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Upadhyay N, Wolska J. Imaging the dense breast. J Surg Oncol 2024; 130:29-35. [PMID: 38685673 DOI: 10.1002/jso.27661] [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: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.
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Affiliation(s)
- Neil Upadhyay
- Faculty of Medicine, Imperial College London, London, UK
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Joanna Wolska
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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2
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Onega T, Abraham L, Miglioretti DL, Lee CI, Henderson LM, Kerlikowske K, Tosteson ANA, Weaver D, Sprague BL, Bowles EJA, di Florio-Alexander RM. Digital mammography and digital breast tomosynthesis for detecting invasive lobular and ductal carcinoma. Breast Cancer Res Treat 2023; 202:505-514. [PMID: 37697031 PMCID: PMC11216536 DOI: 10.1007/s10549-023-07051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer that can make early detection with mammography challenging. We compared imaging performance of digital breast tomosynthesis (DBT) to digital mammography (DM) for diagnoses of ILC, invasive ductal carcinoma (IDC), and invasive mixed carcinoma (IMC) in a screening population. METHODS We included screening exams (DM; n = 1,715,249 or DBT; n = 414,793) from 2011 to 2018 among 839,801 women in the Breast Cancer Surveillance Consortium. Examinations were followed for one year to ascertain incident ILC, IDC, or IMC. We measured cancer detection rate (CDR) and interval invasive cancer rate/1000 screening examinations for each histological subtype and stratified by breast density and modality. We calculated relative risk (RR) for DM vs. DBT using log-binomial models to adjust for the propensity of receiving DBT vs. DM. RESULTS Unadjusted CDR per 1000 mammograms of ILC overall was 0.33 (95%CI: 0.30-0.36) for DM; 0.45 (95%CI: 0.39-0.52) for DBT, and for women with dense breasts- 0.33 (95%CI: 0.29-0.37) for DM and 0.54 (95%CI: 0.43-0.66) for DBT. Similar results were noted for IDC and IMC. Adjusted models showed a significantly increased RR for cancer detection with DBT compared to DM among women with dense breasts for all three histologies (RR; 95%CI: ILC 1.53; 1.09-2.14, IDC 1.21; 1.02-1.44, IMC 1.76; 1.30-2.38), but no significant increase among women with non-dense breasts. CONCLUSION DBT was associated with higher CDR for ILC, IDC, and IMC for women with dense breasts. Early detection of ILC with DBT may improve outcomes for this distinct clinical entity.
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Affiliation(s)
- Tracy Onega
- Department of Population Health Sciences, and the Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr., RS 4725, Salt Lake City, UT, 84018, USA.
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington, and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Donald Weaver
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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Giunta EF, Arrichiello G, Pappalardo A, Federico P, Petrillo A. Transversal Perspectives of Integrative Oncology Care in Gastric and Lobular Breast Cancer. Cancer Treat Res 2023; 188:89-104. [PMID: 38175343 DOI: 10.1007/978-3-031-33602-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The occurrence of gastric cancer has been associated with an increased risk of lobular breast tumors in a subset of patients harboring selected germline mutations. Among all, the germline alteration of the gene coding for E-Cadherin (CDH1) was associated with an increased risk of gastric cancer diffuse-histotype and lobular breast cancer. However, the risk assessment of breast neoplasms and the role of multiple prophylactic procedures in these patients has never been systematically addressed. In addition, the performance of the common screening procedures for lobular breast cancer like mammography is suboptimal. Therefore, recalling the need for a better articulation of the patient-centered strategies of surveillance for individuals with germline CDH1 and other similar alterations, to offer comprehensive approaches for prevention, early diagnosis, and treatment. Accordingly, this chapter aims to discuss the value and the role of integrated oncological care in the era of oncology sub-specializations. Additionally, it sheds light on how the harmonization across the health providers can enhance patient care in this setting.
