the literature. There is also considerable overlap between the sonographic features of benign and malignant causes of nonmass findings. These limitations cause diagnostic difficulty in evaluating clinical significance and recommending appropriate management. The authors review the definitions and classification systems of US nonmass findings proposed in the literature and illustrate the sonographic features of nonmass findings to help radiologists identify them at US. A range of benign and malignant causes of nonmass findings are reviewed, and sonographic-histopathologic correlations of nonmass findings are discussed. Cases of breast MRI and mammographic findings that may manifest as US nonmass findings are presented. Radiologists can improve detection and interpretative accuracy, as well as correlation of mammographic and MRI breast lesions, by increasing their recognition and understanding of nonmass findings at US.©RSNA, 2020.
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Affiliation(s)
- Jihee Choe
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Sona A Chikarmane
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Catherine S Giess
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115
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21
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Zhang F, Jin L, Li G, Jia C, Shi Q, Du L, Wu R. The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. Br J Radiol 2021; 94:20200880. [PMID: 33560894 DOI: 10.1259/bjr.20200880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. METHODS A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. RESULTS Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. CONCLUSIONS CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. ADVANCES IN KNOWLEDGE In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Qian L, Lv Z, Zhang K, Wang K, Zhu Q, Zhou S, Chang C, Tian J. Application of deep learning to predict underestimation in ductal carcinoma in situ of the breast with ultrasound. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:295. [PMID: 33708922 PMCID: PMC7944276 DOI: 10.21037/atm-20-3981] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background To develop an ultrasound-based deep learning model to predict postoperative upgrading of pure ductal carcinoma in situ (DCIS) diagnosed by core needle biopsy (CNB) before surgery. Methods Of the 360 patients with DCIS diagnosed by CNB and identified retrospectively, 180 had lesions upstaged to ductal carcinoma in situ with microinvasion (DCISM) or invasive ductal carcinoma (IDC) postoperatively. Ultrasound images obtained from the hospital database were divided into a training set (n=240) and validation set (n=120), with a ratio of 2:1 in chronological order. Four deep learning models, based on the ResNet and VggNet structures, were established to classify the ultrasound images into postoperative upgrade and pure DCIS. We obtained the area under the receiver operating characteristic curve (AUROC), specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) to estimate the performance of the predictive models. The robustness of the models was evaluated by a 3-fold cross-validation. Results Clinical features were not significantly different between the training set and the test set (P value >0.05). The area under the receiver operating characteristic curve of our models ranged from 0.724 to 0.804. The sensitivity, specificity, and accuracy of the optimal model were 0.733, 0.750, and 0.742, respectively. The three-fold cross-validation results showed that the model was very robust. Conclusions The ultrasound-based deep learning prediction model is effective in predicting DCIS that will be upgraded postoperatively.
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Affiliation(s)
- Lang Qian
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Zhikun Lv
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Kai Zhang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Qian Zhu
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
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23
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Moschetta M, Sardaro A, Nitti A, Telegrafo M, Maggialetti N, Scardapane A, Brunese MC, Lavelli V, Ferrari C. Ultrasound evaluation of ductal carcinoma in situ of the breast. J Ultrasound 2021; 25:41-45. [PMID: 33409862 PMCID: PMC8964906 DOI: 10.1007/s40477-020-00551-x] [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: 10/08/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the role of ultrasound (US) in detecting and characterizing ductal carcinoma in situ (DCIS) of the breast and to investigate the correlation between ultrasonographic and biological features of DCIS. METHODS In total, 171 patients (mean age 44; range 39-62) with 178 lesions were retrospectively evaluated by two independent radiologists searching for US mass or non-mass lesions. Immunohistochemistry analysis was performed to determine estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. The US detection rate and pattern distribution among the lesion types were evaluated. The χ2 test was used to evaluate the correlation between the US findings and the biological factors. Statistical significance was indicated by p values < 0.05. Inter-observer agreement was calculated by Kohen's k test. RESULTS US detected 35% (63/178) of all lesions. Fifty-two (83%) lesions were classified as mass lesions, and 11 (17%) as non-mass lesions (p < 0.0001). Among the mass lesions, the most common shape was irregular (79%; p < 0.0001), with 45 (87%) lesions having indistinct margins. Hypoechogenicity was the most common echo pattern (49 cases, 94%; p < 0.0001). Microcalcifications were found in 23 cases (37%; p = 0.004) and were associated with mass lesions in 15 cases (65%) and with non-mass lesions in 8 cases (35%) (p = 0.21). An almost perfect inter-observer agreement (k = 0.87) was obtained between the two radiologists. A significant ER expression was found in mass lesions (83%; p < 0.0001), with no significant PR (p = 0.89) or HER2 expression (p = 0.81). Among the lesions with microcalcifications, only 7 out of 23 cases (30%) were positive for HER2 (p = 0.09). CONCLUSION DCIS represents a heterogeneous pathological process with variable US appearance (mass-like, non-mass-like, or occult). The most common US finding is represented by mass-type, hypoechogenic lesions with indistinct margins. A significant ER expression exists among mass-type lesions, while microcalcifications seem not to be associated with HER2 expression.
