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Mann RM, Longo V. Contrast-enhanced Mammography versus MR Imaging of the Breast. Radiol Clin North Am 2024; 62:643-659. [PMID: 38777540 DOI: 10.1016/j.rcl.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Breast MR imaging and contrast-enhanced mammography (CEM) are both techniques that employ intravenously injected contrast agent to assess breast lesions. This approach is associated with a very high sensitivity for malignant lesions that typically exhibit rapid enhancement due to the leakiness of neovasculature. CEM may be readily available at the breast imaging department and can be performed on the spot. Breast MR imaging provides stronger enhancement than the x-ray-based techniques and offers higher sensitivity. From a patient perspective, both modalities have their benefits and downsides; thus, patient preference could also play a role in the selection of the imaging technique.
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Affiliation(s)
- Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Valentina Longo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, Rome 00168, Italy
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Fischer U, Diekmann F, Helbich T, Preibsch H, Püsken M, Wenkel E, Wienbeck S, Fallenberg EM. [Use of contrast-enhanced mammography for diagnosis of breast cancer]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:916-924. [PMID: 37889284 PMCID: PMC10692004 DOI: 10.1007/s00117-023-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is an imaging method that is able to improve visualization of intramammary tumors after peripheral venous administration of an iodine-containing contrast medium (ICM). OBJECTIVES AND METHODS The current significance of CEM is discussed. RESULTS Studies were able to show an advantage of CEM in the diagnosis of breast cancer compared to mammography, especially for women with dense breasts. Indications for CEM currently depend on the availability of magnetic resonance imaging (MRI). If MRI is available, CEM is indicated in those cases when MRI cannot be performed. Use of CEM for breast cancer screening is currently viewed critically. This view can change when results and updated assessments of large CEM studies in Europe and USA become available. Patients must be informed about the use of an ICM. As ICM administration for CEM is carried out in a similar manner to established imaging methods, the authors expect the use of ICM for CEM to be unproblematic as long as general contraindications are adhered to. CONCLUSIONS In the future, CEM could have greater importance for the diagnosis of breast cancer, as this imaging method has diagnostic advantages compared to conventional mammography. A great advantage of CEM is its availability. For those who use breast MRI, CEM is helpful when MRI is not feasible due to contraindications or other reasons.
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Affiliation(s)
- Uwe Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen, Deutschland.
| | - Felix Diekmann
- Institut für Radiologische Diagnostik, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Thomas Helbich
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Pädiatrische Radiologie, Medizinische Universität Wien/AKH WIEN, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Heike Preibsch
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Michael Püsken
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Evelyn Wenkel
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Radiologie München, München, Deutschland
| | - Susanne Wienbeck
- Radiologie Schwarzer Bär MVZ, Schwarzer Bär 8, 30449, Hannover, Deutschland
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Eva Maria Fallenberg
- Institut für diagnostische und interventionelle Radiologie, School of Medicine & Klinikum rechts der Isar Technische Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland
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Saleh GA, Batouty NM, Gamal A, Elnakib A, Hamdy O, Sharafeldeen A, Mahmoud A, Ghazal M, Yousaf J, Alhalabi M, AbouEleneen A, Tolba AE, Elmougy S, Contractor S, El-Baz A. Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review. Cancers (Basel) 2023; 15:5216. [PMID: 37958390 PMCID: PMC10650187 DOI: 10.3390/cancers15215216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.
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Affiliation(s)
- Gehad A. Saleh
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Nihal M. Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Abdelrahman Gamal
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elnakib
- Electrical and Computer Engineering Department, School of Engineering, Penn State Erie, The Behrend College, Erie, PA 16563, USA;
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Centre, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Marah Alhalabi
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Amal AbouEleneen
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elsaid Tolba
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
- The Higher Institute of Engineering and Automotive Technology and Energy, New Heliopolis, Cairo 11829, Egypt
| | - Samir Elmougy
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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van Nijnatten TJA, Lobbes MBI, Cozzi A, Patel BK, Zuley ML, Jochelson MS. Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:3-6. [PMID: 36448912 PMCID: PMC11025563 DOI: 10.2214/ajr.22.28567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound and comparable diagnostic performance to MRI for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited because of a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These factors include the following: the risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments needed when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently mitigate or are expected to mitigate these factors are also highlighted.
