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Huang Z, Mo S, Wu H, Kong Y, Luo H, Li G, Zheng J, Tian H, Tang S, Chen Z, Wang Y, Xu J, Zhou L, Dong F. Optimizing breast cancer diagnosis with photoacoustic imaging: An analysis of intratumoral and peritumoral radiomics. PHOTOACOUSTICS 2024; 38:100606. [PMID: 38665366 PMCID: PMC11044033 DOI: 10.1016/j.pacs.2024.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background The differentiation between benign and malignant breast tumors extends beyond morphological structures to encompass functional alterations within the nodules. The combination of photoacoustic (PA) imaging and radiomics unveils functional insights and intricate details that are imperceptible to the naked eye. Purpose This study aims to assess the efficacy of PA imaging in breast cancer radiomics, focusing on the impact of peritumoral region size on radiomic model accuracy. Materials and methods From January 2022 to November 2023, data were collected from 358 patients with breast nodules, diagnosed via PA/US examination and classified as BI-RADS 3-5. The study used the largest lesion dimension in PA images to define the region of interest, expanded by 2 mm, 5 mm, and 8 mm, for extracting radiomic features. Techniques from statistics and machine learning were applied for feature selection, and logistic regression classifiers were used to build radiomic models. These models integrated both intratumoral and peritumoral data, with logistic regressions identifying key predictive features. Results The developed nomogram, combining 5 mm peritumoral data with intratumoral and clinical features, showed superior diagnostic performance, achieving an AUC of 0.950 in the training cohort and 0.899 in validation. This model outperformed those based solely on clinical features or other radiomic methods, with the 5 mm peritumoral region proving most effective in identifying malignant nodules. Conclusion This research demonstrates the significant potential of PA imaging in breast cancer radiomics, especially the advantage of integrating 5 mm peritumoral with intratumoral features. This approach not only surpasses models based on clinical data but also underscores the importance of comprehensive radiomic analysis in accurately characterizing breast nodules.
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Affiliation(s)
- Zhibin Huang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Sijie Mo
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Huaiyu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Yao Kong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Hui Luo
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Guoqiu Li
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Jing Zheng
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Hongtian Tian
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Shuzhen Tang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Zhijie Chen
- Ultrasound Imaging System Development Department, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Youping Wang
- Department of Clinical and Research, Shenzhen Mindray Bio-medical Electronics Co., Ltd., Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
| | - Luyao Zhou
- Department of Ultrasound, Shenzhen Children’ Hospital, No. 7019, Yitian Road, Futian District, Shenzhen 518026, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China
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Huang Z, Tian H, Luo H, Yang K, Chen J, Li G, Ding Z, Luo Y, Tang S, Xu J, Wu H, Dong F. Assessment of Oxygen Saturation in Breast Lesions Using Photoacoustic Imaging: Correlation With Benign and Malignant Disease. Clin Breast Cancer 2024; 24:e210-e218.e1. [PMID: 38423948 DOI: 10.1016/j.clbc.2024.01.006] [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: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hypoxia is a hallmark of breast cancer (BC). Photoacoustic (PA) imaging, based on the use of laser-generated ultrasound (US), can detect oxygen saturation (So2) in the tissues of breast lesion patients. PURPOSE To measure the oxygenation status of tissue in and on both sides of the lesion in breast lesion participants using a multimodal Photoacoustic/ultrasound (PA/US) imaging system and to determine the correlation between So2 measured by PA imaging and benign or malignant disease. MATERIALS AND METHODS Multimodal PA/US imaging and gray-scale US (GSUS) of breast lesion was performed in consecutive breast lesion participants imaged in the US Outpatient Clinic between 2022 and 2023. Dual-wavelength PA imaging was used to measure the So2 value inside the lesion and on both sides of the tissue, and to distinguish benign from malignant lesions based on the So2 value. The ability of So2 to distinguish benign from malignant breast lesions was evaluated by the receiver operating characteristic curve (ROC) and the De-Long test. RESULTS A total of 120 breast lesion participants (median age, 42.5 years) were included in the study. The malignant lesions exhibited lower So2 levels compared to benign lesions (malignant: 71.30%; benign: 83.81%; P < .01). Moreover, PA/US imaging demonstrates superior diagnostic results compared to GSUS, with an area under the curve (AUC) of 0.89 versus 0.70, sensitivity of 89.58% versus 85.42%, and specificity of 86.11% versus 55.56% at the So2 cut-off value of 78.85 (P < .001). The false positive rate in GSUS reduced by 30.75%, and the false negative rate diminished by 4.16% with PA /US diagnosis. Finally, the So2 on both sides tissues of malignant lesions are lower than that of benign lesions (P < .01). CONCLUSION PA imaging allows for the assessment of So2 within the lesions of breast lesion patients, thereby facilitating a superior distinction between benign and malignant lesions.
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Affiliation(s)
- Zhibin Huang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China
| | - Hongtian Tian
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Hui Luo
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Keen Yang
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Jing Chen
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Guoqiu Li
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China; Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Zhimin Ding
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Yuwei Luo
- Department of Breast Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China; Department of General Surgery, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China
| | - Shuzhen Tang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China; Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China; Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Huaiyu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China; Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China.
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, 518020, China; Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China.
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Kobzeva-Herzog A, O'Shea T, Young S, Kenzik K, Zhao X, Slanetz P, Phillips J, Merrill A, Cassidy MR. Breast Cancer Screening and BI-RADS Scoring Trends Before and During the COVID-19 Pandemic in an Academic Safety-Net Hospital. Ann Surg Oncol 2024; 31:2253-2260. [PMID: 38177460 DOI: 10.1245/s10434-023-14787-4] [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] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic affected screening mammography rates and Breast Imaging Reporting and Data Systems (BI-RADS) categorizations within populations facing social and economic inequities. Our study seeks to compare trends in breast cancer screening and BI-RADS assessments in an academic safety-net patient population before and during the COVID-19 pandemic. PATIENTS AND METHODS Our single-center retrospective study evaluated women ≥ 18 years old with no known breast cancer diagnosis who received breast cancer screening from March 2019-September 2020. The screening BI-RADS score, completion of recommended diagnostic imaging, and diagnostic BI-RADS scores were compared between the pre-COVID-19 era (from 1 March 2019 to 19 March 2020) and COVID-19 era (from 20 March 2020 to 30 September 2020). RESULTS Among the 11,798 patients identified, screened patients were younger (median age 57 versus 59 years, p < 0.001) and more likely covered by private insurance (35.9% versus 32.3%, p < 0.001) during the COVID-19 era compared with the pre-COVID-19 era. During the pandemic, there was an increase in screening mammograms categorized as BI-RADS 0 compared with the pre-COVID-19 era (20% versus 14.5%, p < 0.0001). There was no statistically significant difference in rates of completion of diagnostic imaging (81.6% versus 85.4%, p = 0.764) or assignment of suspicious BI-RADS scores (BI-RADS 4-5; 79.9% versus 80.8%, p = 0.762) between the two eras. CONCLUSIONS Although more patients were recommended to undergo diagnostic imaging during the pandemic, there were no significant differences in race, completion of diagnostic imaging, or proportions of mammograms categorized as suspicious between the two time periods. These findings likely reflect efforts to maintain equitable care among diverse racial groups served by our safety-net hospital.
