1
|
Brooks JD, Christensen RAG, Sung JS, Pike MC, Orlow I, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and breast cancer risk factors: A cross-sectional study in pre- and post-menopausal women. NPJ Breast Cancer 2022; 8:97. [PMID: 36008488 PMCID: PMC9411561 DOI: 10.1038/s41523-022-00458-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022] Open
Abstract
Breast tissue enhances on contrast MRI and is called background parenchymal enhancement (BPE). Having high BPE has been associated with an increased risk of breast cancer. We examined the relationship between BPE and the amount of fibroglandular tissue on MRI (MRI-FGT) and breast cancer risk factors. This was a cross-sectional study of 415 women without breast cancer undergoing contrast-enhanced breast MRI at Memorial Sloan Kettering Cancer Center. All women completed a questionnaire assessing exposures at the time of MRI. Prevalence ratios (PR) and 95% confidence intervals (CI) describing the relationship between breast cancer risk factors and BPE and MRI-FGT were generated using modified Poisson regression. In multivariable-adjusted models a positive association between body mass index (BMI) and BPE was observed, with a 5-unit increase in BMI associated with a 14% and 44% increase in prevalence of high BPE in pre- and post-menopausal women, respectively. Conversely, a strong inverse relationship between BMI and MRI-FGT was observed in both pre- (PR = 0.66, 95% CI 0.57, 0.76) and post-menopausal (PR = 0.66, 95% CI 0.56, 0.78) women. Use of preventive medication (e.g., tamoxifen) was associated with having low BPE, while no association was observed for MRI-FGT. BPE is an imaging marker available from standard contrast-enhanced MRI, that is influenced by endogenous and exogenous hormonal exposures in both pre- and post-menopausal women.
Collapse
Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
2
|
Ahmad R, Ahmed B, Ahmed B. Effectiveness of MRI in screening women for breast cancer: a systematic review. BREAST CANCER MANAGEMENT 2022. [DOI: 10.2217/bmt-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Artificial intelligence techniques for the diagnosis of disease continue to develop with rapid pace. This review article systematically determines incremental accuracy and other parameters of current methods, including sensitivity, specificity, positive predictive value and negative predictive value with regard to breast MRI as a screening tool for women under 50 years. Articles were included from the databases of health technology assessment agencies from 2000 to 2019, using various medical subject heading terms. A total of 23 eligible studies were included incorporating a total of 11,688 patients out of which two were multicentered, four were accuracy studies, seven were prospective studies and four were retrospective studies. MRI screening showed an adequate detection of invasive cancers, premalignant lesions and pre-invasive cancers, suggesting that MRI is a powerful surveillance tool to detect cancer in high-risk populations. These findings have indicated that MRI has particular sensitivity and specificity for the diagnosis of breast cancer. PROSPERO Registration Number: CRD42020158372.
Collapse
Affiliation(s)
- Rani Ahmad
- Radiology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Basem Ahmed
- Radiology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bassam Ahmed
- Faculity of Medicine in Rabigh, King Abdulaziz University, Makkah, Saudi Arabia
| |
Collapse
|
3
|
Henze Bancroft LC, Strigel RM, Macdonald EB, Longhurst C, Johnson J, Hernando D, Reeder SB. Proton density water fraction as a reproducible MR-based measurement of breast density. Magn Reson Med 2021; 87:1742-1757. [PMID: 34775638 DOI: 10.1002/mrm.29076] [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] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To introduce proton density water fraction (PDWF) as a confounder-corrected (CC) MR-based biomarker of mammographic breast density, a known risk factor for breast cancer. METHODS Chemical shift encoded (CSE) MR images were acquired using a low flip angle to provide proton density contrast from multiple echo times. Fat and water images, corrected for known biases, were produced by a six-echo CC CSE-MRI algorithm. Fibroglandular tissue (FGT) volume was calculated from whole-breast segmented PDWF maps at 1.5T and 3T. The method was evaluated in (1) a physical fat-water phantom and (2) normal volunteers. Results from two- and three-echo CSE-MRI methods were included for comparison. RESULTS Six-echo CC-CSE-MRI produced unbiased estimates of the total water volume in the phantom (mean bias 3.3%) and was reproducible across protocol changes (repeatability coefficient [RC] = 14.8 cm3 and 13.97 cm3 at 1.5T and 3.0T, respectively) and field strengths (RC = 51.7 cm3 ) in volunteers, while the two- and three-echo CSE-MRI approaches produced biased results in phantoms (mean bias 30.7% and 10.4%) that was less reproducible across field strengths in volunteers (RC = 82.3 cm3 and 126.3 cm3 ). Significant differences in measured FGT volume were found between the six-echo CC-CSE-MRI and the two- and three-echo CSE-MRI approaches (p = 0.002 and p = 0.001, respectively). CONCLUSION The use of six-echo CC-CSE-MRI to create unbiased PDWF maps that reproducibly quantify FGT in the breast is demonstrated. Further studies are needed to correlate this quantitative MR biomarker for breast density with mammography and overall risk for breast cancer.
Collapse
Affiliation(s)
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin B Macdonald
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jacob Johnson
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
4
|
Quantitative Measures of Background Parenchymal Enhancement Predict Breast Cancer Risk. AJR Am J Roentgenol 2021; 217:64-75. [PMID: 32876474 PMCID: PMC9801515 DOI: 10.2214/ajr.20.23804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND. Higher categories of background parenchymal enhancement (BPE) increase breast cancer risk. However, current clinical BPE categorization is subjective. OBJECTIVE. Using a semiautomated segmentation algorithm, we calculated quantitative BPE measures and investigated the utility of individual features and feature pairs in significantly predicting subsequent breast cancer risk compared with radiologist-assigned BPE category. METHODS. In this retrospective case-control study, we identified 95 women at high risk of breast cancer but without a personal history of breast cancer who underwent breast MRI. Of these women, 19 subsequently developed breast cancer and were included as cases. Each case was age matched to four control patients (76 control patients total). Sociodemographic characteristics were compared between the cases and matched control patients using the Mann-Whitney U test. From each dynamic contrast-enhanced MRI examination, quantitative fibroglandular tissue and BPE measures were computed by averaging enhancing voxels above enhancement ratio thresholds (0-100%), totaling the enhancing volume above thresholds (BPE volume in cm3), and estimating the percentage of enhancing tissue above thresholds relative to total breast volume (BPE%) on each gadolinium-enhanced phase. For the 91 imaging features generated, we compared predictive performance using conditional logistic regression with 80:20 hold-out cross validation and ROC curve analysis. ROC AUC was the figure of merit. Sensitivity, specificity, PPV, and NPV were also computed. All feature pairs were exhaustively searched to identify those with the highest AUC and Youden index. A DeLong test was used to compare predictive performance (AUCs). RESULTS. Women subsequently diagnosed with breast cancer were more likely to have mild, moderate, or marked BPE (odds ratio, 3.0; 95% CI, 0.9-10.0; p = .07). According to ROC curve analysis, a BPE category threshold greater than minimal resulted in a maximized AUC (0.62) in distinguishing cases from control patients. Compared with BPE category, the first gadolinium-enhanced (phase 1) BPE% at the 30% and 40% enhancement ratio thresholds yielded significantly higher AUC values of 0.85 (p = .0007) and 0.84 (p = .0004), respectively. Feature combinations showed similar AUC values with improved sensitivity. CONCLUSION. Preliminary data indicate that quantitative BPE measures may outperform radiologist-assigned category in breast cancer risk prediction. CLINICAL IMPACT. Future risk prediction models that incorporate quantitative measures warrant additional investigation.
Collapse
|
5
|
Lo Gullo R, Daimiel I, Rossi Saccarelli C, Bitencourt A, Sevilimedu V, Martinez DF, Jochelson MS, Morris EA, Reiner JS, Pinker K. MRI background parenchymal enhancement, fibroglandular tissue, and mammographic breast density in patients with invasive lobular breast cancer on adjuvant endocrine hormonal treatment: associations with survival. Breast Cancer Res 2020; 22:93. [PMID: 32819432 PMCID: PMC7441557 DOI: 10.1186/s13058-020-01329-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To investigate if baseline and/or changes in contralateral background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) measured on magnetic resonance imaging (MRI) and mammographic breast density (MD) can be used as imaging biomarkers for overall and recurrence-free survival in patients with invasive lobular carcinomas (ILCs) undergoing adjuvant endocrine treatment. METHODS Women who fulfilled the following inclusion criteria were included in this retrospective HIPAA-compliant IRB-approved study: unilateral ILC, pre-treatment breast MRI and/or mammography from 2000 to 2010, adjuvant endocrine treatment, follow-up MRI, and/or mammography 1-2 years after treatment onset. BPE, FGT, and mammographic MD of the contralateral breast were independently graded by four dedicated breast radiologists according to BI-RADS. Associations between the baseline levels and change in levels of BPE, FGT, and MD with overall survival and recurrence-free survival were assessed using Kaplan-Meier survival curves and Cox regression analysis. RESULTS Two hundred ninety-eight patients (average age = 54.1 years, range = 31-79) fulfilled the inclusion criteria. The average follow-up duration was 11.8 years (range = 2-19). Baseline and change in levels of BPE, FGT, and MD were not significantly associated with recurrence-free or overall survival. Recurrence-free and overall survival were affected by histological subtype (p < 0.0001), number of metastatic axillary lymph nodes (p < 0.0001), age (p = 0.01), and adjuvant endocrine treatment duration (p < 0.001). CONCLUSIONS Qualitative evaluation of BPE, FGT, and mammographic MD changes cannot predict which patients are more likely to benefit from adjuvant endocrine treatment.
Collapse
Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Isaac Daimiel
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Almir Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Jeffrey S Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging Service, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.
| |
Collapse
|
6
|
Negrão de Figueiredo G, Ingrisch M, Fallenberg EM. Digital Analysis in Breast Imaging. Breast Care (Basel) 2019; 14:142-150. [PMID: 31316312 DOI: 10.1159/000501099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/21/2019] [Indexed: 01/02/2023] Open
Abstract
Breast imaging is a multimodal approach that plays an essential role in the diagnosis of breast cancer. Mammography, sonography, magnetic resonance, and image-guided biopsy are imaging techniques used to search for malignant changes in the breast or precursors of malignant changes in, e.g., screening programs or follow-ups after breast cancer treatment. However, these methods still have some disadvantages such as interobserver variability and the mammography sensitivity in women with radiologically dense breasts. In order to overcome these difficulties and decrease the number of false positive findings, improvements in imaging analysis with the help of artificial intelligence are constantly being developed and tested. In addition, the extraction and correlation of imaging features with special tumor characteristics and genetics of the patients in order to get more information about treatment response, prognosis, and also cancer risk are coming more and more in focus. The aim of this review is to address recent developments in digital analysis of images and demonstrate their potential value in multimodal breast imaging.
