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Watt GP, Keshavamurthy KN, Nguyen TL, Lobbes MBI, Jochelson MS, Sung JS, Moskowitz CS, Patel P, Liang X, Woods M, Hopper JL, Pike MC, Bernstein JL. Association of breast cancer with quantitative mammographic density measures for women receiving contrast-enhanced mammography. JNCI Cancer Spectr 2024; 8:pkae026. [PMID: 38565262 PMCID: PMC11060476 DOI: 10.1093/jncics/pkae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Women with high mammographic density have an increased risk of breast cancer. They may be offered contrast-enhanced mammography to improve breast cancer screening performance. Using a cohort of women receiving contrast-enhanced mammography, we evaluated whether conventional and modified mammographic density measures were associated with breast cancer. Sixty-six patients with newly diagnosed unilateral breast cancer were frequency matched on the basis of age to 133 cancer-free control individuals. On low-energy craniocaudal contrast-enhanced mammograms (equivalent to standard mammograms), we measured quantitative mammographic density using CUMULUS software at the conventional intensity threshold ("Cumulus") and higher-than-conventional thresholds ("Altocumulus," "Cirrocumulus"). The measures were standardized to enable estimation of odds ratio per adjusted standard deviation (OPERA). In multivariable logistic regression of case-control status, only the highest-intensity measure (Cirrocumulus) was statistically significantly associated with breast cancer (OPERA = 1.40, 95% confidence interval = 1.04 to 1.89). Conventional Cumulus did not contribute to model fit. For women receiving contrast-enhanced mammography, Cirrocumulus mammographic density may better predict breast cancer than conventional quantitative mammographic density.
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Affiliation(s)
- Gordon P Watt
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tuong L Nguyen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prusha Patel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaolin Liang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Woods
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John L Hopper
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Veenhuizen SGA, van Grinsven SEL, Laseur IL, Bakker MF, Monninkhof EM, de Lange SV, Pijnappel RM, Mann RM, Lobbes MBI, Duvivier KM, de Jong MDF, Loo CE, Karssemeijer N, van Diest PJ, Veldhuis WB, van Gils CH. Re-attendance in supplemental breast MRI screening rounds of the DENSE trial for women with extremely dense breasts. Eur Radiol 2024:10.1007/s00330-024-10685-9. [PMID: 38639912 DOI: 10.1007/s00330-024-10685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/19/2024] [Accepted: 02/03/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Supplemental MRI screening improves early breast cancer detection and reduces interval cancers in women with extremely dense breasts in a cost-effective way. Recently, the European Society of Breast Imaging recommended offering MRI screening to women with extremely dense breasts, but the debate on whether to implement it in breast cancer screening programs is ongoing. Insight into the participant experience and willingness to re-attend is important for this discussion. METHODS We calculated the re-attendance rates of the second and third MRI screening rounds of the DENSE trial. Moreover, we calculated age-adjusted odds ratios (ORs) to study the association between characteristics and re-attendance. Women who discontinued MRI screening were asked to provide one or more reasons for this. RESULTS The re-attendance rates were 81.3% (3458/4252) and 85.2% (2693/3160) in the second and third MRI screening round, respectively. A high age (> 65 years), a very low BMI, lower education, not being employed, smoking, and no alcohol consumption were correlated with lower re-attendance rates. Moderate or high levels of pain, discomfort, or anxiety experienced during the previous MRI screening round were correlated with lower re-attendance rates. Finally, a plurality of women mentioned an examination-related inconvenience as a reason to discontinue screening (39.1% and 34.8% in the second and third screening round, respectively). CONCLUSIONS The willingness of women with dense breasts to re-attend an ongoing MRI screening study is high. However, emphasis should be placed on improving the MRI experience to increase the re-attendance rate if widespread supplemental MRI screening is implemented. CLINICAL RELEVANCE STATEMENT For many women, MRI is an acceptable screening method, as re-attendance rates were high - even for screening in a clinical trial setting. To further enhance the (re-)attendance rate, one possible approach could be improving the overall MRI experience. KEY POINTS • The willingness to re-attend in an ongoing MRI screening study is high. • Pain, discomfort, and anxiety in the previous MRI screening round were related to lower re-attendance rates. • Emphasis should be placed on improving MRI experience to increase the re-attendance rate in supplemental MRI screening.