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Affiliation(s)
- Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Migliaro G, Bicchierai G, Valente P, Di Naro F, De Benedetto D, Amato F, Boeri C, Vanzi E, Miele V, Nori J. Contrast Enhanced Mammography (CEM) Enhancing Asymmetry: Single-Center First Case Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061011. [PMID: 36980319 PMCID: PMC10047777 DOI: 10.3390/diagnostics13061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
(1) Purpose: The latest Breast Imaging Reporting and Data System (BI-RADS) lexicon for CEM introduced a new descriptor, enhancing asymmetries (EAs). The purpose of this study was to determine which types of lesions were correlated with EAs. (2) Methods: A total of 3359 CEM exams, executed at AOUC Careggi in Florence, Italy between 2019 and 2021 were retrospectively assessed by two radiologists. For each of the EAs found, the size, the enhancing conspicuity (degree of enhancement relative to background described as low, moderate, or high), whether there was a corresponding finding in the traditional radiology images (US or mammography), the biopsy results when performed including any follow-up exams, and the presence of background parenchymal enhancement (BPE) of the normal breast tissue (minimal, mild, moderate, marked) were described. (3) Results: A total of 64 women were included, 36 of them underwent CEM for a preoperative staging assessment, and 28 for a problem-solving examination. Among the 64 EAs, 19/64 (29.69%) resulted in being category B5 (B5) lesions, 5/64 (7.81%) as category B3 (B3) lesions, and 40/64(62.50%) were negative or benign either after biopsy or second-look exams or follow-up. We assessed that EAs with higher enhancing conspicuity correlated significantly with a higher risk of B5 lesions (p: 0.0071), especially bigger ones (p: 0.0274). Conclusions: EAs can relate both with benign and tumoral lesions, and they need to be assessed as the other CEM descriptors, with re-evaluation of low-energy images and second-look exams, particularly larger EAs with higher enhancing conspicuity.
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Affiliation(s)
- Giuliano Migliaro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Bicchierai
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
- Correspondence:
| | - Pietro Valente
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Federica Di Naro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Diego De Benedetto
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Francesco Amato
- Breast Imaging Diagnostic Unit, Radiology Department, Ospedale San Giovanni di Dio, 92100 Agrigento, Italy
| | - Cecilia Boeri
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Ermanno Vanzi
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Jacopo Nori
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Choi JS. [Breast Imaging Reporting and Data System (BI-RADS): Advantages and Limitations]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:3-14. [PMID: 36818717 PMCID: PMC9935970 DOI: 10.3348/jksr.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 06/18/2023]
Abstract
Breast Imaging Reporting and Data System (BI-RADS) is a communication and data tracking system that standardizes and controls the quality of reporting by presenting lexicon descriptors, assessment categories, and recommendations for managing breast lesions. Using standardized terminology recommended by BI-RADS, radiologists can concisely and reproducibly communicate breast imaging results to clinicians. They can also provide the estimated malignant probability of the lesions found and guide management for them by determining the final assessment category. The limitations of BI-RADS 5th edition currently in use are that there are some areas for which standardized terminologies still need to be established, and that the diagnostic criteria of MRI assessment categories 3 and 4 are ambiguous compared to those for mammography or ultrasound. The next revision of BI-RADS is expected to include solutions for overcoming current limitations.
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Rong X, Kang Y, Xue J, Han P, Li Z, Yang G, Shi G. Value of contrast-enhanced mammography combined with the Kaiser score for clinical decision-making regarding tomosynthesis BI-RADS 4A lesions. Eur Radiol 2022; 32:7439-7447. [PMID: 35639141 DOI: 10.1007/s00330-022-08810-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of contrast-enhanced mammography (CEM) combined with the Kaiser score (KS) in digital breast tomosynthesis (DBT) BI-RADS 4A lesions to potentially reduce unnecessary breast biopsies. METHODS This retrospective study evaluated 106 patients with 109 DBT BI-RADS 4A lesions from June 2019 to June 2021. For the absence of enhancement on CEM, the lesions were downgraded to BI-RADS 3. For lesions with enhancement, the readers were asked to classify all enhancing lesions referring to the KS for breast MRI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance. Two readers rated all cases and interreader agreement was assessed by Cohen's kappa coefficients. RESULTS There were ninety-five benign lesions and 14 malignant lesions. CEM combined with KS's accuracy, represented by the area under the curve (AUC), ranged between 0.880 and 0.906. The use of the KS improved the performance, with a significant difference relative to a single BI-RADS reading or US (p < 0.001). CEM with KS had higher specificity than CEM with BI-RADS or US (p < 0.001), without difference in sensitivity (p > 0.05). CEM combined with KS could have potentially obviated 72 (75.8%) to 78 (82.1%) unnecessary benign biopsies in 95 benign lesions previously DBT classified as BI-RADS 4A. The interreader agreement was substantial (kappa: 0.727) for KS. CONCLUSIONS CEM combined with KS may be used in DBT BI-RADS 4A lesions to substantially reduce unnecessary benign biopsies. KEY POINTS • CEM combined with the Kaiser scoring system shows high diagnostic performance for DBT BI-RADS 4A lesions. • The application of CEM combined with the Kaiser scoring system may avoid 75.8% to 82.1% of unnecessary benign breast biopsies. • CEM combined with the KS aids clinical decision-making in DBT BI-RADS 4A lesions.
