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Kim S, Mai Tran TX, Kim MK, Chung MS, Lee EH, Lee W, Park B. Associations between breast cancer risk factors and mammographic breast density in a large cross-section of Korean women. Eur J Cancer Prev 2024; 33:407-413. [PMID: 38375880 DOI: 10.1097/cej.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND We investigated the association between established risk factors for breast cancer and mammographic breast density in Korean women. METHODS This large cross-sectional study included 8 460 928 women aged >40 years, who were screened for breast cancer between 2009 and 2018. Breast density was assessed using the Breast Imaging Reporting and Data System. This study used multiple logistic regression analyses of age, BMI, age at menarche, menopausal status, menopausal age, parity, breastfeeding status, oral contraceptive use, family history of breast cancer, physical activity, smoking, drinking and hormone replacement therapy use to investigate their associations with mammographic breast density. Analyses were performed using SAS software. RESULTS Of 8 460 928 women, 4 139 869 (48.9%) had nondense breasts and 4 321 059 (51.1%) had dense breasts. Factors associated with dense breasts were: earlier age at menarche [<15 vs. ≥15; adjusted odds ratio (aOR), 1.18; 95% confidence interval (CI), 1.17-1.18], premenopausal status (aOR, 2.01; 95% CI, 2.00-2.02), later age at menopause (≥52 vs. <52; aOR, 1.23; 95% CI, 1.22-1.23), nulliparity (aOR, 1.64; 95% CI, 1.63-1.65), never breastfed (aOR, 1.23; 95% CI, 1.23-1.24) and use of hormone replacement therapy (aOR, 1.29; 95% CI, 1.28-1.29). Women with a higher BMI and the use of oral contraceptives were more likely to have nondense breasts. CONCLUSION Lower BMI, reproductive health and behavioral factors were associated with dense breasts in Korean women. Additional research should investigate the relationship between mammographic breast density, breast cancer risk factors and breast cancer risk.
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Affiliation(s)
- Soyeoun Kim
- Department of Preventive Medicine, Hanyang University College of Medicine
- Institute for Health and Society, Hanyang University
| | - Thi Xuan Mai Tran
- Department of Preventive Medicine, Hanyang University College of Medicine
- Institute for Health and Society, Hanyang University
| | - Mi Kyung Kim
- Department of Preventive Medicine, Hanyang University College of Medicine
- Institute for Health and Society, Hanyang University
| | - Min Sung Chung
- Department of Surgery, Hanyang University College of Medicine, Seoul
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon
| | - Woojoo Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine
- Institute for Health and Society, Hanyang University
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea
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Vilmun BM, Napolitano G, Lauritzen A, Lynge E, Lillholm M, Nielsen MB, Vejborg I. Clinical Significance of Combined Density and Deep-Learning-Based Texture Analysis for Stratifying the Risk of Short-Term and Long-Term Breast Cancer in Screening. Diagnostics (Basel) 2024; 14:1823. [PMID: 39202310 PMCID: PMC11353655 DOI: 10.3390/diagnostics14161823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
Assessing a woman's risk of breast cancer is important for personalized screening. Mammographic density is a strong risk factor for breast cancer, but parenchymal texture patterns offer additional information which cannot be captured by density. We aimed to combine BI-RADS density score 4th Edition and a deep-learning-based texture score to stratify women in screening and compare rates among the combinations. This retrospective study cohort study included 216,564 women from a Danish populations-based screening program. Baseline mammograms were evaluated using BI-RADS density scores (1-4) and a deep-learning texture risk model, with scores categorized into four quartiles (1-4). The incidence rate ratio (IRR) for screen-detected, interval, and long-term cancer were adjusted for age, year of screening and screening clinic. Compared with subgroup B1-T1, the highest IRR for screen-detected cancer were within the T4 category (3.44 (95% CI: 2.43-4.82)-4.57 (95% CI: 3.66-5.76)). IRR for interval cancer was highest in the BI-RADS 4 category (95% CI: 5.36 (1.77-13.45)-16.94 (95% CI: 9.93-30.15)). IRR for long-term cancer increased both with increasing BI-RADS and increasing texture reaching 5.15 (4.31-6.16) for the combination of B4-T4 compared with B1-T1. Deep-learning-based texture analysis combined with BI-RADS density categories can reveal subgroups with increased rates beyond what density alone can ascertain, suggesting the potential of combining texture and density to improve risk stratification in breast cancer screening.
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Affiliation(s)
- Bolette Mikela Vilmun
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Breast Examinations, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - George Napolitano
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Andreas Lauritzen
- Department of Breast Examinations, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Biomediq A/S, Strandlinien 59, 2791 Dragør, Denmark
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Fjordvej 15, 4300 Nykøbing Falster, Denmark
| | - Martin Lillholm
- Biomediq A/S, Strandlinien 59, 2791 Dragør, Denmark
- Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Breast Examinations, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
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3
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Eom HJ, Cha JH, Choi WJ, Cho SM, Jin K, Kim HH. Mammographic density assessment: comparison of radiologists, automated volumetric measurement, and artificial intelligence-based computer-assisted diagnosis. Acta Radiol 2024; 65:708-715. [PMID: 38825883 DOI: 10.1177/02841851241257794] [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: 06/04/2024]
Abstract
BACKGROUND Artificial intelligence-based computer-assisted diagnosis (AI-CAD) is increasingly used for mammographic exams, and its role in mammographic density assessment should be evaluated. PURPOSE To assess the inter-modality agreement between radiologists, automated volumetric density measurement program (Volpara), and AI-CAD system in breast density categorization using the Breast Imaging-Reporting and Data System (BI-RADS) density categories. MATERIAL AND METHODS A retrospective review was conducted on 1015 screening digital mammograms that were performed in Asian female patients (mean age = 56 years ± 10 years) in our health examination center between December 2022 and January 2023. Four radiologists with two different levels of experience (expert and general radiologists) performed density assessments. Agreement between the radiologists, Volpara, and AI-CAD (Lunit INSIGHT MMG) was evaluated using weighted kappa statistics and matched rates. RESULTS Inter-reader agreement between expert and general radiologists was substantial (k = 0.65) with a matched rate of 72.8%. The agreement was substantial between expert or general radiologists and Volpara (k = 0.64-0.67) with a matched rate of 72.0% but moderate between expert or general radiologists and AI-CAD (k = 0.45-0.58) with matched rates of 56.7%-67.0%. The agreement between Volpara and AI-CAD was moderate (k = 0.53) with a matched rate of 60.8%. CONCLUSION The agreement in breast density categorization between radiologists and automated volumetric density measurement program (Volpara) was higher than the agreement between radiologists and AI-CAD (Lunit INSIGHT MMG).
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Affiliation(s)
- Hye Joung Eom
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Min Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kiok Jin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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4
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Kai C, Morita T, Sato I, Yoshida A, Kodama N, Kasai S. The Usefulness of the Breast Density Assessment Application Used by Breast Radiologists. Cureus 2024; 16:e62560. [PMID: 39027798 PMCID: PMC11254854 DOI: 10.7759/cureus.62560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Breast density determined by breast radiologists and also automatically estimated by applications has been widely investigated. However, no study has yet clarified whether the use of these applications by breast radiologists improves reading efficacy. Therefore, this study aimed to assess the usefulness of applications when used by breast radiologists. A Breast Density Assessment application (App) developed by Konica Minolta, Inc. (Tokyo, Japan) was used. Independent and sequential tests were conducted to assess the usefulness of the concurrent- and second-look modes. Fifty and 100 cases were evaluated using sequential and independent tests, respectively. Each dataset was configured based on the evaluation by an expert breast radiologist who developed the Japanese guidelines for breast density. Nine breast radiologists evaluated the mammary gland content ratio and breast density; the inter-observer and expert-to-observer variability were calculated. The time required to complete the experiments was also recorded. The inter-observer variability was significant with the App, as revealed by the independent test. The use of the App significantly improved the agreement between the responses of the observers for the mammary gland content ratio and those of the expert by 6.6% and led to a reduction of 186.9 seconds in the average time required by the observers to evaluate 100 cases. However, the results of the sequential test did not suggest the effectiveness of the App. These findings suggest that the concurrent use of the App improves reading efficiency.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
- Department of Health and Welfare, Graduate School, Niigata University of Health and Welfare, Niigata, JPN
| | - Takako Morita
- Department of Breast Surgery, National Hospital Organization, Nagoya Medical Center, Aichi, JPN
| | - Ikumi Sato
- Department of Health and Welfare, Graduate School, Niigata University of Health and Welfare, Niigata, JPN
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata, JPN
| | - Akifumi Yoshida
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, JPN
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Shimizu A, Iwabuchi Y, Tsukada J, Nakahara T, Sakurai R, Tonda K, Jinzaki M. Correlation between breast cancer and background parenchymal uptake on 18F-fluorodeoxyglucose positron emission tomography. Eur J Radiol 2024; 173:111378. [PMID: 38382424 DOI: 10.1016/j.ejrad.2024.111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE This study aimed to investigate differences in background parenchymal uptake (BPU) between patients with and without breast cancer using 18F-fluorodeoxyglucose positron emission tomography. METHODS Female patients (n = 130, 62.9 ± 12.7 years) with newly diagnosed breast cancer and 50 healthy participants (59.6 ± 13.3 years) without breast cancer were retrospectively included. BPU was evaluated using the maximum standardized uptake value. Data on participant age, body mass index, blood glucose level, and menopausal status were collected from medical records. Breast density was evaluated using mammography. Logistic regression analysis and receiver operating characteristic curves were used to examine the correlation between breast cancer and various characteristic factors, including BPU. RESULTS The BPU of patients with breast cancer was significantly higher than that of controls (P < 0.001). The results of logistic regression analysis regarding the presence of breast cancer demonstrated that BPU and menopausal status showed higher odds ratios of 13.6 and 4.25, respectively. The area under the receiver operating characteristic curve for BPU was 0.751. CONCLUSIONS Patients with breast cancer showed higher 18F-fluorodeoxyglucose-BPU. Glucose metabolism of mammary glands may correlate with the development of breast cancer.