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Affiliation(s)
- Marco Moschetta
- DETO, Department of Emergency and Organ Transplantations, Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Angela Sardaro
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Adriana Nitti
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Michele Telegrafo
- grid.7644.10000 0001 0120 3326DETO, Department of Emergency and Organ Transplantations, Breast Care Unit, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Maggialetti
- grid.10373.360000000122055422Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Arnaldo Scardapane
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Maria Chiara Brunese
- grid.10373.360000000122055422Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Nuclear Medicine, Aldo Moro University of Bari Medical School, Bari, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326DIM, Interdisciplinary Department of Medicine, Section of Nuclear Medicine, Aldo Moro University of Bari Medical School, Bari, Italy
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Lyons D, Wahab RA, Vijapura C, Mahoney MC. The nipple-areolar complex: comprehensive imaging review. Clin Radiol 2020; 76:172-184. [PMID: 33077158 DOI: 10.1016/j.crad.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
The nipple-areolar complex can be affected by a variety of benign and malignant entities that can present with non-specific symptoms. Benign pathologies commonly affecting the nipple-areolar complex include nipple calcifications, nipple adenoma, abscess of Montgomery tubercles, ductal ectasia, periductal mastitis, and papilloma. Malignant pathologies that affect the nipple-areolar complex include Paget's disease of the breast, ductal carcinoma in-situ, and invasive ductal carcinoma. Clinical history and examination, imaging, and tissue sampling when appropriate are co-dependent factors that guide the assessment of nipple-areolar pathologies. This article provides a review of the normal anatomy, common anatomical variants, benign and malignant pathologies, and imaging techniques to guide the diagnostic assessment of the nipple-areolar complex.
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Affiliation(s)
- D Lyons
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA.
| | - R A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - C Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - M C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
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Mehta N, Rousslang L, Shokouh-Amiri M, Wiley EL, Green L. Complex Solid and Cystic Breast Cancer: A Series of Six Case Reports. J Radiol Case Rep 2020; 14:21-44. [PMID: 32184934 DOI: 10.3941/jrcr.v14i2.3712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A cyst in the breast containing a thick wall, internal septations, or a solid intracystic component is defined as a complex solid and cystic breast mass. These lesions carry a malignant potential between 23-31% and thus require further evaluation with biopsy [1]. We report six cases in which patients were found to have a complex solid and cystic mass, all of which were proven to be malignant breast cancers of varying etiologies. We also review the literature on malignant etiologies of complex solid and cystic breast masses, including their clinical presentation, work-up, histopathologic and immunochemistry findings, treatment, and prognosis.
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Affiliation(s)
- Nishi Mehta
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Lee Rousslang
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Mohammad Shokouh-Amiri
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Elizabeth L Wiley
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Lauren Green
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, USA
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26
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Ballantyne N, Chen YA, Rabhar H, Grimm LJ. Multimodality Imaging of Ductal Carcinoma In Situ. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-019-00349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li W, Zhou Q, Xia S, Wu Y, Fei X, Wang Y, Tao L, Fan J, Zhou W. Application of Contrast-Enhanced Ultrasound in the Diagnosis of Ductal Carcinoma In Situ: Analysis of 127 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:39-50. [PMID: 31206200 DOI: 10.1002/jum.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore the characteristics of breast ductal carcinoma in situ (DCIS) on real-time grayscale contrast-enhanced ultrasound (CEUS) imaging and the diagnostic value of CEUS in DCIS. METHODS A total of 127 histopathologically confirmed DCIS lesions and 124 fibroadenomas (FAs; controls) were subjected to conventional ultrasound and CEUS. Next, the CEUS findings of DCIS and FA lesions, including morphologic features and quantitative parameters, were analyzed. RESULTS Binary logistic regression was used to identify the independent risk factors from DCIS and FA lesions detected by CEUS. Contrast-enhanced ultrasound revealed significant differences between DCIS and FA. The wash-in time, enhancement mode, enhancement intensity, blood perfusion defects, peripheral high enhancement, enhancement scope, intratumoral vessels and their courses and dilatation degree, and penetrating vessels on CEUS were identified as features correlated with DCIS (P < .05). Moreover, a multivariate logistic regression analysis was developed, and the area under receiver operating characteristic curve of each index was generated, including the wash-in time, enhancement intensity, blood perfusion defects, enhancement scope, penetrating vessels, arrival time, and peak intensity (P < .05; area under the curve, >0.6). CONCLUSIONS The contrast-enhancement patterns and DCIS parameters appeared different from FA lesions, thus suggesting that CEUS can be very useful in distinguishing DCIS from FA lesions.