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Affiliation(s)
- Xiaocui Rong
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Yihe Kang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Jing Xue
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Pengyin Han
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Zhigang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Guang Yang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
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Contrast-Enhanced Mammography versus Breast Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12081890. [PMID: 36010240 PMCID: PMC9406751 DOI: 10.3390/diagnostics12081890] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CE-MRI) are commonly used in the screening of breast cancer. The present systematic review aimed to summarize, critically analyse, and meta-analyse the available evidence regarding the role of CE-MRI and CEM in the early detection, diagnosis, and preoperative assessment of breast cancer. Methods: The search was performed on PubMed, Google Scholar, and Web of Science on 28 July 2021 using the following terms “breast cancer”, “preoperative staging”, “contrast-enhanced mammography”, “contrast-enhanced spectral mammography”, “contrast enhanced digital mammography”, “contrast-enhanced breast magnetic resonance imaging” “CEM”, “CESM”, “CEDM”, and “CE-MRI”. We selected only those papers comparing the clinical efficacy of CEM and CE-MRI. The study quality was assessed using the QUADAS-2 criteria. The pooled sensitivities and specificity of CEM and CE-MRI were computed using a random-effects model directly from the STATA “metaprop” command. The between-study statistical heterogeneity was tested (I2-statistics). Results: Nineteen studies were selected for this systematic review. Fifteen studies (1315 patients) were included in the metanalysis. Both CEM and CE-MRI detect breast lesions with a high sensitivity, without a significant difference in performance (97% and 96%, respectively). Conclusions: Our findings confirm the potential of CEM as a supplemental screening imaging modality, even for intermediate-risk women, including females with dense breasts and a history of breast cancer.
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Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes. Eur Radiol 2022; 33:417-428. [PMID: 35895121 DOI: 10.1007/s00330-022-09021-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital. METHODS We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications. RESULTS A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1-4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%). CONCLUSION In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance. KEY POINTS • CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.
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Kim G, Mehta TS, Brook A, Du LH, Legare K, Phillips J. Enhancement Type at Contrast-enhanced Mammography and Association with Malignancy. Radiology 2022; 305:299-306. [PMID: 35819328 DOI: 10.1148/radiol.210966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Despite the increasing use of contrast-enhanced mammography (CEM), there are limited data on the evaluation of findings on recombined images and the association with malignancy. Purpose To determine the rates of malignancy of enhancement findings on CEM images in the presence or absence of low-energy findings using the Breast Imaging Reporting and Data System (BI-RADS) lexicon developed for mammography and MRI. Materials and Methods All diagnostic CEM examinations performed at one academic institution between December 2015 and December 2019 had low-energy and recombined images retrospectively. Data were independently reviewed by three breast imaging radiologists with 5-25 years of experience using the BI-RADS mammography and MRI lexicon. Outcome was determined with pathologic analysis or 1-year imaging or clinical follow-up. The χ2 and Fisher exact tests were used for analysis. Results A total of 371 diagnostic CEM studies were performed in 371 women (mean age, 54 years ± 11[SD]). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of enhancement on CEM images was 95% (104 of 109 [95% CI: 90, 98]), 67% (176 of 262 [95% CI: 61, 73]), 55% (104 of 190 [95% CI: 47, 62]), and 97% (176 of 181 [95% CI: 94, 99]), respectively. Among 190 CEM studies with enhancing findings, enhancing lesions were more likely to be malignant when associated with low-energy findings (26% vs 59%, P < .001). Among enhancement types, mass enhancement composed 71% (99 of 140) of all malignancies with PPV of 63% when associated with low-energy findings. Foci, non-mass enhancement, and mass enhancement without low-energy findings had PPV of 6%, 24%, and 38%, respectively. Neither background parenchymal enhancement nor density was associated with enhancement type (P = .19 and P = .28, respectively). Conclusion Mass enhancement on recombined images using CEM was most commonly associated with malignancy, especially when associated with low-energy findings. Enhancement types were more likely to be benign when not associated with low-energy findings; however, they should still be viewed with suspicion, given the high association with malignancy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Geunwon Kim
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
| | - Tejas S Mehta
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
| | - Linda H Du
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
| | - Kaila Legare
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
| | - Jordana Phillips
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (G.K., T.S.M., A.B., L.H.D., K.L., J.P.); and Atrius Health, Newton, Mass (G.K., L.H.D.)