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Affiliation(s)
- Anna Kobzeva-Herzog
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Thomas O'Shea
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sara Young
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Xuewei Zhao
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Priscilla Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jordana Phillips
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Merrill
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michael R Cassidy
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
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Guerra CE, Sharma PV, Castillo BS. Multi-Cancer Early Detection: The New Frontier in Cancer Early Detection. Annu Rev Med 2024; 75:67-81. [PMID: 37729031 DOI: 10.1146/annurev-med-050522-033624] [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: 09/22/2023]
Abstract
The new generation of cancer early detection tests holds remarkable promise for revolutionizing and changing the paradigm of cancer early detection. Dozens of cancer early detection tests are being developed and evaluated. Some are already commercialized and available for use, most as a complement to and not in place of existing recommended cancer screening tests. This review evaluates existing single- and multi-cancer early detection tests (MCEDs), discussing their performance characteristics including sensitivity, specificity, positive and negative predictive values, and accuracy. It also critically looks at the potential harms that could result from these tests, including false positive and negative results, the risk of overdiagnosis and overtreatment, psychological and economic harms, and the risk of widening cancer inequities. We also review the large-scale, population-based studies that are being launched in the United States and United Kingdom to determine the impact of MCEDs on clinically relevant outcomes and implications for current practice.
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Affiliation(s)
- Carmen E Guerra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prateek V Sharma
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Brenda S Castillo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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Ambinder EB, Wang A, Oluyemi E, Myers KS, Mullen LA. Self-scheduling of Screening Mammograms Using an Online Patient Portal: Initial 8-year Experience at a Multisite Academic Institution. J Am Coll Radiol 2024; 21:141-146. [PMID: 37634791 DOI: 10.1016/j.jacr.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE The goal of this study was to determine patient factors associated with the use of self-scheduling of screening mammograms (SMs) using an online portal. METHODS All SMs scheduled at our multisite academic institution from January 1, 2015, to December 31, 2022, were included. The frequency of self-scheduling via an online portal was calculated per year. Univariate and multivariate logistic regression models with generalized estimating equation were used to estimate associations between patient characteristics and scheduling format after accounting for correlations between mammograms performed on the same woman. RESULTS During the study period, 250,369 SMs were performed in 74,860 unique patients (mean age 59 ± 12 years). Of these, 36,200 (14.5%) were self-scheduled via the online portal. Self-scheduling increased each year, from 3.7% in 2015 to 36.9% in 2022. Younger age, non-Black race, being an English speaker, and being from a nondisadvantaged zip code were significant predictors of self-scheduling on univariate and multivariate logistic regression. Age <50 years versus age ≥70 years was the patient characteristic that most strongly predicted the likelihood of self-scheduling (adjusted odds ratio 5.4, 95% confidence interval 5.2-5.6). CONCLUSIONS Over 8 years (2015-2022), utilization of self-scheduling for screening mammography using an online patient portal increased from 3.7% to 36.9%. Age < 50 years was the patient characteristic that most strongly predicted likelihood of self-scheduling.
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Affiliation(s)
- Emily B Ambinder
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland.
| | - Annie Wang
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
| | - Eniola Oluyemi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kelly S Myers
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
| | - Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
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Wang T, Dossett LA. Incorporating Value-Based Decisions in Breast Cancer Treatment Algorithms. Surg Oncol Clin N Am 2023; 32:777-797. [PMID: 37714643 DOI: 10.1016/j.soc.2023.05.008] [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: 09/17/2023]
Abstract
Given the excellent prognosis and availability of evidence-based treatment, patients with early-stage breast cancer are at risk of overtreatment. In this review, we summarize key opportunities to incorporate value-based decisions to optimize the delivery of high-value treatment across the breast cancer care continuum.
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Affiliation(s)
- Ton Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Siviengphanom S, Gandomkar Z, Lewis SJ, Brennan PC. Global Radiomic Features from Mammography for Predicting Difficult-To-Interpret Normal Cases. J Digit Imaging 2023; 36:1541-1552. [PMID: 37253894 PMCID: PMC10406750 DOI: 10.1007/s10278-023-00836-7] [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: 11/28/2022] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023] Open
Abstract
This work aimed to investigate whether global radiomic features (GRFs) from mammograms can predict difficult-to-interpret normal cases (NCs). Assessments from 537 readers interpreting 239 normal mammograms were used to categorise cases as 120 difficult-to-interpret and 119 easy-to-interpret based on cases having the highest and lowest difficulty scores, respectively. Using lattice- and squared-based approaches, 34 handcrafted GRFs per image were extracted and normalised. Three classifiers were constructed: (i) CC and (ii) MLO using the GRFs from corresponding craniocaudal and mediolateral oblique images only, based on the random forest technique for distinguishing difficult- from easy-to-interpret NCs, and (iii) CC + MLO using the median predictive scores from both CC and MLO models. Useful GRFs for the CC and MLO models were recognised using a scree test. The CC and MLO models were trained and validated using the leave-one-out-cross-validation. The models' performances were assessed by the AUC and compared using the DeLong test. A Kruskal-Wallis test was used to examine if the 34 GRFs differed between difficult- and easy-to-interpret NCs and if difficulty level based on the traditional breast density (BD) categories differed among 115 low-BD and 124 high-BD NCs. The CC + MLO model achieved higher performance (0.71 AUC) than the individual CC and MLO model alone (0.66 each), but statistically non-significant difference was found (all p > 0.05). Six GRFs were identified to be valuable in describing difficult-to-interpret NCs. Twenty features, when compared between difficult- and easy-to-interpret NCs, differed significantly (p < 0.05). No statistically significant difference was observed in difficulty between low- and high-BD NCs (p = 0.709). GRF mammographic analysis can predict difficult-to-interpret NCs.
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Affiliation(s)
- Somphone Siviengphanom
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ziba Gandomkar
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah J Lewis
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
| | - Patrick C Brennan
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
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Ecanow JS, Ecanow DB, Hack B, Leloudas N, Prasad PV. Feasibility of Diffusion Tensor Imaging for Decreasing Biopsy Rates in Breast Imaging: Interim Analysis of a Prospective Study. Diagnostics (Basel) 2023; 13:2226. [PMID: 37443620 DOI: 10.3390/diagnostics13132226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Because of the limited specificity of diagnostic imaging, many breast lesions referred for biopsy turn out to be benign. The objective of this study was to evaluate whether diffusion tensor MRI (DTI) parametric maps can be used to safely avoid biopsy of breast lesions. Individuals referred for breast biopsy based on mammogram (MG), ultrasound (US), and/or contrast enhanced (CE)-MRI were recruited. Scans consisting of T2-weighted and DTI sequences were performed. Multiple DTI-derived parametric color maps were evaluated semi-quantitatively to characterize lesions as "definitely benign," "not definitely benign," or "suspicious." All patients subsequently underwent biopsy. In this moderately-sized prospective study, 21 out of 47 pathologically proven benign lesions were characterized by both readers as "definitely benign," which would have precluded the need for biopsy. Biopsy was recommended for 11 out of 13 cancers that were characterized as "suspicious." In the remaining two cancers and 26 of 47 benign lesions, the scans were characterized as "not definitely benign" and hence required biopsy. The main causes for "not definitely benign" scans were small lesion sizes and noise. The results suggest that in appropriately selected patients, DTI may be used to safely reduce the number of unnecessary breast biopsies.