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Affiliation(s)
- Weiwei Li
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qinghua Zhou
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shujun Xia
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaochun Fei
- Departments of Pathology (X.F.), Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingling Tao
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfang Fan
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhou
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Qu N, Luo Y, Yu T. Differentiation between Clinically Noninflammatory Granulomatous Lobular Mastitis and Noncalcified Ductal Carcinoma in situ Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Breast Care (Basel) 2020; 15:619-627. [DOI: 10.1159/000506068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Challenges in differentiation between clinically noninflammatory granulomatous lobular mastitis (GLM) and noncalcified ductal carcinoma in situ (DCIS) remain. <b><i>Objective:</i></b> To identify the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics contributing to their differential diagnosis. <b><i>Methods:</i></b> A total of 33 clinically noninflammatory GLM and 36 noncalcified DCIS were retrospectively analyzed in the study. Internal enhancement of a nonmass enhancement (NME) lesion was divided into clustered enhanced ring (absence/presence), and clustered enhanced ring (presence) was further classified as small and large ring based on the optimal cutoff value. The 5th Breast Imaging and Data System MRI descriptors were used for assessing the other DCE-MRI characteristics. Multivariate analysis including variables with significant differences in univariate analyses was conducted to identify the independent predictors. The discriminative abilities of different predictors and their combination were compared by area under the receiver-operating characteristic curves (AUCs). <b><i>Results:</i></b> An NME lesion was seen more commonly in clinically noninflammatory GLM than in noncalcified DCIS (<i>p</i> = 0.003). DCE-MRI characteristics with significant differences in univariate analyses included NME size, clustered enhanced ring (absence/presence), ring size, initial increase and kinetic characteristics for the differentiation between these two entities presenting as NME lesion. Clustered enhanced ring (presence) was further classified as small (≤7 mm) or large ring (>7 mm). Multivariate analysis revealed that internal enhancement and initial increase were identified as significant independent predictors, and the AUC of their combination achieved the highest value of 0.867 (95% CI, 0.748–0.943). <b><i>Conclusions:</i></b> An NME lesion with a large ring is more highly suggestive of clinically noninflammatory GLM.
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Zaky MM, Hafez A, Zaky MM, Shoma A, Soliman NY, Elmokadem AH. MRI for assessment of pathologic nipple discharge: is it mandatory? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology.
Results
Histopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%.
Conclusion
Magnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.
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30
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Gunawardena DS, Burrows S, Taylor DB. Non-mass versus mass-like ultrasound patterns in ductal carcinoma in situ: is there an association with high-risk histology? Clin Radiol 2019; 75:140-147. [PMID: 31739979 DOI: 10.1016/j.crad.2019.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
AIM To review the ultrasound (US) patterns of pure ductal carcinoma in situ (DCIS) using a non-mass-like (NML) versus mass-like (ML) classification and to investigate histopathological associations. MATERIALS AND METHODS The present study was a retrospective analysis of sonographically evident pure DCIS lesions detected in a mammographic (MG) screening programme over a 7-year period from 2008. All lesions had undergone US-guided 14 G core biopsies with no upgrades to invasive disease on surgical histopathology. Lesions that were three-dimensional with convex margins were classified as ML and all others as NML. ML lesions were subdivided into solid, cystic, or mixed, and NML lesions into ductal and non-ductal. Imaging and pathological characteristics of NML versus ML lesions were investigated using logistic regression. RESULTS There were 78 lesions in 75 participants. NML lesions accounted for 45 (58%) lesions, comprising 27 (60%) ductal and 18 (40%) non-ductal subtypes. There were 33 (42%) ML lesions; the largest subgroup being solid (n=21, 64%). Significant associations between lesion type and lesion size on US (<15 versus ≥15 mm), presence of US and mammographic calcification and posterior shadowing on sonography were identified. NML lesions had fivefold higher odds (OR=5.41 95% confidence interval [CI]: 2.03, 14.39, p=0.001) to be high grade and sevenfold higher odds (OR=7 95% CI: 1.75, 27.99, p=0.006) to have comedo necrosis on histopathology. CONCLUSION DCIS lesions can be successfully classified using ML and NML lesion descriptors and NML morphology on US is associated with histological features of "high-risk" DCIS.