Collapse
Affiliation(s)
| | - Michael Ingrisch
- Department of Radiology, Ludwig Maximilian University of Munich - Grosshadern Campus, Munich, Germany
| | - Eva Maria Fallenberg
- Department of Radiology, Ludwig Maximilian University of Munich - Grosshadern Campus, Munich, Germany
| |
Collapse
|
7
|
Rampun A, Scotney BW, Morrow PJ, Wang H, Winder J. Segmentation of breast MR images using a generalised 2D mathematical model with inflation and deflation forces of active contours. Artif Intell Med 2019; 97:44-60. [DOI: 10.1016/j.artmed.2018.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 11/28/2022]
|
8
|
Wengert GJ, Helbich TH, Leithner D, Morris EA, Baltzer PAT, Pinker K. Multimodality Imaging of Breast Parenchymal Density and Correlation with Risk Assessment. CURRENT BREAST CANCER REPORTS 2019; 11:23-33. [PMID: 35496471 PMCID: PMC9044508 DOI: 10.1007/s12609-019-0302-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review Breast density, or the amount of fibroglandular tissue in the breast, has become a recognized and independent marker for breast cancer risk. Public awareness of breast density as a possible risk factor for breast cancer has resulted in legislation for risk stratification purposes in many US states. This review will provide a comprehensive overview of the currently available imaging modalities for qualitative and quantitative breast density assessment and the current evidence on breast density and breast cancer risk assessment. Recent Findings To date, breast density assessment is mainly performed with mammography and to some extent with magnetic resonance imaging. Data indicate that computerized, quantitative techniques in comparison with subjective visual estimations are characterized by higher reproducibility and robustness. Summary Breast density reduces the sensitivity of mammography due to a masking effect and is also a recognized independent risk factor for breast cancer. Standardized breast density assessment using automated volumetric quantitative methods has the potential to be used for risk prediction and stratification and in determining the best screening plan for each woman.
Collapse
|
9
|
Denholm R, De Stavola BL, Hipwell JH, Doran SJ, Holly JMP, Folkerd E, Dowsett M, Leach MO, Hawkes DJ, Dos-Santos-Silva I. Circulating Growth and Sex Hormone Levels and Breast Tissue Composition in Young Nulliparous Women. Cancer Epidemiol Biomarkers Prev 2018; 27:1500-1508. [PMID: 30228153 DOI: 10.1158/1055-9965.epi-18-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/30/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endogenous hormones are associated with breast cancer risk, but little is known about their role on breast tissue composition, a strong risk predictor. This study aims to investigate the relationship between growth and sex hormone levels and breast tissue composition in young nulliparous women. METHODS A cross-sectional study of 415 young (age ∼21.5 years) nulliparous women from an English prebirth cohort underwent a MRI examination of their breasts to estimate percent-water (a proxy for mammographic percent density) and provided a blood sample to measure plasma levels of growth factors (insulin-like growth factor-I, insulin-like growth factor-II, insulin growth factor-binding protein-3, growth hormone) and, if not on hormonal contraception (n = 117) sex hormones (dehydroepiandrosterone, androstenedione, testosterone, estrone, estadiol, sex hormone-binding globulin, prolactin). Testosterone (n = 330) and sex hormone-binding globulin (n = 318) were also measured at age 15.5 years. Regression models were used to estimate the relative difference (RD) in percent-water associated with one SD increment in hormone levels. RESULTS Estradiol at age 21.5 and sex hormone-binding globulin at age 21.5 were positively associated with body mass index (BMI)-adjusted percent-water [RD (95% confidence interval (CI)): 3% (0%-7%) and 3% (1%-5%), respectively]. There was a positive nonlinear association between androstenedione at age 21.5 and percent-water. Insulin-like growth factor-I and growth hormone at age 21.5 were also positively associated with BMI-adjusted percent-water [RD (95% CI): 2% (0%-4%) and 4% (1%-7%), respectively]. CONCLUSIONS The findings suggest that endogenous hormones affect breast tissue composition in young nulliparous women. IMPACT The well-established associations of childhood growth and development with breast cancer risk may be partly mediated by the role of endogenous hormones on breast tissue composition.
Collapse
Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bianca L De Stavola
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - John H Hipwell
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
| | - Simon J Doran
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeff M P Holly
- IGFs & Metabolic Endocrinology Group, School of Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Folkerd
- The Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- The Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| |
Collapse
|
10
|
Denholm R, De Stavola B, Hipwell JH, Doran SJ, Busana MC, Leach MO, Hawkes DJ, dos-Santos-Silva I. Growth Trajectories, Breast Size, and Breast-Tissue Composition in a British Prebirth Cohort of Young Women. Am J Epidemiol 2018; 187:1259-1268. [PMID: 29140420 PMCID: PMC5982787 DOI: 10.1093/aje/kwx358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 11/14/2022] Open
Abstract
Mammographic percent density, the proportion of fibroglandular tissue in the breast, is a strong risk factor for breast cancer, but its determinants in young women are unknown. We examined associations of magnetic resonance imaging (MRI) breast-tissue composition at age 21 years with prospectively collected measurements of body size and composition from birth to early adulthood and markers of puberty (all standardized) in a sample of 500 nulliparous women from a prebirth cohort of children born in Avon, United Kingdom, in 1991-1992 and followed up to 2011-2014. Linear models were fitted to estimate relative change in MRI percent water, which is equivalent to mammographic percent density, associated with a 1-standard-deviation increase in the exposure of interest. In mutually adjusted analyses, MRI percent water was positively associated with birth weight (relative change (RC) = 1.03, 95% confidence interval (CI): 1.00, 1.06) and pubertal height growth (RC = 1.07, 95% CI: 1.02, 1.13) but inversely associated with pubertal weight growth (RC = 0.86, 95% CI: 0.84, 0.89) and changes in dual-energy x-ray absorptiometry percent body fat mass (e.g., for change between ages 11 years and 13.5 years, RC = 0.96, 95% CI: 0.93, 0.99). Ages at thelarche and menarche were positively associated with MRI percent water, but these associations did not persist upon adjustment for height and weight growth. These findings support the hypothesis that growth trajectories influence breast-tissue composition in young women, whereas puberty plays no independent role.
Collapse
Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John H Hipwell
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Simon J Doran
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Marta C Busana
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Center, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J Hawkes
- Center for Medical Image Computing, Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
11
|
Petrillo A, Catalano O, Fusco R, Filice S, Vallone P, Setola S, Granata V, Raiano C, Avino F, Di Bonito M, Botti G. Optical imaging of the breast: evaluation of deoxyhemoglobin concentration alteration in 166 patients with suspicious breast lesions. Eur Radiol Exp 2018; 2:8. [PMID: 29708210 PMCID: PMC5911436 DOI: 10.1186/s41747-018-0038-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/31/2018] [Indexed: 12/29/2022] Open
Abstract
Background We investigated the performance of optical imaging evaluating deoxyhemoglobin concentration alteration (DeHCA) in breast tissues. Methods We enrolled all consecutive patients from January 2015 to October 2016 with clinically suspicious and/or BI-RADS grade 3–5 lesions at mammography or ultrasound (US). Patients underwent optical imaging (ComfortScan) to evaluate for DeHCA. The reference standard was pathology from a surgical specimen for malignant lesions, pathology from a surgical specimen or core needle biopsy for benign lesions, and negative follow-up for contralateral negative breasts. Non-parametric statistics, receiver operating characteristic, and linear discrimination analyses were performed. Results Of 334 enrolled patients, 168 (50%) were excluded for technical problems and 166 (50%) (median age 52 years) were analyzed totaling 331 breasts and 176 lesions. Of these, 75 were benign (median size 19 mm) and 101 malignant (median size 20 mm). The median DeHCA score in malignant lesions (0.95, interquartile range [IQR] 1.00–0.87) was higher (p < 0.001) than in benign lesions (0.80, IQR 0.95–0.70). Using the optimal cutoff (0.85), DeHCA score was less accurate than mammography, US, and their combination, with 78% sensitivity, 52% specificity, 40% positive predictive value (PPV), and 85% negative predictive value (NPV); using a 0.8 cutoff, sensitivity reached 93% and NPV 91%, but specificity fell to 32% and PPV to 37%. The accuracy of DeHCA score linearly combined with mammography or US was higher than that of DeHCA score alone (p < 0.001) and not significantly higher than that of mammography or US alone. Conclusions DeHCA score was significantly higher in malignant than in benign lesions, but its accuracy was significantly lower than that of mammography or US. Future refinements are needed.
Collapse
Affiliation(s)
- Antonella Petrillo
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Orlando Catalano
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Roberta Fusco
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Salvatore Filice
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Paolo Vallone
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Sergio Setola
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Vincenza Granata
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Concetta Raiano
- 1Radiology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Franca Avino
- 2Senology Surgery Unit, Dipartimento Corp-S Assistenziale e di Ricerca dei Percorsi Oncologici del Distretto Toracico, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Maurizio Di Bonito
- 3Pathology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| | - Gerardo Botti
- 3Pathology Unit, Dipartimento di Supporto ai Percorsi Oncologici Area Diagnostica, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy
| |
Collapse
|
12
|
Alikhassi A, Miratashi Yazdi SN, Akbari H, Kia SA, Baikpour M. Correlation Between Mammographic Breast Density, Breast Tissue Type in Ultrasonography, Fibroglandular Tissue, and Background Parenchymal Enhancement in Magnetic Resonance Imaging. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418771971. [PMID: 29706765 PMCID: PMC5912268 DOI: 10.1177/1178223418771971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/18/2018] [Indexed: 11/16/2022]
Abstract
Objective Breast cancer is the most common malignancy in the female population, and imaging studies play a critical role for its early detection. Mammographic breast density (MBD) is one of the markers used to predict the risk stratification of breast cancer in patients. We aimed to assess the correlations among MBD, ultrasound breast composition (USBC), fibroglandular tissue (FGT), and the amount of background parenchymal enhancement (BPE) in magnetic resonance imaging, after considering the subjects' menopausal status. Methods In this retrospective cross-sectional study, the medical records' archives in a tertiary referral hospital were reviewed. Data including age, menopausal status, their mammograms, and ultrasound assessments were extracted from their records. All of their imaging studies were reviewed, and MBD, USBC, FGT, and BPE were determined, recorded, and entered into SPSS software for analysis. Results A total of 121 women (mean age = 42.7 ± 11.0 years) were included, of which 35 out of 115 (30.4%) had reached menopause. Using the Jonckheere-Terpstra test for evaluating the trends among above mentioned 4 radiologic characteristics in the total sample population, a significant positive relation was found between each of these paired variables: (1) USBC-MBD (P = .006), (2) FGT-MBD (P = .001), (3) USBC-BPE (P = .046), (4) USBC-FGT (P = .036), and (5) BPE-FGT (P < .001). These trends were not found to be significant among premenopausal subjects. Conclusions Considering the trends between different measures of breast density in the 3 radiologic modalities, these factors can be used interchangeably in certain settings.