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Comparison of Contrast-Enhanced Spectral Mammography and Contrast-Enhanced MRI in Screening Multifocal and Multicentric Lesions in Breast Cancer Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4224701. [PMID: 35585943 PMCID: PMC9007694 DOI: 10.1155/2022/4224701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 01/21/2023]
Abstract
Objectives We aimed to determine the difference between contrast-enhanced spectral mammography (CESM) and contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting multifocal and multicentric breast cancer (MMBC). Methods : This study was conducted among breast cancer patients between July 1, 2017, and May 30, 2021. The sensitivity, specificity, and accuracy of CESM and CE-MRI in the diagnosis of MMBC were evaluated with pathological results as the gold standard. Results A total of 188 lesions were detected in 54 patients with MMBC, including 177 breast cancer and 11 benign lesions. Based on CESM and CE-MRI, 4 false-positive cases and 3 false-negative cases and 7 false-positive cases and 1 false-negative case, respectively, were found. The accuracy of CESM was higher than that of MRI (96.3% vs 95.7%), and the specificity was higher than that of MRI (63.6% vs 36.4%). There were no significant differences in the sensitivity, specificity, and accuracy for the detection of MMBC between CESM and CE-MRI (p = 0.500; p = 0.250; p = 0.792). Conclusion CESM is an effective method for the detection of MMBC, which is consistent with the sensitivity and accuracy of CE-MRI.
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Informe estructurado de mamografía espectral con contraste. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Wang S, Sun Y, Mao N, Duan S, Li Q, Li R, Jiang T, Wang Z, Xie H, Gu Y. Incorporating the clinical and radiomics features of contrast-enhanced mammography to classify breast lesions: a retrospective study. Quant Imaging Med Surg 2021; 11:4418-4430. [PMID: 34603996 DOI: 10.21037/qims-21-103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising breast imaging technique. A limited number of studies have focused on the radiomics analysis of CEM. We intended to explore whether a model constructed with both clinical and radiomics features of CEM can better classify benign and malignant breast lesions. Methods This retrospective, double-center study included women who underwent CEM between August 2017 and February 2020. The data from Center 1 were used as training set and the data from Center 2 were used as external testing set (training: testing =2:1). Models were constructed with the clinical, radiomics, and clinical + radiomics features of CEM. The clinical features included patient age and clinical image features interpreted by the radiologists. The radiomics features were extracted from high-energy (HE), low-energy (LE), and dual-energy subtraction (DES) images of CEM. The Mann-Whitney U test, Pearson correlation and Boruta's approach were used to select the radiomics features. Random Forest (RF) and logistic regression were used to establish the models. For the testing set, the areas under the curve (AUCs) and 95% confidence intervals (CIs) were employed to evaluate the performance of the models. For the training set, the mean AUCs were obtained by performing internal validation for 100 iterations and then compared by the Kruskal-Wallis and Mann-Whitney U tests. Results A total of 226 women (mean age: 47.4±10.1 years) with 226 pathologically proven breast lesions (101 benign; 125 malignant) were included. For the external testing set, the AUCs were 0.964 (95% CI: 0.918-1.000) for the combined model, 0.947 (95% CI: 0.891-0.997) for the radiomics model, and 0.882 (95% CI: 0.803-0.962) for the clinical model. In the internal validation process, the combined model achieved a mean AUC of 0.934±0.030, which was significantly higher than those of the radiomics (mean AUC =0.921±0.031, adjusted P<0.050) and clinical models (mean AUC =0.907±0.036; adjusted P<0.050). Conclusions Incorporating both clinical and radiomics features of CEM may achieve better classification results for breast lesions.
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Affiliation(s)
- Simin Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuqi Sun
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Qingdao, China
| | | | - Qin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruimin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tingting Jiang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongyi Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Qingdao, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Qingdao, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Haggag MA, Hamed ST, Mawas ASAEL. Primary breast edema on contrast-enhanced digital mammography: a preliminary experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary breast edema can cause marked increase in skin thickness, breast density and echogenicity due to dense breast tissue filled with fluid and so causes subsequent significant attenuation of both the x-ray and ultrasound beams. The study aim is to assess the value of contrast-enhanced digital mammography (CEDM) in assessment and characterization of the obscured underlying breast lesions in cases of primary breast edema.
Results
Fifty five female participants were evaluated, of median age 51 years old and IQR 21. CEDM shows high sensitivity and specificity in the lesion detection as well as local extension delineation in cases associated with primary breast edema. It was accurate in detection of multifocal/multi-centric disease. CEDM is considered as a good negative test in cases of metastatic axillary lymph nodes to exclude and assess any associated obscured breast lesions, as it is good in delineating breast masses obscured by condensed parenchymal tissue. The calculated sensitivity of DM & CEDM was 87.5%, 95.8%, specificity was 55.5%, 72%, the PPV and NPV were 91, 93.6% and 45%, 77.8%, respectively.
Conclusions
CEDM has an important additional diagnostic value in the assessment, characterization and better delineation of breast lesions in primary edematous breast cases.
