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Pilewskie M, Eroglu I, Sevilimedu V, Le T, Mangino D, Morrow M. Participation in a High-Risk Program Is Associated with a Diagnosis of Earlier-Stage Disease Among Women at Increased Risk for Breast Cancer Development. Ann Surg Oncol 2024; 31:6764-6773. [PMID: 38949720 DOI: 10.1245/s10434-024-15633-x] [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: 08/02/2023] [Accepted: 06/05/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND High-risk programs provide recommendations for surveillance/risk reduction for women at elevated risk for breast cancer development. This study evaluated the impact of high-risk surveillance program participation on clinicopathologic breast cancer features at the time of diagnosis. METHODS Women followed in the authors' high-risk program (high-risk cohort [HRC]) with a diagnosis of breast cancer from January 2015 to June 2021 were identified and compared with the general population of women undergoing breast cancer surgery at Memorial Sloan Kettering Cancer Center (MSK; general cohort [GC]) during the same period. Patient and tumor factors were collected. Clinicopathologic features were compared between the two cohorts and in a subset of women with a family history of known BRCA mutation. RESULTS The study compared 255 women in the HRC with 9342 women in the GC. The HRC patients were slightly older and more likely to be white and have family history than the GC patients. The HRC patients also were more likely to present with DCIS (41 % vs 23 %; p < 0.001), to have smaller invasive tumors (pT1: 100 % vs 77 %; p < 0.001), and to be pN0 (95 % vs 81 %; p < 0.001). The HRC patients had more invasive triple-negative tumors (p = 0.01) and underwent less axillary surgery (p < 0.001), systemic therapy (p < 0.001), and radiotherapy (p = 0.002). Among those with a known BRCA mutation, significantly more women in the HRC underwent screening mammography (75 % vs 40 %; p < 0.001) or magnetic resonance imaging (MRI: 82 % vs 9.9 %; p < 0.001) in the 12 months before diagnosis. CONCLUSIONS Women followed in a high-risk screening program have disease diagnosed at an earlier stage and therefore require less-intensive breast cancer treatment than women presenting to a cancer center at the time of diagnosis. Identification of high-risk women and implementation of increased surveillance protocols are vital to improving outcomes.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Breast Neoplasms/diagnosis
- Middle Aged
- Follow-Up Studies
- Adult
- Risk Factors
- Aged
- Prognosis
- Neoplasm Staging
- Mutation
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Mammography
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Idil Eroglu
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiana Le
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra Mangino
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Mann RM, Longo V. Contrast-enhanced Mammography versus MR Imaging of the Breast. Radiol Clin North Am 2024; 62:643-659. [PMID: 38777540 DOI: 10.1016/j.rcl.2024.02.003] [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: 05/25/2024]
Abstract
Breast MR imaging and contrast-enhanced mammography (CEM) are both techniques that employ intravenously injected contrast agent to assess breast lesions. This approach is associated with a very high sensitivity for malignant lesions that typically exhibit rapid enhancement due to the leakiness of neovasculature. CEM may be readily available at the breast imaging department and can be performed on the spot. Breast MR imaging provides stronger enhancement than the x-ray-based techniques and offers higher sensitivity. From a patient perspective, both modalities have their benefits and downsides; thus, patient preference could also play a role in the selection of the imaging technique.