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Affiliation(s)
- Stefanie G A Veenhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sophie E L van Grinsven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Isabelle L Laseur
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Stéphanie V de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Dutch Expert Centre for Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Katya M Duvivier
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Mathijn D F de Jong
- Department of Radiology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 'S-Hertogenbosch, The Netherlands
| | - Claudette E Loo
- Department of Radiology, the Netherlands Cancer Institute - Antoni Van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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de Wild SR, van Roozendaal LM, de Wilt JHW, van Dalen T, van der Hage JA, van Duijnhoven FH, Simons JM, Schipper RJ, de Munck L, van Kuijk SMJ, Boersma LJ, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, van de Vijver KKBT, de Vries J, Westenberg AH, Strobbe LJA, Smidt ML. De-escalation of axillary treatment in the event of a positive sentinel lymph node biopsy in cT1-2 N0 breast cancer treated with mastectomy: nationwide registry study (BOOG 2013-07). Br J Surg 2024; 111:znae077. [PMID: 38597154 PMCID: PMC11004788 DOI: 10.1093/bjs/znae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/12/2023] [Accepted: 03/01/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Trials have demonstrated the safety of omitting completion axillary lymph node dissection in patients with cT1-2 N0 breast cancer operated with breast-conserving surgery who have limited metastatic burden in the sentinel lymph node. The aim of this registry study was to provide insight into the oncological safety of omitting completion axillary treatment in patients operated with mastectomy who have limited-volume sentinel lymph node metastasis. METHODS Women diagnosed in 2013-2014 with unilateral cT1-2 N0 breast cancer treated with mastectomy, with one to three sentinel lymph node metastases (pN1mi-pN1a), were identified from the Netherlands Cancer Registry, and classified by axillary treatment: no completion axillary treatment, completion axillary lymph node dissection, regional radiotherapy, or completion axillary lymph node dissection followed by regional radiotherapy. The primary endpoint was 5-year regional recurrence rate. Secondary endpoints included recurrence-free interval and overall survival, among others. RESULTS In total, 1090 patients were included (no completion axillary treatment, 219 (20.1%); completion axillary lymph node dissection, 437 (40.1%); regional radiotherapy, 327 (30.0%); completion axillary lymph node dissection and regional radiotherapy, 107 (9.8%)). Patients in the group without completion axillary treatment had more favourable tumour characteristics and were older. The overall 5-year regional recurrence rate was 1.3%, and did not differ significantly between the groups. The recurrence-free interval was also comparable among groups. The group of patients who did not undergo completion axillary treatment had statistically significantly worse 5-year overall survival, owing to a higher percentage of non-cancer deaths. CONCLUSION In this registry study of patients with cT1-2 N0 breast cancer treated with mastectomy, with low-volume sentinel lymph node metastasis, the 5-year regional recurrence rate was low and comparable between patients with and without completion axillary treatment.