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Sistermanns M, Kowall B, Hörnig M, Beiderwellen K, Uhlenbrock D. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. ROFO-FORTSCHR RONTG 2021; 193:1183-1188. [PMID: 33735930 DOI: 10.1055/a-1388-7712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The technically caused delay between low-energy (LE) and high-energy (HE) acquisitions allows motion artifacts in contrast-enhanced dual-energy mammography (CEDEM). In this study the effect of motion correction by nonrigid registration on image quality of the recombined images was investigated. MATERIALS AND METHODS Retrospectively for 354 recombined CEDEM images an additional recombined image was processed from the raw data of LE and HE images using the motion correction algorithm. Five radiologists with many years of experience in breast cancer diagnostic imaging compared side-by-side one conventional processed CEDEM image with the corresponding image processed by the motion correction algorithm. Every pair of images was compared based on six criteria: General image quality (1), sharpness of skin contour (2), reduction of image artifacts (3), sharpness of lesion contour (4), contrast of lesion (5), visibility of lymph nodes (6). These criteria were rated on a Likert scale (improvement: + 1, + 2; deterioration: -1, -2). RESULTS The mean ratings concerning criteria 1-5 showed a superiority of the recombined images processed by the motion correction algorithm. For example, the mean rating of general image quality was 0.86 (95 % CI: 0.78; 0.93). Only the mean rating concerning criterion 6 showed an inferiority of the recombined images processed by the motion correction algorithm (-0.29 (-0.46; -0.13)). CONCLUSION The usage of nonrigid registration for motion correction significantly improves the general image quality and the quality of subordinate criteria on the recombined CEDEM images at the expense of somewhat reduced lymph node visibility in some cases. KEY POINTS · The usage of motion correction in CEDEM improves the general image quality. · Motion correction might have the potential to increase diagnostic accuracy. · Alternative methods of motion artifact reduction are not yet available in clinical practice. CITATION FORMAT · Sistermanns M, Kowall B, Hörnig M et al. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. Fortschr Röntgenstr 2021; 193: 1183 - 1188.
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Affiliation(s)
- Markus Sistermanns
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
| | - Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Germany
| | - Mathias Hörnig
- Department of Diagnostic imaging, X-ray Products, X-ray Physics & Systems, Siemens Healthcare GmbH Forchheim, Germany
| | | | - Detlev Uhlenbrock
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
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Current Status and Future of BI-RADS in Multimodality Imaging, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2020; 216:860-873. [PMID: 33295802 DOI: 10.2214/ajr.20.24894] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BI-RADS is a communication and data tracking system that has evolved since its inception as a brief mammography lexicon and reporting guide into a robust structured reporting platform and comprehensive quality assurance tool for mammography, ultrasound, and MRI. Consistent and appropriate use of the BI-RADS lexicon terminology and assessment categories effectively communicates findings, estimates the risk of malignancy, and provides management recommendations to patients and referring clinicians. The impact of BI-RADS currently extends internationally through six language translations. A condensed version has been proposed to facilitate a phased implementation of BI-RADS in resource-constrained regions. The primary advance of the 5th edition of BI-RADS is harmonization of the lexicon terms across mammography, ultrasound, and MRI. Harmonization has also been achieved across these modalities for the reporting structure, assessment categories, management recommendations, and data tracking system. Areas for improvement relate to certain common findings that lack lexicon descriptors and a need for further clarification of proper use of category 3. BI-RADS is anticipated to continue to evolve for application to a range of emerging breast imaging modalities.
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Covington MF. Contrast-Enhanced Mammography Implementation, Performance, and Use for Supplemental Breast Cancer Screening. Radiol Clin North Am 2020; 59:113-128. [PMID: 33222993 DOI: 10.1016/j.rcl.2020.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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Liu Y, Zhao S, Huang J, Zhang X, Qin Y, Zhong H, Yu J. Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography. Sci Rep 2020; 10:9807. [PMID: 32555338 PMCID: PMC7299980 DOI: 10.1038/s41598-020-66501-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR1: 7.6% vs. 2.7%; median CNR1: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Shuang Zhao
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Juan Huang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xueqin Zhang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yun Qin
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Huanhuan Zhong
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Jianqun Yu
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
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Dual Energy X-ray Methods for the Characterization, Quantification and Imaging of Calcification Minerals and Masses in Breast. CRYSTALS 2020. [DOI: 10.3390/cryst10030198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dual energy (DE) technique has been used by numerous studies in order to detect breast cancer in early stages. Although mammography is the gold standard, the dual energy technique offers the advantage of the suppression of the contrast between adipose and glandular tissues and reveals pathogenesis that is not present in conventional mammography. Both dual energy subtraction and dual energy contrast enhanced techniques were used in order to study the potential of dual energy technique to assist in detection or/and visualization of calcification minerals, masses and lesions obscured by overlapping tissue. This article reviews recent developments in this field, regarding: i) simulation studies carried out for the optimizations of the dual energy technique used in order to characterize and quantify calcification minerals or/and visualize suspected findings, and ii) the subsequent experimental verifications, and finally, the adaptation of the dual energy technique in clinical practice.
