1
|
Mariapun S, Ho WK, Eriksson M, Mohd Taib NA, Yip CH, Rahmat K, Hall P, Teo SH. Association of area- and volumetric-mammographic density and breast cancer risk in women of Asian descent: a case control study. Breast Cancer Res 2024; 26:79. [PMID: 38750574 PMCID: PMC11094942 DOI: 10.1186/s13058-024-01829-2] [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: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Mammographic density (MD) has been shown to be a strong and independent risk factor for breast cancer in women of European and Asian descent. However, the majority of Asian studies to date have used BI-RADS as the scoring method and none have evaluated area and volumetric densities in the same cohort of women. This study aims to compare the association of MD measured by two automated methods with the risk of breast cancer in Asian women, and to investigate if the association is different for premenopausal and postmenopausal women. METHODS In this case-control study of 531 cases and 2297 controls, we evaluated the association of area-based MD measures and volumetric-based MD measures with breast cancer risk in Asian women using conditional logistic regression analysis, adjusting for relevant confounders. The corresponding association by menopausal status were assessed using unconditional logistic regression. RESULTS We found that both area and volume-based MD measures were associated with breast cancer risk. Strongest associations were observed for percent densities (OR (95% CI) was 2.06 (1.42-2.99) for percent dense area and 2.21 (1.44-3.39) for percent dense volume, comparing women in highest density quartile with those in the lowest quartile). The corresponding associations were significant in postmenopausal but not premenopausal women (premenopausal versus postmenopausal were 1.59 (0.95-2.67) and 1.89 (1.22-2.96) for percent dense area and 1.24 (0.70-2.22) and 1.96 (1.19-3.27) for percent dense volume). However, the odds ratios were not statistically different by menopausal status [p difference = 0.782 for percent dense area and 0.486 for percent dense volume]. CONCLUSIONS This study confirms the associations of mammographic density measured by both area and volumetric methods and breast cancer risk in Asian women. Stronger associations were observed for percent dense area and percent dense volume, and strongest effects were seen in postmenopausal individuals.
Collapse
Affiliation(s)
- Shivaani Mariapun
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Weang-Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nur Aishah Mohd Taib
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Kartini Rahmat
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
- Biomedical Imaging Department, Faculty of Medicine, Universiti Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Soo-Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia.
- Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
2
|
O’Driscoll J, Burke A, Mooney T, Phelan N, Baldelli P, Smith A, Lynch S, Fitzpatrick P, Bennett K, Flanagan F, Mullooly M. A scoping review of programme specific mammographic breast density related guidelines and practices within breast screening programmes. Eur J Radiol Open 2023; 11:100510. [PMID: 37560166 PMCID: PMC10407884 DOI: 10.1016/j.ejro.2023.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION High mammographic breast density (MBD) is an independent breast cancer risk factor. In organised breast screening settings, discussions are ongoing regarding the optimal clinical role of MBD to help guide screening decisions. The aim of this scoping review was to provide an overview of current practices incorporating MBD within population-based breast screening programmes and from professional organisations internationally. METHODS This scoping review was conducted in accordance with the framework proposed by the Joanna Briggs Institute. The electronic databases, MEDLINE (PubMed), EMBASE, CINAHL Plus, Scopus, and Web of Science were systematically searched. Grey literature sources, websites of international breast screening programmes, and relevant government organisations were searched to identify further relevant literature. Data from identified materials were extracted and presented as a narrative summary. RESULTS The search identified 78 relevant documents. Documents were identified for breast screening programmes in 18 countries relating to screening intervals for women with dense breasts, MBD measurement, reporting, notification, and guiding supplemental screening. Documents were identified from 18 international professional organisations with the majority of material relating to supplemental screening guidance for women with dense breasts. Key factors collated during the data extraction process as relevant considerations for MBD practices included the evidence base needed to inform decision-making processes and resources (healthcare system costs, radiology equipment, and workforce planning). CONCLUSIONS This scoping review summarises current practices and guidelines incorporating MBD in international population-based breast screening settings and highlights the absence of consensus between organised breast screening programmes incorporating MBD in current breast screening protocols.
Collapse
Affiliation(s)
- Jessica O’Driscoll
- School of Population Health, RCSI University of Medicine and Health Sciences, Beaux Lane House, Mercer St. Lower, Dublin 2, Ireland
| | - Aileen Burke
- School of Population Health, RCSI University of Medicine and Health Sciences, Beaux Lane House, Mercer St. Lower, Dublin 2, Ireland
| | - Therese Mooney
- National Screening Service, Kings Inn House, 200 Parnell Street, Dublin 1, Ireland
| | - Niall Phelan
- BreastCheck, National Screening Service, 36 Eccles Street, Dublin 7, Ireland
| | - Paola Baldelli
- BreastCheck, National Screening Service, 36 Eccles Street, Dublin 7, Ireland
| | - Alan Smith
- National Screening Service, Kings Inn House, 200 Parnell Street, Dublin 1, Ireland
| | - Suzanne Lynch
- BreastCheck, National Screening Service, 36 Eccles Street, Dublin 7, Ireland
| | - Patricia Fitzpatrick
- National Screening Service, Kings Inn House, 200 Parnell Street, Dublin 1, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Beaux Lane House, Mercer St. Lower, Dublin 2, Ireland
| | - Fidelma Flanagan
- BreastCheck, National Screening Service, 36 Eccles Street, Dublin 7, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Beaux Lane House, Mercer St. Lower, Dublin 2, Ireland
| |
Collapse
|
3
|
Olinder J, Johnson K, Åkesson A, Förnvik D, Zackrisson S. Impact of breast density on diagnostic accuracy in digital breast tomosynthesis versus digital mammography: results from a European screening trial. Breast Cancer Res 2023; 25:116. [PMID: 37794480 PMCID: PMC10548633 DOI: 10.1186/s13058-023-01712-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The diagnostic accuracy of digital breast tomosynthesis (DBT) and digital mammography (DM) in breast cancer screening may vary per breast density subgroup. The purpose of this study was to evaluate which women, based on automatically assessed breast density subgroups, have the greatest benefit of DBT compared with DM in the prospective Malmö Breast Tomosynthesis Screening Trial. MATERIALS AND METHODS The prospective European, Malmö Breast Tomosynthesis Screening Trial (n = 14,848, Jan. 27, 2010-Feb. 13, 2015) compared one-view DBT and two-view DM, with consensus meeting before recall. Breast density was assessed in this secondary analysis with the automatic software Laboratory for Individualized Breast Radiodensity Assessment. DBT and DM's diagnostic accuracies were compared by breast density quintiles of breast percent density (PD) and absolute dense area (DA) with confidence intervals (CI) and McNemar's test. The association between breast density and cancer detection was analyzed with logistic regression, adjusted for ages < 55 and ≥ 55 years and previous screening participation. RESULTS In total, 14,730 women (median age: 58 years; inter-quartile range = 16) were included in the analysis. Sensitivity was higher and specificity lower for DBT compared with DM for all density subgroups. The highest breast PD quintile showed the largest difference in sensitivity and specificity at 81.1% (95% CI 65.8-90.5) versus 43.2% (95% CI 28.7-59.1), p < .001 and 95.5% (95% CI 94.7-96.2) versus 97.2% (95% CI 96.6-97.8), p < 0.001, respectively. Breast PD quintile was also positively associated with cancer detected via DBT at odds ratio 1.24 (95% CI 1.09-1.42, p = 0.001). CONCLUSION Women with the highest breast density had the greatest benefit from digital breast tomosynthesis compared with digital mammography with increased sensitivity at the cost of slightly lower specificity. These results may influence digital breast tomosynthesis's use in an individualized screening program stratified by, for instance, breast density. TRIAL REGISTRATION Trial registration at https://www. CLINICALTRIALS gov : NCT01091545, registered March 24, 2010.