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Affiliation(s)
- Atsushi Shimizu
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan.
| | - Jitsuro Tsukada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Ryosuke Sakurai
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; Department of Radiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Kai Tonda
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
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Kai C, Otsuka T, Nara M, Kondo S, Futamura H, Kodama N, Kasai S. Identifying factors that indicate the possibility of non-visible cases on mammograms using mammary gland content ratio estimated by artificial intelligence. Front Oncol 2024; 14:1255109. [PMID: 38505584 PMCID: PMC10949406 DOI: 10.3389/fonc.2024.1255109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/12/2024] [Indexed: 03/21/2024] Open
Abstract
Background Mammography is the modality of choice for breast cancer screening. However, some cases of breast cancer have been diagnosed through ultrasonography alone with no or benign findings on mammography (hereby referred to as non-visibles). Therefore, this study aimed to identify factors that indicate the possibility of non-visibles based on the mammary gland content ratio estimated using artificial intelligence (AI) by patient age and compressed breast thickness (CBT). Methods We used AI previously developed by us to estimate the mammary gland content ratio and quantitatively analyze 26,232 controls and 150 non-visibles. First, we evaluated divergence trends between controls and non-visibles based on the average estimated mammary gland content ratio to ensure the importance of analysis by age and CBT. Next, we evaluated the possibility that mammary gland content ratio ≥50% groups affect the divergence between controls and non-visibles to specifically identify factors that indicate the possibility of non-visibles. The images were classified into two groups for the estimated mammary gland content ratios with a threshold of 50%, and logistic regression analysis was performed between controls and non-visibles. Results The average estimated mammary gland content ratio was significantly higher in non-visibles than in controls when the overall sample, the patient age was ≥40 years and the CBT was ≥40 mm (p < 0.05). The differences in the average estimated mammary gland content ratios in the controls and non-visibles for the overall sample was 7.54%, the differences in patients aged 40-49, 50-59, and ≥60 years were 6.20%, 7.48%, and 4.78%, respectively, and the differences in those with a CBT of 40-49, 50-59, and ≥60 mm were 6.67%, 9.71%, and 16.13%, respectively. In evaluating mammary gland content ratio ≥50% groups, we also found positive correlations for non-visibles when controls were used as the baseline for the overall sample, in patients aged 40-59 years, and in those with a CBT ≥40 mm (p < 0.05). The corresponding odds ratios were ≥2.20, with a maximum value of 4.36. Conclusion The study findings highlight an estimated mammary gland content ratio of ≥50% in patients aged 40-59 years or in those with ≥40 mm CBT could be indicative factors for non-visibles.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | | | - Miyako Nara
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Satoshi Kondo
- Graduate School of Engineering, Muroran Institute of Technology, Muroran, Hokkaido, Japan
| | - Hitoshi Futamura
- Healthcare Business Headquarters, Konica Minolta, Inc., Tokyo, Japan
| | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Niigata, Japan
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7
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Lew CO, Harouni M, Kirksey ER, Kang EJ, Dong H, Gu H, Grimm LJ, Walsh R, Lowell DA, Mazurowski MA. A publicly available deep learning model and dataset for segmentation of breast, fibroglandular tissue, and vessels in breast MRI. Sci Rep 2024; 14:5383. [PMID: 38443410 PMCID: PMC10915139 DOI: 10.1038/s41598-024-54048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
Breast density, or the amount of fibroglandular tissue (FGT) relative to the overall breast volume, increases the risk of developing breast cancer. Although previous studies have utilized deep learning to assess breast density, the limited public availability of data and quantitative tools hinders the development of better assessment tools. Our objective was to (1) create and share a large dataset of pixel-wise annotations according to well-defined criteria, and (2) develop, evaluate, and share an automated segmentation method for breast, FGT, and blood vessels using convolutional neural networks. We used the Duke Breast Cancer MRI dataset to randomly select 100 MRI studies and manually annotated the breast, FGT, and blood vessels for each study. Model performance was evaluated using the Dice similarity coefficient (DSC). The model achieved DSC values of 0.92 for breast, 0.86 for FGT, and 0.65 for blood vessels on the test set. The correlation between our model's predicted breast density and the manually generated masks was 0.95. The correlation between the predicted breast density and qualitative radiologist assessment was 0.75. Our automated models can accurately segment breast, FGT, and blood vessels using pre-contrast breast MRI data. The data and the models were made publicly available.
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Affiliation(s)
- Christopher O Lew
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA.
| | - Majid Harouni
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Ella R Kirksey
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Elianne J Kang
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Haoyu Dong
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Hanxue Gu
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Ruth Walsh
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Dorothy A Lowell
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Box 2731, Durham, NC, 27710, USA
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8
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Althobaiti RF, Brnawe R, Sendi O, Halawani F, Marzogi A. The Level of Awareness Among Healthcare Practitioners Regarding the Relationship Between Breast Density and Breast Cancer. Cureus 2023; 15:e51282. [PMID: 38283416 PMCID: PMC10822193 DOI: 10.7759/cureus.51282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Background Breast cancer is the most prevalent cancer in women, accounting for around 23% of all cancer-related deaths across 140 nations. The awareness about breast density (BD) has a significant impact on early diagnosis of breast cancer. Aim and objective This study aims to assess the awareness of healthcare providers about BD in King Abdullah Medical City. Methods This is an analytical cross-sectional questionnaire-based study among the healthcare practitioners of KAMC in Makkah, Saudi Arabia. Questions measured knowledge about BD and a pass mark indicated participant awareness. The collected data were analyzed using SPSS, and a chi-square test used for bivariate analysis. Results Out of 124 participants, 41% were well aware. Physicians (37% of the sample) were significantly more aware than allied healthcare practitioners and nurses (awareness: 59.6%, 33.3%, 30.4% respectively, (p = 0.03)). Regarding specialty, radiologists and surgeons had the top level of awareness (62% and 64%, respectively) as compared to oncologists (47.1%) and other specialties (29.7%), (p= 0.016). Those above 40 years of age were more aware than those below 40 years (awareness: 62.1% and 34%, respectively, (p=0.007)). Non-significant factors included: gender, years of experience, screened versus non-screened, and receiving information before about BD (p > 0.05). Conclusion The results of this population-based study indicate the existence of moderate deficits in the general knowledge about BD and its relation to breast cancer. This might lead to a late diagnosis. The results showed no dramatic differences in the awareness among healthcare providers.
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Affiliation(s)
| | - Rehab Brnawe
- College of Medicine and Surgery, Umm Al Qura University, Makkah, SAU
| | | | | | - Alaa Marzogi
- Radiology, Breast Imaging, King Abdullah Medical City, Makkah, SAU
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9
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Omoleye OJ, Woodard AE, Howard FM, Zhao F, Yoshimatsu TF, Zheng Y, Pearson AT, Levental M, Aribisala BS, Kulkarni K, Karczmar GS, Olopade OI, Abe H, Huo D. External Evaluation of a Mammography-based Deep Learning Model for Predicting Breast Cancer in an Ethnically Diverse Population. Radiol Artif Intell 2023; 5:e220299. [PMID: 38074785 PMCID: PMC10698602 DOI: 10.1148/ryai.220299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 01/31/2024]
Abstract
Purpose To externally evaluate a mammography-based deep learning (DL) model (Mirai) in a high-risk racially diverse population and compare its performance with other mammographic measures. Materials and Methods A total of 6435 screening mammograms in 2096 female patients (median age, 56.4 years ± 11.2 [SD]) enrolled in a hospital-based case-control study from 2006 to 2020 were retrospectively evaluated. Pathologically confirmed breast cancer was the primary outcome. Mirai scores were the primary predictors. Breast density and Breast Imaging Reporting and Data System (BI-RADS) assessment categories were comparative predictors. Performance was evaluated using area under the receiver operating characteristic curve (AUC) and concordance index analyses. Results Mirai achieved 1- and 5-year AUCs of 0.71 (95% CI: 0.68, 0.74) and 0.65 (95% CI: 0.64, 0.67), respectively. One-year AUCs for nondense versus dense breasts were 0.72 versus 0.58 (P = .10). There was no evidence of a difference in near-term discrimination performance between BI-RADS and Mirai (1-year AUC, 0.73 vs 0.68; P = .34). For longer-term prediction (2-5 years), Mirai outperformed BI-RADS assessment (5-year AUC, 0.63 vs 0.54; P < .001). Using only images of the unaffected breast reduced the discriminatory performance of the DL model (P < .001 at all time points), suggesting that its predictions are likely dependent on the detection of ipsilateral premalignant patterns. Conclusion A mammography DL model showed good performance in a high-risk external dataset enriched for African American patients, benign breast disease, and BRCA mutation carriers, and study findings suggest that the model performance is likely driven by the detection of precancerous changes.Keywords: Breast, Cancer, Computer Applications, Convolutional Neural Network, Deep Learning Algorithms, Informatics, Epidemiology, Machine Learning, Mammography, Oncology, Radiomics Supplemental material is available for this article. © RSNA, 2023See also commentary by Kontos and Kalpathy-Cramer in this issue.
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Affiliation(s)
- Olasubomi J. Omoleye
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Anna E. Woodard
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Frederick M. Howard
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Fangyuan Zhao
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Toshio F. Yoshimatsu
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Yonglan Zheng
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Alexander T. Pearson
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Maksim Levental
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Benjamin S. Aribisala
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Kirti Kulkarni
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Gregory S. Karczmar
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
| | - Olufunmilayo I. Olopade
- From the Center for Clinical Cancer Genetics and Global Health,
Department of Medicine (O.J.O., A.E.W., T.F.Y., Y.Z., B.S.A., O.I.O.), Data
Science Institute (A.E.W.), Division of Hematology/Oncology, Department of
Medicine (F.M.H., A.T.P.), Department of Public Health Sciences (F.Z., D.H.),
Department of Computer Science (M.L.), and Department of Radiology (K.K.,
G.S.K., H.A.), The University of Chicago, 5841 S Maryland Ave, MC 2000, Chicago,
IL 60637; Department of Computer Science, Lagos State University, Lagos, Nigeria
(B.S.A.)
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10
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Sirimahachaiyakul P, Boonjunwetwat D, Meevassana J, Manasnayakorn S, Angspatt A. Weight to volume conversion: an easy and practical breast volume estimation. Gland Surg 2023; 12:1387-1394. [PMID: 38021204 PMCID: PMC10660182 DOI: 10.21037/gs-23-262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023]
Abstract
Background Accurate breast volume estimation is essential for symmetrical breast reconstruction. Easy conversion of the weight of the resected breast tissue to volume could result in precise volume measurements. This study aimed to introduce the use of a mathematical constant (k) to estimate the breast volume from the weight. Methods Eighty-nine female patients with breast cancer who underwent surgery at King Chulalongkorn Memorial Hospital between September 2010 and February 2011 were enrolled in this prospective study. The mammographic density of each patient was classified according to the breast imaging reporting and data system (BI-RADS) into groups a, b, c, and d. The breast density number and mathematical constant (k) were calculated, and the data matched. This technique was validated by comparing the measured and calculated volumes. Results Sixty-six, 22, and 1 patients underwent total mastectomies (TMs), skin-sparing mastectomies (SSMs), and nipple-sparing mastectomies (NSMs), respectively. The breast densities were 1.0629, 1.1545, and 1.2233 g/mL, and the constant number (k) was 0.9409, 0.8662, and 0.8175 for BI-RADS a, combined BI-RADS b and c, and BI-RADS d, respectively. The validation process showed no significant differences between the measured and calculated volumes [95% confidence interval (95% CI)]. The correlation coefficient (r) was 0.984. Conclusions Accurate breast volume estimation is a key factor in achieving symmetry in breast reconstruction. Combining existing data, including the weight of the resected breast tissue and mammographic density findings, an easy and accurate method to calculate the resected breast volume was introduced.
