Association of mammographic density with pathologic findings

The incidence of breast cancer in Egyptian females in correlation to different mammographic ACR densities

INTRODUCTION

The density of breast tissue, radiologically referred to as fibroglandular mammary tissue, was found to be a predisposing factor for breast cancer (BC). However, the stated degree of elevated BC risk varies widely in the literature.

Quantitative breast density measurement based on three-dimensional images: a study on cone-beam breast computed tomography

BACKGROUND

Breast density is an independent predictor of breast cancer risk. Quantitative volumetric breast density (QVBD) is expected to provide more information on the prediction of breast cancer risk.

PURPOSE

To evaluate the reliability of QVBD measurements based on cone-beam breast computed tomography (CBBCT) images.

MATERIAL AND METHODS

A total of 216 breasts were used to evaluate the stability of QVBD measurements based on CBBCT images and the correlations between this volumetric measurement and visual and area-based measurement methods. The intra- and inter-observer consistency of QVBD measurements were compared. Visual breast density (VBD) was evaluated with Breast Imaging Reporting and Data System (BI-RADS) standard on CBBCT images. The correlation between QVBD and VBD was evaluated by Spearman correlation coefficient. Receiver operating characteristic (ROC) curve was used to assess the sensitivity and specificity of the volumetric method in distinguishing dense and non-dense breasts. The correlation between QVBD and quantitative area-based breast density (QABD) was determined with Pearson correlation coefficient. Then, the breast volume measured with CBBCT images was compared with the breast specimen obtained during nipple-sparing mastectomy (NSM) by Pearson correlation coefficient and linear regression.

RESULTS

Excellent intra- and inter-observer consistency was found from QVBD measurements. The volumetric method distinguished dense and non-dense breasts at a cutoff value of 9.5%, with 94.5% sensitivity and 77.1% specificity. Positive correlations were found between QVBD and QABD (r=0.890; P<0.001) and between the volume measured with CBBCT images and Archimedes method (r=0.969; P<0.001).

CONCLUSION

CBBCT images can evaluate breast density reliably on a continuous scale.

Association between MRI background parenchymal enhancement and lymphovascular invasion and estrogen receptor status in invasive breast cancer

Objectives:

In magnetic resonance imaging (MRI), background parenchymal enhancement (BPE) is associated with breast cancer risk, but the associations between BPE and clinical characteristics and histological features are unknown. This study aimed to investigate the association between BPE and clinical characteristics (including age, menopausal status, and tumor histological characteristics) in patients with invasive breast cancer.

Methods:

This was a retrospective study of 163 patients with invasive breast cancer (164 lesions, 1 patient had bilateral cancer) confirmed by surgery and pathological examination, treated between January 2014 and December 2016 at our university (Kunming Medical University). The patients were divided into two groups: extremely minimal and mild enhancement (low BPE group, n = 78) vs moderate and marked enhancement (high BPE group, n = 86).

Results:

Compared with the low BPE group, the high BPE group showed higher frequencies of patients < 50 years of age (88% vs 38%, p < 0.0001), premenopausal (87% vs 29%, p < 0.0001), T1 staging (35% vs 15%, p = 0.027), Grade II (57% vs 37%, p = 0.03), lymphovascular invasion (83% vs 13%, p < 0.0001), and positive estrogen receptor (ER) (79% vs 42%, p < 0.0001). The Spearman correlation coefficients (r) between BPE and age, menopausal status, lymphovascular invasion, and ER status were −0.521 (p < 0.0001), –0.588 (p < 0.0001), 0.697 (p < 0.0001), and 0.377 (p < 0.0001), respectively.

Conclusion:

BPE is negatively associated with age and menopausal status, and is positively associated with lymphovascular invasion and positive ER status.

Advances in knowledge:

BPE is not correlated with T staging and histological classification in patients with invasive breast cancer.

Changes of T2 Relaxation Time From Neoadjuvant Chemotherapy in Breast Cancer Lesions

Background

Neoadjuvant chemotherapy (NAC) is generally an effective method of reducing locally advanced malignant breast lesions before surgery; assessing the tumor response to NAC is crucial for patient management. T2 relaxation times can reflect biological state of lesions, may prove useful to assess the response to NAC.

Objectives

To investigate the lesion T2 relaxation times change in breast cancer neoadjuvant chemotherapy (NAC).

Patients and Methods

In total, 26 patients underwent NAC. Magnetic resonance imaging (MRI) T2 mapping was performed before and after NAC. The T2 relaxation times were obtained by using Functool software on an AW 43 workstation. The treatment response was assessed according to the pathological response classification. We aimed to analyze the changes in the T2 relaxation times before and after NAC as well as to study the relationship between the response and the lesion T2 relaxation times after NAC.

Results

In 26 cases with NAC, the mean lesion T2 relaxation time before NAC was 81.34 ± 13.68 ms, compared with 64.50 ± 8.71 ms after NAC. Significant differences in the lesion T2 relaxation times existed between the pre- and post-NAC (P < 0.001) ; based on the pathology results, the mean lesion T2 relaxation times in 23 of the 26 responders (63.18 ± 8.37 ms) was shorter than in 3 of the 26 nonresponders (74.62 ± 2.32 ms) after NAC (P = 0.029).

Conclusion

In breast cancer after NAC, the lesion T2 relaxation time was reduced in the responders, and this finding is potentially useful to assess the response to NAC.

Ultrasound elastography and magnetic resonance examinations are effective for the accurate diagnosis of mammary duct ectasia

OBJECTIVES

This study is to investigate the values of multiple quantitative evaluation parameters in the diagnosis of mammary duct ectasia (MDE), using real-time ultrasound elastography (UE) and magnetic resonance imaging (MRI).

METHODS

This retrospective study was performed on 15 patients (16 lesions) with MDE. Ultrasound examination was performed with the LOGIQ E9 ultrasound instrument, with all lesions being examined by routine ultrasound and UE. MRI examination was performed with a Signa HD × 3.0T TWINSP MR System, including of plain-scan, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and proton magnetic resonance spectroscopy. Imaging features, as well as semi-quantitative and quantitative parameters, were analyzed to determine their diagnostic value for MDE.

RESULTS

According to the five-point scale in UE, twelve lesions belonged to 1-3 point scale, and four lesions were in 4-5 point scale, with an average of 2.93 ± 0.77. In dynamic contrast-enhanced MRI, the lesions appeared as obviously enhanced signals. The MRI early-enhancement rate ranged from 0.35 to 1.07 (0.67 ± 0.30 on average); the time peak ranged between 192 and 330 s (248 ± 37 s on average); the peak-enhancement ratio ranged from 2.26 to 3.06, with an average of 2.59 ± 0.33. According to MRI time-signal intensity curves classified into persistently enhancing (type I), plateau (type II) and washout (type III), 12 lesions (75%) belonged to type I, three (18.75%) belonged to type II, and one (6.25%) belonged to type III. Magnetic resonance spectroscopy showed that a total choline peak occurred only in one lesion. The diagnosis accuracy rates for ultrasound alone, MRI alone and the combination of ultrasound and MRI were 75% (12/16), 87.5% (14/16) and 93.75% (15/16), respectively.

CONCLUSIONS

Both ultrasound and MRI show clinical importance in MDE diagnosis. However, UE, dynamic contrast-enhanced MRI, and magnetic resonance spectroscopy demonstrate significantly better diagnosis and differential diagnosis of MDE.