Collapse
Affiliation(s)
- Jakob Olinder
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Skåne University Hospital, Carl-Bertil Laurells Gata 9, 20502, Malmö, Sweden.
- Department of Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.
| | - Kristin Johnson
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Skåne University Hospital, Carl-Bertil Laurells Gata 9, 20502, Malmö, Sweden
- Department of Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - Daniel Förnvik
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Radiology Diagnostics, Lund University, Skåne University Hospital, Carl-Bertil Laurells Gata 9, 20502, Malmö, Sweden
- Department of Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
4
|
Feasibility Study and Clinical Impact of Incorporating Breast Tissue Density in High-Risk Breast Cancer Screening Assessment. Curr Oncol 2022; 29:8742-8750. [PMID: 36421341 PMCID: PMC9689826 DOI: 10.3390/curroncol29110688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Breast tissue density (BTD) is known to increase the risk of breast cancer but is not routinely used in the risk assessment of the population-based High-Risk Ontario Breast Screening Program (HROBSP). This prospective, IRB-approved study assessed the feasibility and impact of incorporating breast tissue density (BTD) into the risk assessment of women referred to HROBSP who were not genetic mutation carriers. All consecutive women aged 40-69 years who met criteria for HROBSP assessment and referred to Genetics from 1 December 2020 to 31 July 2021 had their lifetime risk calculated with and without BTD using Tyrer-Cuzick model version 8 (IBISv8) to gauge overall impact. McNemar's test was performed to compare eligibility with and without density. 140 women were referred, and 1 was excluded (BRCA gene mutation carrier and automatically eligible). Eight of 139 (5.8%) never had a mammogram, while 17/131 (13%) did not have BTD reported on their mammogram and required radiologist review. Of 131 patients, 22 (16.8%) were clinically impacted by incorporation of BTD: 9/131 (6.9%) became eligible for HROBSP, while 13/131 (9.9%) became ineligible (p = 0.394). It was feasible for the Genetics clinic to incorporate BTD for better risk stratification of eligible women. This did not significantly impact the number of eligible women while optimizing the use of high-risk supplemental MRI screening.
Collapse
|
5
|
Fitzjohn J, Zhou C, Chase JG. Breast cancer diagnosis using frequency decomposition of surface motion of actuated breast tissue. Front Oncol 2022; 12:969530. [DOI: 10.3389/fonc.2022.969530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
This paper presents a computationally simple diagnostic algorithm for breast cancer using a non-invasive Digital Image Elasto Tomography (DIET) system. N=14 women (28 breasts, 13 cancerous) underwent a clinical trial using the DIET system following mammography diagnosis. The screening involves steady state sinusoidal vibrations applied to the free hanging breast with cameras used to capture tissue motion. Image reconstruction methods provide surface displacement data for approximately 14,000 reference points on the breast surface. The breast surface was segmented into four radial and four vertical segments. Frequency decomposition of reference point motion in each segment were compared. Segments on the same vertical band were hypothesised to have similar frequency content in healthy breasts, with significant differences indicating a tumor, based on the stiffness dependence of frequency and tumors being 4~10 times stiffer than healthy tissue. Twelve breast configurations were used to test robustness of the method. Optimal breast configuration for the 26 breasts analysed (13 cancerous, 13 healthy) resulted in 85% sensitivity and 77% specificity. Combining two opposite configurations resulted in correct diagnosis of all cancerous breasts with 100% sensitivity and 69% specificity. Bootstrapping was used to fit a smooth receiver operator characteristic (ROC) curve to compare breast configuration performance with optimal area under the curve (AUC) of 0.85. Diagnostic results show diagnostic accuracy is comparable or better than mammography, with the added benefits of DIET screening, including portability, non-invasive screening, and no breast compression, with potential to increase screening participation and equity, improving outcomes for women.
Collapse
|
6
|
Deep Learning Models for Automated Assessment of Breast Density Using Multiple Mammographic Image Types. Cancers (Basel) 2022; 14:cancers14205003. [PMID: 36291787 PMCID: PMC9599904 DOI: 10.3390/cancers14205003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary The DL model predictions in automated breast density assessment were independent of the imaging technologies, moderately or substantially agreed with the clinical reader density values, and had improved performance as compared to inclusion of commercial software values. Abstract Recently, convolutional neural network (CNN) models have been proposed to automate the assessment of breast density, breast cancer detection or risk stratification using single image modality. However, analysis of breast density using multiple mammographic types using clinical data has not been reported in the literature. In this study, we investigate pre-trained EfficientNetB0 deep learning (DL) models for automated assessment of breast density using multiple mammographic types with and without clinical information to improve reliability and versatility of reporting. 120,000 for-processing and for-presentation full-field digital mammograms (FFDM), digital breast tomosynthesis (DBT), and synthesized 2D images from 5032 women were retrospectively analyzed. Each participant underwent up to 3 screening examinations and completed a questionnaire at each screening encounter. Pre-trained EfficientNetB0 DL models with or without clinical history were optimized. The DL models were evaluated using BI-RADS (fatty, scattered fibroglandular densities, heterogeneously dense, or extremely dense) versus binary (non-dense or dense) density classification. Pre-trained EfficientNetB0 model performances were compared using inter-observer and commercial software (Volpara) variabilities. Results show that the average Fleiss’ Kappa score between-observers ranged from 0.31–0.50 and 0.55–0.69 for the BI-RADS and binary classifications, respectively, showing higher uncertainty among experts. Volpara-observer agreement was 0.33 and 0.54 for BI-RADS and binary classifications, respectively, showing fair to moderate agreement. However, our proposed pre-trained EfficientNetB0 DL models-observer agreement was 0.61–0.66 and 0.70–0.75 for BI-RADS and binary classifications, respectively, showing moderate to substantial agreement. Overall results show that the best breast density estimation was achieved using for-presentation FFDM and DBT images without added clinical information. Pre-trained EfficientNetB0 model can automatically assess breast density from any images modality type, with the best results obtained from for-presentation FFDM and DBT, which are the most common image archived in clinical practice.
Collapse
|
7
|
Cè M, Caloro E, Pellegrino ME, Basile M, Sorce A, Fazzini D, Oliva G, Cellina M. Artificial intelligence in breast cancer imaging: risk stratification, lesion detection and classification, treatment planning and prognosis-a narrative review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2022; 3:795-816. [PMID: 36654817 PMCID: PMC9834285 DOI: 10.37349/etat.2022.00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 12/28/2022] Open
Abstract
The advent of artificial intelligence (AI) represents a real game changer in today's landscape of breast cancer imaging. Several innovative AI-based tools have been developed and validated in recent years that promise to accelerate the goal of real patient-tailored management. Numerous studies confirm that proper integration of AI into existing clinical workflows could bring significant benefits to women, radiologists, and healthcare systems. The AI-based approach has proved particularly useful for developing new risk prediction models that integrate multi-data streams for planning individualized screening protocols. Furthermore, AI models could help radiologists in the pre-screening and lesion detection phase, increasing diagnostic accuracy, while reducing workload and complications related to overdiagnosis. Radiomics and radiogenomics approaches could extrapolate the so-called imaging signature of the tumor to plan a targeted treatment. The main challenges to the development of AI tools are the huge amounts of high-quality data required to train and validate these models and the need for a multidisciplinary team with solid machine-learning skills. The purpose of this article is to present a summary of the most important AI applications in breast cancer imaging, analyzing possible challenges and new perspectives related to the widespread adoption of these new tools.
