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Sunen I, Isabel Garcia Barrado A, Cruz Ciria S, Garcia Maroto J, Gros Bañeres B, Garcia Mur C. Is contrast-enhanced mammography (CEM) an alternative to MRI in assessing the response to primary systemic therapy of breast cancer? Eur J Radiol 2024; 170:111270. [PMID: 38141263 DOI: 10.1016/j.ejrad.2023.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE To evaluate the accuracy of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) in the assessing radiological response to primary systemic therapy (PST). METHOD Prospective study between February 2021 and October 2022. Women with breast cancer and indication of PST were enrolled. CEM and MRI were performed before and after PST, and the findings, including size and radiological response pattern, were compared with the size of the residual lesion measured in surgical specimens and its Miller-Payne classification (considered the gold standard). Two of four independent radiologists, with 2 years of CEM experience and 10 years of MRI experience, reviewed the images while being blinded to the results of the other technique. The agreement between measurements was evaluated using the Pearson correlation coefficient (r) and Lin's coefficient. RESULTS Forty-eight women with breast cancer who required PST were enrolled in the study, with a mean age of 57.21 ± 10.14 years. A total of thirty-three participants (68.75 %) completed the study. The correlation between CEM and MRI measurements was high before PST (r: 0.97), and local staging was identical for 45 out of 48 patients. MRI demonstrated better accuracy in predicting residual tumor size than CEM, with Lin's coefficient 0.91 and 0.73, respectively. However, no significant differences were observed in predicting response to therapy. Both methods tended to overestimate the size and degree of response in our study, with mean overestimations of 2.87 mm in CEM and 0.51 mm in MRI. CONCLUSION CEM was found to be as accurate as MRI in predicting response to PST, indicating its potential as an alternative imaging technique, but further research is necessary.
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Affiliation(s)
- Ines Sunen
- Department of Radiology, Nuestra Señora de Gracia Hospital, Zaragoza, Spain.
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Jailin C, Milioni De Carvalho P, Mohamed S, Vancamberg L, Amr Farouk Ibrahim M, Gomaa MM, Kamal RM, Muller S. Deformable registration with intensity correction for CESM monitoring response to Neoadjuvant Chemotherapy. Biomed Phys Eng Express 2023; 9. [PMID: 36758233 DOI: 10.1088/2057-1976/acba9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 02/11/2023]
Abstract
This paper proposes a robust longitudinal registration method for Contrast Enhanced Spectral Mammography in monitoring neoadjuvant chemotherapy. Because breast texture intensity changes with the treatment, a non-rigid registration procedure with local intensity compensations is developed. The approach allows registering the low energy images of the exams acquired before and after the chemotherapy. The measured motion is then applied to the corresponding recombined images. The difference of registered images, called residual, makes vanishing the breast texture that did not changed between the two exams. Consequently, this registered residual allows identifying local density and iodine changes, especially in the lesion area. The method is validated with a synthetic NAC case where ground truths are available. Then the procedure is applied to 51 patients with 208 CESM image pairs acquired before and after the chemotherapy treatment. The proposed registration converged in all 208 cases. The intensity-compensated registration approach is evaluated with different mathematical metrics and through the repositioning of clinical landmarks (RMSE: 5.9 mm) and outperforms state-of-the-art registration techniques.
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Affiliation(s)
| | | | | | | | | | | | - Rasha Mohammed Kamal
- Baheya Foundation For Early Detection And Treatment Of Breast Cancer, El Haram, Giza, Egypt
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Surgical Planning after Neoadjuvant Treatment in Breast Cancer: A Multimodality Imaging-Based Approach Focused on MRI. Cancers (Basel) 2023; 15:cancers15051439. [PMID: 36900231 PMCID: PMC10001061 DOI: 10.3390/cancers15051439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.
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Pires-Gonçalves L, Henriques Abreu M, Ferrão A, Guimarães Dos Santos A, Aguiar AT, Gouvêa M, Henrique R. Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer. Acta Radiol 2022; 64:1816-1822. [PMID: 36575580 DOI: 10.1177/02841851221144021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.