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Affiliation(s)
- D S Gunawardena
- Department of Radiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6004, Australia.
| | - S Burrows
- School of Medicine, University of Western Australia, GPO Box X2213, Perth, Western Australia 6847, Australia
| | - D B Taylor
- Department of Radiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6004, Australia; Faculty of Health and Medical Sciences, Medical Schools, University of Western Australia, Western Australia, Australia
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Gauvin G, Yeo CT, Ungi T, Merchant S, Lasso A, Jabs D, Vaughan T, Rudan JF, Walker R, Fichtinger G, Engel CJ. Real-time electromagnetic navigation for breast-conserving surgery using NaviKnife technology: A matched case-control study. Breast J 2019; 26:399-405. [PMID: 31531915 DOI: 10.1111/tbj.13480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Abstract
Breast-conserving surgery (BCS) is a mainstay in breast cancer treatment. For nonpalpable breast cancers, current strategies have limited accuracy, contributing to high positive margin rates. We developed NaviKnife, a surgical navigation system based on real-time electromagnetic (EM) tracking. The goal of this study was to confirm the feasibility of intraoperative EM navigation in patients with nonpalpable breast cancer and to assess the potential value of surgical navigation. We recruited 40 patients with ultrasound visible, single, nonpalpable lesions, undergoing BCS. Feasibility was assessed by equipment functionality and sterility, acceptable duration of the operation, and surgeon feedback. Secondary outcomes included specimen volume, positive margin rate, and reoperation outcomes. Study patients were compared to a control group by a matched case-control analysis. There was no equipment failure or breach of sterility. The median operative time was 66 (44-119) minutes with NaviKnife vs 65 (34-158) minutes for the control (P = .64). NaviKnife contouring time was 3.2 (1.6-9) minutes. Surgeons rated navigation as easy to setup, easy to use, and useful in guiding nonpalpable tumor excision. The mean specimen volume was 95.4 ± 73.5 cm3 with NaviKnife and 140.7 ± 100.3 cm3 for the control (P = .01). The positive margin rate was 22.5% with NaviKnife and 28.7% for the control (P = .52). The re-excision specimen contained residual disease in 14.3% for NaviKnife and 50% for the control (P = .28). Our results demonstrate that real-time EM navigation is feasible in the operating room for BCS. Excisions performed with navigation result in the removal of less breast tissue without compromising postive margin rates.
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Affiliation(s)
- Gabrielle Gauvin
- Department of Surgery, Queen's University, Kingston, ON, Canada.,Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Caitlin T Yeo
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Tamas Ungi
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Shaila Merchant
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Andras Lasso
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Doris Jabs
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Thomas Vaughan
- School of Computing, Queen's University, Kingston, ON, Canada
| | - John F Rudan
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Ross Walker
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Gabor Fichtinger
- Department of Surgery, Queen's University, Kingston, ON, Canada.,School of Computing, Queen's University, Kingston, ON, Canada
| | - Cecil Jay Engel
- Department of Surgery, Queen's University, Kingston, ON, Canada
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Au FWF, Ghai S, Lu FI, Lu H. Clinical Value of Shear Wave Elastography Added to Targeted Ultrasound (Second-Look Ultrasound) in the Evaluation of Breast Lesions Suspicious of Malignancy Detected on Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2395-2406. [PMID: 30666681 DOI: 10.1002/jum.14936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the value of shear wave elastography (SWE) added to targeted ultrasound (US) after breast magnetic resonance imaging (MRI). METHODS From July 2015 to October 2017, 40 patients who underwent targeted US evaluations of suspicious MRI-detected American College of Radiology Breast Imaging Reporting and Data System category 4 lesions (mass or nonmass enhancement) were enrolled in this prospective study. B-mode US and SWE examinations were performed to detect US correlates to MRI-detected lesions; their Breast Imaging Reporting and Data System categories were recorded; lesions that were dark blue on a 6-point color scale or had maximum elasticity of 30 kPa or less were categorized as soft. Biopsy was performed with US or MRI guidance, with the pathologic findings correlated with MRI, US, and SWE findings. The value of SWE for lesion detection and identification of benign lesions was determined. RESULTS The mean age of the 40 patients was 51.1 years. There were 48 MRI-detected lesions (20 cancers, 3 high-risk lesions, and 25 benign lesions). Ultrasound correlates (8 category 3 and 25 category 4) were shown for 33 lesions (69%; P < .0001), with 16 cancers (80%; P < .0001) and 17 benign lesions. Shear wave elastography assisted detection of 3 (19%) cancers on US imaging. All 7 soft US category 3 lesions were benign (7 of 33 [21%]; P = .0014). CONCLUSIONS Shear wave elastography was useful with targeted US after breast MRI to increase cancer detection by US. A significant number of US correlates to MRI-detected lesions could have been identified as benign (category 3 and soft) before biopsy, with the potential of short-interval follow-up of MRI-detected lesions with benign US correlates instead of biopsy.