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Clauser P, Baltzer PAT, Kapetas P, Hoernig M, Weber M, Leone F, Bernathova M, Helbich TH. Low-Dose, Contrast-Enhanced Mammography Compared to Contrast-Enhanced Breast MRI: A Feasibility Study. J Magn Reson Imaging 2020; 52:589-595. [PMID: 32061002 PMCID: PMC7496227 DOI: 10.1002/jmri.27079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
Contrast‐enhanced MRI (CE‐MRI) is the most sensitive technique for breast cancer detection. Contrast‐enhanced mammography (CEM) is emerging as a possible alternative to CE‐MRI. Purpose To evaluate the diagnostic performance of a low radiation dose contrast‐enhanced mammography (L‐CEM) in women with suspicious findings on conventional imaging compared to CE‐MRI of the breast. Study Type Prospective, single center. Population Women with suspicious findings on mammography, tomosynthesis, or ultrasound, and no contraindications for L‐CEM or CE‐MRI. Eighty women were included. Field Strength/Sequence 1.5 and 3T CE‐MRI, standard protocol for breast, with dedicated coils, according to international guidelines. L‐CEM was performed using a dedicated prototype. Assessment Three, off‐site, blinded readers evaluated the images according to the BI‐RADS lexicon in a randomized order, each in two separate reading sessions. Histology served as a gold standard. Statistical Test Lesion detection rate, sensitivity, specificity, and negative and positive predictive values (NPV, PPV) were calculated and compared with multivariate statistics. Results Included were 80 women (mean age, 54.3 years ±11.2 standard deviation) with 93 lesions (32 benign, 61 malignant). The detection rate was significantly higher with CE‐MRI (92.5–94.6%; L‐CEM 79.6–91.4%, P = 0.014). Sensitivity (L‐CEM 65.6–90.2%; CE‐MRI 83.6–93.4%, P = 0.086) and NPV (L‐CEM 59.6–71.4%; CE‐MRI 63.0–76.5%, P = 0.780) did not differ between the modalities. Specificity (L‐CEM 46.9–96.9%; CE‐MRI 37.5–53.1%, P = 0.001) and PPV (L‐CEM 76.4–97.6%; CE‐MRI 73.3–77.3%, P = 0.007) were significantly higher with L‐CEM. Variations between readers were significant for sensitivity and NPV. The accuracy of L‐CEM was as good as CE‐MRI (75.3–76.3% vs. 72.0–75.3%, P = 0.514). Data Conclusion L‐CEM showed a high sensitivity and accuracy in women with suspicious findings on conventional imaging. Compared to CE‐MRI, L‐CEM has the potential to increase specificity and PPV. L‐CEM might help to reduce false‐positive biopsies while obtaining sensitivity comparable to that of CE‐MRI Level of Evidence 1 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:589–595.
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Affiliation(s)
- Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mathias Hoernig
- Diagnostic Imaging, Siemens Healthcare GmbH, Forchheim, Germany
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Federica Leone
- ASST Fatebenefratelli-Sacco, Ospedale Fatebenefrateli e Oftalmico, Milan, Italy
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Cozzi A, Schiaffino S, Sardanelli F. The emerging role of contrast-enhanced mammography. Quant Imaging Med Surg 2019; 9:2012-2018. [PMID: 31929976 DOI: 10.21037/qims.2019.11.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Ghaderi KF, Phillips J, Perry H, Lotfi P, Mehta TS. Contrast-enhanced Mammography: Current Applications and Future Directions. Radiographics 2019; 39:1907-1920. [DOI: 10.1148/rg.2019190079] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kimeya F. Ghaderi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Jordana Phillips
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Hannah Perry
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Parisa Lotfi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
| | - Tejas S. Mehta
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (K.F.G., J.P., P.L., T.S.M.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (H.P.)