Collapse
Affiliation(s)
- Afsaneh Alikhassi
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hedieh Akbari
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Akbari Kia
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Baikpour
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Ding J, Stopeck AT, Gao Y, Marron MT, Wertheim BC, Altbach MI, Galons JP, Roe DJ, Wang F, Maskarinec G, Thomson CA, Thompson PA, Huang C. Reproducible automated breast density measure with no ionizing radiation using fat-water decomposition MRI. J Magn Reson Imaging 2018; 48:971-981. [PMID: 29630755 DOI: 10.1002/jmri.26041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increased breast density is a significant independent risk factor for breast cancer, and recent studies show that this risk is modifiable. Hence, breast density measures sensitive to small changes are desired. PURPOSE Utilizing fat-water decomposition MRI, we propose an automated, reproducible breast density measurement, which is nonionizing and directly comparable to mammographic density (MD). STUDY TYPE Retrospective study. POPULATION The study included two sample sets of breast cancer patients enrolled in a clinical trial, for concordance analysis with MD (40 patients) and reproducibility analysis (10 patients). FIELD STRENGTH/SEQUENCE The majority of MRI scans (59 scans) were performed with a 1.5T GE Signa scanner using radial IDEAL-GRASE sequence, while the remaining (seven scans) were performed with a 3T Siemens Skyra using 3D Cartesian 6-echo GRE sequence with a similar fat-water separation technique. ASSESSMENT After automated breast segmentation, breast density was calculated using FraGW, a new measure developed to reliably reflect the amount of fibroglandular tissue and total water content in the entire breast. Based on its concordance with MD, FraGW was calibrated to MR-based breast density (MRD) to be comparable to MD. A previous breast density measurement, Fra80-the ratio of breast voxels with <80% fat fraction-was also calculated for comparison with FraGW. STATISTICAL TESTS Pearson correlation was performed between MD (reference standard) and FraGW (and Fra80). Test-retest reproducibility of MRD was evaluated using the difference between test-retest measures (Δ1-2 ) and intraclass correlation coefficient (ICC). RESULTS Both FraGW and Fra80 were strongly correlated with MD (Pearson ρ: 0.96 vs. 0.90, both P < 0.0001). MRD converted from FraGW showed higher test-retest reproducibility (Δ1-2 variation: 1.1% ± 1.2%; ICC: 0.99) compared to MD itself (literature intrareader ICC ≤0.96) and Fra80. DATA CONCLUSION The proposed MRD is directly comparable with MD and highly reproducible, which enables the early detection of small breast density changes and treatment response. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:971-981.
Collapse
Affiliation(s)
- Jie Ding
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Alison T Stopeck
- Department of Hematology and Oncology, Stony Brook Medicine, Stony Brook, New York, USA.,Stony Brook University Cancer Center, Stony Brook, New York, USA
| | - Yi Gao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, USA
| | | | | | - Maria I Altbach
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Jean-Philippe Galons
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Denise J Roe
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Fang Wang
- Stony Brook University Cancer Center, Stony Brook, New York, USA
| | | | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Patricia A Thompson
- Stony Brook University Cancer Center, Stony Brook, New York, USA.,Department of Pathology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Chuan Huang
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.,Stony Brook University Cancer Center, Stony Brook, New York, USA.,Department of Radiology, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Psychiatry, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Computer Science, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
14
|
Brooks JD, Sung JS, Pike MC, Orlow I, Stanczyk FZ, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer 2018. [PMID: 29524207 PMCID: PMC6041161 DOI: 10.1002/ijc.31370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background parenchymal enhancement (BPE) is the degree to which normal breast tissue enhances on contrast-enhanced magnetic resonance imaging (MRI). MRI-density is a volumetric measure of breast density that is highly correlated with mammographic density, an established breast cancer risk factor. Endogenous estrogen concentrations are positively associated with postmenopausal breast cancer risk and BPE has been shown to be sensitive to hormonal exposures. The objective of our study was to examine the relationship between BPE and MRI-density and serum hormone concentrations in postmenopausal women. This was a study of cancer-free postmenopausal women undergoing contrast-enhanced breast MRI (N = 118). At the time of MRI all women completed a self-administered questionnaire and blood samples were collected for hormone analyses. Serum concentrations of estrone (E1), estradiol (E2) and bioavailable E2 were examined by category of BPE and MRI-density. Compared to women with "minimal" BPE, those who had "marked" BPE had significantly higher serum concentrations of E1, E2 and bioavailable E2 (90% increase, ptrend across all categories = 0.001; 150% increase, ptrend = 0.001; and 158% increase, ptrend = 0.001, respectively). These associations were only affected to a minor extent by adjustment for BMI and other variables. After adjustment for BMI, no significant associations between MRI-density and serum E1, E2 and bioavailable E2 were observed. Serum estrogen concentrations were significantly positively associated with BPE. Our study provides further evidence of the hormone-sensitive nature of BPE, indicating a potential role for BPE as an imaging marker of endogenous and exogenous hormonal exposures in the breast.
Collapse
Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
15
|
Savaridas S, Taylor D, Gunawardana D, Phillips M. Could parenchymal enhancement on contrast-enhanced spectral mammography (CESM) represent a new breast cancer risk factor? Correlation with known radiology risk factors. Clin Radiol 2017; 72:1085.e1-1085.e9. [DOI: 10.1016/j.crad.2017.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
|
16
|
Doran SJ, Hipwell JH, Denholm R, Eiben B, Busana M, Hawkes DJ, Leach MO, Silva IDS. Breast MRI segmentation for density estimation: Do different methods give the same results and how much do differences matter? Med Phys 2017; 44:4573-4592. [PMID: 28477346 PMCID: PMC5697622 DOI: 10.1002/mp.12320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/02/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare two methods of automatic breast segmentation with each other and with manual segmentation in a large subject cohort. To discuss the factors involved in selecting the most appropriate algorithm for automatic segmentation and, in particular, to investigate the appropriateness of overlap measures (e.g., Dice and Jaccard coefficients) as the primary determinant in algorithm selection. METHODS Two methods of breast segmentation were applied to the task of calculating MRI breast density in 200 subjects drawn from the Avon Longitudinal Study of Parents and Children, a large cohort study with an MRI component. A semiautomated, bias-corrected, fuzzy C-means (BC-FCM) method was combined with morphological operations to segment the overall breast volume from in-phase Dixon images. The method makes use of novel, problem-specific insights. The resulting segmentation mask was then applied to the corresponding Dixon water and fat images, which were combined to give Dixon MRI density values. Contemporaneously acquired T1 - and T2 -weighted image datasets were analyzed using a novel and fully automated algorithm involving image filtering, landmark identification, and explicit location of the pectoral muscle boundary. Within the region found, fat-water discrimination was performed using an Expectation Maximization-Markov Random Field technique, yielding a second independent estimate of MRI density. RESULTS Images are presented for two individual women, demonstrating how the difficulty of the problem is highly subject-specific. Dice and Jaccard coefficients comparing the semiautomated BC-FCM method, operating on Dixon source data, with expert manual segmentation are presented. The corresponding results for the method based on T1 - and T2 -weighted data are slightly lower in the individual cases shown, but scatter plots and interclass correlations for the cohort as a whole show that both methods do an excellent job in segmenting and classifying breast tissue. CONCLUSIONS Epidemiological results demonstrate that both methods of automated segmentation are suitable for the chosen application and that it is important to consider a range of factors when choosing a segmentation algorithm, rather than focus narrowly on a single metric such as the Dice coefficient.
Collapse
Affiliation(s)
- Simon J. Doran
- Division of Radiotherapy and Imaging, The Institute of Cancer ResearchCancer Research UK Cancer Imaging CentreLondonSM2 5NGUK
| | - John H. Hipwell
- Department of Medical Physics and BioengineeringUCL, Centre for Medical Image Computing (CMIC)LondonWC1E 7JEUK
| | - Rachel Denholm
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonWC1E 7HTUK
| | - Björn Eiben
- Department of Medical Physics and BioengineeringUCL, Centre for Medical Image Computing (CMIC)LondonWC1E 7JEUK
| | - Marta Busana
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonWC1E 7HTUK
| | - David J. Hawkes
- Department of Medical Physics and BioengineeringUCL, Centre for Medical Image Computing (CMIC)LondonWC1E 7JEUK
| | - Martin O. Leach
- Division of Radiotherapy and Imaging, The Institute of Cancer ResearchCancer Research UK Cancer Imaging CentreLondonSM2 5NGUK
| | - Isabel dos Santos Silva
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonWC1E 7HTUK
| |
Collapse
|
17
|
Wengert GJ, Pinker K, Helbich TH, Vogl WD, Spijker SM, Bickel H, Polanec SH, Baltzer PA. Accuracy of fully automated, quantitative, volumetric measurement of the amount of fibroglandular breast tissue using MRI: correlation with anthropomorphic breast phantoms. NMR IN BIOMEDICINE 2017; 30:e3705. [PMID: 28295818 DOI: 10.1002/nbm.3705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
To demonstrate the accuracy of fully automated, quantitative, volumetric measurement of the amount of fibroglandular breast tissue (FGT), using MRI, and to investigate the impact of different MRI sequences using anthropomorphic breast phantoms as the ground truth. In this study, 10 anthropomorphic breast phantoms that consisted of different known fractions of adipose and protein tissue, which closely resembled normal breast parenchyma, were developed. Anthropomorphic breast phantoms were imaged with a 1.5 T unit (Siemens, Avantofit) using an 18-channel breast coil. The sequence protocol consisted of an isotropic Dixon sequence (Di), an anisotropic Dixon sequence (Da), and T1 3D FLASH sequences with and without fat saturation (T1). Fully automated, quantitative, volumetric measurement of FGT for all anthropomorphic phantoms and sequences was performed and correlated with the amounts of fatty and protein components in the phantoms as the ground truth. Fully automated, quantitative, volumetric measurements of FGT with MRI for all sequences ranged from 5.86 to 61.05% (mean 33.36%). The isotropic Dixon sequence yielded the highest accuracy (median 0.51%-0.78%) and precision (median range 0.19%) compared with anisotropic Dixon (median 1.92%-2.09%; median range 0.55%) and T1 -weighted sequences (median 2.54%-2.46%; median range 0.82%). All sequences yielded good correlation with the FGT content of the anthropomorphic phantoms. The best correlation of FGT measurements was identified for Dixon sequences (Di, R2 = 0.999; Da, R2 = 0.998) compared with conventional T1 -weighted sequences (R2 = 0.971). MRI yields accurate, fully automated, quantitative, volumetric measurements of FGT, an increasingly important and sensitive imaging biomarker for breast cancer risk. Compared with conventional T1 sequences, Dixon-type sequences show the highest correlation and reproducibility for automated, quantitative, volumetric FGT measurements using anthropomorphic breast phantoms as the ground truth.