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Affiliation(s)
- Sabine R de Wild
- Maastricht University Medical Centre+, Department of Surgery, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs van Dalen
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Janine M Simons
- Maastricht University Medical Centre+, Department of Surgery, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
- Department of Radiotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Liesbeth J Boersma
- Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Philip M P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Koen K B T van de Vijver
- Department of Pathology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Pathology, University Hospital Ghent—Cancer Research Institute Ghent, Ghent, Belgium
| | - Jolanda de Vries
- Department of Psychology and Health, Tilburg University, Tilburg, the Netherlands
| | - A Helen Westenberg
- Department of Radiation Oncology, Radiotherapiegroep Arnhem, Arnhem, the Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Marjolein L Smidt
- Maastricht University Medical Centre+, Department of Surgery, GROW School for Oncology and Reproduction, Maastricht, The Netherlands
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Luu IHY, Mostard GJM, van Mil D, van Berlo MHW, Lobbes MBI, Külcü K, Cate HT, Peeters J, Palmen J, Buijs J, Jie KSG, van Kampen RJW, van Twist DJL. Deferring diagnostic evaluation for suspected deep venous thrombosis using a single dose of anticoagulant: Real-world data from a regionwide care pathway. Eur J Intern Med 2024; 122:54-60. [PMID: 38151419 DOI: 10.1016/j.ejim.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Patients with suspected deep venous thrombosis (DVT) are typically referred to the emergency department (ED) for immediate evaluation. However, this often contributes to ED overcrowding and necessitates round-the-clock sonographic examinations. Therefore, we implemented a regionwide care pathway for deferring diagnostic workup of suspected DVT until the following day. Patients receive a single anticoagulant dose from their general practitioner (GP) to prevent progression of DVT in the interval between referral and diagnostic evaluation. The next day, patients undergo comprehensive evaluation at our outpatient DVT clinic, including venous ultrasound. This retrospective study aims to provide real-world data on the safety of this care pathway regarding the occurrence of bleeding complications and pulmonary embolism (PE). METHODS We included all GP-referred patients with suspected DVT in 2018 and 2019. Patients with absolute contraindications to deferred evaluation or anticoagulation were excluded. The primary endpoint was the occurrence of bleeding complications. Secondary endpoints included PE events and all-cause mortality within seven days following DVT evaluation. RESULTS Among 1,024 included patients, DVT was confirmed in 238 patients (23.2%) and superficial thrombophlebitis in 98 patients (9.6%). No bleeding events were recorded in patients in whom DVT was ruled out. PE was confirmed in eight patients on the same day as DVT evaluation (0.8%, 95%CI 0.4-1.6) and in six patients within seven days following DVT evaluation (0.6%, 0.2-1.3%). No deaths occurred during this timeframe. CONCLUSION This real-world study observed a very low incidence of bleeding complications and PE events, indicating that this care pathway of deferred DVT workup is safe and may offer a more streamlined diagnostic approach for patients with suspected DVT.
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Affiliation(s)
- Inge H Y Luu
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Guy J M Mostard
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Dominique van Mil
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Marlon H W van Berlo
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Kemal Külcü
- Department of Medical Imaging, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos Peeters
- General practice Overhoven-Hoogveld, Huisartsen Coöperatie Westelijke Mijnstreek, Sittard, the Netherlands
| | - Jan Palmen
- General practice Aarveld Medical Center, Huisartsen Oostelijk Zuid-Limburg, Heerlen, the Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Kon-Siong G Jie
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Roel J W van Kampen
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands
| | - Daan J L van Twist
- Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, the Netherlands.
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van Haaren ERM, Spiekerman van Weezelenburg MA, van Bastelaar J, Janssen A, van Nijnatten T, Bouwman LH, Vissers YLJ, Lobbes MBI. Impact of low dose superparamagnetic iron oxide tracer for sentinel node biopsy in breast conserving treatment on susceptibility artefacts on magnetic resonance imaging and contrast enhanced mammography. Surg Oncol 2024; 53:102045. [PMID: 38330805 DOI: 10.1016/j.suronc.2024.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/16/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Residual particles of superparamagnetic iron oxide (SPIO) tracer, used for sentinel node biopsy, cause susceptibility artefacts on breast Magnetic Resonance Imaging (MRI). We investigated the impact of these artefacts on the imaging quality of MRI and explored whether contrast-enhanced mammography (CEM) could be an alternative in the follow-up of breast cancer patients. MATERIALS AND METHODS Data on patients' characteristics, injection site, presence, size (mm) of artefacts on full-field digital mammography (FFDM)/CEM, MRI after 1 ml SPIO was recorded. Image quality scored by two breast radiologists using a 4-point Likert system: 0: no artefacts 1: good diagnostic quality 2: impaired but still readable 3: hampered clinical assessment. Continuous variables reported as means and standard deviations (SD), categorical variables as count and percentage. RESULTS On FFDM/CEM, performed 13 months postoperatively, no iron SPIO particles were detected, with a Likert score of 0. In all MRI (100%) images, executed at 16.6 months after SPIO injection, susceptibility artefacts at the injection sites i.e., retroareolair and lateral quadrant were observed with a mean size of 41.9 ± 9.8 mm (SD) by observer 1, and 44.8 ± 12.5 mm (SD) by observer 2, independent of the injection site. Both observers scored a Likert score of 2: locally impaired on all MRI images and sequences. CONCLUSIONS Even 1 ml SPIO tracer used for sentinel node procedure impairs the evaluation of breast MRI at the tracer injection site beyond one year of follow-up. No impairment was observed on FFDM/CEM, suggesting that CEM might be a reliable alternative to breast MRI if required.