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Travieso-Aja M, Maldonado-Saluzzi D, Naranjo-Santana P, Fernández-Ruiz C, Severino-Rondón W, Rodríguez Rodríguez M, Luzardo O. Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Travieso-Aja M, Maldonado-Saluzzi D, Naranjo-Santana P, Fernández-Ruiz C, Severino-Rondón W, Rodríguez Rodríguez M, Luzardo O. Evaluación de la aplicabilidad del léxico BI-RADS® de la resonancia magnética para la interpretación de la mamografía digital con contraste. RADIOLOGIA 2019; 61:477-488. [DOI: 10.1016/j.rx.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/11/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022]
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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Xing D, Lv Y, Sun B, Xie H, Dong J, Hao C, Chen Q, Chi X. Diagnostic Value of Contrast-Enhanced Spectral Mammography in Comparison to Magnetic Resonance Imaging in Breast Lesions. J Comput Assist Tomogr 2019; 43:245-251. [PMID: 30531546 PMCID: PMC6426358 DOI: 10.1097/rct.0000000000000832] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective The aim of this study was to evaluate the diagnostic value between contrast-enhanced spectral mammography (CESM) and breast magnetic resonance imaging (MRI) in breast disease. Methods Two hundred thirty-five patients who were suspected of having breast abnormalities by clinical examination or mammography underwent CESM and MRI examination. Using histopathologic results as the criterion standard, the diagnostic performance of CESM and MRI was investigated. The areas under receiver operating characteristic curves were applied to analyze diagnostic efficiency. The Pearson correlation coefficients between CESM versus pathology and MRI versus pathology were calculated. Results Two hundred sixty-three breast lesions were found in 235 patients, in which 177 were malignant and 86 were benign. By evaluating the diagnostic value, sensitivity, positive predictive value, negative predictive value, and false-negative rate from CESM examination were comparable to those from MRI (91.5%, 94.7%, 83.7%, and 8.5% vs 91.5%, 90.5%, 82.1%, and 8.5%). Importantly, the accuracy and the specificity were higher for CESM than those for MRI (81% and 89.5% vs 80.2% and 71.7%), whereas the false-positive rate was lower (10.5% vs 19.8%). The areas under receiver operating characteristic curves of CESM and MRI were 0.950 and 0.939, displaying the equivalent diagnostic efficiency (P = 0.48). For the agreement between measurements, mean tumor sizes were 3.1 cm for CESM and 3.4 cm for MRI compared with 3.2 cm on histopathologic results. The Pearson correlation coefficient of CESM versus histopathology (r = 0.774, P = 0.000) was consistent with MRI versus histopathology (r = 0.771, P = 0.000). Conclusions Our results show better accuracy, specificity, and false-positive rate of CESM in breast cancer detection than MRI. Contrast-enhanced spectral mammography displayed a good correlation with histopathology in assessing the lesion size of breast cancer, which is consistent with MRI.
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Affiliation(s)
- Dong Xing
- From the Department of Radiology and
| | | | - Bolin Sun
- Interventional Therapy Ward, Yantai Yuhuangding Hospital
| | | | | | | | - Qianqian Chen
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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van Nijnatten TJ, Jochelson MS, Pinker K, Keating DM, Sung JS, Morrow M, Smidt ML, Lobbes MB. Differences in degree of lesion enhancement on CEM between ILC and IDC. BJR Open 2019; 1:20180046. [PMID: 33178931 PMCID: PMC7592434 DOI: 10.1259/bjro.20180046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: To investigate differences in the degree of enhancement on contrast-enhanced mammography (CEM) between patients with invasive lobular (ILC) and infiltrating ductal carcinoma (IDC) not otherwise specified. Methods and materials: Between 2010 and 2017, all patients diagnosed with ILC and who underwent CEM were included for this dual center study. Twenty-two patients with IDC, matched by size, were identified for comparison. Three independent readers, blinded for histopathology results, re-evaluated all CEM exams to determine degree of lesion enhancement according to a previously defined scoring scale ranging from minimal to strong enhancement. Interobserver agreement among the three readers was calculated by quadratic weighted κ coefficient. Results: 44 patients were included: 22 patients with ILC and 22 patients with IDC. There were no significant differences in age, mean tumor size, tumor grade or receptor status between the two subgroups. Degree of lesion enhancement on CEM was more often considered weak in case of ILC compared to IDC according to two out of three readers (31.8% vs 4.5 %, p = 0.045 and 22.7 vs 4.5 %, p = 0.185). All other lesions showed moderate or strong enhancement. Interobserver agreement between the three independent readers was good (κ = 0.72). Conclusion: In patients with ILC, degree of lesion enhancement on CEM appears to be more often weak than in infiltrating ductal carcinoma not otherwise specified. Radiologists should be aware that weakly enhancing lesions may in fact be malignant and particularly invasive lobular cancers. Advances in knowledge: Three independent readers evaluated 44 CEM cases with ILC or IDC. Degree of lesion enhancement seems more often weak in case of ILC. Radiologists should be aware of ILC in case of weak CEM enhancement.