Collapse
Affiliation(s)
- Georg J Wengert
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Katja Pinker
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
- Memorial Sloan-Kettering Cancer Center, Dept. of Radiology, New York, USA
| | - Thomas H Helbich
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Wolf-Dieter Vogl
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Sylvia M Spijker
- University of Vienna, Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Science, Vienna, Austria
| | - Hubert Bickel
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Stephan H Polanec
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| | - Pascal A Baltzer
- Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Vienna, Austria
| |
Collapse
|
18
|
O'Flynn EA, Fromageau J, Ledger AE, Messa A, D'Aquino A, Schoemaker MJ, Schmidt M, Duric N, Swerdlow AJ, Bamber JC. Ultrasound Tomography Evaluation of Breast Density: A Comparison With Noncontrast Magnetic Resonance Imaging. Invest Radiol 2017; 52:343-348. [PMID: 28121639 PMCID: PMC5417582 DOI: 10.1097/rli.0000000000000347] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Ultrasound tomography (UST) is an emerging whole-breast 3-dimensional imaging technique that obtains quantitative tomograms of speed of sound of the entire breast. The imaged parameter is the speed of sound which is used as a surrogate measure of density at each voxel and holds promise as a method to evaluate breast density without ionizing radiation. This study evaluated the technique of UST and compared whole-breast volume averaged speed of sound (VASS) with MR percent water content from noncontrast magnetic resonance imaging (MRI). MATERIALS AND METHODS Forty-three healthy female volunteers (median age, 40 years; range, 29-59 years) underwent bilateral breast UST and MRI using a 2-point Dixon technique. Reproducibility of VASS was evaluated using Bland-Altman analysis. Volume averaged speed of sound and MR percent water were evaluated and compared using Pearson correlation coefficient. RESULTS The mean ± standard deviation VASS measurement was 1463 ± 29 m s (range, 1434-1542 m s). There was high similarity between right (1464 ± 30 m s) and left (1462 ± 28 m s) breasts (P = 0.113) (intraclass correlation coefficient, 0.98). Mean MR percent water content was 35.7% ± 14.7% (range, 13.2%-75.3%), with small but significant differences between right and left breasts (36.3% ± 14.9% and 35.1% ± 14.7%, respectively; P = 0.004). There was a very strong correlation between VASS and MR percent water density (r = 0.96, P < 0.0001). CONCLUSIONS Ultrasound tomography holds promise as a reliable and reproducible 3-dimensional technique to provide a surrogate measure of breast density and correlates strongly with MR percent water content.
Collapse
Affiliation(s)
- Elizabeth A.M. O'Flynn
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeremie Fromageau
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Araminta E. Ledger
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Alessandro Messa
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Ashley D'Aquino
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Minouk J. Schoemaker
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Maria Schmidt
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Neb Duric
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Anthony J. Swerdlow
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| | - Jeffrey C. Bamber
- From the *Cancer Research UK Cancer Imaging Centre; †Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust; ‡Royal Marsden NHS Foundation Trust; §Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom; ∥Delphinus Medical Technologies, Karmanos Cancer Institute, Wayne State University, Detroit, MI; and ¶Division of Genetics and Epidemiology, and Division of Breast Cancer Research Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
19
|
Ertas G, Doran SJ, Leach MO. A computerized volumetric segmentation method applicable to multi-centre MRI data to support computer-aided breast tissue analysis, density assessment and lesion localization. Med Biol Eng Comput 2017; 55:57-68. [PMID: 27106750 PMCID: PMC5222930 DOI: 10.1007/s11517-016-1484-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/04/2016] [Indexed: 11/05/2022]
Abstract
Density assessment and lesion localization in breast MRI require accurate segmentation of breast tissues. A fast, computerized algorithm for volumetric breast segmentation, suitable for multi-centre data, has been developed, employing 3D bias-corrected fuzzy c-means clustering and morphological operations. The full breast extent is determined on T1-weighted images without prior information concerning breast anatomy. Left and right breasts are identified separately using automatic detection of the midsternum. Statistical analysis of breast volumes from eighty-two women scanned in a UK multi-centre study of MRI screening shows that the segmentation algorithm performs well when compared with manually corrected segmentation, with high relative overlap (RO), high true-positive volume fraction (TPVF) and low false-positive volume fraction (FPVF), and has an overall performance of RO 0.94 ± 0.05, TPVF 0.97 ± 0.03 and FPVF 0.04 ± 0.06, respectively (training: 0.93 ± 0.05, 0.97 ± 0.03 and 0.04 ± 0.06; test: 0.94 ± 0.05, 0.98 ± 0.02 and 0.05 ± 0.07).
Collapse
Affiliation(s)
- Gokhan Ertas
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
- Department of Biomedical Engineering, Yeditepe University, Istanbul, Turkey
| | - Simon J. Doran
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
| |
Collapse
|
20
|
Sak M, Duric N, Littrup P, Bey-Knight L, Ali H, Vallieres P, Sherman ME, Gierach GL. Using Speed of Sound Imaging to Characterize Breast Density. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:91-103. [PMID: 27692872 PMCID: PMC5761326 DOI: 10.1016/j.ultrasmedbio.2016.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/07/2016] [Accepted: 08/16/2016] [Indexed: 05/09/2023]
Abstract
A population of 165 women with negative mammographic screens also received an ultrasound tomography (UST) examination at the Karmanos Cancer Institute in Detroit, MI. Standard statistical techniques were employed to measure the associations between the various mammographic- and UST-related density measures and various participant characteristics such as age, weight and height. The mammographic percent density (MPD) was found to have similar strength associations with UST mean sound speed (Spearman coefficient, rs = 0.722, p < 0.001) and UST median sound speed (rs = 0.737, p < 0.001). Both were stronger than the associations between MPD with two separate measures of UST percent density, a k-means (rs = 0.568, p < 0.001) or a threshold (rs = 0.715, p < 0.001) measure. Segmentation of the UST sound speed images into dense and non-dense volumes showed weak to moderate associations with the mammographically equivalent measures. Relationships were found to be inversely and weakly associated between age and the UST mean sound speed (rs = -0.239, p = 0.002), UST median sound speed (rs = -0.226, p = 0.004) and MPD (rs = -0.204, p = 0.008). Relationships were found to be inversely and moderately associated between body mass index (BMI) and the UST mean sound speed (rs = -0.429, p < 0.001), UST median sound speed (rs = -0.447, p < 0.001) and MPD (rs = -0.489, p < 0.001). The results confirm and strengthen findings presented in previous work indicating that UST sound speed imaging yields viable markers of breast density in a manner consistent with mammography, the current clinical standard. These results lay the groundwork for further studies to assess the role of sound speed imaging in risk prediction.
Collapse
Affiliation(s)
- Mark Sak
- Delphinus Medical Technologies, Plymouth, MI, USA.
| | - Neb Duric
- Delphinus Medical Technologies, Plymouth, MI, USA
| | - Peter Littrup
- Delphinus Medical Technologies, Plymouth, MI, USA; Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lisa Bey-Knight
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | | | - Mark E Sherman
- Division of Cancer Prevention, National Cancer Institute, Department of Health and Human Services, Bethesda, MD, USA
| | - Gretchen L Gierach
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
21
|
Denholm R, De Stavola B, Hipwell JH, Doran SJ, Busana MC, Eng A, Jeffreys M, Leach MO, Hawkes D, dos Santos Silva I. Pre-natal exposures and breast tissue composition: findings from a British pre-birth cohort of young women and a systematic review. Breast Cancer Res 2016; 18:102. [PMID: 27729066 PMCID: PMC5059986 DOI: 10.1186/s13058-016-0751-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/23/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Breast density, the amount of fibroglandular tissue in the adult breast for a women's age and body mass index, is a strong biomarker of susceptibility to breast cancer, which may, like breast cancer risk itself, be influenced by events early in life. In the present study, we investigated the association between pre-natal exposures and breast tissue composition. METHODS A sample of 500 young, nulliparous women (aged approximately 21 years) from a U.K. pre-birth cohort underwent a magnetic resonance imaging examination of their breasts to estimate percent water, a measure of the relative amount of fibroglandular tissue equivalent to mammographic percent density. Information on pre-natal exposures was collected throughout the mothers' pregnancy and shortly after delivery. Regression models were used to investigate associations between percent water and pre-natal exposures. Mediation analysis, and a systematic review and meta-analysis of the published literature, were also conducted. RESULTS Adjusted percent water in young women was positively associated with maternal height (p for linear trend [p t] = 0.005), maternal mammographic density in middle age (p t = 0.018) and the participant's birth size (p t < 0.001 for birthweight). A 1-SD increment in weight (473 g), length (2.3 cm), head circumference (1.2 cm) and Ponderal Index (4.1 g/cm3) at birth were associated with 3 % (95 % CI 2-5 %), 2 % (95 % CI 0-3 %), 3 % (95 % CI 1-4 %) and 1 % (95 % CI 0-3 %), respectively, increases in mean adjusted percent water. The effect of maternal height on the participants' percent water was partly mediated through birth size, but there was little evidence that the effect of birthweight was primarily mediated via adult body size. The meta-analysis supported the study findings, with breast density being positively associated with birth size. CONCLUSIONS These findings provide strong evidence of pre-natal influences on breast tissue composition. The positive association between birth size and relative amount of fibroglandular tissue indicates that breast density and breast cancer risk may share a common pre-natal origin.