Collapse
Affiliation(s)
- Maurizio Cè
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy,Correspondence: Maurizio Cè, Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.
| | - Elena Caloro
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Maria E. Pellegrino
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Mariachiara Basile
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Adriana Sorce
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | | | - Giancarlo Oliva
- Department of Radiology, ASST Fatebenefratelli Sacco, 20121 Milan, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, 20121 Milan, Italy
| |
Collapse
|
8
|
Henze Bancroft LC, Strigel RM, Macdonald EB, Longhurst C, Johnson J, Hernando D, Reeder SB. Proton density water fraction as a reproducible MR-based measurement of breast density. Magn Reson Med 2021; 87:1742-1757. [PMID: 34775638 DOI: 10.1002/mrm.29076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To introduce proton density water fraction (PDWF) as a confounder-corrected (CC) MR-based biomarker of mammographic breast density, a known risk factor for breast cancer. METHODS Chemical shift encoded (CSE) MR images were acquired using a low flip angle to provide proton density contrast from multiple echo times. Fat and water images, corrected for known biases, were produced by a six-echo CC CSE-MRI algorithm. Fibroglandular tissue (FGT) volume was calculated from whole-breast segmented PDWF maps at 1.5T and 3T. The method was evaluated in (1) a physical fat-water phantom and (2) normal volunteers. Results from two- and three-echo CSE-MRI methods were included for comparison. RESULTS Six-echo CC-CSE-MRI produced unbiased estimates of the total water volume in the phantom (mean bias 3.3%) and was reproducible across protocol changes (repeatability coefficient [RC] = 14.8 cm3 and 13.97 cm3 at 1.5T and 3.0T, respectively) and field strengths (RC = 51.7 cm3 ) in volunteers, while the two- and three-echo CSE-MRI approaches produced biased results in phantoms (mean bias 30.7% and 10.4%) that was less reproducible across field strengths in volunteers (RC = 82.3 cm3 and 126.3 cm3 ). Significant differences in measured FGT volume were found between the six-echo CC-CSE-MRI and the two- and three-echo CSE-MRI approaches (p = 0.002 and p = 0.001, respectively). CONCLUSION The use of six-echo CC-CSE-MRI to create unbiased PDWF maps that reproducibly quantify FGT in the breast is demonstrated. Further studies are needed to correlate this quantitative MR biomarker for breast density with mammography and overall risk for breast cancer.
Collapse
Affiliation(s)
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erin B Macdonald
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jacob Johnson
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
9
|
Youk JH, Gweon HM, Son EJ, Eun NL, Kim JA. Fully automated measurements of volumetric breast density adapted for BIRADS 5th edition: a comparison with visual assessment. Acta Radiol 2021; 62:1148-1154. [PMID: 32910685 DOI: 10.1177/0284185120956309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the 5th edition of BI-RADS was released, prior studies have compared BI-RADS and quantitative fully automated volumetric assessment, but with software packages that were not recalibrated according to the 5th edition. PURPOSE To investigate mammographic density assessment of automated volumetric measurements recalibrated according to the BI-RADS 5th edition compared with visual assessment. MATERIAL AND METHODS A total of 4000 full-field digital mammographic examinations were reviewed by three radiologists for the BI-RADS 5th edition density category by consensus after individual assessments. Volumetric density data obtained using Quantra and Volpara software were collected. The comparison of visual and volumetric density assessments was performed in total and according to the presence of cancer. RESULTS Among 4000 examinations, 129 were mammograms of breast cancer. Compared to visual assessment, volumetric measurements showed higher category B (40.6% vs. 19.8%) in Quantra, and higher category D (40.4% vs. 14.7%) and lower category A (0.2% vs. 5.0%) in Volpara (P < 0.0001). All volumetric data showed a difference according to visually assessed categories and were correlated between the two volumetric measurements (P < 0.0001). The group with cancer showed a lower proportion of fatty breast than that without cancer: 17.8% vs. 46.9% for Quantra (P < 0.0001) and 9.3% vs. 21.5% for Volpara (P = 0.003). Both measurements showed significantly higher mean density data in the group with cancer than without cancer (P < 0.005 for all). CONCLUSION Automated volumetric measurements adapted for the BI-RADS 5th edition showed different but correlated results with visual assessment and each other. Recalibration of volumetric measurement has not completely reflected the visual assessment.
Collapse
Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Li WM, Sun QW, Fan XF, Zhang JC, Xu T, Shen QQ, Jia L. Mammography breast density: an effective supplemental modality for the precise grading of ultrasound BI-RADS 4 categories. Gland Surg 2021; 10:2010-2018. [PMID: 34268085 DOI: 10.21037/gs-21-313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/17/2021] [Indexed: 11/06/2022]
Abstract
Background High breast density is significantly associated with an increased risk of breast diseases. Presently, suspected breast masses assessed as Breast Imaging-Reporting and Data System (BI-RADS) grade 4 provide a wide range of positive predictive values. Moreover, subcategories (4a, 4b, and 4c) are still under consideration as the diagnostic criteria are neither comprehensive nor objective. However, whether mammography breast density (MBD) has any impact on the accurate grading of BI-RADS 4 assessed by ultrasound (US) remains unknown. Methods A total of 1,086 women with 1,293 breast masses were included and assessed as BI-RADS 3-5 by US. The subcategories of MBD (from the ACR-a to the ACR-d group) were assessed by mammography according to the criteria of the American College of Radiology (ACR). The clinicopathological characteristics of these patients were reviewed retrospectively. The malignancy rates of breast masses among different subgroups assessed by BI-RADS were re-estimated with MBD. Results Almost all BI-RADS 3 masses were classified as benign and nearly all BI-RADS 5 masses were identified as malignant. Significant inverse associations between MBD and malignancy rates were detected between the BI-RADS 4a and BI-RADS 4b groups. Moreover, malignancy rates decreased significantly from ACR-a to ACR-d for BI-RADS 4a and 4b breast lesions (P<0.001). However, this trend was not observed in BI-RADS 4c breast lesions. Conclusions MBD could serve as a crucial factor for the accurate grading of BI-RADS 4 lesions assessed by US. We strongly recommend the adoption of the MBD as a possible supplemental screening modality for US. Furthermore, it is equally beneficial for accurate risk assessment and screening recommendations based on MBD.
Collapse
Affiliation(s)
- Wei-Min Li
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qiu-Wei Sun
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiao-Fang Fan
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jun-Chao Zhang
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ting Xu
- Department of Clinical and Research, Shenzhen Mindray Biomedical Electronics Co., Ltd, Shenzhen, China
| | - Qi-Qi Shen
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Jia
- Department of Ultrasonography, Affiliated Hospital of Jiangnan University, Wuxi, China
| |
Collapse
|
11
|
Noonpradej S, Wangkulangkul P, Woodtichartpreecha P, Laohawiriyakamol S. Prediction for Breast Cancer in BI-RADS Category 4 Lesion Categorized by Age and Breast Composition of Women in Songklanagarind Hospital. Asian Pac J Cancer Prev 2021; 22:531-536. [PMID: 33639670 PMCID: PMC8190358 DOI: 10.31557/apjcp.2021.22.2.531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Older age and dense breast are the important risk factors for breast cancer. The ACR BI-RADS lexicon 5th edition does not mention how patient age and breast density may affect the category assessment. The aim of this study was to investigate whether patient age and breast density influence the positive predictive value (PPV) of mammographic and ultrasonographic findings categorized as BI-RADS category 4 and subcategories 4a, 4b, and 4c among female patients. Materials and Methods: A retrospective study was conducted in Songklanagarind Hospital between January 1, 2016 and December 31, 2017 in female patients older than 18 years who had breast lesions categorized as BI-RADS category 4 and subcategories 4a, 4b, 4c. A total of 961 breast lesions consisted of 772 (80.33%) benign lesions and 189 (19.67%) malignant lesions. Categorization was done in each lesion based on age ranges of ≤35 years, >35 to 60 years, and >60 years and breast density according to mammographic breast composition. The PPV for each BI-RADS category was calculated based on the pathological diagnoses and were compared using the chi-square test. Results: The overall PPV in each subcategory was in the reference range. The PPV increased with increasing age: 4% vs. 22.63% vs. 36.67% for category 4 (p-value=0.01); 0% vs. 5.81% vs. 6.88% for subcategory 4a (p-value=0.002); 6.67% vs. 26.62% vs. 51.35% for subcategory 4b (p-value=0.001); and 33.33% vs. 76.92% vs. 81.82% for subcategory 4c (p-value=0.02). An association was not found between PPV and breast density. Conclusion: A significantly positive association was found between PPV and age in patients in BI-RADS subcategories 4a, 4b, and 4c. This study could not determine that mammographic breast composition according to the ACR BI-RADS 5th edition was associated with PPV due to improper sample distribution.