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Affiliation(s)
| | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Thiemo van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands.
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands.
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands.
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6
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Wintraecken VM, Boersma LJ, van Roozendaal LM, de Vries J, van Kuijk SMJ, Vane MLG, van Dalen T, van der Hage JA, Strobbe LJA, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, van de Vijver KKBT, Westenberg AH, de Wilt JHW, Smidt ML, Simons JM. Quality assurance of radiation therapy after breast-conserving surgery among patients in the BOOG 2013-08 trial. Radiother Oncol 2024; 191:110069. [PMID: 38141879 DOI: 10.1016/j.radonc.2023.110069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND PURPOSE In the BOOG 2013-08 trial (NCT02271828), cT1-2N0 breast cancer patients were randomized between breast conserving surgery with or without sentinel lymph node biopsy (SLNB) followed by whole breast radiotherapy (WBRT). While awaiting primary endpoint results (axillary recurrence rate), this study aims to perform a quality assurance analysis on protocol adherence and (incidental) axillary radiation therapy (RT) dose. MATERIALS AND METHODS Patients were enrolled between 2015 and 2022. Data on prescribed RT and (in 25% of included patients) planning target volumes (PTV) parameters were recorded for axillary levels I-IV and compared between treatment arms. Multivariable linear regression analysis was performed to determine prognostic variables for incidental axillary RT dose. RESULTS 1,439/1,461 included patients (98.5%) were treated according to protocol and 87 patients (5.9%) received regional RT (SLNB 10.9%, no-SLNB 1.5 %). In 326 patients included in the subgroup analysis, the mean incidental PTV dose at axilla level I was 59.5% of the prescribed breast RT dose. In 5 patients (1.5%) the mean PTV dose at level I was ≥95% of the prescribed breast dose. No statistically or clinically significant differences regarding incidental axillary RT dose were found between treatment arms. Tumour bed boost (yes/no) was associated with a higher incidental mean dose in level I (R2 = 0.035, F(6, 263) = 1.532, p 0.168). CONCLUSION The results indicate that RT-protocol adherence was high, and that incidental axillary RT dose was low in the BOOG 2013-08 trial. Potential differences between treatmentarms regarding the primary endpoint can thus not be attributed to different axillary radiation doses.
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Affiliation(s)
- V M Wintraecken
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - L J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - L M van Roozendaal
- Department of Surgical Oncology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - J de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Board member Adrz, Goes, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - M L G Vane
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - T van Dalen
- Division of Surgical Oncology, Diakonessenhuis Hospital, Utrecht, the Netherlands; Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J A van der Hage
- Division of Surgical Oncology, Leids University Medical Center, Leiden, the Netherlands
| | - L J A Strobbe
- Division of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - S C Linn
- Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M B I Lobbes
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - V C G Tjan-Heijnen
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Division of Medical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - K K B T van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium; Center for Gynecological Oncology Amsterdam (CGOA), Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - A H Westenberg
- Radiation Oncology, Radiotherapiegroep location Arnhem, Arnhem, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M L Smidt
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - J M Simons
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiotherapy, Erasmus Medical Centre, Rotterdam, the Netherlands
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7
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Nobel JM, Puts S, Krdzalic J, Zegers KML, Lobbes MBI, F Robben SG, Dekker ALAJ. Natural Language Processing Algorithm Used for Staging Pulmonary Oncology from Free-Text Radiological Reports: "Including PET-CT and Validation Towards Clinical Use". J Imaging Inform Med 2024; 37:3-12. [PMID: 38343237 DOI: 10.1007/s10278-023-00913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/26/2023] [Accepted: 09/03/2023] [Indexed: 03/02/2024]