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Affiliation(s)
- Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Valentina Longo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, Rome 00168, Italy
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3
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Niell BL, Jochelson MS, Amir T, Brown A, Adamson M, Baron P, Bennett DL, Chetlen A, Dayaratna S, Freer PE, Ivansco LK, Klein KA, Malak SF, Mehta TS, Moy L, Neal CH, Newell MS, Richman IB, Schonberg M, Small W, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update. J Am Coll Radiol 2024; 21:S126-S143. [PMID: 38823941 DOI: 10.1016/j.jacr.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | | | - Tali Amir
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann Brown
- Panel Vice Chair, University of Cincinnati, Cincinnati, Ohio
| | - Megan Adamson
- Clinica Family Health, Lafayette, Colorado; American Academy of Family Physicians
| | - Paul Baron
- Lenox Hill Hospital, Northwell Health, New York, New York; American College of Surgeons
| | | | - Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Sandra Dayaratna
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Linda Moy
- NYU Clinical Cancer Center, New York, New York
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Ilana B Richman
- Yale School of Medicine, New Haven, Connecticut; Society of General Internal Medicine
| | - Mara Schonberg
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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4
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Watt GP, Keshavamurthy KN, Nguyen TL, Lobbes MBI, Jochelson MS, Sung JS, Moskowitz CS, Patel P, Liang X, Woods M, Hopper JL, Pike MC, Bernstein JL. Association of breast cancer with quantitative mammographic density measures for women receiving contrast-enhanced mammography. JNCI Cancer Spectr 2024; 8:pkae026. [PMID: 38565262 PMCID: PMC11060476 DOI: 10.1093/jncics/pkae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Women with high mammographic density have an increased risk of breast cancer. They may be offered contrast-enhanced mammography to improve breast cancer screening performance. Using a cohort of women receiving contrast-enhanced mammography, we evaluated whether conventional and modified mammographic density measures were associated with breast cancer. Sixty-six patients with newly diagnosed unilateral breast cancer were frequency matched on the basis of age to 133 cancer-free control individuals. On low-energy craniocaudal contrast-enhanced mammograms (equivalent to standard mammograms), we measured quantitative mammographic density using CUMULUS software at the conventional intensity threshold ("Cumulus") and higher-than-conventional thresholds ("Altocumulus," "Cirrocumulus"). The measures were standardized to enable estimation of odds ratio per adjusted standard deviation (OPERA). In multivariable logistic regression of case-control status, only the highest-intensity measure (Cirrocumulus) was statistically significantly associated with breast cancer (OPERA = 1.40, 95% confidence interval = 1.04 to 1.89). Conventional Cumulus did not contribute to model fit. For women receiving contrast-enhanced mammography, Cirrocumulus mammographic density may better predict breast cancer than conventional quantitative mammographic density.
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Affiliation(s)
- Gordon P Watt
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tuong L Nguyen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prusha Patel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaolin Liang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Woods
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John L Hopper
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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5
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [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: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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6
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Corines MJ, Sogani J, Hogan MP, Mango VL, Bryce Y. The Role of Contrast-Enhanced Mammography After Cryoablation of Breast Cancer. AJR Am J Roentgenol 2024; 222:e2330250. [PMID: 38019473 DOI: 10.2214/ajr.23.30250] [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: 11/30/2023]
Abstract
Image-guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is a treatment strategy that is an effective alternate to surgery in select patients. Tumor features impacting the efficacy of cryoablation include size, location in relation to skin, and histology (e.g., extent of intraductal component), underscoring the importance of imaging for staging and workup in this patient population. Contrast-enhanced mammography (CEM) utilization is increasing in both the screening and diagnostic settings and may be useful for follow-up imaging after breast cancer cryoablation, given its high sensitivity for cancer detection and its advantages in terms of PPV, time, cost, eligibility, and accessibility compared with contrast-enhanced MRI. This Clinical Perspective describes the novel use of CEM after breast cancer cryoablation, highlighting the advantages and disadvantages of CEM compared with alternate imaging modalities, expected benign postablation CEM findings, and CEM findings suggestive of residual or recurrent tumor.