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Affiliation(s)
- Pornthep Sirimahachaiyakul
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Darunee Boonjunwetwat
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiraroch Meevassana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Burn and Wound Care, Chulalongkorn University, Bangkok, Thailand
| | - Sopark Manasnayakorn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Apichai Angspatt
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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11
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Ye Z, Nguyen TL, Dite GS, MacInnis RJ, Schmidt DF, Makalic E, Al-Qershi OM, Bui M, Esser VFC, Dowty JG, Trinh HN, Evans CF, Tan M, Sung J, Jenkins MA, Giles GG, Southey MC, Hopper JL, Li S. Causal relationships between breast cancer risk factors based on mammographic features. Breast Cancer Res 2023; 25:127. [PMID: 37880807 PMCID: PMC10598934 DOI: 10.1186/s13058-023-01733-1] [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: 06/27/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Mammogram risk scores based on texture and density defined by different brightness thresholds are associated with breast cancer risk differently and could reveal distinct information about breast cancer risk. We aimed to investigate causal relationships between these intercorrelated mammogram risk scores to determine their relevance to breast cancer aetiology. METHODS We used digitised mammograms for 371 monozygotic twin pairs, aged 40-70 years without a prior diagnosis of breast cancer at the time of mammography, from the Australian Mammographic Density Twins and Sisters Study. We generated normalised, age-adjusted, and standardised risk scores based on textures using the Cirrus algorithm and on three spatially independent dense areas defined by increasing brightness threshold: light areas, bright areas, and brightest areas. Causal inference was made using the Inference about Causation from Examination of FAmilial CONfounding (ICE FALCON) method. RESULTS The mammogram risk scores were correlated within twin pairs and with each other (r = 0.22-0.81; all P < 0.005). We estimated that 28-92% of the associations between the risk scores could be attributed to causal relationships between the scores, with the rest attributed to familial confounders shared by the scores. There was consistent evidence for positive causal effects: of Cirrus, light areas, and bright areas on the brightest areas (accounting for 34%, 55%, and 85% of the associations, respectively); and of light areas and bright areas on Cirrus (accounting for 37% and 28%, respectively). CONCLUSIONS In a mammogram, the lighter (less dense) areas have a causal effect on the brightest (highly dense) areas, including through a causal pathway via textural features. These causal relationships help us gain insight into the relative aetiological importance of different mammographic features in breast cancer. For example our findings are consistent with the brightest areas being more aetiologically important than lighter areas for screen-detected breast cancer; conversely, light areas being more aetiologically important for interval breast cancer. Additionally, specific textural features capture aetiologically independent breast cancer risk information from dense areas. These findings highlight the utility of ICE FALCON and family data in decomposing the associations between intercorrelated disease biomarkers into distinct biological pathways.
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Affiliation(s)
- Zhoufeng Ye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Tuong L Nguyen
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
- Genetic Technologies Limited, Fitzroy, VIC, 3065, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
| | - Daniel F Schmidt
- Department of Data Science and AI, Faculty of IT, Monash University, Melbourne, Australia
| | - Enes Makalic
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Osamah M Al-Qershi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Vivienne F C Esser
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - James G Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Ho N Trinh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Christopher F Evans
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Maxine Tan
- Electrical and Computer Systems Engineering Discipline, School of Engineering, Monash University Malaysia, 47500, Sunway City, Malaysia
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK, 73019, USA
| | - Joohon Sung
- Department of Public Health Sciences, Division of Genome and Health Big Data, Graduate School of Public Health, Seoul National University, Seoul, 08826, Korea
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, 3004, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3051, Australia.
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, CB1 8RN, UK.
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3051, Australia.
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12
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Wilding M, Fleming J, Moore K, Crook A, Reddy R, Choi S, Schlub TE, Field M, Thiyagarajan L, Thompson J, Berman Y. Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1. Fam Cancer 2023; 22:499-511. [PMID: 37335380 DOI: 10.1007/s10689-023-00340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30-47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable.
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Affiliation(s)
- Mathilda Wilding
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ranjani Reddy
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Sarah Choi
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jeff Thompson
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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13
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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14
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Behrens A, Fasching PA, Schwenke E, Gass P, Häberle L, Heindl F, Heusinger K, Lotz L, Lubrich H, Preuß C, Schneider MO, Schulz-Wendtland R, Stumpfe FM, Uder M, Wunderle M, Zahn AL, Hack CC, Beckmann MW, Emons J. Predicting mammographic density with linear ultrasound transducers. Eur J Med Res 2023; 28:384. [PMID: 37770952 PMCID: PMC10537934 DOI: 10.1186/s40001-023-01327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments. METHODS We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON® 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models. RESULTS Gray level bins and PMD correlated to a certain extent. Spearman's ρ ranged from - 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R2, 0.255). Overall, ultrasound images from the VOLUSON® 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms. CONCLUSIONS In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
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Affiliation(s)
- Annika Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Hannah Lubrich
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline Preuß
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael O Schneider
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna L Zahn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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15
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Illipse M, Czene K, Hall P, Humphreys K. Studying the association between longitudinal mammographic density measurements and breast cancer risk: a joint modelling approach. Breast Cancer Res 2023; 25:64. [PMID: 37296473 PMCID: PMC10257295 DOI: 10.1186/s13058-023-01667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Researchers have suggested that longitudinal trajectories of mammographic breast density (MD) can be used to understand changes in breast cancer (BC) risk over a woman's lifetime. Some have suggested, based on biological arguments, that the cumulative trajectory of MD encapsulates the risk of BC across time. Others have tried to connect changes in MD to the risk of BC. METHODS To summarize the MD-BC association, we jointly model longitudinal trajectories of MD and time to diagnosis using data from a large ([Formula: see text]) mammography cohort of Swedish women aged 40-80 years. Five hundred eighteen women were diagnosed with BC during follow-up. We fitted three joint models (JMs) with different association structures; Cumulative, current value and slope, and current value association structures. RESULTS All models showed evidence of an association between MD trajectory and BC risk ([Formula: see text] for current value of MD, [Formula: see text] and [Formula: see text] for current value and slope of MD respectively, and [Formula: see text] for cumulative value of MD). Models with cumulative association structure and with current value and slope association structure had better goodness of fit than a model based only on current value. The JM with current value and slope structure suggested that a decrease in MD may be associated with an increased (instantaneous) BC risk. It is possible that this is because of increased screening sensitivity rather than being related to biology. CONCLUSION We argue that a JM with a cumulative association structure may be the most appropriate/biologically relevant model in this context.
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Affiliation(s)
- Maya Illipse
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish eScience Research Centre (SeRC), Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Swedish eScience Research Centre (SeRC), Karolinska Institutet, Stockholm, Sweden
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16
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Kai C, Ishizuka S, Otsuka T, Nara M, Kondo S, Futamura H, Kodama N, Kasai S. Automated Estimation of Mammary Gland Content Ratio Using Regression Deep Convolutional Neural Network and the Effectiveness in Clinical Practice as Explainable Artificial Intelligence. Cancers (Basel) 2023; 15:2794. [PMID: 37345132 DOI: 10.3390/cancers15102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Recently, breast types were categorized into four types based on the Breast Imaging Reporting and Data System (BI-RADS) atlas, and evaluating them is vital in clinical practice. A Japanese guideline, called breast composition, was developed for the breast types based on BI-RADS. The guideline is characterized using a continuous value called the mammary gland content ratio calculated to determine the breast composition, therefore allowing a more objective and visual evaluation. Although a discriminative deep convolutional neural network (DCNN) has been developed conventionally to classify the breast composition, it could encounter two-step errors or more. Hence, we propose an alternative regression DCNN based on mammary gland content ratio. We used 1476 images, evaluated by an expert physician. Our regression DCNN contained four convolution layers and three fully connected layers. Consequently, we obtained a high correlation of 0.93 (p < 0.01). Furthermore, to scrutinize the effectiveness of the regression DCNN, we categorized breast composition using the estimated ratio obtained by the regression DCNN. The agreement rates are high at 84.8%, suggesting that the breast composition can be calculated using regression DCNN with high accuracy. Moreover, the occurrence of two-step errors or more is unlikely, and the proposed method can intuitively understand the estimated results.
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Affiliation(s)
- Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Niigata, Japan
| | - Sachi Ishizuka
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Niigata, Japan
| | | | - Miyako Nara
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo 113-8677, Japan
| | - Satoshi Kondo
- Graduate School of Engineering, Muroran Institute of Technology, Muroran City 050-8585, Hokkaido, Japan
| | | | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Niigata, Japan
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata City 950-3198, Niigata, Japan
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17
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Choi EJ, Choi H, Byon JH, Youk JH. Analysis of background echotexture on automated breast ultrasound using BI-RADS and modified classification: Association with clinical features and mammographic density. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:687-695. [PMID: 37014174 DOI: 10.1002/jcu.23426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/30/2022] [Indexed: 05/03/2023]
Abstract
PURPOSE To analyze BE on ABUS using BI-RADS and a modified classification in association with mammographic density and clinical features. METHODS Menopausal status, parity, and family history of breast cancer were collected for 496 women who underwent ABUS and mammography. Three radiologists independently reviewed all ABUS BE and mammographic density. Statistical analyses including kappa statistics (κ) for interobserver agreement, Fisher's exact test, and univariate and multivariate multinomial logistic regression were performed. RESULTS BE distribution between the two classifications and between each classification and mammographic density were associated (P < 0.001). BI-RADS homogeneous-fibroglandular (76.8%) and modified heterogeneous BE (71.3%, 75.7%, and 87.5% of mild, moderate, and marked heterogeneous background echotexture, respectively) tended to be dense. BE was correlated between BI-RADS homogeneous-fat and modified homogeneous background (95.1%) and between BI-RADS homogeneous-fibroglandular or heterogeneous (90.6%) and modified heterogeneous (86.9%) (P < 0.001). In multinomial logistic regression, age < 50 years was independently associated with heterogeneous BE (OR, 8.89, P = 0.003, in BI-RADS; OR, 3.74; P = 0.020 in modified classification). CONCLUSION BI-RADS homogeneous-fat and modified homogeneous BE on ABUS was likely to be mammographically fatty. However, BI-RADS homogeneous-fibroglandular or heterogeneous BE might be classified as any modified BE. Younger age was independently associated with heterogeneous BE.
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Affiliation(s)
- Eun Jung Choi
- Department of Radiology, Research Institute of Clinical Medicine and Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju City, South Korea
| | - Hyemi Choi
- Department of Statistics, Jeonbuk National University, Research Institute of Applied Statistics, Jeonju City, South Korea
| | - Jung Hee Byon
- Department of Radiology, Research Institute of Clinical Medicine and Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju City, South Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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18
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Acciavatti RJ, Lee SH, Reig B, Moy L, Conant EF, Kontos D, Moon WK. Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities. Radiology 2023; 306:e222575. [PMID: 36749212 PMCID: PMC9968778 DOI: 10.1148/radiol.222575] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023]
Abstract
Breast density is an independent risk factor for breast cancer. In digital mammography and digital breast tomosynthesis, breast density is assessed visually using the four-category scale developed by the American College of Radiology Breast Imaging Reporting and Data System (5th edition as of November 2022). Epidemiologically based risk models, such as the Tyrer-Cuzick model (version 8), demonstrate superior modeling performance when mammographic density is incorporated. Beyond just density, a separate mammographic measure of breast cancer risk is parenchymal textural complexity. With advancements in radiomics and deep learning, mammographic textural patterns can be assessed quantitatively and incorporated into risk models. Other supplemental screening modalities, such as breast US and MRI, offer independent risk measures complementary to those derived from mammography. Breast US allows the two components of fibroglandular tissue (stromal and glandular) to be visualized separately in a manner that is not possible with mammography. A higher glandular component at screening breast US is associated with higher risk. With MRI, a higher background parenchymal enhancement of the fibroglandular tissue has also emerged as an imaging marker for risk assessment. Imaging markers observed at mammography, US, and MRI are powerful tools in refining breast cancer risk prediction, beyond mammographic density alone.
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Affiliation(s)
| | | | - Beatriu Reig
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Linda Moy
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Emily F. Conant
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
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19
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Kaur K, Jajoo R, Naman S, Kandwal T, Brar GS, Garg P, Bhullar PS, Baldi A. Identifying barriers to early diagnosis of breast cancer and perception of women in Malwa region of Punjab, India. GLOBAL HEALTH JOURNAL 2023. [DOI: 10.1016/j.glohj.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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20
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Assessing breast density using the chemical-shift encoding-based proton density fat fraction in 3-T MRI. Eur Radiol 2022; 33:3810-3818. [PMID: 36538074 PMCID: PMC10182116 DOI: 10.1007/s00330-022-09341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Abstract
Objectives
There is a clinical need for a non-ionizing, quantitative assessment of breast density, as one of the strongest independent risk factors for breast cancer. This study aims to establish proton density fat fraction (PDFF) as a quantitative biomarker for fat tissue concentration in breast MRI and correlate mean breast PDFF to mammography.