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Affiliation(s)
- Emilio Francesco Giunta
- Department of Precision Medicine, School of Medicine, University of Study of Campania, 80131, Naples, Italy
| | - Gianluca Arrichiello
- Department of Precision Medicine, School of Medicine, University of Study of Campania, 80131, Naples, Italy
| | | | - Piera Federico
- Medical Oncology Unit, Ospedale del Mare, Via E. Russo, 80147, Naples, Italy
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, Via E. Russo, 80147, Naples, Italy.
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Chen X, Zhang Y, Zhou J, Wang X, Liu X, Nie K, Lin X, He W, Su MY, Cao G, Wang M. Diagnosis of architectural distortion on digital breast tomosynthesis using radiomics and deep learning. Front Oncol 2022; 12:991892. [PMID: 36582788 PMCID: PMC9792864 DOI: 10.3389/fonc.2022.991892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To implement two Artificial Intelligence (AI) methods, radiomics and deep learning, to build diagnostic models for patients presenting with architectural distortion on Digital Breast Tomosynthesis (DBT) images. Materials and Methods A total of 298 patients were identified from a retrospective review, and all of them had confirmed pathological diagnoses, 175 malignant and 123 benign. The BI-RADS scores of DBT were obtained from the radiology reports, classified into 2, 3, 4A, 4B, 4C, and 5. The architectural distortion areas on craniocaudal (CC) and mediolateral oblique (MLO) views were manually outlined as the region of interest (ROI) for the radiomics analysis. Features were extracted using PyRadiomics, and then the support vector machine (SVM) was applied to select important features and build the classification model. Deep learning was performed using the ResNet50 algorithm, with the binary output of malignancy and benignity. The Gradient-weighted Class Activation Mapping (Grad-CAM) method was utilized to localize the suspicious areas. The predicted malignancy probability was used to construct the ROC curves, compared by the DeLong test. The binary diagnosis was made using the threshold of ≥ 0.5 as malignant. Results The majority of malignant lesions had BI-RADS scores of 4B, 4C, and 5 (148/175 = 84.6%). In the benign group, a substantial number of patients also had high BI-RADS ≥ 4B (56/123 = 45.5%), and the majority had BI-RADS ≥ 4A (102/123 = 82.9%). The radiomics model built using the combined CC+MLO features yielded an area under curve (AUC) of 0.82, the sensitivity of 0.78, specificity of 0.68, and accuracy of 0.74. If only features from CC were used, the AUC was 0.77, and if only features from MLO were used, the AUC was 0.72. The deep-learning model yielded an AUC of 0.61, significantly lower than all radiomics models (p<0.01), which was presumably due to the use of the entire image as input. The Grad-CAM could localize the architectural distortion areas. Conclusion The radiomics model can achieve a satisfactory diagnostic accuracy, and the high specificity in the benign group can be used to avoid unnecessary biopsies. Deep learning can be used to localize the architectural distortion areas, which may provide an automatic method for ROI delineation to facilitate the development of a fully-automatic computer-aided diagnosis system using combined AI strategies.