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Affiliation(s)
- Marina J Corines
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Julie Sogani
- Department of Radiology, Englewood Hospital and Medical Center, Englewood, NJ
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Victoria L Mango
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Yolanda Bryce
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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7
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Nicosia L, Rotili A, Pesapane F, Bozzini AC, Battaglia O, Pellegrino G, Fusco N, Porta FM, Frassoni S, Bagnardi V, Corso G, Sangalli C, Cassano E. Contrast-Enhanced Mammography (CEM) compared to Breast Magnetic Resonance (MRI) in the evaluation of breast lobular neoplasia. Breast Cancer Res Treat 2024; 203:135-143. [PMID: 37787819 DOI: 10.1007/s10549-023-07096-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To compare the diagnostic performance (detection, assessment of correct disease extent and multifocality/centricity) of Contrast-Enhanced Mammography (CEM) Versus Breast Magnetic Resonance (MRI) in the study of lobular neoplasms. METHODS We retrospectively selected all the patients who underwent surgery for a lobular breast neoplasm, either an in situ or an invasive tumor, and had undergone both breast CEM and MRI examinations during the pre-surgical planning. Wilcoxon Signed Rank test was performed to assess the differences between size measurements using the different methods and the post-surgical pathological measurements, considered the gold standard. The agreement in identifying multifocality/multicentricity among the different methods and the pathology was assessed using the Kappa statistics. RESULTS We selected 19 patients, of which one presented a bilateral neoplasm. Then, the images of these 19 patients were analyzed, for a total of 52 malignant breast lesions. We found no significant differences between the post-surgical pathological size of the lesions and the calculated size with CEM and MRI (p-value of the difference respectively 0.71 and 0.47). In all 20 cases, neoplasm detection was possible both with CEM and MRI. CEM and MRI showed an excellent ability to identify multifocal and multicentric cases (K statistic equal to 0.93 for both the procedures), while K statistic was 0.11 and 0.59 for FFDM and US, respectively. CONCLUSION The findings of this study suggest that CEM is a reliable imaging technique in the preoperative setting of patients with lobular neoplasm, with comparable results to breast MRI.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Anna Rotili
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Maria Porta
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
- School of Pathology, University of Milan, 20122, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126, Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- European Cancer Prevention Organization (ECP), 20122, Milan, Italy
| | - Claudia Sangalli
- European Cancer Prevention Organization (ECP), 20122, Milan, Italy
- Data Management, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
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8
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Onega T, Abraham L, Miglioretti DL, Lee CI, Henderson LM, Kerlikowske K, Tosteson ANA, Weaver D, Sprague BL, Bowles EJA, di Florio-Alexander RM. Digital mammography and digital breast tomosynthesis for detecting invasive lobular and ductal carcinoma. Breast Cancer Res Treat 2023; 202:505-514. [PMID: 37697031 PMCID: PMC11216536 DOI: 10.1007/s10549-023-07051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer that can make early detection with mammography challenging. We compared imaging performance of digital breast tomosynthesis (DBT) to digital mammography (DM) for diagnoses of ILC, invasive ductal carcinoma (IDC), and invasive mixed carcinoma (IMC) in a screening population. METHODS We included screening exams (DM; n = 1,715,249 or DBT; n = 414,793) from 2011 to 2018 among 839,801 women in the Breast Cancer Surveillance Consortium. Examinations were followed for one year to ascertain incident ILC, IDC, or IMC. We measured cancer detection rate (CDR) and interval invasive cancer rate/1000 screening examinations for each histological subtype and stratified by breast density and modality. We calculated relative risk (RR) for DM vs. DBT using log-binomial models to adjust for the propensity of receiving DBT vs. DM. RESULTS Unadjusted CDR per 1000 mammograms of ILC overall was 0.33 (95%CI: 0.30-0.36) for DM; 0.45 (95%CI: 0.39-0.52) for DBT, and for women with dense breasts- 0.33 (95%CI: 0.29-0.37) for DM and 0.54 (95%CI: 0.43-0.66) for DBT. Similar results were noted for IDC and IMC. Adjusted models showed a significantly increased RR for cancer detection with DBT compared to DM among women with dense breasts for all three histologies (RR; 95%CI: ILC 1.53; 1.09-2.14, IDC 1.21; 1.02-1.44, IMC 1.76; 1.30-2.38), but no significant increase among women with non-dense breasts. CONCLUSION DBT was associated with higher CDR for ILC, IDC, and IMC for women with dense breasts. Early detection of ILC with DBT may improve outcomes for this distinct clinical entity.
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Affiliation(s)
- Tracy Onega
- Department of Population Health Sciences, and the Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr., RS 4725, Salt Lake City, UT, 84018, USA.