Methods
In this retrospective study, 193 women were routinely subjected to 3-T MRI using a six-echo chemical shift encoding-based water-fat sequence. Water-fat separation was based on a signal model accounting for a single T2* decay and a pre-calibrated 7-peak fat spectrum resulting in volumetric fat-only, water-only images, PDFF- and T2*-values. After semi-automated breast segmentation, PDFF and T2* values were determined for the entire breast and fibroglandular tissue. The mammographic and MRI-based breast density was classified by visual estimation using the American College of Radiology Breast Imaging Reporting and Data System categories (ACR A-D).
Results
The PDFF negatively correlated with mammographic and MRI breast density measurements (Spearman rho: −0.74, p < .001) and revealed a significant distinction between all four ACR categories. Mean T2* of the fibroglandular tissue correlated with increasing ACR categories (Spearman rho: 0.34, p < .001). The PDFF of the fibroglandular tissue showed a correlation with age (Pearson rho: 0.56, p = .03).
Conclusion
The proposed breast PDFF as an automated tissue fat concentration measurement is comparable with mammographic breast density estimations. Therefore, it is a promising approach to an accurate, user-independent, and non-ionizing breast density assessment that could be easily incorporated into clinical routine breast MRI exams.
Key Points
• The proposed PDFF strongly negatively correlates with visually determined mammographic and MRI-based breast density estimations and therefore allows for an accurate, non-ionizing, and user-independent breast density measurement.
• In combination with T2*, the PDFF can be used to track structural alterations in the composition of breast tissue for an individualized risk assessment for breast cancer.
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21
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Singh N, Joshi P, Singh DK, Narayan S, Gupta A. Volumetric breast density evaluation using fully automated Volpara software, its comparison with BIRADS density types and correlation with the risk of malignancy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mammography is currently the modality of choice for mass screening of breast cancer, although its sensitivity is low in dense breasts. Besides, higher breast density has been identified as independent risk factor so it has been conceptualized that women with dense breasts should be encouraged for supplemental screening. In this study, we aimed to estimate the distribution of volumetric breast density using fully automated Volpara software and to analyze the level of agreement between volumetric density grades and Breast Imaging Reporting and Data System (BI-RADS) density grades. We also aim to estimate the distribution of breast cancer in different VDG and to find a correlation between VDG and risk of malignancy.
Results
VDG-c was most common followed by VDG-b and BIRADS grade B was commonest followed by grade C. The density distribution was found inversely related to the age. Level of agreement between VDG and BIRADS grades was moderate (κ = 0.5890). Statistically significant correlation was noted between VDG-c and d for risk of malignancy (p < 0.001).
Conclusion
Difficulties associated with the use of BI-RADS density categories may be avoided if assessed using a fully automated volumetric method. High VDG can be considered as independent risk factor for malignancy. Thus, awareness of a woman’s breast density might be useful in determining the frequency and imaging modality for screening.
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22
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Zheng Y, Dong X, Li J, Qin C, Xu Y, Wang F, Cao W, Xia C, Yu Y, Zhao L, Wu Z, Luo Z, Chen W, Li N, He J. Use of Breast Cancer Risk Factors to Identify Risk-Adapted Starting Age of Screening in China. JAMA Netw Open 2022; 5:e2241441. [PMID: 36355372 PMCID: PMC9650608 DOI: 10.1001/jamanetworkopen.2022.41441] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
IMPORTANCE Although current guidelines highlight the need for earlier screening in women at increased risk of breast cancer in China, data on risk-adapted starting ages of screening are limited. OBJECTIVE To explore the risk-adapted starting age of breast cancer screening in China, with comprehensive consideration of breast cancer risk factors. DESIGN, SETTING, AND PARTICIPANTS A multicenter community-based cohort study was conducted under the framework of the Cancer Screening Program in Urban China. Data were collected from January 1, 2013, to December 31, 2018, for unscreened community-dwelling women aged 40 to 74 years without a history of cancer, kidney dysfunction, or severe heart, brain, or lung disease. Data analysis was performed from October 1, 2021, to August 16, 2022. EXPOSURES Baseline characteristics associated with breast cancer, including first-degree family history of breast cancer, benign breast disease, breastfeeding, age at menarche, and body mass index. MAIN OUTCOMES AND MEASURES Outcomes included breast cancer diagnosis and age at diagnosis. Risk-adapted starting age of screening was defined as the age at which women with different levels of breast cancer risk attained a 10-year cumulative risk level similar to women aged 50 years in the general population. RESULTS Of the 1 549 988 women enrolled in this study, 3895 had breast cancer (median follow-up, 4.47 [IQR, 3.16-6.35] years). Participants were divided into different risk groups according to breast cancer risk scores (driven by risk factors including first-degree family history of breast cancer, benign breast disease, breastfeeding, age at menarche, and body mass index). Using the 10-year cumulative risk of breast cancer at age 50 years in the general population as a benchmark (2.65% [95% CI, 2.50%-2.76%]), the optimal starting age of screening for women with high, medium, or low risk of breast cancer was identified as 43, 48, or after 55 years, respectively. An online calculator was developed to calculate an individual's optimal starting age of screening. CONCLUSIONS AND RELEVANCE This study identifies the risk-adapted starting age of breast cancer screening based on the principle of equal management of equal risks, which may inform updates of current screening guidelines.
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Affiliation(s)
- Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesi Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Qin
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Wu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zilin Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Zhang Z, Conant EF, Zuckerman S. Opinions on the Assessment of Breast Density Among Members of the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2022; 4:480-487. [PMID: 38416952 DOI: 10.1093/jbi/wbac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Dense breast decreases the sensitivity and specificity of mammography and is associated with an increased risk of breast cancer. We conducted a survey to assess the opinions of Society of Breast Imaging (SBI) members regarding density assessment. METHODS An online survey was sent to SBI members twice in September 2020. The survey included active members who were practicing radiologists, residents, and fellows. Mammograms from three patients were presented for density assessment based on routine clinical practice and BI-RADS fourth and fifth editions. Dense breasts were defined as heterogeneously or extremely dense. Frequencies were calculated for each survey response. Pearson's correlation coefficient was used to evaluate the correlation of density assessments by different definitions. RESULTS The survey response rate was 12.4% (357/2875). For density assessments, the Pearson correlation coefficients between routine clinical practice and BI-RADS fourth edition were 0.05, 0.43, and 0.12 for patients 1, 2, and 3, respectively; these increased to 0.65, 0.65, and 0.66 between routine clinical practice and BI-RADS fifth edition for patients 1, 2, and 3, respectively. For future density grading, 79.0% (282/357) of respondents thought it should reflect both potential for masking and overall dense tissue for risk assessment. Additionally, 47.1% (168/357) of respondents thought quantitative methods were of use. CONCLUSION Density assessment varied based on routine clinical practice and BI-RADS fourth and fifth editions. Most breast radiologists agreed that density assessment should capture both masking and overall density. Moreover, almost half of respondents believed computer or artificial intelligence-assisted quantitative methods may help refine density assessment.
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Affiliation(s)
- Zi Zhang
- Einstein Healthcare Network of Jefferson Health, Department of Radiology, Philadelphia, PA, USA
| | - Emily F Conant
- Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA, USA
| | - Samantha Zuckerman
- Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA, USA
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24
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Gudhe NR, Behravan H, Sudah M, Okuma H, Vanninen R, Kosma VM, Mannermaa A. Area-based breast percentage density estimation in mammograms using weight-adaptive multitask learning. Sci Rep 2022; 12:12060. [PMID: 35835933 PMCID: PMC9283472 DOI: 10.1038/s41598-022-16141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Breast density, which is a measure of the relative amount of fibroglandular tissue within the breast area, is one of the most important breast cancer risk factors. Accurate segmentation of fibroglandular tissues and breast area is crucial for computing the breast density. Semiautomatic and fully automatic computer-aided design tools have been developed to estimate the percentage of breast density in mammograms. However, the available approaches are usually limited to specific mammogram views and are inadequate for complete delineation of the pectoral muscle. These tools also perform poorly in cases of data variability and often require an experienced radiologist to adjust the segmentation threshold for fibroglandular tissue within the breast area. This study proposes a new deep learning architecture that automatically estimates the area-based breast percentage density from mammograms using a weight-adaptive multitask learning approach. The proposed approach simultaneously segments the breast and dense tissues and further estimates the breast percentage density. We evaluate the performance of the proposed model in both segmentation and density estimation on an independent evaluation set of 7500 craniocaudal and mediolateral oblique-view mammograms from Kuopio University Hospital, Finland. The proposed multitask segmentation approach outperforms and achieves average relative improvements of 2.88% and 9.78% in terms of F-score compared to the multitask U-net and a fully convolutional neural network, respectively. The estimated breast density values using our approach strongly correlate with radiologists' assessments with a Pearson's correlation of [Formula: see text] (95% confidence interval [0.89, 0.91]). We conclude that our approach greatly improves the segmentation accuracy of the breast area and dense tissues; thus, it can play a vital role in accurately computing the breast density. Our density estimation model considerably reduces the time and effort needed to estimate density values from mammograms by radiologists and therefore, decreases inter- and intra-reader variability.
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Affiliation(s)
- Naga Raju Gudhe
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Multidisciplinary Cancer Research community, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Hamid Behravan
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Multidisciplinary Cancer Research community, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Mazen Sudah
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Hidemi Okuma
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, Radiology, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Veli-Matti Kosma
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Multidisciplinary Cancer Research community, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Arto Mannermaa
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Multidisciplinary Cancer Research community, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
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25
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Wanders AJT, Mees W, Bun PAM, Janssen N, Rodríguez-Ruiz A, Dalmış MU, Karssemeijer N, van Gils CH, Sechopoulos I, Mann RM, van Rooden CJ. Interval Cancer Detection Using a Neural Network and Breast Density in Women with Negative Screening Mammograms. Radiology 2022; 303:269-275. [PMID: 35133194 DOI: 10.1148/radiol.210832] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Inclusion of mammographic breast density (BD) in breast cancer risk models improves accuracy, but accuracy remains modest. Interval cancer (IC) risk prediction may be improved by combining assessments of BD and an artificial intelligence (AI) cancer detection system. Purpose To evaluate the performance of a neural network (NN)-based model that combines the assessments of BD and an AI system in the prediction of risk of developing IC among women with negative screening mammography results. Materials and Methods This retrospective nested case-control study performed with screening examinations included women who developed IC and women with normal follow-up findings (from January 2011 to January 2015). An AI cancer detection system analyzed all studies yielding a score of 1-10, representing increasing likelihood of malignancy. BD was automatically computed using publicly available software. An NN model was trained by combining the AI score and BD using 10-fold cross-validation. Bootstrap analysis was used to calculate the area under the receiver operating characteristic curve (AUC), sensitivity at 90% specificity, and 95% CIs of the AI, BD, and NN models. Results A total of 2222 women with IC and 4661 women in the control group were included (mean age, 61 years; age range, 49-76 years). AUC of the NN model was 0.79 (95% CI: 0.77,0.81), which was higher than AUC of the AI cancer detection system or BD alone (AUC, 0.73 [95% CI: 0.71, 0.76] and 0.69 [95% CI: 0.67, 0.71], respectively; P < .001 for both). At 90% specificity, the NN model had a sensitivity of 50.9% (339 of 666 women; 95% CI: 45.2, 56.3) for prediction of IC, which was higher than that of the AI system (37.5%; 250 of 666 women; 95% CI: 33.0, 43.7; P < .001) or BD percentage alone (22.4%; 149 of 666 women; 95% CI: 17.9, 28.5; P < .001). Conclusion The combined assessment of an artificial intelligence detection system and breast density measurements enabled identification of a larger proportion of women who would develop interval cancer compared with either method alone. Published under a CC BY 4.0 license.