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Affiliation(s)
- Frederick Wing-Fai Au
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging, Women's College Hospital, Toronto, Ontario, Canada
| | - Fang-I Lu
- Department of Pathology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Hua Lu
- University of Toronto, Toronto, Ontario, Canada
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Shehata M, Grimm L, Ballantyne N, Lourenco A, Demello LR, Kilgore MR, Rahbar H. Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment. JOURNAL OF BREAST IMAGING 2019; 1:166-176. [PMID: 31538141 DOI: 10.1093/jbi/wbz039] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.
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Affiliation(s)
- Mariam Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA
| | - Lars Grimm
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Nancy Ballantyne
- Duke University Medical School, Department of Radiology, Durham, NC
| | - Ana Lourenco
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Linda R Demello
- Brown University Medical School, Department of Radiology, Providence, RI
| | - Mark R Kilgore
- University of Washington School of Medicine, Department of Anatomic Pathology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
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Qu XX, Song Y, Zhang YH, Qing HM. Value of Ultrasonic Elastography and Conventional Ultrasonography in the Differential Diagnosis of Non-Mass-like Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1358-1366. [PMID: 30975535 DOI: 10.1016/j.ultrasmedbio.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to evaluate the diagnostic value of ultrasonic elastography (UE) and conventional ultrasonography (CUS) in the differential diagnosis of non-mass-like (NML) breast lesions. Static sonograms of 39 pathologically diagnosed NML breast lesions were reviewed. Lesions were evaluated by CUS and UE using CUS subjective ratings (benign, malignant or indeterminate), a 5-point subjective elasticity scoring system and the quantitative strain ratio (SR). Receiver operating characteristic curves and diagnostic tests were used to assess the diagnostic value of CUS and UE. Areas under the receiver operating characteristic curves (Az) of the CUS, 5-point elasticity and SR methods were 0.848 (p < 0.001), 0.895 (p < 0.001) and 0.943 (p < 0.001), respectively. In diagnosing NML breast lesions, there was no significant difference between the 5-point elasticity and CUS methods. The combination of UE and CUS helps to improve the accuracy of the ultrasonic diagnosis of NML breast lesions.
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Affiliation(s)
- Xiao-Xia Qu
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Song
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yu-Hong Zhang
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hua-Min Qing
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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35
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Choi SH, Choi JS, Han BK, Ko EY, Ko ES, Park KW. Long-term Surveillance of Ductal Carcinoma in Situ Detected with Screening Mammography versus US: Factors Associated with Second Breast Cancer. Radiology 2019; 292:37-48. [PMID: 31038406 DOI: 10.1148/radiol.2019181844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The relationship between method of breast cancer screening (mammography or US) and survival outcome in patients with screening-detected ductal carcinoma in situ (DCIS) has not been determined. Purpose To investigate whether different methods of breast cancer screening are associated with different survival outcomes in patients with screening-detected DCIS and to evaluate clinical-pathologic and imaging factors associated with second breast cancer. Materials and Methods We retrospectively identified women who underwent surgery to treat DCIS initially detected with screening mammography or US between July 2004 and December 2011 in a single institution. Overall survival (OS) and disease-free survival (DFS) were assessed. Factors associated with second breast cancer (invasive carcinoma or DCIS) were found with multivariable Cox proportional hazards regression analysis. Subgroups were analyzed according to screening method. Results A total of 814 women (median age, 47 years; age range, 25-81 years) were included; 627 underwent treatment for screening mammography-detected DCIS (mammography-detected group), and 187 underwent treatment for screening US-detected DCIS (US-detected group). During follow-up (median, 7 years; interquartile range, 5-8 years), 26 ipsilateral and 26 contralateral second breast cancers (6.4%, 52 of 814) were found, with 44 in the mammography-detected group and eight in the US-detected group. The overall 5-year OS and DFS rates were 100% and 95.3%, respectively. DFS rates did not differ according to screening method (P = .21, 5-year DFS rates were 94.9% in the mammography-detected group and 96.5% in the US-detected group). In the mammography-detected group, higher nuclear grade (intermediate grade: hazard ratio [HR], 5.7; 95% confidence interval [CI]: 1.3, 24.3; P = 0.02) (high grade: HR, 8.0; 95% CI: 1.9, 34.2; P = .01) and dense breast (HR, 3.5; 95% CI: 1.1, 11.4; P = 0.04) were associated with second breast cancer. In the US-detected group, human epidermal growth factor receptor 2 positivity was associated with second breast cancer (HR, 9.2; 95% CI: 2.2, 38.5; P = .002). Conclusion Disease-free survival of patients who underwent treatment for screening-detected ductal carcinoma in situ (DCIS) did not differ according to screening detection method. In patients with screening mammography-detected DCIS, higher nuclear grade and dense breast were associated with second breast cancer, and in patients with screening US-detected DCIS, human epidermal growth factor 2 positivity was associated with second breast cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Fowler in this issue.