Abstract
Natural language processing (NLP) can be used to process and structure free text, such as (free text) radiological reports. In radiology, it is important that reports are complete and accurate for clinical staging of, for instance, pulmonary oncology. A computed tomography (CT) or positron emission tomography (PET)-CT scan is of great importance in tumor staging, and NLP may be of additional value to the radiological report when used in the staging process as it may be able to extract the T and N stage of the 8th tumor-node-metastasis (TNM) classification system. The purpose of this study is to evaluate a new TN algorithm (TN-PET-CT) by adding a layer of metabolic activity to an already existing rule-based NLP algorithm (TN-CT). This new TN-PET-CT algorithm is capable of staging chest CT examinations as well as PET-CT scans. The study design made it possible to perform a subgroup analysis to test the external validation of the prior TN-CT algorithm. For information extraction and matching, pyContextNLP, SpaCy, and regular expressions were used. Overall TN accuracy score of the TN-PET-CT algorithm was 0.73 and 0.62 in the training and validation set (N = 63, N = 100). The external validation of the TN-CT classifier (N = 65) was 0.72. Overall, it is possible to adjust the TN-CT algorithm into a TN-PET-CT algorithm. However, outcomes highly depend on the accuracy of the report, the used vocabulary, and its context to express, for example, uncertainty. This is true for both the adjusted PET-CT algorithm and for the CT algorithm when applied in another hospital.
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Affiliation(s)
- J Martijn Nobel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, Netherlands.
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands.
| | - Sander Puts
- Department of Radiation Oncology (MAASTRO), Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Jasenko Krdzalic
- Zuyderland Medical Center, Department of Medical Imaging, Sittard-Geleen, Netherlands
| | - Karen M L Zegers
- Department of Radiation Oncology (MAASTRO), Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Zuyderland Medical Center, Department of Medical Imaging, Sittard-Geleen, Netherlands
| | - Simon G F Robben
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Postbox 5800, 6202 AZ, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - André L A J Dekker
- Department of Radiation Oncology (MAASTRO), Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
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Dontchos BN, Lobbes MBI, Rahbar H. Reply to: "Cost-Effectiveness of Breast Cancer Staging Modalities: Is There a Role for MDCT in Low- and Moderate-Income Countries?". AJR Am J Roentgenol 2024; 222:e2330619. [PMID: 38054962 DOI: 10.2214/ajr.23.30619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Brian N Dontchos
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | | | - Habib Rahbar
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
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Schiaffino S, Cozzi A, Clauser P, Giannotti E, Marino MA, van Nijnatten TJA, Baltzer PAT, Lobbes MBI, Mann RM, Pinker K, Fuchsjäger MH, Pijnappel RM. Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI). Eur Radiol 2024:10.1007/s00330-023-10574-7. [PMID: 38227202 DOI: 10.1007/s00330-023-10574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM). METHODS A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics. RESULTS Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (p < 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (p = 0.004) and future indications (p < 0.001). CONCLUSIONS Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique. CLINICAL RELEVANCE STATEMENT In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications. KEY POINTS • Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice. • Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications. • The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Elisabetta Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Lobbes MBI. Breast cancer screening in patients with intermediate risk using contrast-enhanced mammography. Eur Radiol 2023; 33:8407-8409. [PMID: 38041387 DOI: 10.1007/s00330-023-09889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MD, Sittard-Geleen, the Netherlands.
- GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
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11
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Eijkelboom AH, de Munck L, Larsen M, Bijlsma MJ, Tjan-Heijnen VCG, van Gils CH, Broeders MJM, Nygård JF, Lobbes MBI, Helsper CW, Pijnappel RM, Strobbe LJA, Wesseling J, Hofvind S, Siesling S. Impact of the COVID-19 pandemic on breast cancer incidence and tumor stage in the Netherlands and Norway: A population-based study. Cancer Epidemiol 2023; 87:102481. [PMID: 37897970 DOI: 10.1016/j.canep.2023.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Comparing the impact of the COVID-19 pandemic on the incidence of newly diagnosed breast tumors and their tumor stage between the Netherlands and Norway will help us understand the effect of differences in governmental and social reactions towards the pandemic. METHODS Women newly diagnosed with breast cancer in 2017-2021 were selected from the Netherlands Cancer Registry and the Cancer Registry of Norway. The crude breast cancer incidence rate (tumors per 100,000 women) during the first (March-September 2020), second (October 2020-April 2021), and Delta COVID-19 wave (May-December 2021) was compared with the incidence rate in the corresponding periods in 2017, 2018, and 2019. Incidence rates were stratified by age group, method of detection, and clinical tumor stage. RESULTS During the first wave breast cancer incidence declined to a larger extent in the Netherlands than in Norway (27.7% vs. 17.2% decrease, respectively). In both countries, incidence decreased in women eligible for screening. In the Netherlands, incidence also decreased in women not eligible for screening. During the second wave an increase in the incidence of stage IV tumors in women aged 50-69 years was seen in the Netherlands. During the Delta wave an increase in overall incidence and incidence of stage I tumors was seen in Norway. CONCLUSION Alterations in breast cancer incidence and tumor stage seem related to a combined effect of the suspension of the screening program, health care avoidance due to the severity of the pandemic, and other unknown factors.
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Affiliation(s)
- Anouk H Eijkelboom
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands.
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304 Oslo, Norway
| | - Maarten J Bijlsma
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, P.O. Box 196, 9700 AD Groningen, the Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, School for Oncology and Reproduction (GROW), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands
| | - Jan F Nygård
- Department of Register Informatics, Cancer Registry Norway, P.O. Box 5313, 0304 Oslo, Norway
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center Sittard-Geleen, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; School for Oncology and Reproduction (GROW), Maastricht University Medical Centre, Universiteitssingel 40, 6220 ER, Maastricht, the Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands
| | - Ruud M Pijnappel
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Radiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Jelle Wesseling
- Divisions of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. 6050, 9037 Tromsø, Norway
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus SÖ, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Eur Radiol 2023:10.1007/s00330-023-10409-5. [PMID: 37999727 DOI: 10.1007/s00330-023-10409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Julia Camps Herrero
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain
- Ribera Salud Hospitals, Valencia, Spain
| | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
- Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit Aksoy Ozcan
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.R.L., La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Sila Ö Ulus
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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van Haaren ERM, Poodt IGM, Spiekerman van Weezelenburg MA, van Bastelaar J, Janssen A, de Vries B, Lobbes MBI, Bouwman LH, Vissers YLJ. Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients. Breast Cancer Res Treat 2023; 202:245-255. [PMID: 37495799 PMCID: PMC10505596 DOI: 10.1007/s10549-023-07065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The outcome of the sentinel lymph node in breast cancer patients affects adjuvant treatment. Compared to conventional histopathology, analysis by one-step nucleic acid amplification (OSNA) harvests more micrometastasis, potentially inducing overtreatment. In this study we investigated the impact of OSNA analysis on adjuvant treatment, compared to histopathological analysis. METHODS Data from T1-3 breast cancer patients with sentinel nodes analysed between January 2016 and December 2019 by OSNA (OSNA group, n = 1086) from Zuyderland Medical Centre, the Netherlands, were compared to concurrent data from the Netherlands Cancer Registry (NKR) where sentinel nodes were examined by histology (histology group, n = 35,143). Primary outcomes were micro- or macrometastasis, axillary treatments (axillary lymph node dissection (ALND) or axillary radiotherapy (ART)), chemotherapy, and endocrine therapy. Statistics with Pearson Chi-square. RESULTS In the OSNA group more micrometastasis (14.9%) were detected compared to the histology group (7.9%, p < 0.001). No difference in axillary treatment between groups was detected (14.3 vs. 14.4%). In case of mastectomy and macrometastasis, ALND was preferred over ART in the OSNA group (14.9%) compared to the histology group (4.4%, p < 0.001). In cases of micrometastasis, no difference was seen. There was no difference in administration of adjuvant chemotherapy between groups. Endocrine treatment was administrated less often in the OSNA group compared to the histology group (45.8% vs. 50.8%, p < 0.002). CONCLUSION More micrometastasis were detected by OSNA compared to histopathology, but no subsequent increase in adjuvant axillary and systematic treatment was noticed. When performing mastectomy and OSNA, there was a preference for ALND compared to ART.