Collapse
Affiliation(s)
- Rachel Denholm
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - John H. Hipwell
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, UK
| | - Simon J. Doran
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research (ICH) and Royal Marsden NHS Foundation Trust (RHM), London, UK
| | - Marta C. Busana
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amanda Eng
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Mona Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research (ICH) and Royal Marsden NHS Foundation Trust (RHM), London, UK
| | - David Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Bioengineering, UCL, London, UK
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
22
|
Wengert GJ, Pinker-Domenig K, Helbich TH, Vogl WD, Clauser P, Bickel H, Marino MA, Magometschnigg HF, Baltzer PA. Influence of fat-water separation and spatial resolution on automated volumetric MRI measurements of fibroglandular breast tissue. NMR IN BIOMEDICINE 2016; 29:702-708. [PMID: 27061174 DOI: 10.1002/nbm.3516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/04/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to investigate the influence of fat-water separation and spatial resolution in MRI on the results of automated quantitative measurements of fibroglandular breast tissue (FGT). Ten healthy volunteers (age range, 28-71 years; mean, 39.9 years) were included in this Institutional Review Board-approved prospective study. All measurements were performed on a 1.5-T scanner (Siemens, AvantoFit) using an 18-channel breast coil. The protocols included isotropic (Di) [TR/TE1 /TE2 = 6.00 ms/2.45 ms/2.67 ms; flip angle, 6.0°; 256 slices; matrix, 360 × 360; 1 mm isotropic; field of view, 360°; acquisition time (TA) = 3 min 38 s] and anisotropic (Da) (TR/TE1 /TE2 = 10.00 ms/2.39 ms/4.77 ms; flip angle, 24.9°; 80 slices; matrix 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 1 min 25 s) T1 three-dimensional (3D) fast low-angle shot (FLASH) Dixon sequences, and a T1 3D FLASH sequence with the same resolution (T1 ) without (TR/TE = 11.00 ms/4.76 ms; flip angle, 25.0°; 80 slices; matrix, 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 50 s) and with (TR/TE = 29.00 ms/4.76 ms; flip angle, 25.0°; 80 slices; matrix, 360 × 360; voxel size, 0.7 × 0.7 × 2.0 mm(3) ; field of view, 360°; TA = 2 min 35 s) fat saturation. Repeating volunteer measurements after 20 min and repositioning were used to assess reproducibility. An automated and quantitative volumetric breast density measurement system was used for FGT calculation. FGT with Di, Da and T1 measured 4.6-63.0% (mean, 30.6%), 3.2-65.3% (mean, 32.5%) and 1.7-66.5% (mean, 33.7%), respectively. The highest correlation between different MRI sequences was found with the Di and Da sequences (R(2) = 0.976). Coefficients of variation (CVs) for FGT calculation were higher in T1 (CV = 21.5%) compared with Dixon (Di, CV = 5.1%; Da, CV = 4.2%) sequences. Dixon-type sequences worked well for FGT measurements, even at lower resolution, whereas the conventional T1 -weighted sequence was more sensitive to decreasing resolution. The Dixon fat-water separation technique showed superior repeatability of FGT measurements compared with conventional sequences. A standard dynamic protocol using Dixon fat-water separation is best suited for combined diagnostic purposes and prognostic measurements of FGT. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Georg J Wengert
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker-Domenig
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Vogl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Hubert Bickel
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Maria-Adele Marino
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Heinrich F Magometschnigg
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
23
|
Densité mammographique et risque de cancer du sein : qu’en reste-t-il ? IMAGERIE DE LA FEMME 2016. [DOI: 10.1016/j.femme.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Jung S, Goloubeva O, Klifa C, LeBlanc ES, Snetselaar LG, Van Horn L, Dorgan JF. Dietary Fat Intake During Adolescence and Breast Density Among Young Women. Cancer Epidemiol Biomarkers Prev 2016; 25:918-26. [PMID: 27197283 DOI: 10.1158/1055-9965.epi-15-1146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lack of association between fat intake and breast cancer risk in cohort studies might be attributed to the disregard of temporal effects during adolescence when breasts develop and are particularly sensitive to stimuli. We prospectively examined associations between adolescent fat intakes and breast density. METHOD Among 177 women who participated in the Dietary Intervention Study in Children, dietary intakes at ages 10-18 years were assessed on five occasions by 24-hour recalls and averaged. We calculated geometric mean and 95% confidence intervals for MRI-measured breast density at ages 25-29 years across quartiles of fat intake using linear mixed-effect regression. RESULTS Comparing women in the extreme quartiles of adolescent fat intakes, percent dense breast volume (%DBV) was positively associated with saturated fat (mean = 16.4% vs. 21.5%; Ptrend < 0.001). Conversely, %DBV was inversely associated with monounsaturated fat (25.0% vs. 15.8%; Ptrend < 0.001) and the ratio of polyunsaturated fat to saturated fat (P/S ratio; 19.1% vs. 14.3%; Ptrend < 0.001). When examining intake by pubertal stages, %DBV was inversely associated with intake of polyunsaturated fat (20.8% vs. 16.4%; Ptrend = 0.04), long-chain omega-3 fat (17.8% vs. 15.8%; Ptrend < 0.001), and P/S ratio (22.5% vs. 16.1%; Ptrend < 0.001) before menarche, but not after. These associations observed with %DBV were consistently observed with absolute dense breast volume but not with absolute nondense breast volume. CONCLUSIONS In our study, adolescent intakes of higher saturated fat and lower mono- and polyunsaturated fat are associated with higher breast density measured approximately 15 years later. IMPACT The fat subtype composition in adolescent diet may be important in early breast cancer prevention. Cancer Epidemiol Biomarkers Prev; 25(6); 918-26. ©2016 AACR.
Collapse
Affiliation(s)
- Seungyoun Jung
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Olga Goloubeva
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joanne F Dorgan
- University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
25
|
Inter- and intra-observer agreement of BI-RADS-based subjective visual estimation of amount of fibroglandular breast tissue with magnetic resonance imaging: comparison to automated quantitative assessment. Eur Radiol 2016; 26:3917-3922. [PMID: 27108300 PMCID: PMC5052327 DOI: 10.1007/s00330-016-4274-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/31/2016] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the inter-/intra-observer agreement of BI-RADS-based subjective visual estimation of the amount of fibroglandular tissue (FGT) with magnetic resonance imaging (MRI), and to investigate whether FGT assessment benefits from an automated, observer-independent, quantitative MRI measurement by comparing both approaches. Materials and methods Eighty women with no imaging abnormalities (BI-RADS 1 and 2) were included in this institutional review board (IRB)-approved prospective study. All women underwent un-enhanced breast MRI. Four radiologists independently assessed FGT with MRI by subjective visual estimation according to BI-RADS. Automated observer-independent quantitative measurement of FGT with MRI was performed using a previously described measurement system. Inter-/intra-observer agreements of qualitative and quantitative FGT measurements were assessed using Cohen’s kappa (k). Results Inexperienced readers achieved moderate inter-/intra-observer agreement and experienced readers a substantial inter- and perfect intra-observer agreement for subjective visual estimation of FGT. Practice and experience reduced observer-dependency. Automated observer-independent quantitative measurement of FGT was successfully performed and revealed only fair to moderate agreement (k = 0.209–0.497) with subjective visual estimations of FGT. Conclusion Subjective visual estimation of FGT with MRI shows moderate intra-/inter-observer agreement, which can be improved by practice and experience. Automated observer-independent quantitative measurements of FGT are necessary to allow a standardized risk evaluation. Key Points • Subjective FGT estimation with MRI shows moderate intra-/inter-observer agreement in inexperienced readers. • Inter-observer agreement can be improved by practice and experience. • Automated observer-independent quantitative measurements can provide reliable and standardized assessment of FGT with MRI.
Collapse
|
26
|
Ledger AEW, Scurr ED, Hughes J, Macdonald A, Wallace T, Thomas K, Wilson R, Leach MO, Schmidt MA. Comparison of Dixon Sequences for Estimation of Percent Breast Fibroglandular Tissue. PLoS One 2016; 11:e0152152. [PMID: 27011312 PMCID: PMC4806997 DOI: 10.1371/journal.pone.0152152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/09/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate sources of error in the Magnetic Resonance Imaging (MRI) measurement of percent fibroglandular tissue (%FGT) using two-point Dixon sequences for fat-water separation. METHODS Ten female volunteers (median age: 31 yrs, range: 23-50 yrs) gave informed consent following Research Ethics Committee approval. Each volunteer was scanned twice following repositioning to enable an estimation of measurement repeatability from high-resolution gradient-echo (GRE) proton-density (PD)-weighted Dixon sequences. Differences in measures of %FGT attributable to resolution, T1 weighting and sequence type were assessed by comparison of this Dixon sequence with low-resolution GRE PD-weighted Dixon data, and against gradient-echo (GRE) or spin-echo (SE) based T1-weighted Dixon datasets, respectively. RESULTS %FGT measurement from high-resolution PD-weighted Dixon sequences had a coefficient of repeatability of ±4.3%. There was no significant difference in %FGT between high-resolution and low-resolution PD-weighted data. Values of %FGT from GRE and SE T1-weighted data were strongly correlated with that derived from PD-weighted data (r = 0.995 and 0.96, respectively). However, both sequences exhibited higher mean %FGT by 2.9% (p < 0.0001) and 12.6% (p < 0.0001), respectively, in comparison with PD-weighted data; the increase in %FGT from the SE T1-weighted sequence was significantly larger at lower breast densities. CONCLUSION Although measurement of %FGT at low resolution is feasible, T1 weighting and sequence type impact on the accuracy of Dixon-based %FGT measurements; Dixon MRI protocols for %FGT measurement should be carefully considered, particularly for longitudinal or multi-centre studies.
Collapse
Affiliation(s)
- Araminta E. W. Ledger
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Erica D. Scurr
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julie Hughes
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Macdonald
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Toni Wallace
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin Wilson
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Maria A. Schmidt
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
27
|
Chen JH, Chan S, Tang YT, Hon JS, Tseng PC, Cheriyan AT, Shah NR, Yeh DC, Lee SK, Chen WP, McLaren CE, Su MY. Impact of positional difference on the measurement of breast density using MRI. Med Phys 2016; 42:2268-75. [PMID: 25979021 DOI: 10.1118/1.4917083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study investigated the impact of arms/hands and body position on the measurement of breast density using MRI. METHODS Noncontrast-enhanced T1-weighted images were acquired from 32 healthy women. Each subject received four MR scans using different experimental settings, including a high resolution hands-up, a low resolution hands-up, a high resolution hands-down, and finally, another high resolution hands-up after repositioning. The breast segmentation was performed using a fully automatic chest template-based method. The breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) measured from the four MR scan settings were analyzed. RESULTS A high correlation of BV, FV, and PD between any pair of the four MR scans was noted (r > 0.98 for all). Using the generalized estimating equation method, a statistically significant difference in mean BV among four settings was noted (left breast, score test p = 0.0056; right breast, score test p = 0.0016), adjusted for age and body mass index. Despite differences in BV, there were no statistically significant differences in the mean PDs among the four settings (p > 0.10 for left and right breasts). Using Bland-Altman plots, the smallest mean difference/bias and standard deviations for BV, FV, and PD were noted when comparing hands-up high vs low resolution when the breast positions were exactly the same. CONCLUSIONS The authors' study showed that BV, FV, and PD measurements from MRI of different positions were highly correlated. BV may vary with positions but the measured PD did not differ significantly between positions. The study suggested that the percent density analyzed from MRI studies acquired using different arms/hands and body positions from multiple centers can be combined for analysis.
Collapse
Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020 and Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Siwa Chan
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yi-Ting Tang
- Department of Radiological Technology, China Medical University, Taichung 40402, Taiwan
| | - Jia Shen Hon
- Department of Radiological Technology, China Medical University, Taichung 40402, Taiwan
| | - Po-Chuan Tseng
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Angela T Cheriyan
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Nikita Rakesh Shah
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| | - Dah-Cherng Yeh
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - San-Kan Lee
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Wen-Pin Chen
- Department of Epidemiology, University of California, Irvine, California 92697-5020
| | - Christine E McLaren
- Department of Epidemiology, University of California, Irvine, California 92697-5020
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California 92697-5020
| |
Collapse
|
28
|
Imaging Breast Density: Established and Emerging Modalities. Transl Oncol 2015; 8:435-45. [PMID: 26692524 PMCID: PMC4700291 DOI: 10.1016/j.tranon.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022] Open
Abstract
Mammographic density has been proven as an independent risk factor for breast cancer. Women with dense breast tissue visible on a mammogram have a much higher cancer risk than women with little density. A great research effort has been devoted to incorporate breast density into risk prediction models to better estimate each individual’s cancer risk. In recent years, the passage of breast density notification legislation in many states in USA requires that every mammography report should provide information regarding the patient’s breast density. Accurate definition and measurement of breast density are thus important, which may allow all the potential clinical applications of breast density to be implemented. Because the two-dimensional mammography-based measurement is subject to tissue overlapping and thus not able to provide volumetric information, there is an urgent need to develop reliable quantitative measurements of breast density. Various new imaging technologies are being developed. Among these new modalities, volumetric mammographic density methods and three-dimensional magnetic resonance imaging are the most well studied. Besides, emerging modalities, including different x-ray–based, optical imaging, and ultrasound-based methods, have also been investigated. All these modalities may either overcome some fundamental problems related to mammographic density or provide additional density and/or compositional information. The present review article aimed to summarize the current established and emerging imaging techniques for the measurement of breast density and the evidence of the clinical use of these density methods from the literature.