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington, and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Donald Weaver
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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Berg WA, Seitzman RL, Pushkin J. Implementing the National Dense Breast Reporting Standard, Expanding Supplemental Screening Using Current Guidelines, and the Proposed Find It Early Act. JOURNAL OF BREAST IMAGING 2023; 5:712-723. [PMID: 38141231 DOI: 10.1093/jbi/wbad034] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Indexed: 12/25/2023]
Abstract
Thirty-eight states and the District of Columbia (DC) have dense breast notification laws that mandate varying levels of patient notification about breast density after a mammogram, and these cover over 90% of American women. On March 10, 2023, the Food and Drug Administration issued a final rule amending regulations under the Mammography Quality Standards Act for a national dense breast reporting standard for both patient results letters and mammogram reports. Effective September 10, 2024, letters will be required to tell a woman her breasts are "dense" or "not dense," that dense tissue makes it harder to find cancers on a mammogram, and that it increases the risk of developing cancer. Women with dense breasts will also be told that other imaging tests in addition to a mammogram may help find cancers. The specific density category can be added (eg, if mandated by a state "inform" law). Reports to providers must include the Breast Imaging Reporting and Data System density category. Implementing appropriate supplemental screening should be based on patient risk for missed breast cancer on mammography; such assessment should include consideration of breast density and other risk factors. This article discusses strategies for implementation. Currently 21 states and DC have varying insurance laws for supplemental breast imaging; in addition, Oklahoma requires coverage for diagnostic breast imaging. A federal insurance bill, the Find It Early Act, has been introduced that would ensure no-cost screening and diagnostic imaging for women with dense breasts or at increased risk and close loopholes in state laws.
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Affiliation(s)
- Wendie A Berg
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA, USA
| | - Robin L Seitzman
- Seitzman Epidemiology, LLC, San Diego, CA, USA
- DenseBreast-info, Inc, Deer Park, NY, USA
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10
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Coffey K, Dixon LB, Sevilimedu V, Jochelson MS, Sung JS. Short-term follow-up of contrast-enhanced mammography lesions after negative breast MRI in women with elevated breast cancer risk. Eur J Radiol 2023; 168:111097. [PMID: 37738835 DOI: 10.1016/j.ejrad.2023.111097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To determine the outcome of enhancing lesions detected on contrast-enhanced mammography (CEM) that had no correlate on magnetic resonance imaging (MRI) and underwent short-term follow-up CEM. METHODS In this retrospective single-center study, we identified patients with elevated breast cancer risk who had a CEM between 2014 and 2021 showing indeterminate enhancement on recombined images (BI-RADS 0, 3, 4) that had no correlate on subsequent MRI (performed within one month), and therefore underwent short-term follow-up CEM (performed within eight months). Medical records and imaging studies were reviewed to collect data on patient and lesion characteristics, and outcomes. Cancer incidence with 95% confidence interval (CI) was calculated. RESULTS This study included 71 women (median age 49 years) with 81 enhancing CEM lesions who underwent short-term follow-up CEM (median 6.2 months) after MRI reported no correlate. Of 81 lesions (median size = 0.7 cm), 73 (90%) were non-mass enhancement and 8 (10%) were enhancing masses. No sonographic correlate was identified for 75 lesions that had a same-day targeted ultrasound. Two cancers (2.5%, 95% CI 0.3-8.6) were diagnosed during the short-term follow-up period, one at 6-months (invasive ductal carcinoma) and one at 12-months (ductal carcinoma in situ). The remaining 79 lesions were benign at 6-month follow-up CEM and at one-year mammographic follow-up. CONCLUSIONS Follow-up CEM of MRI-occult lesions is prudent and may be reasonable to perform at one-year given the low incidence of cancer detected at six-months (one of 81) in our small study sample.