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Affiliation(s)
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | | | - Delia M Keating
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Janice S Sung
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
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Classification of contrast-enhanced spectral mammography (CESM) images. Int J Comput Assist Radiol Surg 2018; 14:249-257. [PMID: 30367322 DOI: 10.1007/s11548-018-1876-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Contrast-enhanced spectral mammography (CESM) is a recently developed breast imaging technique. CESM relies on dual-energy acquisition following contrast agent injection to improve mammography sensitivity. CESM is comparable to contrast-enhanced MRI in terms of sensitivity, at a fraction of the cost. However, since lesion variability is large, even with the improved visibility provided by CESM, differentiation between benign and malignant enhancement is not accurate and a biopsy is usually performed for final assessment. Breast biopsies can be stressful to the patient and are expensive to healthcare systems. Moreover, as the biopsies results are most of the time benign, a specificity improvement in the radiologist diagnosis is required. This work presents a deep learning-based decision support system, which aims at improving the specificity of breast cancer diagnosis by CESM without affecting sensitivity. METHODS We compare two analysis approaches, fine-tuning a pretrained network and fully training a convolutional neural network, for classification of CESM breast mass as benign or malignant. Breast Imaging Reporting and Data Systems (BIRADS) is a radiological lexicon, used with breast images, to categorize lesions. We improve each classification network by incorporating BIRADS textual features as an additional input to the network. We evaluate two ways of BIRADS fusion as network input: feature fusion and decision fusion. This leads to multimodal network architectures. At classification, we also exploit information from apparently normal breast tissue in the CESM of the considered patient, leading to a patient-specific classification. RESULTS We evaluate performance using fivefold cross-validation, on 129 randomly selected breast lesions annotated by an experienced radiologist. Each annotation includes a contour of the mass in the image, biopsy-proven label of benign or malignant lesion and BIRADS descriptors. At 100% sensitivity, specificity of 66% was achieved using a multimodal network, which combines inputs at feature level and patient-specific classification. CONCLUSIONS The presented multimodal network may significantly reduce benign biopsies, without compromising sensitivity.
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Early non-invasive detection of breast cancer using exhaled breath and urine analysis. Comput Biol Med 2018; 96:227-232. [PMID: 29653351 DOI: 10.1016/j.compbiomed.2018.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 11/21/2022]
Abstract
The main focus of this pilot study is to develop a statistical approach that is suitable to model data obtained by different detection methods. The methods used in this study examine the possibility to detect early breast cancer (BC) by exhaled breath and urine samples analysis. Exhaled breath samples were collected from 48 breast cancer patients and 45 healthy women that served as a control group. Urine samples were collected from 37 patients who were diagnosed with breast cancer based on physical or mammography tests prior to any surgery, and from 36 healthy women. Two commercial electronic noses (ENs) were used for the exhaled breath analysis. Urine samples were analyzed using Gas-Chromatography Mass-Spectrometry (GC-MS). Statistical analysis of results is based on an artificial neural network (ANN) obtained following feature extraction and feature selection processes. The model obtained allows classification of breast cancer patients with an accuracy of 95.2% ± 7.7% using data of one EN, and an accuracy of 85% for the other EN and for urine samples. The developed statistical analysis method enables accurate classification of patients as healthy or with BC based on simple non-invasive exhaled breath and a urine sample analysis. This study demonstrates that available commercial ENs can be used, provided that the data analysis is carried out using an appropriate scheme.
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Lee KA, Talati N, Oudsema R, Steinberger S, Margolies LR. BI-RADS 3: Current and Future Use of Probably Benign. CURRENT RADIOLOGY REPORTS 2018; 6:5. [PMID: 29399419 PMCID: PMC5787219 DOI: 10.1007/s40134-018-0266-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Probably benign (BI-RADS 3) causes confusion for interpreting physicians and referring physicians and can induce significant patient anxiety. The best uses and evidence for using this assessment category in mammography, breast ultrasound, and breast MRI will be reviewed; the reader will have a better understanding of how and when to use BI-RADS 3. RECENT FINDINGS Interobserver variability in the use of BI-RADS 3 has been documented. The 5th edition of the BI-RADS atlas details the appropriate use of BI-RADS 3 for diagnostic mammography, ultrasound, and MRI, and discourages its use in screening mammography. Data mining, elastography, and diffusion weighted MRI have been evaluated to maximize the accuracy of BI-RADS 3. SUMMARY BI-RADS 3 is an evolving assessment category. When used properly, it reduces the number of benign biopsies while allowing the breast imager to maintain a high sensitivity for the detection of early stage breast cancer.
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Affiliation(s)
- Karen A. Lee
- Department of Radiology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1234, New York, NY 10029 USA
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Nishi Talati
- Department of Radiology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1234, New York, NY 10029 USA
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Rebecca Oudsema
- Department of Radiology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1234, New York, NY 10029 USA
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sharon Steinberger
- Department of Radiology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1234, New York, NY 10029 USA
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Laurie R. Margolies
- Department of Radiology, The Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1234, New York, NY 10029 USA
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, NY USA
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Pinker K. Advanced Imaging for Precision Medicine in Breast Cancer: From Morphology to Function. Breast Care (Basel) 2017; 12:208-210. [PMID: 29070982 DOI: 10.1159/000480397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
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