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Affiliation(s)
- Jacob S Ecanow
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - David B Ecanow
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Bradley Hack
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Nondas Leloudas
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Pottumarthi V Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
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Jani C, Lotz M, Keates S, Gupta Y, Walker A, Al Omari O, Parvez A, Patel D, Gnata M, Perry J, Khorashadi L, Weissmann L, Pories SE. Management of Lobular Neoplasia Diagnosed by Core Biopsy. Breast J 2023; 2023:8185446. [PMID: 37114120 PMCID: PMC10129432 DOI: 10.1155/2023/8185446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023]
Abstract
Lobular neoplasia (LN) involves proliferative changes within the breast lobules. LN is divided into lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). LCIS can be further subdivided into three subtypes: classic LCIS, pleomorphic LCIS, and LCIS with necrosis (florid type). Because classic LCIS is now considered as a benign etiology, current guidelines recommend close follow-up with imaging versus surgical excision. The goal of our study was to determine if the diagnosis of classic LN on core needle biopsy (CNB) merits surgical excision. This is a retrospective, observational study conducted at Mount Auburn Hospital, Cambridge, MA, from May 17, 2017, through June 30, 2020. We reviewed the data of breast biopsies conducted at our hospital over this period and included patients who were diagnosed with classic LN (LCIS and/or ALH) and excluded patients having any other atypical lesions on CNB. All known cancer patients were excluded. Of the 2707 CNBs performed during the study period, we identified 68 women who were diagnosed with ALH or LCIS on CNB. CNB was performed for an abnormal mammogram in the majority of patients (60; 88%) while 7(10.3%) had an abnormal breast magnetic resonance imaging study (MRI), and 1 had an abnormal ultrasound (US). A total of 58 patients (85%) underwent excisional biopsy, of which 3 (5.2%) showed malignancy, including 2 cases of DCIS and 1 invasive carcinoma. In addition, there was 1 case (1.7%) with pleomorphic LCIS and 11 cases with ADH (15.5%). The management of LN found on core biopsy is evolving, with some advocating surgical excision and others recommending observation. Our data show a change in diagnosis with excisional biopsy in 13 (22.4%) of patients with 2 cases of DCIS, 1 invasive carcinoma, 1 pleomorphic LCIS, and 9 cases of ADH, diagnosed on excisional biopsy. While ALH and classic LCIS are considered benign, the choice of ongoing surveillance versus excisional biopsy should be made with shared decision making with the patient, with consideration of personal and family history, as well as patient preferences.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Margaret Lotz
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Sarah Keates
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Yasha Gupta
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Alexander Walker
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Omar Al Omari
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Arshi Parvez
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Dipesh Patel
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Maria Gnata
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - John Perry
- Department of Pathology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Leila Khorashadi
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Lisa Weissmann
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Susan E. Pories
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
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Integrating age, BMI, and serum N-glycans detected by MALDI mass spectrometry to classify suspicious mammogram findings as benign lesions or breast cancer. Sci Rep 2022; 12:20801. [PMID: 36460712 PMCID: PMC9718781 DOI: 10.1038/s41598-022-25401-0] [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: 09/09/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
While mammograms are the standard tool for breast cancer screening, there remains challenges for mammography to effectively distinguish benign lesions from breast cancers, leading to many unnecessary biopsy procedures. A blood-based biomarker could provide a minimally invasive supplemental assay to increase the specificity of breast cancer screening. Serum N-glycosylation alterations have associations with many cancers and several of the clinical characteristics of breast cancer. The current study utilized a high-throughput mass spectrometry workflow to identify serum N-glycans with differences in intensities between patients that had a benign lesion from patients with breast cancer. The overall N-glycan profiles of the two patient groups had no differences, but there were several individual N-glycans with significant differences in intensities between patients with benign lesions and ductal carcinoma in situ (DCIS). Many N-glycans had strong associations with age and/or body mass index, but there were several of these associations that differed between the patients with benign lesions and breast cancer. Accordingly, the samples were stratified by the patient's age and body mass index, and N-glycans with significant differences between these subsets were identified. For women aged 50-74 with a body mass index of 18.5-24.9, a model including the intensities of two N-glycans, 1850.666 m/z and 2163.743 m/z, age, and BMI were able to clearly distinguish the breast cancer patients from the patients with benign lesions with an AUROC of 0.899 and an optimal cutoff with 82% sensitivity and 84% specificity. This study indicates that serum N-glycan profiling is a promising approach for providing clarity for breast cancer screening, especially within the subset of healthy weight women in the age group recommended for mammograms.
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11
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Disparities Associated With Patient Adherence to BI-RADS 3 Assessment Follow-up Recommendations for Mammography and Ultrasound. J Am Coll Radiol 2022; 19:1302-1309. [PMID: 36182098 DOI: 10.1016/j.jacr.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment. METHODS This retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression. RESULTS There were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46). DISCUSSION Multiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.
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12
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Muldoon A, Kabeer A, Cormier J, Saksena MA, Fang Q, Carp SA, Deng B. Method to improve the localization accuracy and contrast recovery of lesions in separately acquired X-ray and diffuse optical tomographic breast imaging. BIOMEDICAL OPTICS EXPRESS 2022; 13:5295-5310. [PMID: 36425617 PMCID: PMC9664870 DOI: 10.1364/boe.470373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 05/11/2023]
Abstract
Near-infrared diffuse optical tomography (DOT) has the potential to improve the accuracy of breast cancer diagnosis and aid in monitoring the response of breast tumors to chemotherapy by providing hemoglobin-based functional imaging. The use of structural lesion priors derived from clinical breast imaging methods, such as mammography, can improve recovery of tumor optical contrast; however, accurate lesion prior placement is essential to take full advantage of prior-guided DOT image reconstruction. Simultaneous optical and anatomical imaging may not always be possible or desired, which can make the accurate registration of the lesion prior challenging. In this paper, we present a three-step lesion prior scanning approach to facilitate improved accuracy in lesion localization based on the optical contrast quantified by the total hemoglobin concentration (HbT) for non-simultaneous multimodal DOT and digital breast tomosynthesis (DBT) imaging. In three challenging breast cancer patient cases, where no clear optical contrast was present initially, we have demonstrated consistent improvement in the recovered HbT lesion contrast by utilizing this method.