Collapse
Affiliation(s)
- Seechad Noonpradej
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
| | - Piyanun Wangkulangkul
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
| | - Piyanoot Woodtichartpreecha
- Division of Radiology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Suphawat Laohawiriyakamol
- Division of General Surgery, Faculty of Medicine, Songklanagarind hospital. Prince of Songkla University, Songkla, Thailand
| |
Collapse
|
12
|
Sak M, Littrup P, Brem R, Duric N. Whole Breast Sound Speed Measurement from US Tomography Correlates Strongly with Volumetric Breast Density from Mammography. JOURNAL OF BREAST IMAGING 2020; 2:443-451. [PMID: 33015618 DOI: 10.1093/jbi/wbaa052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 11/14/2022]
Abstract
Objective To assess the feasibility of using tissue sound speed as a quantitative marker of breast density. Methods This study was carried out under an Institutional Review Board-approved protocol (written consent required). Imaging data were selected retrospectively based on the availability of US tomography (UST) exams, screening mammograms with volumetric breast density data, patient age of 18 to 80 years, and weight less than 300 lbs. Sound speed images from the UST exams were used to measure the volume of dense tissue, the volume averaged sound speed (VASS), and the percent of high sound speed tissue (PHSST). The mammographic breast density and volume of dense tissue were estimated with three-dimensional (3D) software. Differences in volumes were assessed with paired t-tests. Spearman correlation coefficients were calculated to determine the strength of the correlations between the mammographic and UST assessments of breast density. Results A total of 100 UST and 3D mammographic data sets met the selection criteria. The resulting measurements showed that UST measured a more than 2-fold larger volume of dense tissue compared to mammography. The differences were statistically significant (P < 0.001). A strong correlation of rS = 0.85 (95% CI: 0.79-0.90) between 3D mammographic breast density (BD) and the VASS was noted. This correlation is significantly stronger than those reported in previous two-dimensional studies (rS = 0.85 vs rS = 0.71). A similar correlation was found for PHSST and mammographic BD with rS = 0.86 (95% CI: 0.80-0.90). Conclusion The strong correlations between UST parameters and 3D mammographic BD suggest that breast sound speed should be further studied as a potential new marker for inclusion in clinical risk models.
Collapse
Affiliation(s)
- Mark Sak
- Delphinus Medical Technologies, Inc, Novi, MI
| | | | - Rachel Brem
- George Washington University, Department of Radiology, Washington, DC
| | - Neb Duric
- Delphinus Medical Technologies, Inc, Novi, MI.,Wayne State University, Barbara Ann Karmanos Cancer Institute, Department of Oncology, Detroit, MI
| |
Collapse
|
13
|
Porembka JH, Ma J, Le-Petross HT. Breast density, MR imaging biomarkers, and breast cancer risk. Breast J 2020; 26:1535-1542. [PMID: 32654416 DOI: 10.1111/tbj.13965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
Abstract
Mammographic breast density and various breast MRI features are imaging biomarkers that can predict a woman's future risk of breast cancer. While mammographic density (MD) has been established as an independent risk factor for the development of breast cancer, MD assessment methods need to be accurate and reproducible for widespread clinical use in stratifying patients based on their risk. In addition, a number of breast MRI biomarkers using contrast-enhanced and noncontrast-enhanced techniques are also being investigated as risk predictors. The validation and standardization of these breast MRI biomarkers will be necessary for population-based clinical implementation of patient risk stratification, as well. This review provides an update on MD assessment methods, breast MRI biomarkers, and their ability to predict breast cancer risk.
Collapse
Affiliation(s)
- Jessica H Porembka
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingfei Ma
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Huong T Le-Petross
- Diagnostic Imaging Division, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
14
|
Ghieh D, Saade C, Najem E, El Zeghondi R, Rawashdeh MA, Berjawi G. Staying abreast of imaging - Current status of breast cancer detection in high density breast. Radiography (Lond) 2020; 27:229-235. [PMID: 32611494 DOI: 10.1016/j.radi.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.
Collapse
Affiliation(s)
- D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - E Najem
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - R El Zeghondi
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - M A Rawashdeh
- Department of Allied Medical Sciences, Jordan University of Science and Technology, P.O.Box: 3030, Irbid 22110, Jordan.
| | - G Berjawi
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| |
Collapse
|
15
|
Alomaim W, O’Leary D, Ryan J, Rainford L, Evanoff M, Foley S. Subjective Versus Quantitative Methods of Assessing Breast Density. Diagnostics (Basel) 2020; 10:diagnostics10050331. [PMID: 32455552 PMCID: PMC7277954 DOI: 10.3390/diagnostics10050331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.
Collapse
Affiliation(s)
- Wijdan Alomaim
- Radiography & Medical Imaging, Fatima College of Health Sciences, Abu Dhabi, UAE
- Correspondence: ; Tel.: +9712-5078639
| | - Desiree O’Leary
- Radiography (Diagnostic Imaging), Keele University, Keele ST5 5BG, UK; D.s.o'
| | - John Ryan
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | - Louise Rainford
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | | | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| |
Collapse
|
16
|
Kanbayti IH, Rae WID, McEntee MF, Al-Foheidi M, Ashour S, Turson SA, Ekpo EU. Is mammographic density a marker of breast cancer phenotypes? Cancer Causes Control 2020; 31:749-765. [PMID: 32410205 DOI: 10.1007/s10552-020-01316-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the association between mammographic density (MD) phenotypes and both clinicopathologic features of breast cancer (BC) and tumor location. METHODS MD was measured for 297 BC-affected females using qualitative (visual method) and quantitative (fully automated area-based method) approaches. Radiologists' description, visible external markers, and surgical scar were used to establish the location of tumors. Binary logistic regression models were used to assess the association between MD phenotypes and BC clinicopathologic features. RESULTS Categorical and numerical MD measures showed no association with clinicopathologic features of BC (p > 0.05). Participants with higher BI-RADS scores [(51-75% glandular) and (> 75% glandular)] (p < 0.001), and percent density (PD) categories [PD (21-49%) and PD ≥ 50%] (p = 0.01) were more likely to have tumors emanating from dense areas. Additionally, tumors were commonly found in dense regions of the breast among patients with higher medians of PD (p = 0.001), dense area (DA) (p = 0.02), and lower medians of non-dense area (NDA) (p < 0.001). Adjusted logistic regression models showed that high BI-RADS density (> 75% glandular) has an almost fivefold increased odds of tumors developing within dense areas (OR 4.99, 95% CI 0.93-25.9; p = 0.05. PD (OR 1.02, 95% CI 1-1.03, p = 0.002) and NDA (OR 0.99, 95% CI 0.991-0.997, p < 0.001) had very small effect on tumor location. Compared to tumors within non-dense areas, tumors in dense areas tended to exhibit human epidermal growth factor receptor 2 positive (p = 0.05) and carcinoma in situ (p = 0.01) characteristics. CONCLUSION MD shows no significant association with clinicopathologic features of BC. However, BC was more likely to originate from dense tissue, with tumors in dense regions having human epidermal growth receptor 2 positive and carcinoma in situ characteristics.