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Affiliation(s)
- Seung Hee Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ji Soo Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Boo-Kyung Han
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Young Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Eun Sook Ko
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Ko Woon Park
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
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Relea A, Alonso J, González M, Zornoza C, Bahamonde S, Viñuela B, Encinas M. Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rxeng.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Amornsiripanitch N, Lam DL, Rahbar H. Advances in Breast MRI in the Setting of Ductal Carcinoma In Situ. Semin Roentgenol 2018; 53:261-269. [PMID: 30449344 DOI: 10.1053/j.ro.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Diana L Lam
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
| | - Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
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Relea A, Alonso JA, González M, Zornoza C, Bahamonde S, Viñuela BE, Encinas MB. Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications. RADIOLOGIA 2018; 60:413-423. [PMID: 29907260 DOI: 10.1016/j.rx.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/04/2018] [Accepted: 04/25/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether the twinkling artifact on Doppler ultrasound imaging corresponds to microcalcifications previously seen on mammograms and to evaluate the usefulness of this finding in the ultrasound management of suspicious microcalcifications. MATERIAL AND METHODS We used ultrasonography to prospectively examine 46 consecutive patients with groups of microcalcifications suspicious for malignancy identified at mammography, searching for the presence of the twinkling artifact to identify the microcalcifications. Once we identified the microcalcifications, we obtained core-needle biopsy specimens with 11G needles and then used X-rays to check the specimens for the presence of microcalcifications. We analyzed the percentage of detection and obtainment of microcalcifications by core-needle biopsy with this technique and the radiopathologic correlation. Microcalcifications that were not detected by ultrasound or discordant lesions were biopsied by stereotaxy at another center. We also used ultrasound guidance for preoperative marking with clips, usually orienting them radially. RESULTS We identified and biopsied 41 of the 46 lesions under ultrasound guidance, including 24 of 25 carcinomas (17 in situ). B-mode ultrasound was sufficient for biopsying the microcalcifications in 14 patients, although the presence of the twinkling artifact increased the number of microcalcifications detected and thus enabled more accurate preoperative marking. Thanks to the twinkling sign, we were able to identify 27 additional groups of microcalcifications (89% vs. 30%; p < 0.05). All the surgical specimens had margins free of disease. CONCLUSIONS The twinkling artifact is useful for microcalcifications in ultrasound examinations, enabling a significant increase in the yield of ultrasound-guided biopsies and better preoperative marking of groups of microcalcifications.
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Affiliation(s)
- A Relea
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - J A Alonso
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - M González
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - C Zornoza
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - S Bahamonde
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - B E Viñuela
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - M B Encinas
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España
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van Zelst JCM, Mann RM. Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization. Radiographics 2018; 38:663-683. [DOI: 10.1148/rg.2018170162] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jan C. M. van Zelst
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
| | - Ritse M. Mann
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
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Tan EJ, Moey THL, Madhukumar P, Leong LCH. Clinics in diagnostic imaging (180). Ductal carcinoma in situ (DCIS). Singapore Med J 2017; 58:585-592. [PMID: 29119195 DOI: 10.11622/smedj.2017098] [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: 11/18/2022]
Abstract
A 26-year-old woman presented with a slow-growing right breast lump. Excision biopsy of the lump showed invasive ductal carcinoma with adjacent ductal carcinoma in situ (DCIS). Preoperative imaging was performed to assess the extent of disease. Magnetic resonance (MR) imaging of the breasts showed an area of clustered ring enhancement deep to the biopsy site, which was representative of residual DCIS. DCIS is a common noninvasive malignancy that manifests as a primary breast tumour or in association with other lesions. The radiological features of DCIS are discussed herein, with special attention to the clustered ring enhancement pattern on MR imaging.
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Affiliation(s)
- Eu Jin Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Tammy Hui Lin Moey
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Preetha Madhukumar
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
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Cha H, Chang YW, Lee EJ, Hwang JY, Kim HJ, Lee EH, Ryu JK. Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers. Ultrasonography 2017; 37:307-314. [PMID: 29169230 PMCID: PMC6177689 DOI: 10.14366/usg.17039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/13/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. Methods A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of <0.05 were considered to indicate statistical significance. Results Of the 141 lesions, 75 (53.2%) were mass lesions, 56 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006). Microcalcifications were significantly associated with high-grade DCIS (P<0.001), the presence of comedonecrosis (P<0.001), an elevated Ki-67 (P<0.001), and HER2 positivity (P=0.003). Conclusion The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.