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Affiliation(s)
- Kristen Coffey
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
| | - Linden B Dixon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Phillips J, Mehta TS, Portnow LH, Fishman MDC, Zhang Z, Pisano ED. Comparison of Contrast-enhanced Mammography with MRI Utilizing an Enriched Reader Study: A Breast Cancer Study (CONTRRAST Trial). Radiology 2023; 309:e230530. [PMID: 37962503 DOI: 10.1148/radiol.230530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Despite growing interest in using contrast-enhanced mammography (CEM) for breast cancer screening as an alternative to breast MRI, limited literature is available. Purpose To determine whether CEM is noninferior to breast MRI or abbreviated breast MRI (AB MRI) and superior to two-dimensional mammography in an asymptomatic population simulating those who would present for screening and then undergo diagnostic work-up. Materials and Methods This enriched reader study used CEM and MRI data prospectively collected from asymptomatic individuals at a single institution from December 2014 to March 2020. Case sets were obtained at screening, as part of work-up for a screening-detected finding, or before biopsy of a screening-detected abnormality. All images were anonymized and randomized, and all 12 radiologists interpreted them. For CEM interpretation, readers were first shown low-energy images as a surrogate for digital mammography and asked to give a forced Breast Imaging Reporting and Data System score for up to three abnormalities. The highest score was used as the case score. Readers then reviewed the full CEM examination and scored it similarly. After a minimum 1-month washout, the readers similarly interpreted AB MRI and full MRI examinations. Receiver operating characteristic analysis, powered to test CEM noninferiority to full MRI, was performed. Results The study included 132 case sets (14 negative, 74 benign, and 44 malignant; all female participants; mean age, 54 years ± 12 [SD]). The mean areas under the receiver operating characteristic curve (AUCs) for digital mammography, CEM, AB MRI, and full MRI were 0.79, 0.91, 0.89, and 0.91, respectively. CEM was superior to digital mammography (P < .001). No evidence of a difference in AUC was found between CEM and AB MRI and MRI. Conclusion In an asymptomatic study sample, CEM was noninferior to full MRI and AB MRI and was superior to digital mammography. Clinical trial registration no. NCT03482557 and NCT02275871 © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Jordana Phillips
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Tejas S Mehta
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Leah H Portnow
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Michael D C Fishman
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Zheng Zhang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
| | - Etta D Pisano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, TCC 4th Floor, Boston, MA 02215 (J.P.); Department of Radiology, UMass Memorial Medical Center, Worcester, Mass (T.S.M.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (L.H.P.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.P., M.D.C.F.); Takeda Pharmaceuticals, Cambridge, Mass (Z.Z.); and Department of Radiology, Penn Medicine, Philadelphia, Pa (E.D.P.)
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12
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Cockmartin L, Bosmans H, Marshall NW. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: I. Iodine signal testing. Phys Med Biol 2023; 68:215017. [PMID: 37820689 DOI: 10.1088/1361-6560/ad027d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
The technique of dual-energy contrast enhanced mammography (CEM) visualizes iodine uptake in cancerous breast lesions following an intravenous injection of a contrast medium. The CEM image is generated by recombining two images acquired in rapid succession: a low energy image, with a mean energy below the iodine K-edge, and a higher energy image. The first part of this study examines the use of both commercially available and custom made phantoms to investigate iodine imaging under different imaging conditions, with the focus on quality control (QC) testing. Four CEM equipped systems were included in the study, with units from Fujifilm, GE Healthcare, Hologic and Siemens-Healthineers. The CEM parameters assessed in part I were: (1) image signal as a function of iodine concentration, measured in breast tissue simulating backgrounds of varying thickness and adipose/glandular compositions; (2) normal breast texture cancellation in homogeneous and structured backgrounds; (3) visibility of iodinated structures. For all four systems, a linear response to iodine concentration was found but the degree to which this was independent of background composition differed between the systems. Good cancellation of the glandular tissue inserts was found on all the units. Visibility scores of iodinated targets were similar between the four systems. Specialized phantoms are needed to fully evaluate important CEM performance markers, such as system response to iodine concentration and the ability of the system to cancel background texture. An extensive evaluation of the iodine signal imaging performance is recommended at the Commissioning stage for a new CEM device.
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Affiliation(s)
- L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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13
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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14
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Jochelson MS, Mukhtar RA. Editorial: Contrast mammography-a promising tool for the pre-operative evaluation of lobular breast cancer. Eur J Radiol 2023; 166:110982. [PMID: 37523873 DOI: 10.1016/j.ejrad.2023.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Maxine S Jochelson
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Rita A Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA 94158, USA.