Collapse
Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia. .,Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Faculty of Health Science, University of Sydney, Cumberland Campus C42
- 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - William I D Rae
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medicine Roinn na Sláinte, UG 12 Áras Watson
- Brookfield Health Sciences, Cork, T12 AK54, Ireland
| | - Meteb Al-Foheidi
- King Saud Bin Abdulaziz University for Health Science-National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sawsan Ashour
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Smeera A Turson
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ernest U Ekpo
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
| |
Collapse
|
17
|
Update on Breast Density, Risk Estimation, and Supplemental Screening. AJR Am J Roentgenol 2020; 214:296-305. [DOI: 10.2214/ajr.19.21994] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
18
|
Lee E, Doanvo N, Lee M, Soe Z, Lee AW, Van Doan C, Deapen D, Ursin G, Spicer D, Reynolds P, Wu AH. Immigration history, lifestyle characteristics, and breast density in the Vietnamese American Women's Health Study: a cross-sectional analysis. Cancer Causes Control 2020; 31:127-138. [PMID: 31916076 PMCID: PMC7842111 DOI: 10.1007/s10552-019-01264-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Breast density is an important risk factor for breast cancer and varies substantially across racial-ethnic groups. However, determinants of breast density in Vietnamese immigrants in the United States (US) have not been studied. We investigated whether reproductive factors, immigration history, and other demographic and lifestyle factors were associated with breast density in Vietnamese Americans. METHODS We collected information on demographics, immigration history, and other lifestyle factors and mammogram reports from a convenience sample of 380 Vietnamese American women in California aged 40 to 70 years. Breast Imaging Reporting and Data System (BI-RADS) breast density was abstracted from mammogram reports. Multivariable logistic regression was used to investigate the association between lifestyle factors and having dense breasts (BI-RADS 3 or 4). RESULTS All participants were born in Viet Nam and 82% had lived in the US for 10 years or longer. Younger age, lower body mass index, nulliparity/lower number of deliveries, and longer US residence (or younger age at migration) were associated with having dense breasts. Compared to women who migrated at age 40 or later, the odds ratios and 95% confidence intervals for having dense breasts among women who migrated between the ages of 30 and 39 and before age 30 were 1.72 (0.96-3.07) and 2.48 (1.43-4.32), respectively. CONCLUSIONS Longer US residence and younger age at migration were associated with greater breast density in Vietnamese American women. Identifying modifiable mediating factors to reduce lifestyle changes that adversely impact breast density in this traditionally low-risk population for breast cancer is warranted.
Collapse
Affiliation(s)
- Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Namphuong Doanvo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - MiHee Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Zayar Soe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, 92831, USA
| | - Cam Van Doan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Dennis Deapen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | | | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| |
Collapse
|
19
|
Breast density measured volumetrically in a clinical environment: cross-sectional study with photon counting technology. Breast Cancer Res Treat 2019; 179:755-762. [DOI: 10.1007/s10549-019-05502-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
|
20
|
Arefan D, Mohamed AA, Berg WA, Zuley ML, Sumkin JH, Wu S. Deep learning modeling using normal mammograms for predicting breast cancer risk. Med Phys 2019; 47:110-118. [PMID: 31667873 DOI: 10.1002/mp.13886] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/30/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate two deep learning-based modeling schemes for predicting short-term risk of developing breast cancer using prior normal screening digital mammograms in a case-control setting. METHODS We conducted a retrospective Institutional Review Board-approved study on a case-control cohort of 226 patients (including 113 women diagnosed with breast cancer and 113 controls) who underwent general population breast cancer screening. For each patient, a prior normal (i.e., with negative or benign findings) digital mammogram examination [including mediolateral oblique (MLO) view and craniocaudal (CC) view two images] was collected. Thus, a total of 452 normal images (226 MLO view images and 226 CC view images) of this case-control cohort were analyzed to predict the outcome, i.e., developing breast cancer (cancer cases) or remaining breast cancer-free (controls) within the follow-up period. We implemented an end-to-end deep learning model and a GoogLeNet-LDA model and compared their effects in several experimental settings using two mammographic view images and inputting two different subregions of the images to the models. The proposed models were also compared to logistic regression modeling of mammographic breast density. Area under the receiver operating characteristic curve (AUC) was used as the model performance metric. RESULTS The highest AUC was 0.73 [95% Confidence Interval (CI): 0.68-0.78; GoogLeNet-LDA model on CC view] when using the whole-breast and was 0.72 (95% CI: 0.67-0.76; GoogLeNet-LDA model on MLO + CC view) when using the dense tissue, respectively, as the model input. The GoogleNet-LDA model significantly (all P < 0.05) outperformed the end-to-end GoogLeNet model in all experiments. CC view was consistently more predictive than MLO view in both deep learning models, regardless of the input subregions. Both models exhibited superior performance than the percent breast density (AUC = 0.54; 95% CI: 0.49-0.59). CONCLUSIONS The proposed deep learning modeling approach can predict short-term breast cancer risk using normal screening mammogram images. Larger studies are needed to further reveal the promise of deep learning in enhancing imaging-based breast cancer risk assessment.
Collapse
Affiliation(s)
- Dooman Arefan
- Department of Radiology, University of Pittsburgh, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Aly A Mohamed
- Department of Radiology, University of Pittsburgh, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.,Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA, 15213, USA
| | - Margarita L Zuley
- Department of Radiology, University of Pittsburgh, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.,Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA, 15213, USA
| | - Jules H Sumkin
- Department of Radiology, University of Pittsburgh, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.,Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA, 15213, USA
| | - Shandong Wu
- Departments of Radiology, Biomedical Informatics, Bioengineering, and Intelligent Systems Program, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| |
Collapse
|
21
|
Saikiran P, Ramzan R, S N, Kamineni PD, Priyanka, John AM. Mammographic Breast Density Assessed with Fully Automated Method and its Risk for Breast Cancer. J Clin Imaging Sci 2019; 9:43. [PMID: 31662951 PMCID: PMC6800411 DOI: 10.25259/jcis_70_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives: We evaluated the association between breast cancer and breast density (BD) measured using fully automated software. We also evaluated the performance of cancer risk models such as only clinical risk factors, density related measures, and both clinical risk factors and density-related measures for determining cancer risk. Materials and Methods: This is a retrospective case–control study. The data were collected from August 2015 to December 2018. Two hundred fifty women with breast cancer and 400 control subjects were included in this study. We evaluated the BD qualitatively using breast imaging-reporting and data system density and quantitatively using 3D slicer. We also collected clinical factors such as age, familial history of breast cancer, menopausal status, number of births, body mass index, and hormonal replacement therapy use. We calculated the odds ratio (OR) for BD to determine the risk of breast cancer. We performed receiver operating characteristic (ROC) curve to assess the performance of cancer risk models. Results: The OR for the percentage BD for second, third, and fourth quartiles was 1.632 (95% confidence intervals [CI]: 1.102–2.416), 2.756 (95% CI: 1.704–4.458), and 3.163 (95% CI: 1.356–5.61). The area under ROC curve for clinical risk factors only, mammographic density measures, combined mammographic, and clinical risk factors was 0.578 (95% CI: 0.45, 0.64), 0.684 (95% CI: 0.58, 0.75), and 0.724 (95% CI: 0.64, 0.80), respectively. Conclusion: Mammographic BD was found to be positively associated with breast cancer. The density related measures combined clinical risk factors, and density model had good discriminatory power in identifying the cancer risk.