Collapse
|
29
|
Diffusion tensor imaging in the normal breast: influences of fibroglandular tissue composition and background parenchymal enhancement. Clin Imaging 2015; 40:506-11. [PMID: 27133695 DOI: 10.1016/j.clinimag.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate effects of fibroglandular tissue (FGT) composition and background parenchymal enhancement (BPE) on diffusion tensor imaging (DTI) parameters in normal breast tissue. METHODS DTI analysis was performed on 35 breasts with regions of interest drawn to include only normal tissue. Breasts were dichotomized by FGT composition and by BPE; DTI parameters were compared. RESULTS The λ1 principal diffusion coefficient was lower in breasts with moderate/marked BPE versus those with minimal/mild BPE (P=.039). All other parameters were unaffected. CONCLUSION λ1 is sensitive to differences in BPE within normal breast tissue that should be taken into account in DTI evaluation.
Collapse
|
30
|
Ng KH, Lau S. Vision 20/20: Mammographic breast density and its clinical applications. Med Phys 2015; 42:7059-77. [PMID: 26632060 DOI: 10.1118/1.4935141] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kwan-Hoong Ng
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Susie Lau
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
31
|
Association between breast cancer, breast density, and body adiposity evaluated by MRI. Eur Radiol 2015; 26:2308-16. [PMID: 26489749 DOI: 10.1007/s00330-015-4058-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/12/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite the lack of reliable methods with which to measure breast density from 2D mammograms, numerous studies have demonstrated a positive association between breast cancer and breast density. The goal of this study was to study the association between breast cancer and body adiposity, as well as breast density quantitatively assessed from 3D MRI breast images. METHODS Breast density was calculated from 3D T1-weighted MRI images. The thickness of the upper abdominal adipose layer was used as a surrogate marker for body adiposity. We evaluated the correlation between breast density, age, body adiposity, and breast cancer. RESULTS Breast density was calculated for 410 patients with unilateral invasive breast cancer, 73 patients with ductal carcinoma in situ (DCIS), and 361 controls without breast cancer. Breast density was inversely related to age and the thickness of the upper abdominal adipose layer. Breast cancer was only positively associated with body adiposity and age. CONCLUSION Age and body adiposity are predictive of breast density. Breast cancer was not associated with breast density; however, it was associated with the thickness of the upper abdominal adipose layer, a surrogate marker for body adiposity. Our results based on a limited number of patients warrant further investigations. KEY POINTS • MRI breast density is negatively associated with body adiposity. • MRI breast density is negatively associated with age. • Breast cancer is positively associated with body adiposity. • Breast Cancer is not associated with MRI breast density.
Collapse
|
32
|
Khodr ZG, Sak MA, Pfeiffer RM, Duric N, Littrup P, Bey-Knight L, Ali H, Vallieres P, Sherman ME, Gierach GL. Determinants of the reliability of ultrasound tomography sound speed estimates as a surrogate for volumetric breast density. Med Phys 2015; 42:5671-8. [PMID: 26429241 PMCID: PMC4567583 DOI: 10.1118/1.4929985] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 12/28/2022] Open
Abstract
PURPOSE High breast density, as measured by mammography, is associated with increased breast cancer risk, but standard methods of assessment have limitations including 2D representation of breast tissue, distortion due to breast compression, and use of ionizing radiation. Ultrasound tomography (UST) is a novel imaging method that averts these limitations and uses sound speed measures rather than x-ray imaging to estimate breast density. The authors evaluated the reproducibility of measures of speed of sound and changes in this parameter using UST. METHODS One experienced and five newly trained raters measured sound speed in serial UST scans for 22 women (two scans per person) to assess inter-rater reliability. Intrarater reliability was assessed for four raters. A random effects model was used to calculate the percent variation in sound speed and change in sound speed attributable to subject, scan, rater, and repeat reads. The authors estimated the intraclass correlation coefficients (ICCs) for these measures based on data from the authors' experienced rater. RESULTS Median (range) time between baseline and follow-up UST scans was five (1-13) months. Contributions of factors to sound speed variance were differences between subjects (86.0%), baseline versus follow-up scans (7.5%), inter-rater evaluations (1.1%), and intrarater reproducibility (∼0%). When evaluating change in sound speed between scans, 2.7% and ∼0% of variation were attributed to inter- and intrarater variation, respectively. For the experienced rater's repeat reads, agreement for sound speed was excellent (ICC = 93.4%) and for change in sound speed substantial (ICC = 70.4%), indicating very good reproducibility of these measures. CONCLUSIONS UST provided highly reproducible sound speed measurements, which reflect breast density, suggesting that UST has utility in sensitively assessing change in density.
Collapse
Affiliation(s)
- Zeina G Khodr
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive MSC 9774, Bethesda, Maryland 20892
| | - Mark A Sak
- Karmanos Cancer Institute, Wayne State University, 4100 John R, Detroit, Michigan 48201
| | - Ruth M Pfeiffer
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive MSC 9774, Bethesda, Maryland 20892
| | - Nebojsa Duric
- Karmanos Cancer Institute, Wayne State University, 4100 John R, Detroit, Michigan 48201 and Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, Michigan 48170
| | - Peter Littrup
- Karmanos Cancer Institute, Wayne State University, 4100 John R, Detroit, Michigan 48201 and Delphinus Medical Technologies, 46701 Commerce Center Drive, Plymouth, Michigan 48170
| | - Lisa Bey-Knight
- Karmanos Cancer Institute, Wayne State University, 4100 John R, Detroit, Michigan 48201
| | - Haythem Ali
- Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Patricia Vallieres
- Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Mark E Sherman
- Division of Cancer Prevention, National Cancer Institute, Department of Health and Human Services, 9609 Medical Center Drive MSC 9774, Bethesda, Maryland 20892
| | - Gretchen L Gierach
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive MSC 9774, Bethesda, Maryland 20892
| |
Collapse
|
33
|
Introduction of an automated user-independent quantitative volumetric magnetic resonance imaging breast density measurement system using the Dixon sequence: comparison with mammographic breast density assessment. Invest Radiol 2015; 50:73-80. [PMID: 25333307 DOI: 10.1097/rli.0000000000000102] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purposes of this study were to introduce and assess an automated user-independent quantitative volumetric (AUQV) breast density (BD) measurement system on the basis of magnetic resonance imaging (MRI) using the Dixon technique as well as to compare it with qualitative and quantitative mammographic (MG) BD measurements. MATERIALS AND METHODS Forty-three women with normal mammogram results (Breast Imaging Reporting and Data System 1) were included in this institutional review board-approved prospective study. All participants were subjected to BD assessment with MRI using the following sequence with the Dixon technique (echo time/echo time, 6 milliseconds/2.45 milliseconds/2.67 milliseconds; 1-mm isotropic; 3 minutes 38 seconds). To test the reproducibility, a second MRI after patient repositioning was performed. The AUQV magnetic resonance (MR) BD measurement system automatically calculated percentage (%) BD. The qualitative BD assessment was performed using the American College of Radiology Breast Imaging Reporting and Data System BD categories. Quantitative BD was estimated semiautomatically using the thresholding technique Cumulus4. Appropriate statistical tests were used to assess the agreement between the AUQV MR measurements and to compare them with qualitative and quantitative MG BD estimations. RESULTS The AUQV MR BD measurements were successfully performed in all 43 women. There was a nearly perfect agreement of AUQV MR BD measurements between the 2 MR examinations for % BD (P < 0.001; intraclass correlation coefficient, 0.998) with no significant differences (P = 0.384). The AUQV MR BD measurements were significantly lower than quantitative and qualitative MG BD assessment (P < 0.001). CONCLUSIONS The AUQV MR BD measurement system allows a fully automated, user-independent, robust, reproducible, as well as radiation- and compression-free volumetric quantitative BD assessment through different levels of BD. The AUQV MR BD measurements were significantly lower than the currently used qualitative and quantitative MG-based approaches, implying that the current assessment might overestimate breast density with MG.
Collapse
|
34
|
Belkić K, Cohen M, Wilczek B, Andersson S, Berman AH, Márquez M, Vukojević V, Mints M. Imaging surveillance programs for women at high breast cancer risk in Europe: Are women from ethnic minority groups adequately included? (Review). Int J Oncol 2015; 47:817-39. [PMID: 26134040 DOI: 10.3892/ijo.2015.3063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/02/2015] [Indexed: 11/06/2022] Open
Abstract
Women from ethnic minority groups, including immigrants and refugees are reported to have low breast cancer (BC) screening rates. Active, culturally-sensitive outreach is vital for increasing participation of these women in BC screening programs. Women at high BC risk and who belong to an ethnic minority group are of special concern. Such women could benefit from ongoing trials aimed at optimizing screening strategies for early BC detection among those at increased BC risk. Considering the marked disparities in BC survival in Europe and its enormous and dynamic ethnic diversity, these issues are extremely timely for Europe. We systematically reviewed the literature concerning European surveillance studies that had imaging in the protocol and that targeted women at high BC risk. The aim of the present review was thereby to assess the likelihood that women at high BC risk from minority ethnic groups were adequately included in these surveillance programs. Twenty-seven research groups in Europe reported on their imaging surveillance programs for women at increased BC risk. The benefit of strategies such as inclusion of magnetic resonance imaging and/or more intensive screening was clearly documented for the participating women at increased BC risk. However, none of the reports indicated that sufficient outreach was performed to ensure that women at increased BC risk from minority ethnic groups were adequately included in these surveillance programs. On the basis of this systematic review, we conclude that the specific screening needs of ethnic minority women at increased BC risk have not yet been met in Europe. Active, culturally-sensitive outreach is needed to identify minority women at increased BC risk and to facilitate their inclusion in on-going surveillance programs. It is anticipated that these efforts would be most effective if coordinated with the development of European-wide, population-based approaches to BC screening.