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Affiliation(s)
- Ailis Muldoon
- Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Aiza Kabeer
- Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Jayne Cormier
- Breast Imaging Division, Department of Radiology,
Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mansi A. Saksena
- Breast Imaging Division, Department of Radiology,
Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Stefan A. Carp
- Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Bin Deng
- Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA 02129, USA
- Harvard Medical School, Boston, MA 02115, USA
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13
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Breast-Specific Gamma Imaging: An Added Value in the Diagnosis of Breast Cancer, a Systematic Review. Cancers (Basel) 2022; 14:cancers14194619. [PMID: 36230540 PMCID: PMC9559460 DOI: 10.3390/cancers14194619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Breast-specific gamma imaging represents an emergent instrument for breast cancer detection. We selected on Medline articles published from 1995 to 2022 that compare various imaging modalities with breast-specific gamma imaging. The aim of this paper was to assess if this imaging method is a more valuable choice in detecting breast malignant lesions compared to morphological counterparts such mammography, ultrasound, and magnetic resonance imaging in terms of specificity, sensibility and positive and negative predictive value. At the cost of a major radiology burden, breast-specific gamma imaging is more specific, with a sensibility comparable to magnetic resonance imaging and higher than ultrasonography and mammography. Abstract Purpose: Breast cancer is the most common solid tumor and the second highest cause of death in the United States. Detection and diagnosis of breast tumors includes various imaging modalities, such as mammography (MMG), ultrasound (US), and contrast-enhancement MRI. Breast-specific gamma imaging (BSGI) is an emerging tool, whereas morphological imaging has the disadvantage of a higher absorbed dose. Our aim was to assess if this imaging method is a more valuable choice in detecting breast malignant lesions compared to morphological counterparts. Methods: research on Medline from 1995 to June 2022 was conducted. Studies that compared at least one anatomical imaging modality with BSGI were screened and assessed through QUADAS2 for risk of bias and applicability concerns assessment. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) were reported. Results: A total of 15 studies compared BSGI with MMG, US, and MRI. BSGI sensitivity was similar to MRI, but specificity was higher. Specificity was always higher than MMG and US. BSGI had higher PPV and NPV. When used for the evaluation of a suspected breast lesion, the overall sensitivity was better than the examined overall sensitivity when BSGI was excluded. Risk of bias and applicability concerns domain showed mainly low risk of bias. Conclusion: BSGI is a valuable imaging modality with similar sensitivity to MRI but higher specificity, although at the cost of higher radiation burden.
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14
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de Vasconcelos Silva ACP, Araujo BM, Spiegel T, da Cunha Reis A. May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review. J Cancer Policy 2022; 34:100350. [DOI: 10.1016/j.jcpo.2022.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
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15
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Chowdhury A, Razzaque RR, Muhtadi S, Shafiullah A, Ul Islam Abir E, Garra BS, Kaisar Alam S. Ultrasound classification of breast masses using a comprehensive Nakagami imaging and machine learning framework. ULTRASONICS 2022; 124:106744. [PMID: 35390626 DOI: 10.1016/j.ultras.2022.106744] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
In this study we investigate the potential of parametric images formed from ultrasound B-mode scans using the Nakagami distribution for non-invasive classification of breast lesions and characterization of breast tissue. Through a sliding window technique, we generated seven types of Nakagami images for each patient scan in our dataset using basic and as well as derived parameters of the Nakagami distribution. To determine the suitable window size for image generation, we conducted an empirical analysis using 4 windows, which includes 3 column windows of lengths 0.1875 mm, 0.45 mm and 0.75 mm and widths of 0.002 mm, along with the standard square window with sides equal to three times the pulse length of incident ultrasound. From the parametric image sets generated using each window, we extracted a total of 72 features that consisted of morphometric, elemental and hybrid features. To our knowledge no other literature has conducted such a comprehensive analysis of Nakagami parametric images for the classification of breast lesions. Feature selection was performed to find the most useful subset of features from each of the parametric image sets for the classification of breast cancer. Analyzing the classification accuracy and Area under the Receiver Operating Characteristic (ROC) Curve (AUC) of the selected feature subsets, we determined that the selected features acquired from Nakagami parametric images generated using a column window of length 0.75 mm provides the best results for characterization of breast lesions. This optimal feature set provided a classification accuracy of 93.08%, an AUC of 0.9712, a False Negative Rate (FNR) of 0%, and a very low False Positive Rate (FPR) of 8.65%. Our results indicate that the high accuracy of such a procedure may assist in the diagnosis of breast cancer by helping to reduce false positive diagnoses.
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Affiliation(s)
- Ahmad Chowdhury
- Department of Electrical and Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh
| | - Rezwana R Razzaque
- Department of Electrical and Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh
| | - Sabiq Muhtadi
- Department of Electrical and Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh.
| | - Ahmad Shafiullah
- Department of Electrical and Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh
| | - Ehsan Ul Islam Abir
- Department of Electrical and Electronic Engineering, Islamic University of Technology, Gazipur, Bangladesh
| | - Brian S Garra
- Division of Imaging, Diagnostics and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, United States
| | - S Kaisar Alam
- Imagine Consulting LLC, Dayton, NJ, United States; Prep Excellence LLC, Dayton, NJ, United States; The Center for Computational Biomedicine Imaging and Modelling (CBIM), Rutgers University, NJ, Piscataway, United States
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16
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Kennard K, Wang O, Kjelstrom S, Larson S, Sizer LM, Carruthers C, Carter WB, Ciocca R, Sabol J, Frazier TG, Carp NZ. Outcomes of Abbreviated MRI (Ab-MRI) for Women of any Breast Cancer Risk and Breast Density in a Community Academic Setting. Ann Surg Oncol 2022; 29:6215-6221. [PMID: 35857199 DOI: 10.1245/s10434-022-12194-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging (Ab-MRI) has been evaluated for elevated breast cancer risk or dense breasts but has not been evaluated across all risk profiles. METHODS Patients selected underwent Ab-MRI from February 2020 to September 2021. Women were older than aged 30 years, up to date with screening mammography, and paid $299 cash. RESULTS A total of 93 patients were identified with a mean age of 52 years; 92.5% were Caucasian, 0% black, and 97.9% were from high socioeconomic status. Mean Gail score was 14.2, and 83.3% had a lifetime risk of breast cancer <20%. Reasons for Ab-MRI: dense breasts (36.6%); family history (24.7%); palpable mass (12.9%). Providers ordering: OBGYN (49.5%); breast surgeon (39.1%); primary care (6.6%). Thirteen biopsies (14%) detected one breast cancer. 31.1% had a change in follow-up screening: 58.6% 6-month MRI, 20.7% 6-month mammogram, and 10.3% 6-month ultrasound. Negative predictive value was 100% (95% confidence interval [CI]: 95-100%, p < 0.0001). Sensitivity was 100% (95% CI: 2.5-100%, p < 0.0001), and specificity was 87% (95% CI: 78.3-93.1%, p < 0.0001) compared with 77.6% and 98.8% for mammography. Only one cancer was detected: cost of $27,807 plus cost of 13 MRI or ultrasound (US)-guided biopsies and additional follow-up imaging. Historically 20% of abnormalities detected on full MRI are malignant; however, 7.7% of ab-MRI abnormalities were malignant CONCLUSIONS: One third of women were recommended a change in follow-up, which predominantly included a 6-month MRI. Ab-MRI may introduce average risk women to unnecessary follow-up and increased biopsies with a lower cancer detection rate. Ab-MRI should be evaluated closely before implementation.