Collapse
Affiliation(s)
- Pendem Saikiran
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Ruqiya Ramzan
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Nandish S
- School of Information Sciences, Manipal Institute of Technology, Manipal, Karnataka, India
| | - Phani Deepika Kamineni
- Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| | - Arathy Mary John
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal, Karnataka, India
| |
Collapse
|
22
|
Pertuz S, Sassi A, Karivaara-Mäkelä M, Holli-Helenius K, Lääperi AL, Rinta-Kiikka I, Arponen O, Kämäräinen JK. Micro-parenchymal patterns for breast cancer risk assessment. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab42f4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
23
|
Fowler EE, Smallwood A, Khan N, Miltich C, Drukteinis J, Sellers TA, Heine J. Calibrated Breast Density Measurements. Acad Radiol 2019; 26:1181-1190. [PMID: 30545682 PMCID: PMC6557684 DOI: 10.1016/j.acra.2018.10.009] [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: 06/07/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Mammographic density is an important risk factor for breast cancer, but translation to the clinic requires assurance that prior work based on mammography is applicable to current technologies. The purpose of this work is to evaluate whether a calibration methodology developed previously produces breast density metrics predictive of breast cancer risk when applied to a case-control study. MATERIALS AND METHODS A matched case control study (n = 319 pairs) was used to evaluate two calibrated measures of breast density. Two-dimensional mammograms were acquired from six Hologic mammography units: three conventional Selenia two-dimensional full-field digital mammography systems and three Dimensions digital breast tomosynthesis systems. We evaluated the capability of two calibrated breast density measures to quantify breast cancer risk: the mean (PGm) and standard deviation (PGsd) of the calibrated pixels. Matching variables included age, hormone replacement therapy usage/duration, screening history, and mammography unit. Calibrated measures were compared to the percentage of breast density (PD) determined with the operator-assisted Cumulus method. Conditional logistic regression was used to generate odds ratios (ORs) from continuous and quartile (Q) models with 95% confidence intervals. The area under the receiver operating characteristic curve (Az) was also used as a comparison metric. Both univariate models and models adjusted for body mass index and ethnicity were evaluated. RESULTS In adjusted models, both PGsd and PD were statistically significantly associated with breast cancer with similar Az of 0.61-0.62. The corresponding ORs and confidence intervals were also similar. For PGsd, the OR was 1.34 (1.09, 1.66) for the continuous measure and 1.83 (1.11, 3.02), 2.19 (1.28, 3.73), and 2.20 (1.26, 3.85) for Q2-Q4. For PD, the OR was 1.43 (1.16, 1.76) for the continuous measure and 0.84 (0.52, 1.38), 1.96 (1.19, 3.23), and 2.27 (1.29, 4.00) for Q2-Q4. The results for PGm were slightly attenuated and not statistically significant. The OR was 1.22 (0.99, 1.51) with Az = 0.60 for the continuous measure and 1.24 (0.78, 1.97), 0.98 (0.60, 1.61), and 1.26, (0.77, 2.07) for Q2-Q4 with Az = 0.60. CONCLUSION The calibrated PGsd measure provided significant associations with breast cancer comparable to those given by PD. The calibrated PGm performed slightly worse. These findings indicate that the calibration approach developed previously replicates under more general conditions.
Collapse
Affiliation(s)
| | | | | | | | - Jennifer Drukteinis
- Moffitt Cancer Center & Research Institute, 12901 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | | | - John Heine
- Corresponding Author information: John Heine, PhD, Moffitt Cancer Center & Research Institute, 12901 Bruce B, Downs Blvd, Mail Stop: Can/Cont, Tampa, FL 33612, Phone: 813-745-6719
| |
Collapse
|
24
|
Kanbayti IH, Rae WID, McEntee MF, Ekpo EU. Are mammographic density phenotypes associated with breast cancer treatment response and clinical outcomes? A systematic review and meta-analysis. Breast 2019; 47:62-76. [PMID: 31352313 DOI: 10.1016/j.breast.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Mammographic density (MD) increases breast cancer (BC) risk, however, its association with patient outcomes is unclear. We examined the association of baseline MD (BMD), and MD reduction (MDR) following BC treatment with patient outcomes. Six databases (CINAHL, Scopus, PubMed, Web of Science, MEDLINE, and Embase) were used to identify relevant articles. The PRISMA strategy was used to extract relevant details. Study quality and risk of bias were assessed using the "Quality In Prognosis Studies" (QUIPS) tool. A Meta-analysis and pooled risk estimates were performed. Results showed that BMD is associated with contralateral breast cancer (CBC) risk (HR = 1.9; 95%CI: 1.3-3.0, p = 0.0007), recurrence (HR = 2.0; 95%CI: 1.0-4.0, p = 0.04), and mortality (HR = 1.4; 95%CI: 1.1-1.9, p = 0.003). No association was found between BMD and prognosis (HR = 3.2; 95%CI: 0.9-11.2, p = 0.06). Data on risk estimates (95%CI) from BMD for survival [RR: 1.75; 0.99-3.1 to 2.4; 1.4-4.1], ipsilateral BC [HR: 1; 0.6-1.6 to 3; 1.2-7.5], and treatment response (OR, 1.8; 0.98-3.3) are limited. MDR showed no association with mortality (HR = 0.5; 95%CI: 0.2-1.2, p = 0.13). MDR is associated with a reduced risk of recurrence [HR/RR: 0.35; 0.17-0.68 to 1.33; 0.67-2.65)], however data on MDR and outcomes such as mortality [HR/RR: 0.5; 0.27-0.93 to 0.59; 0.22-0.88], and CBC risk [RR/HR: 0.53; 0.24-0.84 to 1.3; 0.6-2.7] are limited. Evidence, although sparse, demonstrates that high BMD is associated with an increased risk of recurrence, CBC, and mortality. Conversely, MDR is associated with a reduced risk of BC recurrence, CBC, and BC-related mortality.
Collapse
Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Saudi Arabia; Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia.