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Affiliation(s)
- Xiao Chen
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yang Zhang
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, United States,Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Jiahuan Zhou
- Department of Radiology, Yuyao Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Xiao Wang
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Xinmiao Liu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Ke Nie
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Xiaomin Lin
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwen He
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan,*Correspondence: Min-Ying Su, ; Guoquan Cao, ; Meihao Wang,
| | - Guoquan Cao
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,*Correspondence: Min-Ying Su, ; Guoquan Cao, ; Meihao Wang,
| | - Meihao Wang
- Department of Radiology, Key Laboratory of Intelligent Medical Imaging of Wenzhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,*Correspondence: Min-Ying Su, ; Guoquan Cao, ; Meihao Wang,
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Locally advanced invasive lobular carcinoma presenting as skin erythema, with multimodality imaging correlation. Radiol Case Rep 2022; 17:3681-3685. [PMID: 35942269 PMCID: PMC9356098 DOI: 10.1016/j.radcr.2022.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
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Farrokh A, Goldmann G, Meyer-Johann U, Hille-Betz U, Hillemanns P, Bader W, Wojcinski S. Clinical Differences between Invasive Lobular Breast Cancer and Invasive Carcinoma of No Special Type in the German Mammography-Screening-Program. Women Health 2022; 62:144-156. [DOI: 10.1080/03630242.2022.2030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- André Farrokh
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Ursula Hille-Betz
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Werner Bader
- Department of Obstetrics and Gynecology, Klinikum Bielefeld, Bielefeld, Germany
| | - Sebastian Wojcinski
- Department of Obstetrics and Gynecology, Klinikum Bielefeld, Bielefeld, Germany
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Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size. Pol J Radiol 2021; 86:e353-e358. [PMID: 34322184 PMCID: PMC8297481 DOI: 10.5114/pjr.2021.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to evaluate mammographic findings associated with invasive lobular carcinoma in different age groups, taking into account breast composition and tumour size. Material and methods A total of 1023 invasive lobular carcinoma preoperative mammograms were evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion, and asymmetry, and breasts were assessed as dense (C or D breast composition) or non-dense (A or B). The patient cohort was subdivided into 3 age groups (< 50, 50-69, ≥ 70 years of age). In order to make the size and age groups dichotomous variables and to perform multiple regression analysis, a cut-off of 10 mm was chosen for tumour size, and < 50-years-old and 50-69-years-old age groups were grouped together (< 70-years-old age group). Results Significant results of multivariate analysis were the association between mass finding and non-dense breasts and size ≥ 10 mm (p < 0.0001), between calcifications, and dense breasts, size < 10 mm and < 70-years-old age group (p < 0.0001), between distortion and < 70-years-old age group (p = 0.0366), and between asymmetry and ≥ 70-years-old age group (p = 0.0090). Conclusions Various mammographic findings are differently associated with age group, breast composition, and tumour size.
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Axillary Nodal Metastases in Invasive Lobular Carcinoma Versus Invasive Ductal Carcinoma: Comparison of Node Detection and Morphology by Ultrasound. AJR Am J Roentgenol 2021; 218:33-41. [PMID: 34319162 DOI: 10.2214/ajr.21.26135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Invasive lobular carcinoma is more subtle on imaging compared with invasive ductal carcinoma; nodal metastases may also differ on imaging between these. Objective: To determine whether invasive lobular carcinoma and invasive ductal carcinoma differ in the detection rate by ultrasound (US) of metastatic axillary nodes and in metastatic nodes' US characteristics. Methods: This retrospective study included 695 women (median age 53 years) with breast cancer in a total of 723 breasts (76 lobular, 586 ductal, 61 mixed), with biopsy-proven axillary nodal metastases and who underwent pretreatment US. A single breast radiologist reviewed US images in patients with suspicious nodes on US and classified node number, size, and morphology. Morphologic assessment used a previously described classification based on the relationship between node cortex and hilum. Nodal findings were compared between lobular and ductal carcinoma. A second radiologist independently classified node morphology in 241 cancers to assess interreader agreement. Results: A total of 99 metastatic axillary nodes (15 lobular, 66 ductal, 18 mixed) were not visualized on US and were diagnosed by surgical biopsy. The remaining 624 metastatic nodes (61 lobular, 520 ductal, 43 mixed) were visualized on US and diagnosed by US-guided FNA. Thus, US detected the metastatic nodes in 80.3% for lobular carcinoma versus 88.7% for ductal carcinoma (p=.04). Among metastatic nodes detected by US, retrospective review identified ≥3 abnormal nodes in 50.8% of lobular carcinoma versus 69.2% of ductal carcinoma (p=.003); node size was ≤2.0 cm in 65.6% for lobular carcinoma versus 47.3% for ductal carcinoma (p=.03); morphology was type III/IV (diffuse cortical thickening without hilar mass effect) rather than type V/VI (marked cortical thickening with hilar mass effect) in 68.9% for lobular carcinoma versus 28.8% for ductal carcinoma (p<.001). Interreader agreement assessment for morphology exhibited kappa coefficient of 0.63 (95% CI, 0.54-0.73). Conclusion: US detects a lower percentage of nodal metastases in lobular than ductal carcinoma. Nodal metastases in lobular carcinoma more commonly show diffuse cortical thickening and with less hilar mass effect. Clinical Impact: A lower threshold may be warranted to recommend biopsy of suspicious axillary nodes detected on US in patients with lobular carcinoma.