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Affiliation(s)
- Kaitlyn Kennard
- The Bryn Mawr Hospital, Bryn Mawr, PA, USA. .,Lankenau Medical Center, Wynnewood, PA, USA. .,Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA.
| | | | - Stephanie Kjelstrom
- Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Sharon Larson
- Center for Population Health at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | | | | | | | | | | | | | - Ned Z Carp
- Lankenau Medical Center, Wynnewood, PA, USA
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17
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Pereira C, Parolo C, Idili A, Gomis RR, Rodrigues L, Sales G, Merkoçi A. Paper-based biosensors for cancer diagnostics. TRENDS IN CHEMISTRY 2022. [DOI: 10.1016/j.trechm.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Covington MF. Ultrasound Elastography May Better Characterize BI-RADS 3 and BI-RADS 4A Lesions to Decrease False-Positive Breast Biopsy Rates and Enable Earlier Detection of Breast Cancer. J Am Coll Radiol 2022; 19:635-636. [DOI: 10.1016/j.jacr.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
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19
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Wu N, Huang Z, Shen Y, Park J, Phang J, Makino T, Gene Kim S, Cho K, Heacock L, Moy L, Geras KJ. Reducing False-Positive Biopsies using Deep Neural Networks that Utilize both Local and Global Image Context of Screening Mammograms. J Digit Imaging 2021; 34:1414-1423. [PMID: 34731338 PMCID: PMC8669066 DOI: 10.1007/s10278-021-00530-6] [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: 09/19/2020] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022] Open
Abstract
Breast cancer is the most common cancer in women, and hundreds of thousands of unnecessary biopsies are done around the world at a tremendous cost. It is crucial to reduce the rate of biopsies that turn out to be benign tissue. In this study, we build deep neural networks (DNNs) to classify biopsied lesions as being either malignant or benign, with the goal of using these networks as second readers serving radiologists to further reduce the number of false-positive findings. We enhance the performance of DNNs that are trained to learn from small image patches by integrating global context provided in the form of saliency maps learned from the entire image into their reasoning, similar to how radiologists consider global context when evaluating areas of interest. Our experiments are conducted on a dataset of 229,426 screening mammography examinations from 141,473 patients. We achieve an AUC of 0.8 on a test set consisting of 464 benign and 136 malignant lesions.
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Affiliation(s)
- Nan Wu
- Center for Data Science, New York University, New York City, USA.
| | - Zhe Huang
- Center for Data Science, New York University, New York City, USA
| | - Yiqiu Shen
- Center for Data Science, New York University, New York City, USA
| | - Jungkyu Park
- Center for Data Science, New York University, New York City, USA
| | - Jason Phang
- Center for Data Science, New York University, New York City, USA
| | - Taro Makino
- Center for Data Science, New York University, New York City, USA
| | - S Gene Kim
- Department of Radiology, New York University School of Medicine, New York City, USA
- Perlmutter Cancer Center, NYU Langone Health, New York City, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York City, USA
| | - Kyunghyun Cho
- Center for Data Science, New York University, New York City, USA
- Department of Computer Science, Courant Institute of Mathematical Sciences, New York University, New York City, USA
- CIFAR Associate Fellow, New York City, USA
| | - Laura Heacock
- Department of Radiology, New York University School of Medicine, New York City, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, New York City, USA
- Perlmutter Cancer Center, NYU Langone Health, New York City, USA
| | - Krzysztof J Geras
- Center for Data Science, New York University, New York City, USA
- Department of Radiology, New York University School of Medicine, New York City, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York City, USA
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20
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Nguyen DL, Oluyemi E, Myers KS, Panigrahi B, Mullen LA, Ambinder EB. Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors. J Am Coll Radiol 2021; 19:20-23. [PMID: 34800367 DOI: 10.1016/j.jacr.2021.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Eniola Oluyemi
- Johns Hopkins Medicine, Baltimore, Maryland; Member, ACR National Mammography Database Committee
| | | | | | - Lisa A Mullen
- Breast Imaging Fellowship Director, Johns Hopkins Medicine, Baltimore, Maryland
| | - Emily B Ambinder
- Assistant Chief of Breast Imaging, Johns Hopkins Medicine, Baltimore, Maryland.
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21
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Hackshaw A, Cohen SS, Reichert H, Kansal AR, Chung KC, Ofman JJ. Estimating the population health impact of a multi-cancer early detection genomic blood test to complement existing screening in the US and UK. Br J Cancer 2021; 125:1432-1442. [PMID: 34426664 PMCID: PMC8575970 DOI: 10.1038/s41416-021-01498-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multi-cancer early detection (MCED) next-generation-sequencing blood tests represent a potential paradigm shift in screening. METHODS We estimated the impact of screening in the US and UK. We used country-specific parameters for uptake, and test-specific sensitivity and false-positive rates for current screening: breast, colorectal, cervical and lung (US only) cancers. For the MCED test, we used cancer-specific sensitivities by stage. Outcomes included the true-positive:false-positive (TP:FP) ratio; and the cost of diagnostic investigations among screen positives, per cancer detected (Diagcost). Outcomes were estimated for recommended screening only, and then when giving the MCED test to anyone without cancer detected by current screening plus similarly aged adults ineligible for recommended screening. RESULTS In the US, current screening detects an estimated 189,498 breast, cervical, colorectal and lung cancers. An MCED test with 25-100% uptake detects an additional 105,526-422,105 cancers (multiple types). The estimated TP:FP (Diagcost) was 1.43 ($89,042) with current screening but only 1:1.8 ($7060) using an MCED test. For the UK the corresponding estimates were 1:18 (£10,452) for current screening, and 1:1.6 (£2175) using an MCED test. CONCLUSIONS Adding an MCED blood test to recommended screening can potentially be an efficient strategy. Ongoing randomised studies are required for full efficacy and cost-effectiveness evaluations.
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Affiliation(s)
- Allan Hackshaw
- Cancer Research UK & University College London Cancer Trials Centre, London, UK.
| | - Sarah S Cohen
- EpidStrategies, A Division of ToxStrategies, Inc, Cary, NC, USA
| | - Heidi Reichert
- EpidStrategies, A Division of ToxStrategies, Inc, Ann Arbor, MI, USA
| | | | - Karen C Chung
- GRAIL, Inc., 1525 O'Brien Drive, Menlo Park, CA, USA
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22
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Bartkowiak K, Heidrich I, Kwiatkowski M, Banys-Paluchowski M, Andreas A, Wurlitzer M, Geffken M, Voß H, Zeller T, Blankenberg S, Peine S, Joosse SA, Müller V, Schlüter H, Oliveira-Ferrer L, Pantel K. Circulating Cellular Communication Network Factor 1 Protein as a Sensitive Liquid Biopsy Marker for Early Detection of Breast Cancer. Clin Chem 2021; 68:344-353. [PMID: 34458901 DOI: 10.1093/clinchem/hvab153] [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: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite recent progress in liquid biopsy technologies, early blood-based detection of breast cancer is still a challenge. METHODS We analyzed secretion of the protein cellular communication network factor 1 (CCN1, formerly cysteine-rich angiogenic inducer 61) in breast cancer cell lines by an enzyme-linked immunosorbent assay (ELISA). Soluble CCN1 in the plasma (2.5 µL) of 544 patients with breast cancer and 427 healthy controls was analyzed by ELISA. The breast cancer samples were acquired at the time of primary diagnosis prior to neoadjuvant therapy or surgery. A classifier was established on a training cohort of patients with breast cancer and age-adapted healthy controls and further validated on an independent cohort comprising breast cancer patients and healthy controls. Samples from patients with benign breast diseases were investigated as additional controls. Samples from patients with acute heart diseases (n = 127) were investigated as noncancer controls. The diagnostic accuracy was determined by receiver operating characteristic using the parameters area under the curve, sensitivity, and specificity. RESULTS CCN1 was frequently secreted by breast cancer cell lines into the extracellular space. Subsequent analysis of clinical blood samples from patients with breast cancer and age-adjusted healthy controls revealed an overall specificity of 99.0% and sensitivity of 80.0% for cancer detection. Remarkably, 81.5% of small T1 cancers were already CCN1-positive, while CCN1 concentrations in patients with benign breast lesions were below the threshold for breast cancer detection. CONCLUSIONS Circulating CCN1 is a potentially novel blood biomarker for the detection of breast cancer at the earliest invasive stage.