Collapse
Affiliation(s)
- Karen Belkić
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Miri Cohen
- University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Brigitte Wilczek
- Sankt Görans Hospital, Unilabs Department of Mammography, Stockholm, Sweden
| | - Sonia Andersson
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Anne H Berman
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Marcela Márquez
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Vladana Vukojević
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| | - Miriam Mints
- The Karolinska Institute and Hospital, Departments of Oncology-Pathology, Women's and Children's Health and of Clinical Neuroscience, Stockholm, Sweden
| |
Collapse
|
35
|
Jung S, Egleston BL, Chandler DW, Van Horn L, Hylton NM, Klifa CC, Lasser NL, LeBlanc ES, Paris K, Shepherd JA, Snetselaar LG, Stanczyk FZ, Stevens VJ, Dorgan JF. Adolescent endogenous sex hormones and breast density in early adulthood. Breast Cancer Res 2015; 17:77. [PMID: 26041651 PMCID: PMC4468804 DOI: 10.1186/s13058-015-0581-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During adolescence the breasts undergo rapid growth and development under the influence of sex hormones. Although the hormonal etiology of breast cancer is hypothesized, it remains unknown whether adolescent sex hormones are associated with adult breast density, which is a strong risk factor for breast cancer. METHODS Percentage of dense breast volume (%DBV) was measured in 2006 by magnetic resonance imaging in 177 women aged 25-29 years who had participated in the Dietary Intervention Study in Children from 1988 to 1997. They had sex hormones and sex hormone-binding globulin (SHBG) measured in serum collected on one to five occasions between 8 and 17 years of age. Multivariable linear mixed-effect regression models were used to evaluate the associations of adolescent sex hormones and SHBG with %DBV. RESULTS Dehydroepiandrosterone sulfate (DHEAS) and SHBG measured in premenarche serum samples were significantly positively associated with %DBV (all P trend ≤0.03) but not when measured in postmenarche samples (all P trend ≥0.42). The multivariable geometric mean of %DBV across quartiles of premenarcheal DHEAS and SHBG increased from 16.7 to 22.1 % and from 14.1 to 24.3 %, respectively. Estrogens, progesterone, androstenedione, and testosterone in pre- or postmenarche serum samples were not associated with %DBV (all P trend ≥0.16). CONCLUSIONS Our results suggest that higher premenarcheal DHEAS and SHBG levels are associated with higher %DBV in young women. Whether this association translates into an increased risk of breast cancer later in life is currently unknown. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier, NCT00458588 April 9, 2007; NCT00000459 October 27, 1999.
Collapse
Affiliation(s)
- Seungyoun Jung
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
| | - Brian L Egleston
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - D Walt Chandler
- Esoterix Inc, 4301 Lost Hills Road, Calabasas Hills, CA, 91301, USA.
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 303 E Chicago Avenue, Chicago, IL, 60611, USA.
| | - Nola M Hylton
- Department of Radiology, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Catherine C Klifa
- Dangeard Group, 580 W Remington Drive, San Francisco, CA, 94087, USA.
| | - Norman L Lasser
- Department of Medicine, Rutgers New Jersey Medical School, 185 S Orange Avenue, Newark, NJ, 07103, USA.
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA.
| | - Kenneth Paris
- Department of Pediatrics, Louisiana State University School of Medicine, 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | - John A Shepherd
- Department of Radiology, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
| | - Victor J Stevens
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA.
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
| |
Collapse
|
36
|
Wang Z, Hauser N, Kubik-Huch RA, D’Isidoro F, Stampanoni M. Quantitative volumetric breast density estimation using phase contrast mammography. Phys Med Biol 2015; 60:4123-35. [DOI: 10.1088/0031-9155/60/10/4123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
37
|
Abstract
OBJECTIVE. The purpose of this article is to review the use of MRI in breast density measurement and breast cancer risk estimation and to discuss the role of MRI as an alternative screening to mammography for screening women with dense breasts. CONCLUSION. The potential of MRI for screening women with dense breasts remains controversial because of the paucity of clinical evidence, the possibility of overdiagnosis, and the cost-effectiveness of the technique in this population. Although methods of MRI measurement require standardization and automation, future addition of MRI density to risk models may positively impact their value.
Collapse
Affiliation(s)
- Elizabeth A M O'Flynn
- 1 All authors: Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | | | | |
Collapse
|
38
|
Jung S, Stanczyk FZ, Egleston BL, Snetselaar LG, Stevens VJ, Shepherd JA, Van Horn L, LeBlanc ES, Paris K, Klifa C, Dorgan JF. Endogenous sex hormones and breast density in young women. Cancer Epidemiol Biomarkers Prev 2014; 24:369-78. [PMID: 25371447 DOI: 10.1158/1055-9965.epi-14-0939] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast density is a strong risk factor for breast cancer and reflects epithelial and stromal content. Breast tissue is particularly sensitive to hormonal stimuli before it fully differentiates following the first full-term pregnancy. Few studies have examined associations between sex hormones and breast density among young women. METHODS We conducted a cross-sectional study among 180 women ages 25 to 29 years old who participated in the Dietary Intervention Study in Children 2006 Follow-up Study. Eighty-five percent of participants attended a clinic visit during their luteal phase of menstrual cycle. Magnetic resonance imaging measured the percentage of dense breast volume (%DBV), absolute dense breast volume (ADBV), and absolute nondense breast volume (ANDBV). Multiple-linear mixed-effect regression models were used to evaluate the association of sex hormones and sex hormone-binding globulin (SHBG) with %DBV, ADBV, and ANDBV. RESULTS Testosterone was significantly positively associated with %DBV and ADBV. The multivariable geometric mean of %DBV and ADBV across testosterone quartiles increased from 16.5% to 20.3% and from 68.6 to 82.3 cm(3), respectively (Ptrend ≤ 0.03). There was no association of %DBV or ADBV with estrogens, progesterone, non-SHBG-bound testosterone, or SHBG (Ptrend ≥ 0.27). Neither sex hormones nor SHBG was associated with ANDBV except progesterone; however, the progesterone result was nonsignificant in analysis restricted to women in the luteal phase. CONCLUSIONS These findings suggest a modest positive association between testosterone and breast density in young women. IMPACT Hormonal influences at critical periods may contribute to morphologic differences in the breast associated with breast cancer risk later in life.
Collapse
Affiliation(s)
- Seungyoun Jung
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Frank Z Stanczyk
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | | | | | - John A Shepherd
- University of California San Francisco, San Francisco, California
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Kenneth Paris
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | | | - Joanne F Dorgan
- University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
39
|
Similarity of fibroglandular breast tissue content measured from magnetic resonance and mammographic images and by a mathematical algorithm. Int J Breast Cancer 2014; 2014:961679. [PMID: 25132995 PMCID: PMC4123610 DOI: 10.1155/2014/961679] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 01/16/2023] Open
Abstract
Women with high breast density (BD) have a 4- to 6-fold greater risk for breast cancer than women with low BD. We found that BD can be easily computed from a mathematical algorithm using routine mammographic imaging data or by a curve-fitting algorithm using fat and nonfat suppression magnetic resonance imaging (MRI) data. These BD measures in a strictly defined group of premenopausal women providing both mammographic and breast MRI images were predicted as well by the same set of strong predictor variables as were measures from a published laborious histogram segmentation method and a full field digital mammographic unit in multivariate regression models. We also found that the number of completed pregnancies, C-reactive protein, aspartate aminotransferase, and progesterone were more strongly associated with amounts of glandular tissue than adipose tissue, while fat body mass, alanine aminotransferase, and insulin like growth factor-II appear to be more associated with the amount of breast adipose tissue. Our results show that methods of breast imaging and modalities for estimating the amount of glandular tissue have no effects on the strength of these predictors of BD. Thus, the more convenient mathematical algorithm and the safer MRI protocols may facilitate prospective measurements of BD.
Collapse
|
40
|
Mammographic density is not a worthwhile examination to distinguish high cancer risk women in screening. Eur Radiol 2014; 24:2412-6. [PMID: 24972955 DOI: 10.1007/s00330-014-3278-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/07/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
Numerous studies established high mammographic density (MD) as a significant breast cancer risk. By adopting both radiological and epidemiological perspectives, we analysed the capacity of this radiological parameter to express an individual level of risk and the methods for assessing the relationship between MD categories and risk. MD is unable to identify individual underlying anatomical and physiological components. Many factors affect accurate and reproducible measurements and consequently classifications of MD. Significant relative risks were found by comparing the MD categories in the tails of distribution (i.e. the group of women with the lowest MD to that with the highest MD), which represent <10 % of women in each group: the majority of the population was ignored. When a relevant threshold of MD was applied to compare another group and the entire population was included to compare the two groups, some studies showed no significant or only moderate relative risk (RR) between women with readings above and those below the threshold. Sensitivity and specificity remain unknown. MD cannot be considered a worthwhile test by which to categorically identify high-risk women in screening. Key points • Unknown individual anatomical and physiological components do not express the risk level.• The epidemiological conditions are not relevant to distinguish a high-risk category.• The most relevant studies show no or moderate risks.
Collapse
|
41
|
Breast density assessment using a 3T MRI system: comparison among different sequences. PLoS One 2014; 9:e99027. [PMID: 24892933 PMCID: PMC4044003 DOI: 10.1371/journal.pone.0099027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/09/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare MRI sequences for breast density measurements on a 3T MRI system using IDEAL (Iterative Decomposition of water and fat with Echo Asymmetry and Least squares estimation) as possible physiology-like reference. Materials and Methods MRI examination was performed in 48 consecutive patients (mean age 41, years; range, 35–67 years) on a 3.0T scanner and 46 were included. All (fertile) women, were examined between days 5 and 15 of their menstrual cycle. MRI protocol included: T1-turbo spin-echo (T1-tSE), T2-turbo spin-echo (T2-tSE), VIBRANT (Volume Imaging for Breast Assessment) before and after injection of contrast media and IDEAL. Breast density was calculated with semi-automated software. Statistical analysis was performed with non-parametric tests. Results Mean percentage of breast density calculated in each sequence was: T1-tSE = 56%; T2-tSE = 52%; IDEAL FatOnly = 55%; IDEAL WaterOnly = 53%, VIBRANT = 55%. Significant differences were observed between T2-tSE and both T1-tSE (p<0.001), VIBRANT sequences (p = 0.009), T1-tSE and both IDEAL WaterOnly (p = 0.007) and IDEAL FatOnly (p = 0.047). Breast density percentage showed a positive linear correlation among different sequences: r≥0.93. Conclusions Differences exist between MRI sequences used to assess breast density percentage. T1-weighted sequences values were similar to IDEAL sequences.