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Affiliation(s)
- Hwajin Cha
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ji Young Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung Kyu Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Watanabe R, Ando T, Osawa M, Ido M, Kousaka J, Mouri Y, Fujii K, Nakano S, Kimura J, Ishiguchi T, Yoshida M, Imai T, Fukutomi T. Second-look US Using Real-time Virtual Sonography, a Coordinated Breast US and MRI System with Electromagnetic Tracking Technology: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2362-2371. [PMID: 28666549 DOI: 10.1016/j.ultrasmedbio.2017.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Our aim was to retrospectively evaluate the utility of second-look ultrasound (US) using real-time virtual sonography (RVS) for detection of conventional B-mode (cB-mode) occult magnetic resonance imaging (MRI)-detected breast lesions. Between July 2011 and May 2015, 53 consecutive patients who underwent second-look US to identify lesions detected by prone MRI were enrolled in this study. Second-look US using RVS was performed for cB-mode occult MRI-detected breast lesions after an additional supine MRI. In the 53 patients, 59 lesions were initially detected by prone MRI, followed by second-look US. Of the 59 lesions, 20 (34%) were identified by second-look US using cB-mode. Of the 39 (66%) cB-mode occult lesions, 38 (97%) were detected in supine MRI and 33 (85%) were detected by second-look US using RVS. MRI morphology types of the 33 lesions were as follows: mass, 16; non-mass enhancement, 5; and focus, 12. US-guided biopsy under RVS or excisional biopsy demonstrated that of the 33 lesions, 8 (24%) were malignant and the remaining 25 (76%) were benign. A total of 53 (90%) MRI-detected lesions were sonographically identified using both cB-mode and RVS (p < 0.001). All five remaining US-occult lesions could be followed up under RVS after the enhancing area was marked on the breast surface using RVS. Although further prospective studies are required, the findings of our pilot study suggest that second-look US using RVS with additional supine MRI may improve the sonographic and histopathologic detection rate of cB-mode occult MRI-detected breast lesions.
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Affiliation(s)
- Rie Watanabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan; Department of Breast Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Takahito Ando
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Manami Osawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Mirai Ido
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Junko Kousaka
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Yukako Mouri
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Kimihito Fujii
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shogo Nakano
- Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.
| | - Junko Kimura
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Miwa Yoshida
- Department of Breast Surgical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Tsuneo Imai
- Department of Breast and Endocrine Surgery, Higashinagoya National Hospital, Nagoya, Japan
| | - Takashi Fukutomi
- Department of Breast Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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Kuerer HM, Smith BD, Chavez-MacGregor M, Albarracin C, Barcenas CH, Santiago L, Edgerton ME, Rauch GM, Giordano SH, Sahin A, Krishnamurthy S, Woodward W, Tripathy D, Yang WT, Hunt KK. DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer 2017; 8:2653-2662. [PMID: 28928852 PMCID: PMC5604195 DOI: 10.7150/jca.20871] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/14/2017] [Indexed: 12/31/2022] Open
Abstract
Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS. Use of these protocols over the past 20-years has resulted in 10-year local recurrence rates below 5% for patients with negative margins < 2 mm who received RT. Patients with margins < 2 mm who do not receive RT experience significantly higher local failure rates. Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive.
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Affiliation(s)
- Henry M. Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mariana Chavez-MacGregor
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Constance Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos H. Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lumarie Santiago
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary E. Edgerton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gaiane M. Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H. Giordano
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aysegul Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Savitri Krishnamurthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debasish Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei T. Yang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Hwang H, Park S, Koo JS, Park HS, Kim SI, Cho YU, Park BW, Yoon JH, Kim MJ, Kim EK. Factors predictive of occult nipple-areolar complex involvement in patients with carcinoma in situ of the breast. J Surg Oncol 2017; 116:1046-1055. [DOI: 10.1002/jso.24768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 06/26/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Hyeoseong Hwang
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Seho Park
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Frontier Research Institute of Convergence Sports Science; Yonsei University; Seoul Republic of Korea
| | - Ja Seung Koo
- Department of Pathology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Hyung Seok Park
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Seung Il Kim
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Young Up Cho
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Byeong-Woo Park
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science; Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science; Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science; Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