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Affiliation(s)
- Kai Bartkowiak
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Heidrich
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Kwiatkowski
- Department of Functional Proteo-Metabolomics, Institute of Biochemistry, University of Innsbruck, Innsbruck, Austria
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Lübeck, Germany.,Department Working Group Gynecological Oncology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Antje Andreas
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Wurlitzer
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Geffken
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Voß
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg -Eppendorf, Hamburg, Germany.,German Center of Cardiovascular Disease (DZHK), Partner Site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Stefan Blankenberg
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Peine
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartmut Schlüter
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Nguyen DL, Oluyemi E, Myers KS, Panigrahi B, Mullen LA, Ambinder EB. Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols. J Am Coll Radiol 2021; 18:1540-1546. [PMID: 34364841 DOI: 10.1016/j.jacr.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Currently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Due to the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates. METHODS This retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression. RESULTS The study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer. CONCLUSION Sociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.
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Lin CN, Lee KT, Chang SM, Wang JD. Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data. J Formos Med Assoc 2021; 121:633-642. [PMID: 34246512 DOI: 10.1016/j.jfma.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.
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Affiliation(s)
- Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ting Lee
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Maxwell D, Estes M, Walcott JM, Canady JW, Hunter TD, Gache L, Wang-Ashraf B, Alexander D. Safety and Effectiveness of Silicone Gel-Filled Breast Implants in Primary Augmentation Patients. Aesthet Surg J 2021; 41:NP329-NP335. [PMID: 33647937 PMCID: PMC8129466 DOI: 10.1093/asj/sjaa388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Results from the MemoryGel Breast Implants Core Clinical Study suggest these devices are safe and effective at 10 years after implantation. Although clinical trials are essential for measuring the safety and effectiveness of a device, real-world evidence can supplement clinical trials by providing information on outcomes observed in diverse clinical settings for a more heterogeneous population, without fixed treatment patterns, and without continuous patient monitoring, such that follow-up is more representative of normal clinical practice. Objectives The aim of this study was to measure real-world outcomes, including safety and effectiveness, in patients who underwent primary breast augmentation with smooth MemoryGel implants. Methods This was a case series looking at patients, age 22 years and older, who underwent primary breast augmentation at a single site between December 2006 and December 2016 and who had a minimum of 2 years of follow-up. Descriptive statistics were used to summarize baseline characteristics and outcomes. Kaplan-Meier models were used to estimate safety outcomes for capsular contracture (Baker grade III/IV), infection, and rupture. Results A total of 50/777 (6.4%) patients reported a complication, with an average time to complication of 3.9 years (range, 19 days-11.8 years) postprocedure. Kaplan-Meier estimates of the 10-year cumulative incidence of capsular contracture (Baker grade III/IV), infection, and rupture were 4.7%, 0.1%, and 1.6%, respectively. Conclusions Analyses of a large population from a single site provide further support for the long-term safety and effectiveness of MemoryGel breast implants in a primary augmentation cohort. Level of Evidence: 4
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Affiliation(s)
| | - Megan Estes
- Corresponding Author: Dr Megan Estes, 31 Technology Drive, Building 29A, Irvine, CA 92618, USA.
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Twahir M, Oyesegun R, Yarney J, Gachii A, Edusa C, Nwogu C, Mangutha G, Anderson P, Benjamin E, Müller B, Ngoh C. Real-world challenges for patients with breast cancer in sub-Saharan Africa: a retrospective observational study of access to care in Ghana, Kenya and Nigeria. BMJ Open 2021; 11:e041900. [PMID: 33653746 PMCID: PMC7929861 DOI: 10.1136/bmjopen-2020-041900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa. DESIGN Data were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards. SETTING Six tertiary care institutions in Ghana, Kenya and Nigeria were included. PARTICIPANTS Health records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria. INTERVENTIONS As directed by the treating physician. OUTCOME MEASURES Parameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns. RESULTS Use of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%-88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%-67%) or breast-conserving surgery (15%-26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%-93%) paid for diagnostic tests entirely OOP versus 30%-32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%-79% in Ghana, 8%-20% in Kenya and 72%-89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage. CONCLUSIONS Patients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.
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Song H, Bergman A, Chen AT, Ellis D, David G, Friedman AB, Bond AM, Bailey JM, Brooks R, Smith‐McLallen A. Disruptions in preventive care: Mammograms during the COVID-19 pandemic. Health Serv Res 2021; 56:95-101. [PMID: 33146429 PMCID: PMC7839639 DOI: 10.1111/1475-6773.13596] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines. DATA SOURCES De-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. STUDY DESIGN We used a difference-in-differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. DATA COLLECTION We used data from the first 30 weeks of each year from 2018 to 2020. PRINCIPAL FINDINGS Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years' and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. CONCLUSIONS The provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.
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Affiliation(s)
- Hummy Song
- Operations, Information and Decisions DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alon Bergman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Angela T. Chen
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dan Ellis
- Independence Blue CrossPhiladelphiaPennsylvaniaUSA
| | - Guy David
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ari B. Friedman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amelia M. Bond
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Population Health SciencesWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Ong A, Azizi A, Ambinder EB, Oluyemi ET, Harvey SC, Hung J. Image-guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis. JOURNAL OF BREAST IMAGING 2021; 3:57-63. [PMID: 38424837 DOI: 10.1093/jbi/wbaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Perform a comparison between the costs of image-guided breast procedures versus 2-year imaging follow-up for findings classified as BI-RADS assessment category 3-probably benign. METHODS The national payment amount costs at non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule for breast imaging-related Current Procedural Terminology codes. Total costs were calculated and compared for management algorithms of 2-year imaging follow-up of a BI-RADS 3 lesion from 2018 through 2019 versus performing an image-guided procedure of the lesion in 2018 after the initial diagnostic imaging. RESULTS Two-year mammographic follow-up of a BI-RADS 3 finding costs $484. This was less than a stereotactic-guided breast biopsy, which cost at least $1055. Two-year follow-up for a probably benign US finding cost $615 compared to $1173 for the least expensive US-guided breast biopsy scenario. For breast MRI, 2-year imaging follow-up cost $1510, which was also less than most MRI-guided breast biopsy scenarios. The one exception in which biopsy costs less than 2-year imaging follow-up was in the setting of an MRI-guided biopsy in the average-risk population without a post-benign biopsy follow-up breast MRI; in this setting, MRI biopsy cost $1235. CONCLUSION In 2018-2019, 2-year imaging follow-up of a BI-RADS 3 finding continues to be less costly than an immediate procedure, except for MRI-guided breast biopsy in the average-risk population without a post-benign biopsy follow-up MRI.
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Affiliation(s)
- Andrew Ong
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Armina Azizi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Emily B Ambinder
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Eniola T Oluyemi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Susan C Harvey
- Hologic, Inc., Department of Breast and Skeletal Health, Danbury, CT
| | - Jessica Hung
- Christiana Care Health System, Department of Radiology, Newark, DE
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Contrast-Enhanced Digital Mammography: Technique, Clinical Applications, and Pitfalls. AJR Am J Roentgenol 2020; 215:1267-1278. [PMID: 32877247 DOI: 10.2214/ajr.19.22412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE. Contrast-enhanced digital mammography (CEDM) combines the high spatial resolution of mammography with the improved enhancement provided by contrast medium. In this article, CEDM technique-the current and potential clinical applications and current challenges-will be reviewed. CONCLUSION. CEDM is a promising technique in the supplemental evaluation of patients with mammographically inconclusive findings and potentially in the screening of women with mammographically dense breasts. CEDM is emerging as a cost-effective alternative to dynamic contrast-enhanced MRI to stage newly diagnosed breast cancer and evaluate response to neoadjuvant chemotherapy.