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Hovda T, Tsuruda K, Hoff SR, Sahlberg KK, Hofvind S. Radiological review of prior screening mammograms of screen-detected breast cancer. Eur Radiol 2021; 31:2568-2579. [PMID: 33001307 PMCID: PMC7979605 DOI: 10.1007/s00330-020-07130-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To perform a radiological review of mammograms from prior screening and diagnosis of screen-detected breast cancer in BreastScreen Norway, a population-based screening program. METHODS We performed a consensus-based informed review of mammograms from prior screening and diagnosis for screen-detected breast cancers. Mammographic density and findings on screening and diagnostic mammograms were classified according to the Breast Imaging-Reporting and Data System®. Cases were classified based on visible findings on prior screening mammograms as true (no findings), missed (obvious findings), minimal signs (minor/non-specific findings), or occult (no findings at diagnosis). Histopathologic tumor characteristics were extracted from the Cancer Registry of Norway. The Bonferroni correction was used to adjust for multiple testing; p < 0.001 was considered statistically significant. RESULTS The study included mammograms for 1225 women with screen-detected breast cancer. Mean age was 62 years ± 5 (SD); 46% (567/1225) were classified as true, 22% (266/1225) as missed, and 32% (392/1225) as minimal signs. No difference in mammographic density was observed between the classification categories. At diagnosis, 59% (336/567) of true and 70% (185/266) of missed cancers were classified as masses (p = 0.004). The percentage of histological grade 3 cancers was higher for true (30% (138/469)) than for missed (14% (33/234)) cancers (p < 0.001). Estrogen receptor positivity was observed in 86% (387/469) of true and 95% (215/234) of missed (p < 0.001) cancers. CONCLUSIONS We classified 22% of the screen-detected cancers as missed based on a review of prior screening mammograms with diagnostic images available. One main goal of the study was quality improvement of radiologists' performance and the program. Visible findings on prior screening mammograms were not necessarily indicative of screening failure. KEY POINTS • After a consensus-based informed review, 46% of screen-detected breast cancers were classified as true, 22% as missed, and 32% as minimal signs. • Less favorable prognostic and predictive tumor characteristics were observed in true screen-detected breast cancer compared with missed. • The most frequent mammographic finding for all classification categories at the time of diagnosis was mass, while the most frequent mammographic finding on prior screening mammograms was a mass for missed cancers and asymmetry for minimal signs.
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Affiliation(s)
- Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, PO Box 800, 3004, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
| | - Kaitlyn Tsuruda
- Section for Breast Cancer Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, 0317, Oslo, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Åsehaugen 5, 6017, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Kristine Kleivi Sahlberg
- Department of Research and Innovation, Vestre Viken Hospital Trust, PO Box 800, 3004, Drammen, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital Trust, PO Box 4950, 0424, Oslo, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304, Oslo, Norway.
- Faculty of Health Science, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
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Whelehan P, Ali K, Vinnicombe S, Ball G, Cox J, Farry P, Jenkin M, Lowry K, McIntosh SA, Nutt R, Oeppen R, Reilly M, Stahnke M, Steel J, Sim YT, Warwick V, Wilkinson L, Zafeiris D, Evans AJ. Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women. Br J Radiol 2021; 94:20201105. [PMID: 33411577 DOI: 10.1259/bjr.20201105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer. METHODS This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted. RESULTS Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases. CONCLUSIONS Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.