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15
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Berg WA, Zuley ML, Chang TS, Gizienski TA, Chough DM, Böhm-Vélez M, Sharek DE, Straka MR, Hakim CM, Hartman JY, Harnist KS, Tyma CS, Kelly AE, Waheed U, Houshmand G, Nair BE, Shinde DD, Lu AH, Bandos AI, Berg JM, Lettiere NB, Ganott MA. Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound After Tomosynthesis in Women With Dense Breasts (the DBTUST). J Clin Oncol 2023; 41:2403-2415. [PMID: 36626696 PMCID: PMC10150890 DOI: 10.1200/jco.22.01445] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/25/2022] [Accepted: 11/19/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To assess diagnostic performance of digital breast tomosynthesis (DBT) alone or combined with technologist-performed handheld screening ultrasound (US) in women with dense breasts. METHODS In an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant multicenter protocol in western Pennsylvania, 6,179 women consented to three rounds of annual screening, interpreted by two radiologist observers, and had appropriate follow-up. Primary analysis was based on first observer results. RESULTS Mean participant age was 54.8 years (range, 40-75 years). Across 17,552 screens, there were 126 cancer events in 125 women (7.2/1,000; 95% CI, 5.9 to 8.4). In year 1, DBT-alone cancer yield was 5.0/1,000, and of DBT+US, 6.3/1,000, difference 1.3/1,000 (95% CI, 0.3 to 2.1; P = .005). In years 2 + 3, DBT cancer yield was 4.9/1,000, and of DBT+US, 5.9/1,000, difference 1.0/1,000 (95% CI, 0.4 to 1.5; P < .001). False-positive rate increased from 7.0% for DBT in year 1 to 11.5% for DBT+US and from 5.9% for DBT in year 2 + 3 to 9.7% for DBT+US (P < .001 for both). Nine cancers were seen only by double reading DBT and one by double reading US. Ten interval cancers (0.6/1,000 [95% CI, 0.2 to 0.9]) were identified. Despite reduction in specificity, addition of US improved receiver operating characteristic curves, with area under receiver operating characteristic curve increasing from 0.83 for DBT alone to 0.92 for DBT+US in year 1 (P = .01), with smaller improvements in subsequent years. Of 6,179 women, across all 3 years, 172/6,179 (2.8%) unique women had a false-positive biopsy because of DBT as did another 230/6,179 (3.7%) women because of US (P < .001). CONCLUSION Overall added cancer detection rate of US screening after DBT was modest at 19/17,552 (1.1/1,000; CI, 0.5- to 1.6) screens but potentially overcomes substantial increases in false-positive recalls and benign biopsies.
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Affiliation(s)
- Wendie A. Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Margarita L. Zuley
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | - Terri-Ann Gizienski
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Denise M. Chough
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | | | | | | | - Christiane M. Hakim
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Jamie Y. Hartman
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Kimberly S. Harnist
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Cathy S. Tyma
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Amy E. Kelly
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Uzma Waheed
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Golbahar Houshmand
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bronwyn E. Nair
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Dilip D. Shinde
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Amy H. Lu
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Andriy I. Bandos
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Jeremy M. Berg
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nicole B. Lettiere
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
- ICON-Amgen, Pittsburgh, PA
| | - Marie A. Ganott
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
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Elhatw A, Chung HL, Kamal RM, De Jesus C, Jean S, Vishwanath V, Ferreira Dalla Pria HR, Patel MM, Guirguis MS, Moseley TW. Advanced Breast Imaging Modalities — DBT, CEM, MBI, PEM, MRI, AI. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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17
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Kang Y, Li Z, Yang G, Xue J, Zhang L, Rong X. Diagnostic performance of the Kaiser score in the evaluation of breast lesions on contrast-enhanced mammography. Eur J Radiol 2022; 156:110524. [PMID: 36126352 DOI: 10.1016/j.ejrad.2022.110524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate whether the Kaiser score (KS) could improve the diagnostic performance of breast imaging reporting and data system (BI-RADS) in evaluating breast enhancing lesions on contrast-enhanced mammography (CEM). METHODS Three hundred fifty-nine patients with 375 lesions (231 malignant and 144 benign) were included in this retrospective study from April 2019 to December 2021.Two readers with different levels of experience in breast imaging were asked to give a BI-RADS assessment category according to the CEM BI-RADS and final score based on the KS. The diagnostic performance of all lesions, mass and non-mass enhancement (NME) were assessed by receiver operating characteristic (ROC) analysis, and the areas under the ROC curve (AUCs) were measured. The weighted kappa coefficients were calculated to investigate the interreader agreement. RESULTS The AUCs of the KS for all lesions were 0.915 (95 %CI: 0.884-0.947) and 0.876 (95 %CI: 0.838-0.914) for two readers. When mass and NME were evaluated separately, the AUCs of the KS for mass were higher than those for NME (p < 0.001). The AUCs of BI-RADS for all lesion diagnoses ranged between 0.821 (95 %CI: 0.778-0.864) and 0.842(95 %CI: 0.801-0.883) for two readers. The AUCs of the KS were higher than those of BI-RADS (p < 0.001, p = 0.016). There were no significant differences in the sensitivity between the KS (97.4 %) and BI-RADS (99.6 %) for all lesions (p = 0.130). The specificity of the KS was significantly higher than that of BI-RADS (p < 0.001). Compared with BI-RADS, the application of the KS could have potentially obviated 41.7 % to 47.9 % unnecessary biopsies in 144 benign lesions. Interreader agreement between the two readers of the KS was almost perfect (k = 0.883 [95 % CI: 0.842-0.924]). CONCLUSION The use of the KS provided a high diagnostic performance in distinguishing malignant and benign breast lesions on CEM and outperformed BI-RADS. The application of the KS can downgrade up to 47.9% of unnecessary biopsies of benign breast lesions.