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Newsome IG, Dayton PA. Visualization of Microvascular Angiogenesis Using Dual-Frequency Contrast-Enhanced Acoustic Angiography: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2625-2635. [PMID: 32703659 PMCID: PMC7608693 DOI: 10.1016/j.ultrasmedbio.2020.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/25/2020] [Accepted: 06/14/2020] [Indexed: 05/07/2023]
Abstract
Cancerous tumor growth is associated with the development of tortuous, chaotic microvasculature, and this aberrant microvascular morphology can act as a biomarker of malignant disease. Acoustic angiography is a contrast-enhanced ultrasound technique that relies on superharmonic imaging to form high-resolution 3-D maps of the microvasculature. To date, acoustic angiography has been performed with dual-element transducers that can achieve high contrast-to-tissue ratio and resolution in pre-clinical small animal models. In this review, we first describe the development of acoustic angiography, including the principle, transducer design, and optimization of superharmonic imaging techniques. We then detail several preclinical applications of this microvascular imaging method, as well as the current and future development of acoustic angiography as a pre-clinical and clinical diagnostic tool.
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Affiliation(s)
- Isabel G Newsome
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA.
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31
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Whitworth P, Hogan A, Ferko N, Son D, Wang F, Xiong Y, Suri H, Barclay B. Reduced Hospital Costs for Ultrasound-guided Vacuum-assisted Excision Compared with Open Surgery in Patients with Benign Breast Masses and High-risk Lesions. JOURNAL OF BREAST IMAGING 2020; 2:452-461. [PMID: 38424905 DOI: 10.1093/jbi/wbaa055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL). METHODS In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective. RESULTS A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001). CONCLUSION Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
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Affiliation(s)
| | | | | | | | - Faye Wang
- Becton, Dickinson and Company, Tempe, AZ
| | - Yan Xiong
- Becton, Dickinson and Company, Franklin Lakes, NJ
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Adrada BE, Moseley T, Kappadath SC, Whitman GJ, Rauch GM. Molecular Breast Imaging-guided Percutaneous Biopsy of Breast Lesions: A New Frontier on Breast Intervention. JOURNAL OF BREAST IMAGING 2020; 2:484-491. [PMID: 33015619 DOI: 10.1093/jbi/wbaa057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 01/29/2023]
Abstract
Molecular breast imaging (MBI) is an increasingly recognized nuclear medicine imaging modality to detect breast lesions suspicious for malignancy. Recent advances have allowed the development of tissue sampling of MBI-detected lesions using a single-headed camera (breast-specific gamma imaging system) or a dual-headed camera system (MBI system). In this article, we will review current indications of MBI, differences of the two single- and dual-headed camera systems, the appropriate selection of biopsy equipment, billing considerations, and radiation safety. It will also include practical considerations and guidance on how to integrate MBI and MBI-guided biopsy in the current breast imaging workflow.
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Affiliation(s)
- Beatriz E Adrada
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - S Cheenu Kappadath
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Gary J Whitman
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Bansal S, Deshpande V, Zhao X, Lauer JA, Meheus F, Ilbawi A, Gopalappa C. Analysis of Mammography Screening Schedules under Varying Resource Constraints for Planning Breast Cancer Control Programs in Low- and Middle-Income Countries: A Mathematical Study. Med Decis Making 2020; 40:364-378. [PMID: 32160823 DOI: 10.1177/0272989x20910724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Low-and-middle-income countries (LMICs) have higher mortality-to-incidence ratio for breast cancer compared to high-income countries (HICs) because of late-stage diagnosis. Mammography screening is recommended for early diagnosis, however, the infrastructure capacity in LMICs are far below that needed for adopting current screening guidelines. Current guidelines are extrapolations from HICs, as limited data had restricted model development specific to LMICs, and thus, economic analysis of screening schedules specific to infrastructure capacities are unavailable. Methods. We applied a new Markov process method for developing cancer progression models and a Markov decision process model to identify optimal screening schedules under a varying number of lifetime screenings per person, a proxy for infrastructure capacity. We modeled Peru, a middle-income country, as a case study and the United States, an HIC, for validation. Results. Implementing 2, 5, 10, and 15 lifetime screens would require about 55, 135, 280, and 405 mammography machines, respectively, and would save 31, 62, 95, and 112 life-years per 1000 women, respectively. Current guidelines recommend 15 lifetime screens, but Peru has only 55 mammography machines nationally. With this capacity, the best strategy is 2 lifetime screenings at age 50 and 56 years. As infrastructure is scaled up to accommodate 5 and 10 lifetime screens, screening between the ages of 44-61 and 41-64 years, respectively, would have the best impact. Our results for the United States are consistent with other models and current guidelines. Limitations. The scope of our model is limited to analysis of national-level guidelines. We did not model heterogeneity across the country. Conclusions. Country-specific optimal screening schedules under varying infrastructure capacities can systematically guide development of cancer control programs and planning of health investments.
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Affiliation(s)
| | | | - Xinmeng Zhao
- University of Massachusetts-Amherst, Amherst, MA, USA
| | | | - Filip Meheus
- International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
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Vanna R, Morasso C, Marcinnò B, Piccotti F, Torti E, Altamura D, Albasini S, Agozzino M, Villani L, Sorrentino L, Bunk O, Leporati F, Giannini C, Corsi F. Raman Spectroscopy Reveals That Biochemical Composition of Breast Microcalcifications Correlates with Histopathologic Features. Cancer Res 2020; 80:1762-1772. [PMID: 32094303 DOI: 10.1158/0008-5472.can-19-3204] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/28/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
Breast microcalcifications are a common mammographic finding. Microcalcifications are considered suspicious signs of breast cancer and a breast biopsy is required, however, cancer is diagnosed in only a few patients. Reducing unnecessary biopsies and rapid characterization of breast microcalcifications are unmet clinical needs. In this study, 473 microcalcifications detected on breast biopsy specimens from 56 patients were characterized entirely by Raman mapping and confirmed by X-ray scattering. Microcalcifications from malignant samples were generally more homogeneous, more crystalline, and characterized by a less substituted crystal lattice compared with benign samples. There were significant differences in Raman features corresponding to the phosphate and carbonate bands between the benign and malignant groups. In addition to the heterogeneous composition, the presence of whitlockite specifically emerged as marker of benignity in benign microcalcifications. The whole Raman signature of each microcalcification was then used to build a classification model that distinguishes microcalcifications according to their overall biochemical composition. After validation, microcalcifications found in benign and malignant samples were correctly recognized with 93.5% sensitivity and 80.6% specificity. Finally, microcalcifications identified in malignant biopsies, but located outside the lesion, reported malignant features in 65% of in situ and 98% of invasive cancer cases, respectively, suggesting that the local microenvironment influences microcalcification features. This study confirms that the composition and structural features of microcalcifications correlate with breast pathology and indicates new diagnostic potentialities based on microcalcifications assessment. SIGNIFICANCE: Raman spectroscopy could be a quick and accurate diagnostic tool to precisely characterize and distinguish benign from malignant breast microcalcifications detected on mammography.