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Affiliation(s)
- Patsy Whelehan
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK.,NHS Tayside, Dundee, UK
| | - Kulsam Ali
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Graham Ball
- Nottingham Trent University, Nottingham, UK & Intelligent OMICS Ltd, Nottingham, UK
| | - Julie Cox
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Paul Farry
- Western Health and Social Care Trust, Londonderry, UK
| | | | - Keith Lowry
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rachel Nutt
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | - Rachel Oeppen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Michaela Stahnke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Violet Warwick
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Dimitrios Zafeiris
- Nottingham Trent University, Nottingham, UK & Intelligent OMICS Ltd, Nottingham, UK
| | - Andrew J Evans
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
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Gao Y, Moy L, Heller SL. Digital Breast Tomosynthesis: Update on Technology, Evidence, and Clinical Practice. Radiographics 2021; 41:321-337. [PMID: 33544665 DOI: 10.1148/rg.2021200101] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Digital breast tomosynthesis (DBT) has been widely adopted in breast imaging in both screening and diagnostic settings. The benefits of DBT are well established. Compared with two-dimensional digital mammography (DM), DBT preferentially increases detection of invasive cancers without increased detection of in-situ cancers, maximizing identification of biologically significant disease, while mitigating overdiagnosis. The higher sensitivity of DBT for architectural distortion allows increased diagnosis of invasive cancers overall and particularly improves the visibility of invasive lobular cancers. Implementation of DBT has decreased the number of recalls for false-positive findings at screening, contributing to improved specificity at diagnostic evaluation. Integration of DBT in diagnostic examinations has also resulted in an increased percentage of biopsies with positive results, improving diagnostic confidence. Although individual DBT examinations have a longer interpretation time compared with that for DM, DBT has streamlined the diagnostic workflow and minimized the need for short-term follow-up examinations, redistributing much-needed time resources to screening. Yet DBT has limitations. Although improvements in cancer detection and recall rates are seen for patients in a large spectrum of age groups and breast density categories, these benefits are minimal in women with extremely dense breast tissue, and the extent of these benefits may vary by practice environment and by geographic location. Although DBT allows detection of more invasive cancers than does DM, its incremental yield is lower than that of US and MRI. Current understanding of the biologic profile of DBT-detected cancers is limited. Whether DBT improves breast cancer-specific mortality remains a key question that requires further investigation. ©RSNA, 2021.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016
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13
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Wadhwa A, Majidi SS, Cherian S, Dykstra DS, Deitch SG, Hansen C, Bhave S, Koch KM. Architectural Distortion on Screening Digital Breast Tomosynthesis: Pathologic Outcomes and Indicators of Malignancy. JOURNAL OF BREAST IMAGING 2021; 3:34-43. [PMID: 38424835 DOI: 10.1093/jbi/wbaa099] [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: 06/15/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Digital breast tomosynthesis (DBT) has significantly improved cancer detection capabilities through its identification of subtle findings often imperceptible on 2D digital mammography, particularly architectural distortion (AD). The purpose of this study was to analyze of suspicious AD detected on screening DBT to evaluate the incidence of malignancy and to determine other patient or imaging characteristics in these cases as possible predictors of malignancy. METHODS This was an IRB approved retrospective analysis of subjects with AD detected on DBT screening mammography who were given a biopsy recommendation between January 1, 2016, and June 30, 2018. Univariate analysis of various imaging characteristics and patient high-risk factors was performed for statistical correlation with diagnosis of malignancy. RESULTS In the 218 DBT-detected AD findings with a final BI-RADS assessment of 4 or 5 on diagnostic workup, 94 (43.1%) yielded malignancy, 57 (26.2%) were classified as high-risk, and 67 (30.7%) were benign. There was a strong statistically significant association with malignancy in the cases with an US correlate (P < 0.0001). There was a statistically significant inverse correlation between malignancy and one-view findings (P = 0.0002). The presence of AD on 2D (P = 0.005) or synthetic 2D views (P = 0.002) showed statistically significant correlations with malignancy, whereas breast density or high-risk factors (P = 0.316) did not. CONCLUSION AD detected on DBT that persists on further workup and has no explainable cause should be considered suspicious for malignancy. Identification of the AD on both standard mammographic views and the presence of an US correlate significantly increase the probability of malignancy.