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Affiliation(s)
- Yihe Kang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Zhigang Li
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Guang Yang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Jing Xue
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Lingling Zhang
- Department of Pathology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Xiaocui Rong
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
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18
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Coffey K, Jochelson MS. Contrast-enhanced mammography in breast cancer screening. Eur J Radiol 2022; 156:110513. [PMID: 36108478 PMCID: PMC10680079 DOI: 10.1016/j.ejrad.2022.110513] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023]
Abstract
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
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Van Baelen K, Geukens T, Maetens M, Tjan-Heijnen V, Lord CJ, Linn S, Bidard FC, Richard F, Yang WW, Steele RE, Pettitt SJ, Van Ongeval C, De Schepper M, Isnaldi E, Nevelsteen I, Smeets A, Punie K, Voorwerk L, Wildiers H, Floris G, Vincent-Salomon A, Derksen PWB, Neven P, Senkus E, Sawyer E, Kok M, Desmedt C. Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer. Ann Oncol 2022; 33:769-785. [PMID: 35605746 DOI: 10.1016/j.annonc.2022.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers. DESIGN Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials. RESULTS At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC. CONCLUSION ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST.
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Affiliation(s)
- K Van Baelen
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - T Geukens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - M Maetens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - V Tjan-Heijnen
- Medical Oncology Department, Maastricht University Medical Center (MUMC), School of GROW, Maastricht, The Netherlands
| | - C J Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Linn
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Medical Oncology, Amsterdam, The Netherlands; Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclav University, Paris, France
| | - F Richard
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - W W Yang
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R E Steele
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S J Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - C Van Ongeval
- Departments of Radiology, UZ Leuven, Leuven, Belgium
| | - M De Schepper
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Pathology, UZ Leuven, Leuven, Belgium
| | - E Isnaldi
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - A Smeets
- Surgical Oncology, UZ Leuven, Leuven, Belgium
| | - K Punie
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - L Voorwerk
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Wildiers
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - G Floris
- Pathology, UZ Leuven, Leuven, Belgium
| | | | - P W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Neven
- Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - E Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - M Kok
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Desmedt
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium.