| | - William I D Rae
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia; Department of Medicine Roinn na Sláinte, UG 12 Áras Watson, Brookfield Health Sciences, T12 AK54, Ireland
| | - Ernest U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
| |
Collapse
|
25
|
Fowler EEE, Hathaway C, Tillman F, Weinfurtner R, Sellers TA, Heine J. Spatial Correlation and Breast Cancer Risk. Biomed Phys Eng Express 2019; 5. [PMID: 33304615 DOI: 10.1088/2057-1976/ab1dad] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present a novel method for evaluating local spatial correlation structure in two-dimensional (2D) mammograms and evaluate its capability for risk prediction as one possible application. Two matched case-control studies were analyzed. Study 1 included women (N = 588 pairs) with mammograms acquired with either Hologic Selenia full field digital mammography (FFDM) units or Hologic Dimensions digital breast tomosynthesis units. Study 2 included women (N =180 pairs) with mammograms acquired with a General Electric Senographe 2000D FFDM unit. Matching variables included age, HRT usage/duration, screening history, and mammography unit. Local autocorrelation functions were determined with Fourier analysis and compared with a template defined as a 2D double-sided exponential function with one spatial extent parameter: n = 4, 12, 24, 50, 74, 100, and 124, where (n+1)×(n+1) is the area of the local spatial extent measured in pixels. The difference between the local correlation and template was gauged within an adjustable parameter kernel and summarized, producing two measures: the mean (mn+1), and standard deviation (sn+1). Both adjustable parameters were varied in Study 1. Select measures that produced significant associations with breast cancer were translated to Study 2. Breast cancer associations were evaluated with conditional logistic regression, adjusted for body mass index and ethnicity. Odds ratios (ORs) were estimated as per standard deviation increment with 95% confidence intervals (CIs). Two measures were selected for breast cancer association analysis in Study 1: m75 and s25. Both measures revealed significant associations with breast cancer: OR = 1.45 (1.23, 1.66) for m75 and OR = 1.30 (1.14, 1.49) for s25. When translating to Study 2, these measures also revealed significant associations: OR = 1.49 (1.12, 1.96) for m75 and OR = 1.34 (1.06, 1.69) for s25. Novel correlation metrics presented in this work produced significant associations with breast cancer risk. This approach is general and may have applications beyond mammography.
Collapse
Affiliation(s)
- Erin E E Fowler
- Cancer Epidemiology Department, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | - Cassandra Hathaway
- Cancer Epidemiology Department, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | - Fabryann Tillman
- Cancer Epidemiology Department, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | - Robert Weinfurtner
- Diagnostic Imaging, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | - Thomas A Sellers
- Cancer Epidemiology Department, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| | - John Heine
- Cancer Epidemiology Department, MCC, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa FL, 33612 (MCC)
| |
Collapse
|
26
|
Moran O, Eisen A, Demsky R, Blackmore K, Knight JA, Panchal S, Ginsburg O, Zbuk K, Yaffe M, Metcalfe KA, Narod SA, Kotsopoulos J. Predictors of mammographic density among women with a strong family history of breast cancer. BMC Cancer 2019; 19:631. [PMID: 31242899 PMCID: PMC6595553 DOI: 10.1186/s12885-019-5855-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mammographic density is one of the strongest risk factors for breast cancer. In the general population, mammographic density can be modified by various exposures; whether this is true for women a strong family history is not known. Thus, we evaluated the association between reproductive, hormonal, and lifestyle risk factors and mammographic density among women with a strong family history of breast cancer but no BRCA1 or BRCA2 mutation. METHODS We included 97 premenopausal and 59 postmenopausal women (age range: 27-68 years). Risk factor data was extracted from the research questionnaire closest in time to the mammogram performed nearest to enrollment. The Cumulus software was used to measure percent density, dense area, and non-dense area for each mammogram. Multivariate generalized linear models were used to evaluate the relationships between breast cancer risk factors and measures of mammographic density, adjusting for relevant covariates. RESULTS Among premenopausal women, those who had two live births had a mean percent density of 28.8% vs. 41.6% among women who had one live birth (P=0.04). Women with a high body weight had a lower mean percent density compared to women with a low body weight among premenopausal (17.6% vs. 33.2%; P=0.0006) and postmenopausal women (8.7% vs. 14.7%; P=0.04). Among premenopausal women, those who smoked for 14 years or longer had a lower mean dense area compared to women who smoked for a shorter duration (25.3cm2 vs. 53.1cm2; P=0.002). Among postmenopausal women, former smokers had a higher mean percent density (19.5% vs. 10.8%; P=0.003) and dense area (26.9% vs. 16.4%; P=0.01) compared to never smokers. After applying the Bonferroni correction, the association between body weight and percent density among premenopausal women remained statistically significant. CONCLUSIONS In this cohort of women with a strong family history of breast cancer, body weight was associated with mammographic density. These findings suggest that mammographic density may explain the underlying relationship between some of these risk factors and breast cancer risk, and lend support for the inclusion of mammographic density into risk prediction models.
Collapse
Affiliation(s)
- Olivia Moran
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Rochelle Demsky
- Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | | | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Seema Panchal
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ophira Ginsburg
- Perlmutter Cancer Centre, Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Kevin Zbuk
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Martin Yaffe
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Kelly A Metcalfe
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., 6th Floor, Toronto, ON, Canada. .,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
27
|
Vourtsis A, Berg WA. Breast density implications and supplemental screening. Eur Radiol 2019; 29:1762-1777. [PMID: 30255244 PMCID: PMC6420861 DOI: 10.1007/s00330-018-5668-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/21/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast ultrasound detects additional early-stage, invasive breast cancers when combined with mammography; however, its relevant limitations, including the shortage of trained operators, operator dependence and small field of view, have limited its widespread implementation. Automated breast sonography (ABS) is a promising technique but the time to interpret and false-positive rates need to be improved. Supplemental screening with contrast-enhanced magnetic resonance imaging (MRI) in high-risk women reduces late-stage disease; abbreviated MRI protocols may reduce cost and increase accessibility to women of average risk with dense breasts. Contrast-enhanced digital mammography (CEDM) and molecular breast imaging improve cancer detection but require further validation for screening and direct biopsy guidance should be implemented for any screening modality. This article reviews the status of screening women with dense breasts. KEY POINTS: • The sensitivity of mammography is reduced in women with dense breasts. Supplemental screening with US detects early-stage, invasive breast cancers. • Tomosynthesis reduces recall rate and increases cancer detection rate but is less effective in women with extremely dense breasts. • Screening MRI improves early diagnosis of breast cancer more than ultrasound and is currently recommended for women at high risk. Risk assessment is needed, to include breast density, to ascertain who should start early annual MRI screening.
Collapse
Affiliation(s)
- Athina Vourtsis
- "Diagnostic Mammography", Medical Diagnostic Imaging Unit, Founding President of the Hellenic Breast Imaging Society, Kifisias Ave 362, Chalandri, 15233, Athens, Greece.
| | - Wendie A Berg
- Department of Radiology, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
28
|
A new automated method to evaluate 2D mammographic breast density according to BI-RADS® Atlas Fifth Edition recommendations. Eur Radiol 2019; 29:3830-3838. [DOI: 10.1007/s00330-019-06016-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/13/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
|
29
|
Fowler EEE, Smallwood A, Miltich C, Drukteinis J, Sellers TA, Heine J. Generalized breast density metrics. Phys Med Biol 2018; 64:015006. [PMID: 30523909 DOI: 10.1088/1361-6560/aaf307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Mammograms represent data that can inform future risk of breast cancer. Data from two case-control study populations were analyzed. Population 1 included women (N = 180 age matched case-control pairs) with mammograms acquired with one indirect x-ray conversion mammography unit. Population 2 included women (N = 319 age matched case-control pairs) with mammograms acquired from 6 direct x-ray conversion units. The Fourier domain was decomposed into n concentric rings (radial spatial frequency bands). The power in each ring was summarized giving a set of measures. We investigated images in raw, for presentation (processed) and calibrated representations and made comparison with the percentage of breast density (BD) determined with the operator assisted Cumulus method. Breast cancer associations were evaluated with conditional logistic regression, adjusted for body mass index and ethnicity. Odds ratios (ORs), per standard deviation increase derived from the respective breast density distributions and 95% confidence intervals (CIs) were estimated. A measure from a lower radial frequency ring, corresponding 0.083-0.166 cycles mm-1 and BD had significant associations with risk in both populations. In Population 1, the Fourier measure produced significant associations in each representation: OR = 1.76 (1.33, 2.32) for raw; OR = 1.43 (1.09, 1.87) for processed; and OR = 1.68 (1.26, 2.25) for calibrated. BD also provided significant associations in Population 1: OR = 1.72 (1.27, 2.33). In Population 2, the Fourier measure produced significant associations for each representation as well: OR = 1.47 (1.19, 1.80) for raw; OR = 1.38 (1.15, 1.67) for processed; and OR = 1.42 (1.15, 1.75) for calibrated. BD provided significant associations in Population 2: OR = 1.43 (1.17, 1.76). Other coincident spectral regions were also predictive of case-control status. In sum, generalized breast density measures were significantly associated with breast cancer in both FFDM technologies.