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Affiliation(s)
- Lígia Pires-Gonçalves
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Anabela Ferrão
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | | | - Ana Teresa Aguiar
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Margarida Gouvêa
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Savaridas S. Misinterpretation of raw data: fundamental flaws in ' The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis'. Br J Radiol 2021:20210741. [PMID: 34757825 PMCID: PMC10392648 DOI: 10.1259/bjr.20210741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Steinhof-Radwańska K, Grażyńska A, Lorek A, Gisterek I, Barczyk-Gutowska A, Bobola A, Okas K, Lelek Z, Morawska I, Potoczny J, Niemiec P, Szyluk K. Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer. Curr Oncol 2021; 28:3448-3462. [PMID: 34590596 PMCID: PMC8482113 DOI: 10.3390/curroncol28050298] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Evaluating the tumor response to neoadjuvant chemotherapy is key to planning further therapy of breast cancer. Our study aimed to evaluate the effectiveness of low-energy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 63 female patients were qualified for our retrospective analysis. Low-energy and subtraction CESM images just before the beginning of NAC and as a follow-up examination 2 weeks before the end of chemotherapy were compared with one another and assessed for compliance with the postoperative histopathological examination (HP). The response to preoperative chemotherapy was evaluated based on the RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Results: Low-energy images tend to overestimate residual lesions (6.28 mm) and subtraction images tend to underestimate them (2.75 mm). The sensitivity of low-energy images in forecasting CR amounted to 33.33%, while the specificity was 92.86%. In the case of subtraction CESM, the sensitivity amounted to 85.71% and the specificity to 71.42%. Conclusions: CESM is characterized by high sensitivity in the assessment of CR after NAC. The use of only morphological assessment is insufficient. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions.
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Affiliation(s)
- Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-358-1350
| | - Anna Grażyńska
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
| | - Iwona Gisterek
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (I.G.); (A.B.)
| | - Anna Barczyk-Gutowska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
| | - Agnieszka Bobola
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (I.G.); (A.B.)
| | - Karolina Okas
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Zuzanna Lelek
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Irmina Morawska
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Jakub Potoczny
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland;
| | - Karol Szyluk
- 1st Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62, 41-940 Piekary Śląskie, Poland;
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Xing D, Mao N, Dong J, Ma H, Chen Q, Lv Y. Quantitative analysis of contrast enhanced spectral mammography grey value for early prediction of pathological response of breast cancer to neoadjuvant chemotherapy. Sci Rep 2021; 11:5892. [PMID: 33723322 PMCID: PMC7960703 DOI: 10.1038/s41598-021-85353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
A quantitative analysis of contrast-enhanced spectral mammography (CESM) enhancement was conducted for the early prediction of the pathological response after neoadjuvant chemotherapy (NAC). Retrospective analysis of the data of 111 patients was conducted, and all of them underwent NAC in our hospital and surgical resection after the end of all cycles from January 2018 to May 2019. They were divided into pathological complete response (PCR) and non-PCR groups. We determined whether a statistical difference in the percentage of CESM grey value reduction (ΔCGV) was present in the PCR and non-PCR groups and whether a statistical difference was observed in the diagnostic efficiency of craniocaudal (CC) and mediolateral oblique (MLO) view subtraction images. Independent sample t-test was used to compare different groups, the receiver operating characteristic (ROC) curve was used to compare the diagnostic efficacy of CC and MLO for pathological response after NAC, and the Delong test was used to compare the area under the ROC curve (AUC). Statistical significance was considered at P < 0.05. A statistical difference was observed in the ΔCGV in the PCR and non-PCR groups. No statistical difference was observed in the AUCs of CC and MLO view subtraction images. The ΔCGV can be used as a quantitative index to predict PCR early, and no statistical difference was observed in the diagnostic efficacy of CC and MLO view subtraction images.
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Affiliation(s)
- Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, People's Republic of China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, People's Republic of China
| | - Jianjun Dong
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, People's Republic of China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, People's Republic of China
| | - Qianqian Chen
- GE Healthcare, Institute of Precision Medicine, No. 1 Huatuo Road, Shanghai, 201203, People's Republic of China
| | - Yongbin Lv
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Road, Yantai, 264000, Shandong, People's Republic of China.
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Tang S, Xiang C, Yang Q. The diagnostic performance of CESM and CE-MRI in evaluating the pathological response to neoadjuvant therapy in breast cancer: a systematic review and meta-analysis. Br J Radiol 2020; 93:20200301. [PMID: 32574075 PMCID: PMC7446000 DOI: 10.1259/bjr.20200301] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. METHODS Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. RESULTS There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67-0.84) and 0.82 (95%CI, 0.73-0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66-0.93) and 0.82 (95%CI, 0.68-0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. CONCLUSIONS Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. ADVANCES IN KNOWLEDGE CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.
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Affiliation(s)
- Sudan Tang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Chunhong Xiang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
| | - Quan Yang
- Department of Radiology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Yongchuan District, Chongqing, PR China
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