3
|
Nissan N, Massasa EEM, Bauer E, Halshtok-Neiman O, Shalmon A, Gotlieb M, Faermann R, Samoocha D, Yagil Y, Ziv-Baran T, Anaby D, Sklair-Levy M. MRI can accurately diagnose breast cancer during lactation. Eur Radiol 2023; 33:2935-2944. [PMID: 36348090 DOI: 10.1007/s00330-022-09234-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/27/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the diagnostic performance of breast dynamic contrast-enhanced (DCE) MRI during lactation. MATERIALS AND METHODS Datasets of 198 lactating patients, including 66 pregnancy-associated breast cancer (PABC) patients and 132 controls, who were scanned by DCE on 1.5-T MRI, were retrospectively evaluated. Six blinded, expert radiologists independently read a single DCE maximal intensity projection (MIP) image for each case and were asked to determine whether malignancy was suspected and the background-parenchymal-enhancement (BPE) grade. Likewise, computer-aided diagnosis CAD MIP images were independently read by the readers. Contrast-to-noise ratio (CNR) analysis was measured and compared among four consecutive acquisitions of DCE subtraction images. RESULTS For MIP-DCE images, the readers achieved the following means: sensitivity 93.3%, specificity 80.3%, positive-predictive-value 70.4, negative-predictive-value 96.2, and diagnostic accuracy of 84.6%, with a substantial inter-rater agreement (Kappa = 0.673, p value < 0.001). Most false-positive interpretations were attributed to either the MIP presentation, an underlying benign lesion, or an asymmetric appearance due to prior treatments. CAD's derived diagnostic accuracy was similar (p = 0.41). BPE grades were significantly increased in the healthy controls compared to the PABC cohort (p < 0.001). CNR significantly decreased by 11-13% in each of the four post-contrast images (p < 0.001). CONCLUSION Breast DCE MRI maintains its high efficiency among the lactating population, probably due to a vascular-steal phenomenon, which causes a significant reduction of BPE in cancer cases. Upon validation by prospective, multicenter trials, this study could open up the opportunity for breast MRI to be indicated in the screening and diagnosis of lactating patients, with the aim of facilitating an earlier diagnosis of PABC. KEY POINTS • A single DCE MIP image was sufficient to reach a mean sensitivity of 93.3% and NPV of 96.2%, to stress the high efficiency of breast MRI during lactation. • Reduction in BPE among PABC patients compared to the lactating controls suggests that several factors, including a possible vascular steal phenomenon, may affect cancer patients. • Reduction in CNR along four consecutive post-contrast acquisitions highlights the differences in breast carcinoma and BPE kinetics and explains the sufficient conspicuity on the first subtracted image.
Collapse
Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efi Efraim Moss Massasa
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
| | - Ethan Bauer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Halshtok-Neiman
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shalmon
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gotlieb
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renata Faermann
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Samoocha
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagil
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st. Tel Hashomer, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Faermann R, Friedman E, Kaidar-Person O, Brodsky M, Neiman OH, Shalmon A, Gotlieb M, Yagil Y, Samocha D, Feldman DM, Weidenfeld J, Sklair-Levy M. Pregnancy Associated Breast Cancer Among Israeli BRCA1/BRCA2 Carriers in a High-Risk Clinic. Acad Radiol 2023; 30:248-254. [PMID: 35527100 DOI: 10.1016/j.acra.2022.03.030] [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: 01/03/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Female carriers of pathogenic sequence variants (PSVs) in the BRCA1 /BRCA2 (Breast Cancer gene - BRCA) genes are at a substantially high-risk for developing breast cancer (BC), hence are offered active surveillance scheme based on semiannual breast exam and imaging from age 25 years to facilitate BC early detection (mammography/breast ultrasound depending on the age, and MRI). However, there are not specific guidelines for screening in case of pregnancy or lactation. In the current study, we summarize the experience at the largest high-risk clinic in Israel. MATERIALS AND METHODS Data of consecutive BRCA-PSV carriers undergoing surveillance as well as diagnostic ultrasound at the Meirav high-risk clinic from January 2014 to 2021 who were pregnant and/or breastfeeding at time of follow-up were identified. Relevant clinical data including results of breast exam, breast ultrasonography, biopsies and histological results were retrieved. Percentage of biopsies with malignancy, cancer detection rate and positive predictive values were calculated. Data is presented in descriptive statistics. RESULTS A total of 263 BRCA-carriers were included. Of these, 593 breast-ultrasonograms were performed in 263 BRCA-carriers for 292 pregnancies and 409 breast-ultrasonograms for 175 breastfeeding carriers. Of 36 breast biopsies in 292 pregnancies, 4 (PPV = 11%) had BC diagnosed (high grade invasive). Of 175 breastfeeding women, 25 biopsies were performed and 2 (PPV = 8%) were high grade invasive BC. Five of 6 BC were diagnosed in BRCA1 carriers, and 4/6 were screen detected. The rate of pregnancy-associated breast cancer was 6/292 (2.05%). CONCLUSION The overall detection rate of pregnancy-associated BC in BRCA-carriers is relatively low (2.05%), but still much higher than that in the general population. Two thirds of the BC were detected by screening. Therefore, despite the changes of the glandular breast tissue at time of pregnancy and breastfeeding, screening plays an important role in early detection. Ultrasound should be considered as a screening tool during this period of life of high-risk patients.
Collapse
Affiliation(s)
- Renata Faermann
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel.
| | - Eitan Friedman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Orit Kaidar-Person
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Malka Brodsky
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Osnat Halshtok Neiman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Anat Shalmon
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Michael Gotlieb
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Yael Yagil
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - David Samocha
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Dana Madorsky Feldman
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Jonathan Weidenfeld
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| | - Miri Sklair-Levy
- Meirav Center for Women's Health and High-Risk clinic (R.F., E.F., M.B., O.H.N, A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Division of Diagnostic Imaging (R.F., O.H.N., A.S., M.G., Y.Y., D.S., M.S.L.), Sheba Medical Center, Ramat Gan, Israel; Department of Radiation Oncology (O.K.P.), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (R.F., E.F., O.K.P., O.H.N., A.S., M.G., Y.Y., D.S., D.M.F., M.S.L.), Tel-Aviv University, Tel- Aviv, Ramat Gan, Israel; Department of Pathology (J.W.), Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|