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Affiliation(s)
- Anubha Wadhwa
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Shadie S Majidi
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Solomon Cherian
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Daniel S Dykstra
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Sarah G Deitch
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Colin Hansen
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Sampada Bhave
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
| | - Kevin M Koch
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI
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14
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Burky MJ, Ray EM, Ollila DW, O’Connor SM, Hertel JD, Calhoun BC. Pleomorphic Invasive Lobular Carcinoma of the Breast With Extracellular Mucin and HER2 Amplification. Breast Cancer (Auckl) 2020; 14:1178223420976383. [PMID: 33281451 PMCID: PMC7691944 DOI: 10.1177/1178223420976383] [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: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive lobular carcinoma with extracellular mucin is an uncommon pattern of invasive breast carcinoma. The 5th Edition of the World Health Organization Classification of Breast Tumors states that it is unknown whether these tumors are a subtype of mucinous carcinoma or invasive lobular carcinoma. Invasive lobular carcinoma with extracellular mucin frequently presents as a palpable mass and may be more likely to be grade 2 to 3 and HER2-positive than classic invasive lobular carcinoma. This case of pleomorphic invasive lobular carcinoma with extracellular mucin was detected by imaging only and was HER2-amplified, suggesting that a subset of these tumors may be clinically occult with an aggressive phenotype. Invasive lobular carcinoma with extracellular mucin is infrequently encountered and awareness of this entity is helpful in avoiding misdiagnosis.
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Affiliation(s)
- Matthew J Burky
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Emily M Ray
- Division of Oncology, Department of
Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
| | - David W Ollila
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
- Division of Surgical Oncology,
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Siobhan M. O’Connor
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Johann D. Hertel
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Benjamin C Calhoun
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
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15
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Garlaschi A, Calabrese M, Zaottini F, Tosto S, Gipponi M, Baccini P, Gallo M, Tagliafico AS. Influence of Tumor Subtype, Radiological Sign and Prognostic Factors on Tumor Size Discrepancies Between Digital Breast Tomosynthesis and Final Histology. Cureus 2019; 11:e6046. [PMID: 31803564 PMCID: PMC6890152 DOI: 10.7759/cureus.6046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Influence of tumor subtype, radiological sign and prognostic factors on tumor size discrepancies between DBT and final histology has not been completely investigated so far. Purpose To study the influence of tumor subtype, radiological sign and prognostic factors on tumor size discrepancies between digital breast tomosynthesis and final histology. Material and methods This is a retrospective study conducted between January 2015 and December 2016. After IRB approval, 130 consecutive patients with breast cancer diagnosed with digital breast tomosynthesis (DBT) were evaluated. A discrepancy between DBT and final histology was considered present if the difference was above the cut-off of 5 mm. Tumor subtype, radiological sign and prognostic factors were evaluated in patients with discrepancies. Descriptive statistic and non-parametric tests were used. Results A total of 105 cases of cancer, in 96 patients, all female, were included. Mean age was 61 years (range: 35-82 yrs). In 19 (18.1%) cases, discrepancies were found: 13 (68.4%) were underestimated by DBT. For tumor subtype, 10 (52.6%) were infiltrating lobular carcinomas (ILC) (p < 0.01). Fourteen (73.7%) discordant cases were architectural distortions (p < 0.01). Prognostic factors did not affect tumor size discrepancies. Conclusion ILC or an architectural distortion represents the majority of cases of tumor size discrepancies between DBT and final histology.