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Watanabe T, Yamaguchi T, Tsunoda H, Kaoku S, Tohno E, Yasuda H, Ban K, Hirokaga K, Tanaka K, Umemoto T, Okuno T, Fujimoto Y, Nakatani S, Ito J, Ueno E. Ultrasound Image Classification of Ductal Carcinoma In Situ (DCIS) of the Breast: Analysis of 705 DCIS Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:918-925. [PMID: 28242086 DOI: 10.1016/j.ultrasmedbio.2017.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 06/06/2023]
Abstract
The Japan Association of Breast and Thyroid Sonology (JABTS) proposed, in 2003, a conceptual classification system for non-mass abnormalities to be applied in addition to the conventional concept of masses, to facilitate detecting ductal carcinoma in situ (DCIS) lesions. The aim of this study was to confirm the utility of this system and to clarify the distribution of these findings in DCIS lesions. Data on 705 surgically treated DCIS lesions from 16 institutions in Japan were retrospectively reviewed. All 705 DCIS lesions could be classified according to the JABTS classification system. The most frequent findings were hypo-echoic areas in the mammary gland (48.6%), followed by solid masses (28.0%) and duct abnormalities (10.2%) or mixed masses (8.1%). Distortion (1.3%), clustered microcysts (1.4%) and echogenic foci without a hypo-echoic area (2.5%) were uncommon. These results suggest that the concept of non-mass abnormalities is useful in detecting DCIS lesions.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Clinical Research Data Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Setsuko Kaoku
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Hidemitsu Yasuda
- Department of Breast Surgery, National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, Shinjuku-ku, Tokyo, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Kumiko Tanaka
- Breast Surgery, Shonan Kamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Takeshi Umemoto
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
| | - Toshitaka Okuno
- Breast Surgery, Nishi-kobe Medical Center, Nishi-ku, Kobe City, Japan
| | | | - Shuichi Nakatani
- Department of Breast Surgery, Minami Osaka General Hospital, Higashi-Kagaya Suminoe-ku, Osaka City, Japan
| | - Jun Ito
- Department of Surgery I, Dokkyo Medical University, Mibu-Machi, Tochigi, Japan
| | - Ei Ueno
- Tsukuba International Breast Clinic, Tsukuba, Ibaraki, Japan
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Shrestha Taylor S. Ductal carcinoma in situin breastfeeding breasts - role of sonography. SONOGRAPHY 2016. [DOI: 10.1002/sono.12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ozan E, Atac GK, Gundogdu S. Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall? J Med Ultrason (2001) 2016; 43:361-71. [PMID: 27126510 DOI: 10.1007/s10396-016-0715-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/04/2016] [Indexed: 12/19/2022]
Abstract
The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.
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Affiliation(s)
- Ebru Ozan
- Department of Radiology, Ufuk University School of Medicine, Dr. Ridvan Ege Training and Research Hospital, Mevlana Bulvarı (Konya Yolu) No: 86-88, 06520, Balgat, Ankara, Turkey.
| | - Gokce Kaan Atac
- Department of Radiology, Ufuk University School of Medicine, Dr. Ridvan Ege Training and Research Hospital, Mevlana Bulvarı (Konya Yolu) No: 86-88, 06520, Balgat, Ankara, Turkey
| | - Sadi Gundogdu
- Department of Radiology, Ufuk University School of Medicine, Dr. Ridvan Ege Training and Research Hospital, Mevlana Bulvarı (Konya Yolu) No: 86-88, 06520, Balgat, Ankara, Turkey
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The Japanese Breast Cancer Society clinical practice guidelines for screening and imaging diagnosis of breast cancer, 2015 edition. Breast Cancer 2016; 23:357-66. [PMID: 27052720 DOI: 10.1007/s12282-016-0674-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/11/2015] [Indexed: 12/21/2022]
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Bae S, Yoon JH, Moon HJ, Kim MJ, Kim EK. Breast Microcalcifications: Diagnostic Outcomes According to Image-Guided Biopsy Method. Korean J Radiol 2015; 16:996-1005. [PMID: 26357494 PMCID: PMC4559796 DOI: 10.3348/kjr.2015.16.5.996] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/22/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic outcomes of ultrasonography-guided core needle biopsy (US-CNB), US-guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB) for diagnosing suspicious breast microcalcification. MATERIALS AND METHODS We retrospectively reviewed 336 cases of suspicious breast microcalcification in patients who subsequently underwent image-guided biopsy. US-CNB was performed for US-visible microcalcifications associated with a mass (n = 28), US-VAB for US-visible microcalcifications without an associated mass (n = 59), and S-VAB for mammogram-only visible lesions (n = 249). Mammographic findings, biopsy failure rate, false-negative rate, and underestimation rate were analyzed. Histological diagnoses and the Breast Imaging Reporting and Data System (BI-RADS) categories were reported. RESULTS Biopsy failure rates for US-CNB, US-VAB, and S-VAB were 7.1% (2/28), 0% (0/59), and 2.8% (7/249), respectively. Three false-negative cases were detected for US-CNB and two for S-VAB. The rates of biopsy-diagnosed ductal carcinoma in situ that were upgraded to invasive cancer at surgery were 41.7% (5/12), 12.9% (4/31), and 8.6% (3/35) for US-CNB, US-VAB, and S-VAB, respectively. Sonographically visible lesions were more likely to be malignant (66.2% [51/77] vs. 23.2% [46/198]; p < 0.001) or of higher BI-RADS category (61.0% [47/77] vs. 22.2% [44/198]; p < 0.001) than sonographically invisible lesions. CONCLUSION Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions.
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Affiliation(s)
- Sohi Bae
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
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