Collapse
Affiliation(s)
- Erin E E Fowler
- Cancer Epidemiology Department, Moffitt Cancer Center & Research Institute, 12902 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America
| | | | | | | | | | | |
Collapse
|
30
|
Physical activity and mammographic density in an Asian multi-ethnic cohort. Cancer Causes Control 2018; 29:883-894. [DOI: 10.1007/s10552-018-1064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 07/25/2018] [Indexed: 01/14/2023]
|
31
|
Förnvik D, Förnvik H, Fieselmann A, Lång K, Sartor H. Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort. Eur Radiol 2018; 29:330-336. [PMID: 29943180 PMCID: PMC6291428 DOI: 10.1007/s00330-018-5582-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare software estimates of volumetric breast density (VBD) based on breast tomosynthesis (BT) projections to those based on digital mammography (DM) images in a large screening cohort, the Malmö Breast Tomosynthesis Screening Trial (MBTST). METHODS DM and BT images of 9909 women (enrolled 2010-2015) were retrospectively analysed with prototype software to estimate VBD. Software calculation is based on a physics model of the image acquisition process and incorporates the effect of masking in DM based on accumulated dense tissue areas. VBD (continuously and categorically) was compared between BT [central projection (mediolateral oblique view (MLO)] and two-view DM, and with radiologists' BI-RADS density 4th ed. scores. Agreement and correlation were investigated with weighted kappa (κ), Spearman's correlation coefficient (r), and Bland-Altman analysis. RESULTS There was a high correlation (r = 0.83) between VBD in DM and BT and substantial agreement between the software breast density categories [observed agreement, 61.3% and 84.8%; κ = 0.61 and ĸ = 0.69 for four (a/b/c/d) and two (fat involuted vs. dense) density categories, respectively]. There was moderate agreement between radiologists' BI-RADS scores and software density categories in DM (ĸ = 0.55) and BT (ĸ = 0.47). CONCLUSIONS In a large public screening setting, we report a substantial agreement between VBD in DM and BT using software with special focus on masking effect. This automated and objective mode of measuring VBD may be of value to radiologists and women when BT is used as the primary breast cancer screening modality. KEY POINTS • There was a high correlation between continuous volumetric breast density in DM and BT. • There was substantial agreement between software breast density categories (four groups) in DM and BT; with clinically warranted binary software breast density categories, the agreement increased markedly. • There was moderate agreement between radiologists' BI-RADS scores and software breast density categories in DM and BT.
Collapse
Affiliation(s)
- Daniel Förnvik
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | - Hannie Förnvik
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | | | - Kristina Lång
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | - Hanna Sartor
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden.
| |
Collapse
|
32
|
A comprehensive tool for measuring mammographic density changes over time. Breast Cancer Res Treat 2018; 169:371-379. [PMID: 29392583 PMCID: PMC5945741 DOI: 10.1007/s10549-018-4690-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/21/2018] [Indexed: 11/14/2022]
Abstract
Background Mammographic density is a marker of breast cancer risk and diagnostics accuracy. Density change over time is a strong proxy for response to endocrine treatment and potentially a stronger predictor of breast cancer incidence. We developed STRATUS to analyse digital and analogue images and enable automated measurements of density changes over time. Method Raw and processed images from the same mammogram were randomly sampled from 41,353 healthy women. Measurements from raw images (using FDA approved software iCAD) were used as templates for STRATUS to measure density on processed images through machine learning. A similar two-step design was used to train density measures in analogue images. Relative risks of breast cancer were estimated in three unique datasets. An alignment protocol was developed using images from 11,409 women to reduce non-biological variability in density change. The protocol was evaluated in 55,073 women having two regular mammography screens. Differences and variances in densities were compared before and after image alignment. Results The average relative risk of breast cancer in the three datasets was 1.6 [95% confidence interval (CI) 1.3–1.8] per standard deviation of percent mammographic density. The discrimination was AUC 0.62 (CI 0.60–0.64). The type of image did not significantly influence the risk associations. Alignment decreased the non-biological variability in density change and re-estimated the yearly overall percent density decrease from 1.5 to 0.9%, p < 0.001. Conclusions The quality of STRATUS density measures was not influenced by mammogram type. The alignment protocol reduced the non-biological variability between images over time. STRATUS has the potential to become a useful tool for epidemiological studies and clinical follow-up. Electronic supplementary material The online version of this article (10.1007/s10549-018-4690-5) contains supplementary material, which is available to authorized users.
Collapse
|
33
|
Häberle L, Hack CC, Heusinger K, Wagner F, Jud SM, Uder M, Beckmann MW, Schulz-Wendtland R, Wittenberg T, Fasching PA. Using automated texture features to determine the probability for masking of a tumor on mammography, but not ultrasound. Eur J Med Res 2017; 22:30. [PMID: 28854966 PMCID: PMC5577694 DOI: 10.1186/s40001-017-0270-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/11/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tumors in radiologically dense breast were overlooked on mammograms more often than tumors in low-density breasts. A fast reproducible and automated method of assessing percentage mammographic density (PMD) would be desirable to support decisions whether ultrasonography should be provided for women in addition to mammography in diagnostic mammography units. PMD assessment has still not been included in clinical routine work, as there are issues of interobserver variability and the procedure is quite time consuming. This study investigated whether fully automatically generated texture features of mammograms can replace time-consuming semi-automatic PMD assessment to predict a patient's risk of having an invasive breast tumor that is visible on ultrasound but masked on mammography (mammography failure). METHODS This observational study included 1334 women with invasive breast cancer treated at a hospital-based diagnostic mammography unit. Ultrasound was available for the entire cohort as part of routine diagnosis. Computer-based threshold PMD assessments ("observed PMD") were carried out and 363 texture features were obtained from each mammogram. Several variable selection and regression techniques (univariate selection, lasso, boosting, random forest) were applied to predict PMD from the texture features. The predicted PMD values were each used as new predictor for masking in logistic regression models together with clinical predictors. These four logistic regression models with predicted PMD were compared among themselves and with a logistic regression model with observed PMD. The most accurate masking prediction was determined by cross-validation. RESULTS About 120 of the 363 texture features were selected for predicting PMD. Density predictions with boosting were the best substitute for observed PMD to predict masking. Overall, the corresponding logistic regression model performed better (cross-validated AUC, 0.747) than one without mammographic density (0.734), but less well than the one with the observed PMD (0.753). However, in patients with an assigned mammography failure risk >10%, covering about half of all masked tumors, the boosting-based model performed at least as accurately as the original PMD model. CONCLUSION Automatically generated texture features can replace semi-automatically determined PMD in a prediction model for mammography failure, such that more than 50% of masked tumors could be discovered.
Collapse
Affiliation(s)
- Lothar Häberle
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany. .,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany.
| | - Carolin C Hack
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Katharina Heusinger
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Florian Wagner
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Sebastian M Jud
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Michael Uder
- University Breast Center for Franconia, Institute of Radiology, Comprehensive Cancer Center EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- University Breast Center for Franconia, Institute of Radiology, Comprehensive Cancer Center EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Peter A Fasching
- University Breast Center for Franconia, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Division Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|