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Affiliation(s)
- Renzo Vanna
- Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Carlo Morasso
- Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Beatrice Marcinnò
- Custom Computing and Processing Systems Laboratory, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Francesca Piccotti
- Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Emanuele Torti
- Custom Computing and Processing Systems Laboratory, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Davide Altamura
- Institute of Crystallography, National Research Council, Bari, Italy
| | - Sara Albasini
- Nanomedicine and Molecular Imaging Lab, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Manuela Agozzino
- Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Laura Villani
- Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Luca Sorrentino
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Oliver Bunk
- Paul Scherrer Institut, Villigen, Switzerland
| | - Francesco Leporati
- Custom Computing and Processing Systems Laboratory, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Cinzia Giannini
- Institute of Crystallography, National Research Council, Bari, Italy
| | - Fabio Corsi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy. .,Breast Unit, Department of Surgery, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Zalev J, Richards LM, Clingman BA, Harris J, Cantu E, Menezes GLG, Avila C, Bertrand A, Saenz X, Miller S, Oraevsky AA, Kolios MC. Opto-acoustic imaging of relative blood oxygen saturation and total hemoglobin for breast cancer diagnosis. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-16. [PMID: 31849204 PMCID: PMC7005558 DOI: 10.1117/1.jbo.24.12.121915] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/22/2019] [Indexed: 05/14/2023]
Abstract
Opto-acoustic imaging involves using light to produce sound waves for visualizing blood in biological tissue. By using multiple optical wavelengths, diagnostic images of blood oxygen saturation and total hemoglobin are generated using endogenous optical contrast, without injection of any external contrast agent and without using any ionizing radiation. The technology has been used in recent clinical studies for diagnosis of breast cancer to help distinguish benign from malignant lesions, potentially reducing the need for biopsy through improved diagnostic imaging accuracy. To enable this application, techniques for mapping oxygen saturation differences within tissue are necessary. Using biologically relevant opto-acoustic phantoms, we analyze the ability of an opto-acoustic imaging system to display colorized parametric maps that are generated using a statistical mapping approach. To mimic breast tissue, a material with closely matching properties for optical absorption, optical scattering, acoustic attenuation, and speed of sound is used. The phantoms include two vessels filled with whole blood at oxygen saturation levels determined using a sensor-based approach. A flow system with gas-mixer and membrane oxygenator adjusts the oxygen saturation of each vessel independently. Datasets are collected with an investigational Imagio® breast imaging system. We examine the ability to distinguish vessels as the oxygen saturation level and imaging depth are varied. At depth of 15 mm and hematocrit of 42%, a sufficient level of contrast to distinguish between two 1.6-mm diameter vessels was measured for an oxygen saturation difference of ∼4.6 % . In addition, an oxygenated vessel was visible at a depth of 48 mm using an optical wavelength of 1064 nm, and a deoxygenated vessel was visible to a depth of 42 mm with 757 nm. The results provide insight toward using color mapped opto-acoustic images for diagnosing breast cancer.
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Affiliation(s)
- Jason Zalev
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
- Ryerson University, Department of Physics, Toronto, Ontario, Canada
- Address all correspondence to Jason Zalev, E-mail: ; Lisa M. Richards, E-mail: ; Bryan A. Clingman, E-mail:
| | - Lisa M. Richards
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
- Address all correspondence to Jason Zalev, E-mail: ; Lisa M. Richards, E-mail: ; Bryan A. Clingman, E-mail:
| | - Bryan A. Clingman
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
- Address all correspondence to Jason Zalev, E-mail: ; Lisa M. Richards, E-mail: ; Bryan A. Clingman, E-mail:
| | - Jeff Harris
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
| | - Edgar Cantu
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
| | | | - Carlos Avila
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
| | - Allison Bertrand
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
| | - Xavier Saenz
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
| | - Steve Miller
- Seno Medical Instruments, Inc., San Antonio, Texas, United States
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Collado-Mesa F, Kaplan SS. Has the Time Come for Breast Imaging and Intervention to Become a Medical Specialty with Its Own Residency Training Program? JOURNAL OF BREAST IMAGING 2019; 1:249-250. [PMID: 38424757 DOI: 10.1093/jbi/wbz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Indexed: 03/02/2024]
Affiliation(s)
| | - Stuart S Kaplan
- University of Miami Miller School of Medicine, Department of Radiology, Miami, FL
- Mount Sinai Medical Center, Department of Radiology, Miami Beach, FL
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Oraevsky A, Clingman B, Zalev J, Stavros A, Yang W, Parikh J. Clinical optoacoustic imaging combined with ultrasound for coregistered functional and anatomical mapping of breast tumors. PHOTOACOUSTICS 2018; 12:30-45. [PMID: 30306043 PMCID: PMC6172480 DOI: 10.1016/j.pacs.2018.08.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/31/2018] [Accepted: 08/22/2018] [Indexed: 05/04/2023]
Abstract
Optoacoustic imaging, based on the differences in optical contrast of blood hemoglobin and oxyhemoglobin, is uniquely suited for the detection of breast vasculature and tumor microvasculature with the inherent capability to differentiate hypoxic from the normally oxygenated tissue. We describe technological details of the clinical ultrasound (US) system with optoacoustic (OA) imaging capabilities developed specifically for diagnostic imaging of breast cancer. The combined OA/US system provides co-registered and fused images of breast morphology based upon gray scale US with the functional parameters of total hemoglobin and blood oxygen saturation in the tumor angiogenesis related microvasculature based upon OA images. The system component that enabled clinical utility of functional OA imaging is the hand-held probe that utilizes a linear array of ultrasonic transducers sensitive within an ultrawide-band of acoustic frequencies from 0.1 MHz to 12 MHz when loaded to the high-impedance input of the low-noise analog preamplifier. The fiberoptic light delivery system integrated into a dual modality probe through a patented design allowed acquisition of OA images while minimizing typical artefacts associated with pulsed laser illumination of skin and the probe components in the US detection path. We report technical advances of the OA/US imaging system that enabled its demonstrated clinical viability. The prototype system performance was validated in well-defined tissue phantoms. Then a commercial prototype system named Imagio™ was produced and tested in a multicenter clinical trial termed PIONEER. We present examples of clinical images which demonstrate that the spatio-temporal co-registration of functional and anatomical images permit radiological assessment of the vascular pattern around tumors, microvascular density of tumors as well as the relative values of the total hemoglobin [tHb] and blood oxygen saturation [sO2] in tumors relative to adjacent normal breast tissues. The co-registration technology enables increased accuracy of radiologist assessment of malignancy by confirming, upgrading and/or downgrading US categorization of breast tumors according to Breast Imaging Reporting And Data System (BI-RADS). Microscopic histologic examinations on the biopsied tissue of the imaged tumors served as a gold standard in verifying the functional and anatomic interpretations of the OA/US image feature analysis.
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Affiliation(s)
- A.A. Oraevsky
- TomoWave Laboratories, Houston, TX, United States
- Corresponding author.
| | - B. Clingman
- Seno Medical Instruments, San Antonio, TX, United States
| | - J. Zalev
- Department of Physics, Ryerson University, Toronto, Canada
| | - A.T. Stavros
- Seno Medical Instruments, San Antonio, TX, United States
| | - W.T. Yang
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J.R. Parikh
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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