Collapse
|
42
|
Pike MC, Pearce CL. Mammographic density, MRI background parenchymal enhancement and breast cancer risk. Ann Oncol 2014; 24 Suppl 8:viii37-viii41. [PMID: 24131968 DOI: 10.1093/annonc/mdt310] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mammographic density (MD), representing connective and epithelial tissue (fibroglandular tissue, FGT) is a major risk factor for breast cancer. In an analysis of an autopsy series (Bartow SA, Pathak DR, Mettler FA. Radiographic microcalcification and parenchymal patterns as indicators of histologic "high-risk" benign breast disease. Cancer 1990; 66: 1721-1725, Bartow SA, Pathak DR, Mettler FA et al. Breast mammographic pattern: a concatenation of confounding and breast cancer risk factors. Am J Epidemiol 1995; 142: 813-819), MD was found to be strongly correlated with the collagen and epithelial content of the breast (Li T, Sun L, Miller N et al. The association of measured breast tissue characteristics with MD and other risk factors for breast cancer. Cancer Epidemiol Biomarkers Prev 2005; 14: 343-349), and another report showed that breast epithelium was highly concentrated in the areas of collagen concentration (Hawes D, Downey S, Pearce CL et al. Dense breast stromal tissue shows greatly increased concentration of breast epithelium but no increase in its proliferative activity. Breast Cancer Res 2006; 8: R24). Collagen comprises the overwhelming majority of the FGT, occupying an area on the slides obtained from the autopsy series some 15 times the area of glandular tissue. The relationship of MD with breast cancer risk appears likely to be due to a major extent to increasing epithelial cell numbers with increasing MD. FGT is also seen in breast magnetic resonance imaging (breast MRI) and, as expected, it has been shown that this measure of FGT (MRI-FGT) is highly correlated with MD. A contrast-enhanced breast MRI shows that normal FGT 'enhances' (background parenchymal enhancement, BPE) after contrast agent is administered(Morris EA. Diagnostic breast MR imaging: current status and future directions. Radiol Clin North Am 2007; 45: 863-880, vii., Kuhl C. The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 2007; 244: 356-378), and a recent study suggests that BPE is also a major breast cancer risk factor, possibly as important as, and independent of MD (King V, Brooks JD, Bernstein JL et al. BPE at breast MR imaging and breast cancer risk. Radiology 2011; 260: 50-60). BPE is much more sensitive to the effects of menopause and tamoxifen than is FGT (King V, Gu Y, Kaplan JB et al. Impact of menopausal status on BPE and fibroglandular tissue on breast MRI. Eur Radiol 2012; 22: 2641-2647, King V, Kaplan J, Pike MC et al. Impact of tamoxifen on amount of fibroglandular tissue, BPE, and cysts on breast MRI. Breast J 2012; 18: 527-534). Changes in MD and BPE may be most useful in predicting response to chemopreventive agents aimed at blocking breast cell proliferation. More study of the biological basis of the effects of MD and BPE is needed if we are to fully exploit these factors in developing chemopreventive approaches to breast cancer.
Collapse
Affiliation(s)
- M C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
43
|
Huo CW, Chew GL, Britt KL, Ingman WV, Henderson MA, Hopper JL, Thompson EW. Mammographic density-a review on the current understanding of its association with breast cancer. Breast Cancer Res Treat 2014; 144:479-502. [PMID: 24615497 DOI: 10.1007/s10549-014-2901-2] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/24/2014] [Indexed: 01/07/2023]
Abstract
There has been considerable recent interest in the genetic, biological and epidemiological basis of mammographic density (MD), and the search for causative links between MD and breast cancer (BC) risk. This report will critically review the current literature on MD and summarize the current evidence for its association with BC. Keywords 'mammographic dens*', 'dense mammary tissue' or 'percent dens*' were used to search the existing literature in English on PubMed and Medline. All reports were critically analyzed. The data were assigned to one of the following aspects of MD: general association with BC, its relationship with the breast hormonal milieu, the cellular basis of MD, the generic variations of MD, and its significance in the clinical setting. MD adjusted for age, and BMI is associated with increased risk of BC diagnosis, advanced tumour stage at diagnosis and increased risk of both local recurrence and second primary cancers. The MD measures that predict BC risk have high heritability, and to date several genetic markers associated with BC risk have been found to also be associated with these MD risk predictors. Change in MD could be a predictor of the extent of chemoprevention with tamoxifen. Although the biological and genetic pathways that determine and perhaps modulate MD remain largely unresolved, significant inroads are being made into the understanding of MD, which may lead to benefits in clinical screening, assessment and treatment strategies. This review provides a timely update on the current understanding of MD's association with BC risk.
Collapse
Affiliation(s)
- C W Huo
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia,
| | | | | | | | | | | | | |
Collapse
|
44
|
Baltzer HL, Alonzo-Proulx O, Mainprize JG, Yaffe MJ, Metcalfe KA, Narod SA, Warner E, Semple JL. MRI Volumetric Analysis of Breast Fibroglandular Tissue to Assess Risk of the Spared Nipple in BRCA1 and BRCA2 Mutation Carriers. Ann Surg Oncol 2014; 21:1583-8. [DOI: 10.1245/s10434-014-3532-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Indexed: 11/18/2022]
|
45
|
Chen JH, Pan WF, Kao J, Lu J, Chen LK, Kuo CC, Chang CK, Chen WP, McLaren CE, Bahri S, Mehta RS, Su MY. Effect of taxane-based neoadjuvant chemotherapy on fibroglandular tissue volume and percent breast density in the contralateral normal breast evaluated by 3T MR. NMR IN BIOMEDICINE 2013; 26:1705-13. [PMID: 23940080 PMCID: PMC3838444 DOI: 10.1002/nbm.3006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 05/23/2023]
Abstract
The aim of this study was to evaluate the change of breast density in the normal breast of patients receiving neoadjuvant chemotherapy (NAC). Forty-four breast cancer patients were studied. MRI acquisition was performed before treatment (baseline), and 4 and 12 weeks after treatment. A computer-algorithm-based program was used to segment breast tissue and calculate breast volume (BV), fibroglandular tissue volume (FV), and percent density (PD) (the ratio of FV over BV × 100%). The reduction of FV and PD after treatment was compared with baseline using paired t-tests with a Bonferroni-Holm correction. The association of density reduction with age was analyzed. FV and PD after NAC showed significant decreases compared with the baseline. FV was 110.0 ml (67.2, 189.8) (geometric mean (interquartile range)) at baseline, 104.3 ml (66.6, 164.4) after 4 weeks (p < 0.0001), and 94.7 ml (60.2, 144.4) after 12 weeks (comparison with baseline, p < 0.0001; comparison with 4 weeks, p = 0.016). PD was 11.2% (6.4, 22.4) at baseline, 10.6% (6.6, 20.3) after 4 weeks (p < 0.0001), and 9.7% (6.2, 17.9) after 12 weeks (comparison with baseline, p = 0.0001; comparison with 4 weeks, p = 0.018). Younger patients tended to show a higher density reduction, but overall correlation with age was only moderate (r = 0.28 for FV, p = 0.07, and r = 0.52 for PD, p = 0.0003). Our study showed that breast density measured from MR images acquired at 3T MR can be accurately quantified using a robust computer-aided algorithm based on non-parametric non-uniformity normalization (N3) and an adaptive fuzzy C-means algorithm. Similar to doxorubicin and cyclophosphamide regimens, the taxane-based NAC regimen also caused density atrophy in the normal breast and showed reduction in FV and PD. The effect of breast density reduction was age related and duration related.
Collapse
Affiliation(s)
- Jeon-Hor Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Wei-Fan Pan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Julian Kao
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Jocelyn Lu
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Li-Kuang Chen
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Chih-Chen Kuo
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Kai Chang
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Pin Chen
- Department of Epidemiology, University of California Irvine, California, USA
| | | | - Shadfar Bahri
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| | - Rita S. Mehta
- Department of Medicine, University of California Irvine, California
| | - Min-Ying Su
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, California, USA
| |
Collapse
|
46
|
Biomarker Endpoints for Early-Phase Cancer-Prevention Studies. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
47
|
Chen JH, Chen WP, Chan S, Yeh DC, Su MY, McLaren CE. Correlation of endogenous hormonal levels, fibroglandular tissue volume and percent density measured using 3D MRI during one menstrual cycle. Ann Oncol 2013; 24:2329-35. [PMID: 23661294 DOI: 10.1093/annonc/mdt158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We measured breast density (BD) on MRI and correlated with endogenous hormonal levels. PATIENTS AND METHODS Twenty-four premenopausal women received four weekly breast MRI. A blood sample was collected on the same day of MRI. BD was measured using a computer-based algorithm. The generalized estimation equation method was applied to model mean fibroglandular tissue volume (FV) and mean percent density (PD) from predictor variables including estradiol, progesterone, and week during a cycle. RESULTS In week 3, a borderline significant correlation between estradiol and PD (r = 0.43, P = 0.04), estradiol and FV (r = 0.40, P = 0.05) and between progesterone and FV (r = 0.42, P = 0.04) was noted. The FV and PD measured in weeks 4 and 1 were higher than in weeks 2 and 3, adjusted for variation in endogenous estradiol and progesterone, indicating that the hormone change could not account for the changes in density. No lag effect of endogenous hormone on the change of FV or PD was noted (all P-values > 0.05). CONCLUSIONS Our results showed that BD is not strongly associated with the endogenous hormone. Their association with breast cancer risk was likely coming from different mechanisms, and they should be considered as independent risk factors.
Collapse
Affiliation(s)
- J H Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California Irvine, Irvine, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Comparative estimation of percentage breast tissue density for digital mammography, digital breast tomosynthesis, and magnetic resonance imaging. Breast Cancer Res Treat 2013; 138:311-7. [PMID: 23338763 DOI: 10.1007/s10549-013-2419-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
|
49
|
Clendenen TV, Zeleniuch-Jacquotte A, Moy L, Pike MC, Rusinek H, Kim S. Comparison of 3-point Dixon imaging and fuzzy C-means clustering methods for breast density measurement. J Magn Reson Imaging 2013; 38:474-81. [PMID: 23292922 DOI: 10.1002/jmri.24002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 11/26/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess two methods of fat and fibroglandular tissue (FGT) segmentation for measuring breast MRI FGT volume and FGT%, the volume percentage of FGT in the breast, in longitudinal studies. MATERIALS AND METHODS Nine premenopausal women provided one MRI per week for 4 weeks during a natural menstrual cycle for a total of 36 datasets. We compared a fuzzy c-means (FC) and a 3-point Dixon segmentation method for estimation of changes in FGT volume and FGT% across the menstrual cycle. We also assessed whether differences due to changes in positioning each week could be minimized by coregistration, i.e., the application of the breast boundary selected at one visit to images obtained at other visits. RESULTS FC and Dixon FGT volume were highly correlated (r = 0.93, P < 0.001), as was FC and Dixon FGT% (r = 0.86, P = 0.01), although Dixon measurements were on average 10-20% higher. Although FGT measured by both methods showed the expected pattern of increase during the menstrual cycle, the magnitude, and for one woman the direction, of change varied according to the method used. Measurements of FGT for coregistered images were in close agreement with those for which the boundaries were determined independently. CONCLUSION The method of segmentation of fat and FGT tissue may have an impact on the results of longitudinal studies of changes in breast MRI FGT.
Collapse
Affiliation(s)
- Tess V Clendenen
- New York University School of Medicine, Department of Environmental Medicine, Division of Epidemiology, New York, NY 10016, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Magnetic Resonance Imaging (MRI) of hormone-induced breast changes in young premenopausal women. Magn Reson Imaging 2013; 31:1-9. [DOI: 10.1016/j.mri.2012.06.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 06/22/2012] [Accepted: 06/24/2012] [Indexed: 11/18/2022]
|