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Affiliation(s)
- Alexander J T Wanders
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Willem Mees
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Petra A M Bun
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Natasja Janssen
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Alejandro Rodríguez-Ruiz
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Mehmet Ufuk Dalmış
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Nico Karssemeijer
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Carla H van Gils
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Ioannis Sechopoulos
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Ritse M Mann
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Cornelis Jan van Rooden
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
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26
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Lee S, Kim H, Lee H, Cho S. Deep-learning-based projection-domain breast thickness estimation for shape-prior iterative image reconstruction in digital breast tomosynthesis. Med Phys 2022; 49:3670-3682. [PMID: 35297075 DOI: 10.1002/mp.15612] [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: 10/27/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) is a technique that can overcome the shortcomings of conventional X-ray mammography and can be effective for the early screening of breast cancer. The compression of the breast is essential during the DBT imaging. However, since the periphery of the breast cannot be compressed to a constant value, nonuniformity of thickness and in-plane shape variation happen. These cause inconvenience in diagnosis, scatter correction, and breast density estimation. PURPOSE In this study, we propose a deep-learning-based methodology for projection-domain breast thickness estimation and demonstrate a shape-prior iterative DBT image reconstruction. METHODS We prepared the Euclidean distance map, the thickness map, and the thickness corrected image of the simulated breast projections for thickness and shape estimation. Each pixel of the Euclidean distance map denotes a distance to the closest skin-line. The thickness map is defined as a conceptual projection of ideal breast support that differentiates the inner and outer regions of the breast phantom. The thickness projection map thus represents the x-ray path lengths of a homogeneous breast phantom. We generated the thickness corrected image by dividing the projection image by the thickness map in a pixel-wise manner. We developed a convolutional neural network for thickness estimation and correction. The network utilizes a projection image and a Euclidean distance image together as a dual input. An estimated breast thickness map is then used for constructing the breast shape mask by use of the discrete algebraic reconstruction technique (DART). RESULTS The proposed network effectively corrected the breast thickness in various simulation situations. Low normalized root-mean-squared error (NRMSE; 1.976%) and high structural similarity (SSIM; 99.997%) indicated a good agreement between the network-generated thickness corrected image and the ground-truth image. Compared to the existing methods and simple single-input network, the proposed method showed outperformance in breast thickness estimation and accordingly in breast shape recovery for various numerical phantoms without provoking any significant artifact. We have demonstrated that the uniformity of voxel value has improved by the inclusion of a shape-prior for the iterative DBT reconstruction. CONCLUSIONS We presented a novel deep-learning-based breast thickness correction and a shape reconstruction method. This approach to estimating the true thickness map and the shape of the breast undergoing compression can benefit various fields such as improvement of diagnostic breast images, scatter correction, material decomposition, and breast density estimation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Seoyoung Lee
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - Hyeongseok Kim
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
| | - Hoyeon Lee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, 02114, USA
| | - Seungryong Cho
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea.,KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea.,KAIST Institutes for IT Convergence and Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Korea
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27
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AKHANLI P, HEPŞEN S, UÇAN B, DÜĞER H, BOSTAN H, KIZILGÜL M, SENCAR ME, ÇAKAL E. The evaluation of breast findings detected through different visualisation techniques in acromegaly patients — a retrospective study. Turk J Med Sci 2021; 51:3073-3081. [PMID: 34530525 PMCID: PMC10734832 DOI: 10.3906/sag-2105-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/16/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim It is known that the increased growth hormone (GH) and insulin-like growth factor-1 (IGF-1) have mitogenic and antiapoptotic properties in breast cells in acromegaly. Our study aims to evaluate breast findings in patients with acromegaly by comparing them to the control group. Materials and methods Sixty-one patients followed with acromegaly diagnosis and 180 healthy controls were included in our study. Demographic data, laboratory results, Breast Imaging-Reporting and Data System (BI-RADS) scores, and breast density evaluated via mammography, malign and benign breast lesions evaluated via mammography, breast ultrasonography (USG), and breast magnetic resonance imaging (MRI) of patients were compared to the control group. Results While BI-RADS scores were similar in patient and control groups, breast density in acromegaly patients was found out to be higher compared to the control group (p = 0.754, p = 0.001, respectively). In acromegaly patients, the breast calcification rate was higher than controls (p = 0.021). t was observed that mass frequency in USG in acromegaly patients increased when GH level increased as well (p = 0.021). No difference was detected between benign and malign breast lesions diagnosed histopathologically ( p = 0.031, p = 0.573, respectively). There was not any difference in terms of BI-RADS scores, breast types, and breast lesions in acromegaly patients that were in remission and not in remission (p > 0.05). Conclusion Benign and malign breast lesions were found out to be similar to the control group, although breast density rate was detected to be higher in acromegaly patients. A regular follow-up is required in these patients via suitable breast visualization techniques considering their age and clinical status due to mass formation risk derived from increased GH level and extreme breast density despite the absence of any detected breast lesion frequency in acromegaly patients.
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Affiliation(s)
- Pınar AKHANLI
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Sema HEPŞEN
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Bekir UÇAN
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Hakan DÜĞER
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Hayri BOSTAN
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Muhammed KIZILGÜL
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Muhammed Erkam SENCAR
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
| | - Erman ÇAKAL
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey
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28
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Wang J, Greuter MJW, Vermeulen KM, Brokken FB, Dorrius MD, Lu W, de Bock GH. Cost-effectiveness of abbreviated-protocol MRI screening for women with mammographically dense breasts in a national breast cancer screening program. Breast 2021; 61:58-65. [PMID: 34915447 PMCID: PMC8683595 DOI: 10.1016/j.breast.2021.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Magnetic resonance imaging (MRI) has shown the potential to improve the screening effectiveness among women with dense breasts. The introduction of fast abbreviated protocols (AP) makes MRI more feasible to be used in a general population. We aimed to investigate the cost-effectiveness of AP-MRI in women with dense breasts (heterogeneously/extremely dense) in a population-based screening program. Methods A previously validated model (SiMRiSc) was applied, with parameters updated for women with dense breasts. Breast density was assumed to decrease with increased age. The base scenarios included six biennial AP-MRI strategies, with biennial mammography from age 50–74 as reference. Fourteen alternative scenarios were performed by varying screening interval (triennial and quadrennial) and by applying a combined strategy of mammography and AP-MRI. A 3% discount rate for both costs and life years gained (LYG) was applied. Model robustness was evaluated using univariate and probabilistic sensitivity analyses. Results The six biennial AP-MRI strategies ranged from 132 to 562 LYG per 10,000 women, where more frequent application of AP-MRI was related to higher LYG. The optimal strategy was biennial AP-MRI screening from age 50–65 for only women with extremely dense breasts, producing an incremental cost-effectiveness ratio of € 18,201/LYG. At a threshold of € 20,000/LYG, the probability that the optimal strategy was cost-effective was 79%. Conclusion Population-based biennial breast cancer screening with AP-MRI from age 50–65 for women with extremely dense breasts might be a cost-effective alternative to mammography, but is not an option for women with heterogeneously dense breasts. AP-MRI can be cost-effective for screening women with extremely dense breast. The more frequent the use of AP-MRI, the more life years will be gained. Biennial AP-MRI for women with extremely dense breast up to age 65 is optimal.
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Affiliation(s)
- Jing Wang
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
| | - Marcel J W Greuter
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands.
| | - Karin M Vermeulen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
| | - Frank B Brokken
- University of Groningen, Department of Computing Science, Groningen, the Netherlands.
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands.
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
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29
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Hu X, Jiang L, You C, Gu Y. Fibroglandular Tissue and Background Parenchymal Enhancement on Breast MR Imaging Correlates With Breast Cancer. Front Oncol 2021; 11:616716. [PMID: 34660251 PMCID: PMC8515131 DOI: 10.3389/fonc.2021.616716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate the association of breast cancer with both the background parenchymal enhancement intensity and volume (BPEI and BPEV, respectively) and the amount of fibroglandular tissue (FGT) using an automatic quantitative assessment method in breast magnetic resonance imaging (MRI). Materials and Methods Among 17,274 women who underwent breast MRI, 132 normal women (control group), 132 women with benign breast lesions (benign group), and 132 women with breast cancer (cancer group) were randomly selected and matched by age and menopausal status. The area under the receiver operating characteristic curve (AUC) was compared in Cancer vs Control and Cancer vs Benign groups to assess the discriminative ability of BPEI, BPEV and FGT. Results Compared with the control groups, the cancer group showed a significant difference in BPEV with a maximum AUC of 0.715 and 0.684 for patients in premenopausal and postmenopausal subgroup, respectively. And the cancer group showed a significant difference in BPEV with a maximum AUC of 0.622 and 0.633 for patients in premenopausal and postmenopausal subgroup, respectively, when compared with the benign group. FGT showed no significant difference when breast cancer group was compared with normal control and benign lesion group, respectively. Compared with the control groups, BPEI showed a slight difference in the cancer group. Compared with the benign group, no significant difference was seen in cancer group. Conclusion Increased BPEV is correlated with a high risk of breast cancer While FGT is not.
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Affiliation(s)
- Xiaoxin Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Luan Jiang
- Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
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30
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Noguchi N, Marinovich ML, Wylie EJ, Lund HG, Houssami N. Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening. Med J Aust 2021; 215:359-365. [PMID: 34374095 PMCID: PMC9290915 DOI: 10.5694/mja2.51216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Objectives To estimate rates of screen‐detected and interval breast cancers, stratified by risk factor, to inform discussions of risk‐stratified population screening. Design Retrospective population‐based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data. Setting, participants All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 ‒ 30 June 2017. Main outcome measures Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor. Results A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67‒70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2‒10.1) cancers per 10 000 women‐years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk‐relevant benign conditions (P = 0.012), hormone‐replacement therapy (P = 0.002), and self‐reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone‐replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40‒49 years. Conclusions Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk‐relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self‐reported breast‐related symptoms, and women using hormone‐replacement therapy. Our findings could inform the evaluation of risk‐based screening.
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Affiliation(s)
| | | | | | | | - Nehmat Houssami
- Sydney School of Public Health, University of Sydney, Sydney, NSW
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31
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Barkhausen J, Bischof A, Haverstock D, Klemens M, Brueggenwerth G, Weber O, Endrikat J. Diagnostic efficacy of contrast-enhanced breast MRI versus X-ray mammography in women with different degrees of breast density. Acta Radiol 2021; 62:586-593. [PMID: 32678675 DOI: 10.1177/0284185120936271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Detection of breast cancer in women with high breast densities is a clinical challenge. PURPOSE To study the influence of different degrees of breast density on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) versus X-ray mammography (XRM). MATERIAL AND METHODS We performed an additional analysis of two large Phase III clinical trials (G1; G2) which included women with histologically proven breast cancers, called "index cancers." Additional cancers were detected during image reading. We compared the sensitivity of CE-BMRI and XRM in women with different breast densities (ACR A→D; Version 5). For each study, six blinded readers evaluated the images. Results are given as the "Median Reader." RESULTS A total of 774 patients were included, 169 had additional cancers. While sensitivity of CE-BMRI for detecting all index cancers was independent of breast density (ACR A→D) (G1: 83%→83%; G2: 91%→91%) the sensitivity of XRM declined (ACR A→D) (G1: 79%→62%; G2: 82%→64%). Thus, the sensitivity difference between both imaging modalities in ACR A breasts of 3% (G1) and 9% (G2) increased to 21% (G1) and 26% (G2) in ACR D breasts. Sensitivity of CE-BMRI for detecting at least one additional cancer increased with increasing breast density (ACR A→D) (G1: 50%→73%, G2: 57%→81%). XRM's sensitivity decreased (G1: 34%→20%) or remained stable (G2: 24%→25%). CONCLUSION CE-BMRI showed significantly higher sensitivity compared to XRM.