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Affiliation(s)
| | | | | | - Simona Tosto
- Radiology, Ospedale Policlinico San Martino, Genova, ITA
| | - Marco Gipponi
- Surgery, Ospedale Policlinico San Martino, Genova, ITA
| | - Paola Baccini
- Pathology, University of Genova/ AOU IRCCS Policlinico San Martino, Genova, ITA
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16
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Corso G, Figueiredo J, La Vecchia C, Veronesi P, Pravettoni G, Macis D, Karam R, Lo Gullo R, Provenzano E, Toesca A, Mazzocco K, Carneiro F, Seruca R, Melo S, Schmitt F, Roviello F, De Scalzi AM, Intra M, Feroce I, De Camilli E, Villardita MG, Trentin C, De Lorenzi F, Bonanni B, Galimberti V. Hereditary lobular breast cancer with an emphasis on E-cadherin genetic defect. J Med Genet 2018; 55:431-441. [PMID: 29929997 DOI: 10.1136/jmedgenet-2018-105337] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022]
Abstract
Recent studies have reported germline CDH1 mutations in cases of lobular breast cancer (LBC) not associated with the classical hereditary diffuse gastric cancer syndrome. A multidisciplinary workgroup discussed genetic susceptibility, pathophysiology and clinical management of hereditary LBC (HLBC). The team has established the clinical criteria for CDH1 screening and results' interpretation, and created consensus guidelines regarding genetic counselling, breast surveillance and imaging techniques, clinicopathological findings, psychological and decisional support, as well as prophylactic surgery and plastic reconstruction. Based on a review of current evidence for the identification of HLBC cases/families, CDH1 genetic testing is recommended in patients fulfilling the following criteria: (A) bilateral LBC with or without family history of LBC, with age at onset <50 years, and (B) unilateral LBC with family history of LBC, with age at onset <45 years. In CDH1 asymptomatic mutant carriers, breast surveillance with clinical examination, yearly mammography, contrast-enhanced breast MRI and breast ultrasonography (US) with 6-month interval between the US and the MRI should be implemented as a first approach. In selected cases with personal history, family history of LBC and CDH1 mutations, prophylactic mastectomy could be discussed with an integrative group of clinical experts. Psychodecisional support also plays a pivotal role in the management of individuals with or without CDH1 germline alterations. Ultimately, the definition of a specific protocol for CDH1 genetic screening and ongoing coordinated management of patients with HLBC is crucial for the effective surveillance and early detection of LBC.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Joana Figueiredo
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy.,Oncology and Hematology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Oncology and Hematology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Debora Macis
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | | | - Roberto Lo Gullo
- Division of Breast Imaging, European Institute of Oncology, Milan, Italy
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.,Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Ketti Mazzocco
- Oncology and Hematology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Fátima Carneiro
- Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Division of Pathology, Hospital São Joao, Porto, Portugal
| | - Raquel Seruca
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Soraia Melo
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Fernando Schmitt
- EPIC Lab, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal.,Medical Faculty of the University of Porto, Porto, Portugal
| | - Franco Roviello
- Departments of Surgery and Pathology, Le Scotte Hospital, University of Siena, Siena, Italy
| | | | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | | | - Chiara Trentin
- Division of Breast Imaging, European Institute of Oncology, Milan, Italy
| | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology, Milano, Italy
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17
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Eghtedari M, Tsai C, Robles J, Blair SL, Ojeda-Fournier H. Tomosynthesis in Breast Cancer Imaging. Surg Oncol Clin N Am 2018; 27:33-49. [DOI: 10.1016/j.soc.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Chamming's F, Bouaboula M, Depetiteville MP, Catena V, Rousseau C, Boisserie-Lacroix M. Cancers lobulaires infiltrants : imagerie conventionnelle et gestes interventionnels. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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