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Amir T, Hogan MP, Jacobs S, Sevilimedu V, Sung J, Jochelson MS. Comparison of False-Positive Versus True-Positive Findings on Contrast-Enhanced Digital Mammography. AJR Am J Roentgenol 2022; 218:797-808. [PMID: 34817195 PMCID: PMC9110098 DOI: 10.2214/ajr.21.26847] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. Contrast-enhanced digital mammography (CEDM) has been shown to outperform standard mammography while performing comparably to contrast-enhanced MRI. OBJECTIVE. The purpose of our study was to compare imaging characteristics of false-positive and true-positive findings on CEDM. METHODS. This retrospective study included women who underwent baseline screening CEDM between January 2013 and December 2018 assessed as BI-RADS category 0, 3, 4, or 5 and who underwent biopsy with histopathologic diagnosis or had a 2-year imaging follow-up. Lesion characteristics were extracted from CEDM reports. A true-positive finding was defined as a lesion in which biopsy yielded malignancy. A false-positive finding was defined as a lesion in which biopsy yielded benign or benign high-risk pathology or in which 2-year imaging follow-up was negative. RESULTS. Of 157 patients (median age, 52 years), 24 had a total of 26 true-positive lesions, and 133 had a total of 147 false-positive lesions. Of the 26 true-positive lesions, one (4%) exhibited only a mammographic finding on low-iodine images, 13 (50%) exhibited only a contrast finding on iodine images, and 12 (46%) exhibited both a mammographic finding on low-energy images and a contrast finding on iodine images. A true-positive result was more likely (p = .02) for lesions present on both low-energy images and iodine images (31%) than on low-energy images only (4%) or iodine images only (12%). Among lesions present on both low-energy and iodine images, a true-positive result was more likely (p < .001) when the type of mammographic finding was an asymmetry (46%) or calcification (80%) than a mass (11%) or distortion (0%). A true-positive result was more likely (p = .01) among those with, versus those without, an ultrasound correlate (36% vs 9%) and also was more likely (p = .02) among those with, versus those without, an MRI correlate (18% vs 2%). Of 25 false-positive calcifications, 24 had no associated mammographic enhancement; of five true-positive calcifications, four had mammographic enhancement. CONCLUSION. A low-energy mammographic finding with associated enhancement or a finding with a sonographic or MRI correlate predicts a true-positive result. Calcifications with associated enhancement had a high malignancy rate. Nonetheless, half of true-positive lesions enhanced on iodine images without a mammographic finding on low-energy images. CLINICAL IMPACT. These observations inform radiologists' management of abnormalities detected on screening CEDM.
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Affiliation(s)
- Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Stefanie Jacobs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Janice Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 711, New York, NY 10065
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Gennaro G, Cozzi A, Schiaffino S, Sardanelli F, Caumo F. Radiation Dose of Contrast-Enhanced Mammography: A Two-Center Prospective Comparison. Cancers (Basel) 2022; 14:1774. [PMID: 35406546 PMCID: PMC8997084 DOI: 10.3390/cancers14071774] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only by single-center studies. In this retrospective study, we aimed to compare the radiation dose between two centers performing CEM within two prospective studies, using the same type of equipment. The CEM mean glandular dose (MGD) was computed for low energy (LE) and high energy (HE) images and their sum was calculated for each view. MGD and related parameters (entrance dose, breast thickness, compression, and density) were compared between the two centers using the Mann−Whitney test. Finally, per-patient MGD was calculated by pooling the two datasets and determining the contribution of LE and HE images. A total of 348 CEM examinations were analyzed (228 from Center 1 and 120 from Center 2). The median total MGD per view was 2.33 mGy (interquartile range 2.19−2.51 mGy) at Center 1 and 2.46 mGy (interquartile range 2.32−2.70 mGy) at Center 2, with a 0.15 mGy median difference (p < 0.001) equal to 6.2%. LE-images contributed between 64% and 77% to the total patient dose in CEM, with the remaining 23−36% being associated with HE images. The mean radiation dose for a two-view bilateral CEM exam was 4.90 mGy, about 30% higher than for digital mammography.
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Affiliation(s)
- Gisella Gennaro
- Unit of Breast Radiology, Veneto Institute of Oncology (IOV) IRCCS, Via Gattamelata 64, 35128 Padua, Italy;
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (A.C.); (F.S.)
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; (A.C.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy;
| | - Francesca Caumo
- Unit of Breast Radiology, Veneto Institute of Oncology (IOV) IRCCS, Via Gattamelata 64, 35128 Padua, Italy;
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22
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Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
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Woodard S, Murray A. Contrast-Enhanced Mammography: Reviewing the Past and Looking to the Future. Semin Roentgenol 2021; 57:126-133. [DOI: 10.1053/j.ro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
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Hannsun G, Saponaro S, Sylvan P, Elmi A. Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls.
Recent Findings
Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed.
Summary
CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.
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Editor's Notebook: June 2021. AJR Am J Roentgenol 2021; 216:1409-1410. [PMID: 34019460 DOI: 10.2214/ajr.21.25770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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