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Affiliation(s)
- Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Arpad Bischof
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | | | - Mark Klemens
- Bayer AG, General Clinical Imaging Services, 13353, Germany
| | | | - Olaf Weber
- Bayer AG, Radiology R&D, Berlin, Germany
- Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Jan Endrikat
- Bayer AG, Radiology R&D, Berlin, Germany
- University Medical School of Saarland, Dept of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany
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32
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Valencia-Hernandez I, Peregrina-Barreto H, Reyes-Garcia CA, Lopez-Armas GC. Density map and fuzzy classification for breast density by using BI-RADS. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105825. [PMID: 33190944 DOI: 10.1016/j.cmpb.2020.105825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
Mammographic density (MD) is conformed by a different percentage of stromal, epithelial, and adipose tissue within the breast. One of the most critical findings in mammographic patterns for establishing a diagnosis of breast cancer is high breast tissue density. There is a wide variety of works focused on the study and automatic calculation of general breast density; however, they do not provide more detailed information about the changes that may occur within the breast tissue. This work proposes to generate a breast density map based on a texture analysis to identify the internal composition and distribution of the breast tissue through the diffuse division technique of the different densities inside the breast. Therefore, it is possible to obtain a density map associated with the breast that allows us to distinguish and quantify the different types of breast densities and their distribution according to the Breast Imaging Reporting and Data System (BI-RADS Breast Density Category). The proposed methodology was tested with mammograms from the BCDR and InBreast databases, demonstrating consistency in results and reaching an accuracy of 84.2% and 81.3%, respectively. Finally, the information obtained from the density map and its analysis could be a support tool for the specialist physician to monitor changes in breast density over time, since the fuzzy classification carried out allows quantifying the degree of membership in the BI-RADS breast density classes.
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Affiliation(s)
- I Valencia-Hernandez
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro 1, Santa Maria Tonantzintla, Puebla 72840, México
| | - H Peregrina-Barreto
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro 1, Santa Maria Tonantzintla, Puebla 72840, México.
| | - C A Reyes-Garcia
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro 1, Santa Maria Tonantzintla, Puebla 72840, México
| | - G C Lopez-Armas
- Centro de Enseñanza Técnica Industrial, Nueva Escocia 1885, Guadalajara, Jalisco, 44638, México
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Guo ZF, Kong FL. Akt regulates RSK2 to alter phosphorylation level of H2A.X in breast cancer. Oncol Lett 2021; 21:187. [PMID: 33574926 PMCID: PMC7816342 DOI: 10.3892/ol.2021.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
Histone H2AX (H2A.X) is a variant of the histone H2A family. Phosphorylation of H2A.X is a marker of DNA strand breaks and the presence or absence of H2A.X is closely related to tumor susceptibility and drug resistance. The present study found that the activity of the serine/threonine kinase Akt was negatively associated with H2A.X phosphorylated at the Ser16 site (H2A.X S16ph), but the mechanism of the inverse relationship remains elusive. The aim of the present study was to elucidate the mechanism of action between Akt and H2A.X S16ph and the exact role of this mechanism. Western blot analysis was performed to detect the regulatory association between p-Akt and H2A.X S16ph/p-RSK2, and immunoprecipitation and chromatin immunoprecipitation were performed to prove that Akt, RSK2 and H2A.X combine and interact in human breast cancer cells. The changes of cellular proliferation and migration induced by the interaction of Akt, RSK2 and H2A.X was determined by MTT, soft agar colony formation and cell migration experiments. The effect of interaction of Akt, RSK2 and H2A.X on cancer-promoting genes, such as PSAT-1 was determined via reverse transcription-quantitative PCR analysis. The current study indicated that the serine/threonine kinase ribosomal S6 kinase 2 (RSK2) as a kinase of H2A.X could be phosphorylated by Akt at Ser19 site. Moreover, Akt positively regulated the phosphorylation of RSK2 to inhibit phosphorylation of H2A.X, thereby affecting the affinity between RSK2 and substrate histone, promoting the survival and migration of breast cancer cells. In conclusion, Akt-mediated phosphorylation of RSK2 regulated the phosphorylation of H2A.X, thereby promoting oncogenic activity. This finding provides new insights to understand the pathogenesis and treatment mechanisms of breast cancer.
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Affiliation(s)
- Zhi-Feng Guo
- Department of Oncology, Section II, Chifeng Municipal Hospital, Chifeng, Inner Mongolia Autonomous Region 024000, P.R. China
| | - Fan-Long Kong
- Department of Oncology, Section II, Chifeng Municipal Hospital, Chifeng, Inner Mongolia Autonomous Region 024000, P.R. China
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Yang W, He X, He C, Peng L, Xing S, Li D, Wang L, Jin T, Yuan D. Impact of ESR1 Polymorphisms on Risk of Breast Cancer in the Chinese Han Population. Clin Breast Cancer 2020; 21:e235-e242. [PMID: 33281037 DOI: 10.1016/j.clbc.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/20/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The estrogen receptor-1 (ESR1) gene encodes estrogen receptor-α, which is a major biomarker in the development of breast cancer. This study aimed to investigate the effect of ESR1 polymorphisms on breast cancer in Chinese Han women. MATERIALS AND METHODS We genotyped 4 candidate single nucleotide polymorphisms (SNPs) in ESR1 among 503 patients with breast cancer and 503 healthy people using the Agena MassARRAY platform. The association between ESR1 polymorphisms and breast cancer risk was evaluated using odds ratios (ORs) and 95% confidence intervals (95% CIs) under 4 genetic models. The HaploReg v4.1 and GEPIA database were used for SNP functional annotation and ESR1 expression analysis, respectively. RESULTS The T allele of rs9383938 in ESR1 was significantly associated with an increased breast cancer risk (OR, 1.26; 95% CI, 1.05-1.50; P = .013). In genetic models, rs9383938 increased breast cancer risk in the codominant model (OR, 1.54; 95% CI, 1.07-2.22; P = .021), the dominant model (OR, 1.31; 95% CI, 1.01-1.68; P = .040), and the additive model (OR, 1.24; 95% CI, 1.04-1.48; P = .017). Stratification analysis showed that rs9383938 and rs2228480 raised the breast cancer susceptibility in individuals aged younger than 52 years old. Rs1801132 of ESR1 was significantly associated with the status of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 in the allele model and genetic models (P < .05). CONCLUSIONS This study demonstrated that ESR1 polymorphisms might influence breast cancer susceptibility in the Chinese Han population. Further mechanism studies are needed to confirm the contribution of ESR1.
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Affiliation(s)
- Wei Yang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Xue He
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Chunjuan He
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Linna Peng
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Shishi Xing
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Dandan Li
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Li Wang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
| | - Tianbo Jin
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China.
| | - Dongya Yuan
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China.
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Wernli KJ, Bowles EA, Knerr S, Leppig KA, Ehrlich K, Gao H, Schwartz MD, O’Neill SC. Characteristics Associated with Participation in ENGAGED 2 - A Web-based Breast Cancer Risk Communication and Decision Support Trial. Perm J 2020; 24:1-4. [PMID: 33482952 PMCID: PMC7849258 DOI: 10.7812/tpp/19.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 10/14/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated demographic and clinical characteristics associated with participation in a clinical trial testing the efficacy of an online tool to support breast cancer risk communication and decision support for risk mitigation to determine the generalizability of trial results. METHODS Eligible women were members of Kaiser Permanente Washington aged 40-69 years with a recent normal screening mammogram, heterogeneously or extremely dense breasts and a calculated risk of > 1.67% based on the Breast Cancer Surveillance Consortium 5-year breast cancer risk model. Trial outcomes were chemoprevention and breast magnetic resonance imaging by 12-months post-baseline. Women were recruited via mail with phone follow-up using plain language materials notifying them of their density status and higher than average breast cancer risk. Multivariable logistic regression calculated independent odds ratios (ORs) for associations between demographic and clinical characteristics with trial participation. RESULTS Of 2,569 eligible women contacted, 995 (38.7%) participated. Women with some college (OR = 1.99, 95% confidence interval [CI] 1.34-2.96) or college degree (OR = 3.35, 95% CI 2.29-4.90) were more likely to participate than high school-educated women. Race/ethnicity also was associated with participation (African-American OR = 0.50, 95% CI 0.29-0.87; Asian OR = 0.22, 95% CI 0.12-0.41). Multivariate adjusted ORs for family history of breast/ovarian cancer were not associated with trial participation. DISCUSSION Use of plain language and potential access to a website providing personal breast cancer risk information and education were insufficient in achieving representative participation in a breast cancer prevention trial. Additional methods of targeting and tailoring, potentially facilitated by clinical and community outreach, are needed to facilitate equitable engagement for all women.
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Affiliation(s)
- Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin A Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Suzanne C O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Barkovskaya A, Buffone A, Žídek M, Weaver VM. Proteoglycans as Mediators of Cancer Tissue Mechanics. Front Cell Dev Biol 2020; 8:569377. [PMID: 33330449 PMCID: PMC7734320 DOI: 10.3389/fcell.2020.569377] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022] Open
Abstract
Proteoglycans are a diverse group of molecules which are characterized by a central protein backbone that is decorated with a variety of linear sulfated glycosaminoglycan side chains. Proteoglycans contribute significantly to the biochemical and mechanical properties of the interstitial extracellular matrix where they modulate cellular behavior by engaging transmembrane receptors. Proteoglycans also comprise a major component of the cellular glycocalyx to influence transmembrane receptor structure/function and mechanosignaling. Through their ability to initiate biochemical and mechanosignaling in cells, proteoglycans elicit profound effects on proliferation, adhesion and migration. Pathologies including cancer and cardiovascular disease are characterized by perturbed expression of proteoglycans where they compromise cell and tissue behavior by stiffening the extracellular matrix and increasing the bulkiness of the glycocalyx. Increasing evidence indicates that a bulky glycocalyx and proteoglycan-enriched extracellular matrix promote malignant transformation, increase cancer aggression and alter anti-tumor therapy response. In this review, we focus on the contribution of proteoglycans to mechanobiology in the context of normal and transformed tissues. We discuss the significance of proteoglycans for therapy response, and the current experimental strategies that target proteoglycans to sensitize cancer cells to treatment.
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Affiliation(s)
- Anna Barkovskaya
- Center for Bioengineering & Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Alexander Buffone
- Center for Bioengineering & Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Martin Žídek
- Center for Bioengineering & Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Valerie M. Weaver
- Center for Bioengineering & Tissue Regeneration, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Radiation Oncology, Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, United States
- Department of Therapeutic Sciences, Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
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Wang JM, Zhao HG, Liu TT, Wang FY. Evaluation of the association between mammographic density and the risk of breast cancer using Quantra software and the BI-RADS classification. Medicine (Baltimore) 2020; 99:e23112. [PMID: 33181680 PMCID: PMC7668426 DOI: 10.1097/md.0000000000023112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the association between mammographic density (MD) and the risk of breast cancer (BC) in Chinese women and to investigate the role of fertility risk factors in regulating the relationship between MD and BC.We used Quantra software and the BI-RADS classification to assess MD in 466 patients and 932 controls. Conditional matched logistic multiple regression analysis was used to determine the relationship between MD and BC, and risk was evaluated with the odds ratio (OR) and 95% confidence interval (CI).The ORs for category 4 versus category 2 were 1.95 (95% confidence interval [95% CI] (1.42∼2.66)) and 1.76 (95% CI (1.28∼2.42)) for the BI-RADS and Quantra classifications, respectively. The ORs for category 5 volumetric breast density (VBD) versus category 2 VBD and 5 fibroglandular tissue volume (FGV) versus category 2 FGV were 1.63 (95% CI (1.20∼2.23)) and 1.92 (95% CI (1.40∼2.63)), respectively. Females with category 5 VBD whose age at menarche was ≤13 years had the highest risk of BC (OR = 2.16, 95% CI (1.24∼3.79)), and females with category 5 FGV whose age at menarche was = 15 years had the lowest risk of BC (OR = 1.65, 95% CI (1.05∼2.62)). Females with categories 3-5 VBD and categories 3-5 FGV had reduced risks of BC with increasing number of births. Females with category 5 VBD had an increased risk of BC with increasing age at first childbirth (the OR increased from 1.49 to 1.95). Those with category 5 VBD had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 2.08 to 1.55). Females with category 5 FGV had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 4.12 to 1.62).Both the BI-RADS density classification and Quantra measures indicated that MD is positively associated with the risk of BC in Chinese women and that associations between MD and BC risk differ by age at menarche, parity, age at first childbirth and breastfeeding duration.
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Azam S, Eriksson M, Sjölander A, Hellgren R, Gabrielson M, Czene K, Hall P. Mammographic Density Change and Risk of Breast Cancer. J Natl Cancer Inst 2020; 112:391-399. [PMID: 31298705 DOI: 10.1093/jnci/djz149] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We examined the association between annual mammographic density change (MDC) and breast cancer (BC) risk, and how annual MDC influences the association between baseline mammographic density (MD) and BC risk. METHODS We used the Karolinska Mammography Project for Risk Prediction of Breast Cancer cohort of Swedish women (N = 43 810) aged 30-79 years with full access to BC risk factors and mammograms. MD was measured as dense area (cm2) and percent MD using the STRATUS method. We used the contralateral mammogram for women with BC and randomly selected a mammogram from either left or right breast for healthy women. We calculated relative area MDC between repeated examinations. Relative area MDC was categorized as decreased (>10% decrease per year), stable (no change), or increased (>10% increase per year). We used Cox proportional hazards regression to estimate the association of BC with MDC and interaction analysis to investigate how MDC modified the association between baseline MD and BC risk. All tests of statistical significance were two-sided. RESULTS In all, 563 women were diagnosed with BC. Compared with women with a decreased MD over time, no statistically significant difference in BC risk was seen for women with either stable MD or increasing MD (hazard ratio = 1.01, 95% confidence interval = 0.82 to 1.23, P = .90; and hazard ratio = 0.98, 95% confidence interval = 0.80 to 1.22, P = .90, respectively). Categorizing baseline MD and subsequently adding MDC did not seem to influence the association between baseline MD and BC risk. CONCLUSIONS Our results suggest that annual MDC does not influence BC risk. Furthermore, MDC does not seem to influence the association between baseline MD and BC risk.
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Affiliation(s)
- Shadi Azam
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Roxanna Hellgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Södersjukhuset, Stockholm, Sweden
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
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Cheng Q, Parvin B. Organoid model of mammographic density displays a higher frequency of aberrant colony formations with radiation exposure. Bioinformatics 2020; 36:1989-1993. [PMID: 31778145 DOI: 10.1093/bioinformatics/btz888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/10/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
MOTIVATION Aberrant three-dimensional (3D) colony organization of premalignant human mammary epithelial cells (HMECs) is one of the indices of dysplasia. An experiment has been designed where the stiffness of the microenvironment, in 3D culture, has been set at either low or high level of mammographic density (MD) and the organoid models are exposed to 50 cGy X-ray radiation. This study utilizes published bioinformatics tools to quantify the frequency of aberrant colony formations by the combined stressors of stiffness and X-ray exposure. One of the goals is to develop a quantitative assay for evaluating the risk factors associated with women with high MD exposed to X-ray radiation. RESULTS Analysis of 3D colony formations indicate that high stiffness, within the range of high MD, and X-ray radiation have an approximately additive effect on increasing the frequency of aberrant colony formations. Since both stiffness and X-ray radiation are DNA-damaging stressors, the additive effect of these stressors is also independently validated by profiling activin A-secreted protein. Secretion of activin A is known to be higher in tissues with a high MD as well as tumor cells. In addition, we show that increased stiffness of the microenvironment also induces phosphorylation of γH2AX-positive foci. The study uses two HMECs derived from a diseased tissue (e.g. MCF10A) and reduction mammoplasty of normal breast tissue (e.g. 184A1) to further demonstrate similar traits in the frequency of aberrant colony organization. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Qingsu Cheng
- Department of Electrical and Biomedical Engineering, University of Nevada, Reno, NV 89557-0260, USA
| | - Bahram Parvin
- Department of Electrical and Biomedical Engineering, University of Nevada, Reno, NV 89557-0260, USA
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Development of digital breast tomosynthesis and diffuse optical tomography fusion imaging for breast cancer detection. Sci Rep 2020; 10:13127. [PMID: 32753578 PMCID: PMC7403423 DOI: 10.1038/s41598-020-70103-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Diffuse optical tomography (DOT) non-invasively measures the functional characteristics of breast lesions using near infrared light to probe tissue optical properties. This study aimed to evaluate a new digital breast tomosynthesis (DBT)/DOT fusion imaging technique and obtain preliminary data for breast cancer detection. Twenty-eight women were prospectively enrolled and underwent both DBT and DOT examinations. DBT/DOT fusion imaging was created after acquisition of both examinations. Two breast radiologists analyzed DBT and DOT images independently, and then finally evaluated the fusion images. The diagnostic performance of each reading session was compared and interobserver agreement was assessed. The technical success rate was 96.4%, with one failure due to an error during DOT data storage. Among the 27 women finally included in the analysis, 13 had breast cancer. The areas under the receiver operating characteristic curve (AUCs) for DBT were 0.783 and 0.854 for readers 1 and 2, respectively. DOT showed comparable diagnostic performance to DBT for both readers. The AUCs were significantly improved (P = 0.004) when the DBT/DOT fusion images were used. Interobserver agreements were highest for the DBT/DOT fusion images. In conclusion, this study suggests that DBT/DOT fusion imaging technique appears to be a promising tool for breast cancer diagnosis.
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Ghieh D, Saade C, Najem E, El Zeghondi R, Rawashdeh MA, Berjawi G. Staying abreast of imaging - Current status of breast cancer detection in high density breast. Radiography (Lond) 2020; 27:229-235. [PMID: 32611494 DOI: 10.1016/j.radi.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.
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Affiliation(s)
- D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - E Najem
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - R El Zeghondi
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - M A Rawashdeh
- Department of Allied Medical Sciences, Jordan University of Science and Technology, P.O.Box: 3030, Irbid 22110, Jordan.
| | - G Berjawi
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Alomaim W, O’Leary D, Ryan J, Rainford L, Evanoff M, Foley S. Subjective Versus Quantitative Methods of Assessing Breast Density. Diagnostics (Basel) 2020; 10:diagnostics10050331. [PMID: 32455552 PMCID: PMC7277954 DOI: 10.3390/diagnostics10050331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.
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Affiliation(s)
- Wijdan Alomaim
- Radiography & Medical Imaging, Fatima College of Health Sciences, Abu Dhabi, UAE
- Correspondence: ; Tel.: +9712-5078639
| | - Desiree O’Leary
- Radiography (Diagnostic Imaging), Keele University, Keele ST5 5BG, UK; D.s.o'
| | - John Ryan
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | - Louise Rainford
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | | | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
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Araújo ALC, Soares HB, Carvalho DF, Mendonça RM, Oliveira AG. Design and clinical validation of a software program for automated measurement of mammographic breast density. BMC Med Inform Decis Mak 2020; 20:45. [PMID: 32122371 PMCID: PMC7053043 DOI: 10.1186/s12911-020-1062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mammographic breast density is an important predictor of breast cancer, but its measurement has limitations related to subjectivity of visual evaluation or to difficult access for automatic volumetric measurement methods. Herein, we describe the design and clinical validation of Aguida, a software program for automated quantification of breast density from flat mammography images. Materials and methods The software program was developed in MatLab. After image segmentation separating the background from the breast image, the operator positions a cursor defining a region of interest on the pectoralis major muscle from the mediolateral oblique view. Then, in the craniocaudal view, the threshold for separation of the dense tissue is based on the optical density of the pectoral muscle, and the proportion of dense tissue is calculated by the program. Mammograms obtained from 2 different occasions in 291 women were used for clinical evaluation. Results The intraclass correlation coefficient (ICC) between breast density measurements by the software and by a radiologist was 0.96, with a bias of only 0.67 percentage points and a 95% limit of agreement of 13.5 percentage points; the ICC was 0.94 in the interobserver reliability assessment by two radiologists with different experience; and the ICC was 0.98 in the intraobserver reliability assessment. The distribution among the density classes was close to the values obtained with the volumetric software. Conclusions Measurement of breast density with the Aguida program from flat mammography images showed high agreement with the visual determination by radiologists, and high inter- and intra-observer reliability.
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Affiliation(s)
- Adriano L C Araújo
- Department of Radiology, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha 620, Petrópolis, Natal, RN, 59012-300, Brazil. .,Instituto de Radiologia de Natal, Av. Afonso Pena 744 - Tirol, Natal, RN, 59020-100, Brazil.
| | - Heliana B Soares
- Department of Biomedical Engineering, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Av. Senador Salgado Filho 300, Lagoa Nova, Natal, RN, 59078-970, Brazil
| | - Daniel F Carvalho
- Department of Biomedical Engineering, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Av. Senador Salgado Filho 300, Lagoa Nova, Natal, RN, 59078-970, Brazil
| | - Roberto M Mendonça
- Department of Radiology, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha 620, Petrópolis, Natal, RN, 59012-300, Brazil
| | - Antonio G Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias s/n, Petrópolis, Natal, RN, 29012-570, Brazil
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Johnson HM, Shivalingappa H, Irish W, Wong JH, Muzaffar M, Verbanac K, Vohra NA. Race May Not Impact Endocrine Therapy-Related Changes in Breast Density. Cancer Epidemiol Biomarkers Prev 2020; 29:1049-1057. [PMID: 32098892 DOI: 10.1158/1055-9965.epi-19-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/03/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reduction in breast density may be a biomarker of endocrine therapy (ET) efficacy. Our objective was to assess the impact of race on ET-related changes in volumetric breast density (VBD). METHODS This retrospective cohort study assessed longitudinal changes in VBD measures in women with estrogen receptor-positive invasive breast cancer treated with ET. VBD, the ratio of fibroglandular volume (FGV) to breast volume (BV), was measured using Volpara software. Changes in measurements were evaluated using a multivariable linear mixed effects model. RESULTS Compared with white women (n = 191), black women (n = 107) had higher rates of obesity [mean ± SD body mass index (BMI) 34.5 ± 9.1 kg/m2 vs. 30.6 ± 7.0 kg/m2, P < 0.001] and premenopausal status (32.7% vs. 16.7%, P = 0.002). Age- and BMI-adjusted baseline FGV, BV, and VBD were similar between groups. Modeled longitudinal changes were also similar: During a follow-up of 30.7 ± 15.0 months (mean ± SD), FGV decreased over time in premenopausal women (slope = -0.323 cm3; SE = 0.093; P = 0.001), BV increased overall (slope = 2.475 cm3; SE = 0.483; P < 0.0001), and VBD decreased (premenopausal slope = -0.063%, SE = 0.011; postmenopausal slope = -0.016%, SE = 0.004; P < 0.0001). Race was not significantly associated with these longitudinal changes, nor did race modify the effect of time on these changes. Higher BMI was associated with lower baseline VBD (P < 0.0001). Among premenopausal women, VBD declined more steeply for women with lower BMI (time × BMI, P = 0.0098). CONCLUSIONS Race does not appear to impact ET-related longitudinal changes in VBD. IMPACT Racial disparities in estrogen receptor-positive breast cancer recurrence and mortality may not be explained by differential declines in breast density due to ET.
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Affiliation(s)
- Helen M Johnson
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Hitesh Shivalingappa
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.,Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - William Irish
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jan H Wong
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Mahvish Muzaffar
- Division of Hematology Oncology, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Kathryn Verbanac
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Nasreen A Vohra
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.
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The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review. Breast 2020; 50:95-103. [PMID: 32120064 PMCID: PMC7073883 DOI: 10.1016/j.breast.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The majority of ‘low-risk’ (grade I/II) Ductal Carcinoma In Situ (DCIS) may not progress to invasive breast cancer during a women’s lifetime. Therefore, the safety of active surveillance versus standard surgical treatment for DCIS is prospectively being evaluated in clinical trials. If proven safe and selectively implemented in clinical practice, a significant group of women with low-risk DCIS may forego surgery and radiotherapy in the future. Identification of modifiable and non-modifiable risk factors associated with prognosis after a primary DCIS would also enhance our care of women with low-risk DCIS. Methods To identify modifiable and non-modifiable risk factors for subsequent breast events after DCIS, we performed a systematic literature search in PUBMED, EMBASE and Scopus. Results Six out of the 3870 articles retrieved were included for final data extraction. These six studies included a total of 4950 patients with primary DCIS and 640 recorded subsequent breast events. There was moderate evidence for an association of a family history of breast cancer, premenopausal status, high BMI, and high breast density with a subsequent breast cancer or further DCIS. Conclusion There is a limited number of recent studies published on the impact of modifiable and non-modifiable risk factors on subsequent events after DCIS. The available evidence is insufficient to identify potential targets for risk reduction strategies, reflecting the relatively small numbers and the lack of long-term follow-up in DCIS, a low-event condition. Need for risk management strategies for untreated DCIS patients. Limited evidence for association between lifestyle factors and prognosis after DCIS. Positive family history, premenopausal status, high breast density associated with prognosis.
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47
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Mahorter SS, Knerr S, Bowles EJA, Wernli KJ, Gao H, Schwartz MD, O'Neill SC. Prior breast density awareness, knowledge, and communication in a health system-embedded behavioral intervention trial. Cancer 2020; 126:1614-1621. [PMID: 31977078 DOI: 10.1002/cncr.32711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/22/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Breast density is an important breast cancer risk factor and a focus of recent national and state health policy efforts. This article describes breast density awareness, knowledge, and communication among participants in a health system-embedded trial with clinically elevated breast cancer risk 1 year before state-mandated density disclosure. METHODS Trial participants' demographics and prior health history were ascertained from electronic health records. The proportions of women reporting prior breast density awareness, knowledge of density's masking effect, and communication with a provider about their own breast density were calculated using baseline interview data collected from 2017 to 2018. Multiple logistic regression was used to estimate associations between women's characteristics and density awareness, knowledge, and communication. RESULTS Although the overwhelming majority of participants had heard of breast density (91%) and were aware of breast density's masking effect (87%), only 60% had ever discussed their breast density with a provider. Annual mammography screening was associated with prior breast density awareness (odds ratio [OR], 2.97; 95% confidence interval [CI], 1.29-6.81), knowledge (OR, 2.83; 95% CI, 1.20-6.66), and communication (OR, 2.87; 95% CI, 1.34-6.16) compared with an infrequent or unknown screening interval. Receipt of breast biopsy was also associated with prior knowledge (OR, 1.60; 95% CI, 1.04-2.45) and communication (OR, 1.36; 95% CI, 1.00-1.85). CONCLUSIONS Breast density awareness and knowledge are high among insured women participating in clinical research, even in the absence of mandated density disclosure. Patient-provider communication about personal density status is less common, particularly among women with fewer interactions with breast health specialists.
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Affiliation(s)
- Siobhan S Mahorter
- Department of Health Services, University of Washington, Seattle, Washington
| | - Sarah Knerr
- Department of Health Services, University of Washington, Seattle, Washington
| | | | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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48
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Minami CA, Zabor EC, Gilbert E, Newman A, Park A, Jochelson MS, King TA, Pilewskie ML. Do Body Mass Index and Breast Density Impact Cancer Risk Among Women with Lobular Carcinoma In Situ? Ann Surg Oncol 2020; 27:1844-1851. [PMID: 31898097 DOI: 10.1245/s10434-019-08126-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Both body mass index (BMI) and breast density impact breast cancer risk in the general population. Whether obesity and density represent additive risk factors in women with lobular carcinoma in situ (LCIS) is unknown. METHODS Patients diagnosed with LCIS from 1988 to 2017 were identified from a prospectively maintained database. BMI was categorized by World Health Organization classification. Density was captured as the mammographic Breast Imaging Reporting and Data System (BIRADS) value. Other covariates included age at LCIS diagnosis, menopausal status, family history, chemoprevention, and prophylactic mastectomy. Cancer-free probability was estimated using the Kaplan-Meier method, and Cox regression models were used for univariable and multivariable analyses. RESULTS A total of 1222 women with LCIS were identified. At a median follow-up of 7 years, 179 women developed breast cancer (121 invasive, 58 ductal carcinoma in situ); 5- and 10-year cumulative incidences of breast cancer were 10% and 17%, respectively. In multivariable analysis, increased breast density (BIRADS C/D vs. A/B) was significantly associated with increased hazard of breast cancer (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.52-3.88), whereas BMI was not. On multivariable analysis, chemoprevention use was associated with a significantly decreased hazard of breast cancer (HR 0.49, 95% CI 0.29-0.84). Exploratory analyses did not demonstrate significant interaction between BMI and menopausal status, BMI and breast density, BMI and chemoprevention use, or breast density and chemoprevention. CONCLUSIONS Breast cancer risk among women with LCIS is impacted by breast density. These results aid in personalizing risk assessment among women with LCIS and highlight the importance of chemoprevention counseling for risk reduction.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ashley Newman
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Park
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Melissa L Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Quantitative Volumetric K-Means Cluster Segmentation of Fibroglandular Tissue and Skin in Breast MRI. J Digit Imaging 2019; 31:425-434. [PMID: 29047034 DOI: 10.1007/s10278-017-0031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Mammographic breast density (MBD) is the most commonly used method to assess the volume of fibroglandular tissue (FGT). However, MRI could provide a clinically feasible and more accurate alternative. There were three aims in this study: (1) to evaluate a clinically feasible method to quantify FGT with MRI, (2) to assess the inter-rater agreement of MRI-based volumetric measurements and (3) to compare them to measurements acquired using digital mammography and 3D tomosynthesis. This retrospective study examined 72 women (mean age 52.4 ± 12.3 years) with 105 disease-free breasts undergoing diagnostic 3.0-T breast MRI and either digital mammography or tomosynthesis. Two observers analyzed MRI images for breast and FGT volumes and FGT-% from T1-weighted images (0.7-, 2.0-, and 4.0-mm-thick slices) using K-means clustering, data from histogram, and active contour algorithms. Reference values were obtained with Quantra software. Inter-rater agreement for MRI measurements made with 2-mm-thick slices was excellent: for FGT-%, r = 0.994 (95% CI 0.990-0.997); for breast volume, r = 0.985 (95% CI 0.934-0.994); and for FGT volume, r = 0.979 (95% CI 0.958-0.989). MRI-based FGT-% correlated strongly with MBD in mammography (r = 0.819-0.904, P < 0.001) and moderately to high with MBD in tomosynthesis (r = 0.630-0.738, P < 0.001). K-means clustering-based assessments of the proportion of the fibroglandular tissue in the breast at MRI are highly reproducible. In the future, quantitative assessment of FGT-% to complement visual estimation of FGT should be performed on a more regular basis as it provides a component which can be incorporated into the individual's breast cancer risk stratification.
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50
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Pacilè S, Dullin C, Baran P, Tonutti M, Perske C, Fischer U, Albers J, Arfelli F, Dreossi D, Pavlov K, Maksimenko A, Mayo SC, Nesterets YI, Taba ST, Lewis S, Brennan PC, Gureyev TE, Tromba G, Wienbeck S. Free propagation phase-contrast breast CT provides higher image quality than cone-beam breast-CT at low radiation doses: a feasibility study on human mastectomies. Sci Rep 2019; 9:13762. [PMID: 31551475 PMCID: PMC6760215 DOI: 10.1038/s41598-019-50075-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/22/2019] [Indexed: 12/09/2022] Open
Abstract
In this study we demonstrate the first direct comparison between synchrotron x-ray propagation-based CT (PB-CT) and cone-beam breast-CT (CB-CT) on human mastectomy specimens (N = 12) including different benign and malignant lesions. The image quality and diagnostic power of the obtained data sets were compared and judged by two independent expert radiologists. Two cases are presented in detail in this paper including a comparison with the corresponding histological evaluation. Results indicate that with PB-CT it is possible to increase the level of contrast-to-noise ratio (CNR) keeping the same level of dose used for the CB-CT or achieve the same level of CNR reached by CB-CT at a lower level of dose. In other words, PB-CT can achieve a higher diagnostic potential compared to the commercial breast-CT system while also delivering a considerably lower mean glandular dose. Therefore, we believe that PB-CT technique, if translated to a clinical setting, could have a significant impact in improving breast cancer diagnosis.
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Affiliation(s)
- S Pacilè
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy. .,Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - C Dullin
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy.,Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.,Translational Molecular Imaging, Max-Plank-Institute for Experimental Medicine, Goettingen, Germany
| | - P Baran
- ARC Centre of Excellence in Advanced Molecular Imaging, School of Physics, The University of Melbourne, Parkville, Australia
| | - M Tonutti
- Department of Radiology, Academic Hospital of Trieste, Trieste, Italy
| | - C Perske
- Institute for Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - U Fischer
- Diagnostic Breast Center Goettingen, Goettingen, Germany
| | - J Albers
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - F Arfelli
- Department of Physics, University of Trieste, Trieste, Italy
| | - D Dreossi
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy
| | - K Pavlov
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand.,School of Science and Technology, University of New England, Armidale, Australia.,School of Physics and Astronomy, Monash University, Clayton, Australia
| | | | - S C Mayo
- Commonwealth Scientific and Industrial Research Organisation, Clayton, Australia
| | - Y I Nesterets
- Commonwealth Scientific and Industrial Research Organisation, Clayton, Australia.,School of Science and Technology, University of New England, Armidale, Australia
| | - S Tavakoli Taba
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - S Lewis
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - P C Brennan
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - T E Gureyev
- ARC Centre of Excellence in Advanced Molecular Imaging, School of Physics, The University of Melbourne, Parkville, Australia.,School of Science and Technology, University of New England, Armidale, Australia.,School of Physics and Astronomy, Monash University, Clayton, Australia.,The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - G Tromba
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy
| | - S Wienbeck
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
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