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Affiliation(s)
- Elisabeth R M van Haaren
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands.
| | - Ingrid G M Poodt
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Bart de Vries
- Department of Pathology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
- Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
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14
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Lobbes MBI, Essers BAB. Cost-Effectiveness of Breast Cancer Staging Modalities: Point-Contrast-Enhanced Mammography as an Alternative to Breast MRI for Preoperative Staging in Patients With Breast Cancer. AJR Am J Roentgenol 2023; 221:434-435. [PMID: 37098966 DOI: 10.2214/ajr.23.29337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Brigitte A B Essers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
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15
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Hamersma DT, Schreuder K, Geleijnse G, Heeg E, Cellamare M, Lobbes MBI, Mureau MAM, Koppert LB, Skjerven H, Nygård JF, Groothuis-Oudshoorn CGM, Siesling S. Comparing quality of breast cancer care in the Netherlands and Norway by federated propensity score analytics. Breast Cancer Res Treat 2023; 201:247-256. [PMID: 37355527 PMCID: PMC10361850 DOI: 10.1007/s10549-023-06986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of the study was to benchmark and compare breast cancer care quality indicators (QIs) between Norway and the Netherlands using federated analytics preventing transfer of patient-level data. METHODS Breast cancer patients (2017-2018) were retrieved from the Netherlands Cancer Registry and the Cancer Registry of Norway. Five European Society of Breast Cancer Specialists (EUSOMA) QIs were assessed: two on magnetic resonance imaging (MRI), two on surgical approaches, and one on postoperative radiotherapy. The QI outcomes were calculated using 'Vantage 6' federated Propensity Score Stratification (PSS). Likelihood of receiving a treatment was expressed in odds ratios (OR). RESULTS In total, 39,163 patients were included (32,786 from the Netherlands and 6377 from Norway). PSS scores were comparable to the crude outcomes of the QIs. The Netherlands scored higher on the QI 'proportions of patients preoperatively examined with breast MRI' [37% vs.17.5%; OR 2.8 (95% CI 2.7-2.9)], the 'proportions of patients receiving primary systemic therapy examined with breast MRI' [83.3% vs. 70.8%; OR 2.3 (95% CI 1.3-3.3)], and 'proportion of patients receiving a single breast operation' [95.2% vs. 91.5%; OR 1.8 (95% CI 1.4-2.2)]. Country scores for 'immediate breast reconstruction' and 'postoperative radiotherapy after breast-conserving surgery' were comparable. The EUSOMA standard was achieved in both countries for 4/5 indicators. CONCLUSION Both countries achieved high scores on the QIs. Differences were observed in the use of MRI and proportion of patients receiving single surgery. The federated approach supports future possibilities on benchmark QIs without transfer of privacy-sensitive data.
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Affiliation(s)
- Dave T Hamersma
- Faculty Science & Technology, Health Sciences, University of Twente, Enschede, The Netherlands
| | - Kay Schreuder
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/Eindhoven/Enschede, The Netherlands
| | - Gijs Geleijnse
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/Eindhoven/Enschede, The Netherlands
| | - Erik Heeg
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/Eindhoven/Enschede, The Netherlands
- Department of Plastic & Reconstructive Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Matteo Cellamare
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/Eindhoven/Enschede, The Netherlands
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Marc A M Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Helle Skjerven
- Section for Breast and Endocrine Surgery Department, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Registry Informatics, Cancer Registry of Norway, Oslo, Norway
| | - Jan F Nygård
- Department of Registry Informatics, Cancer Registry of Norway, Oslo, Norway
- Machine Learning Group, The Arctic University of Norway, Tromsø, Norway
| | | | - Sabine Siesling
- Faculty Science & Technology, Health Sciences, University of Twente, Enschede, The Netherlands.
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht/Eindhoven/Enschede, The Netherlands.
- Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH, Enschede, The Netherlands.
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16
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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17
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Watt GP, Thakran S, Sung JS, Jochelson MS, Lobbes MBI, Weinstein SP, Bradbury AR, Buys SS, Morris EA, Apte A, Patel P, Woods M, Liang X, Pike MC, Kontos D, Bernstein JL. Association of Breast Cancer Odds with Background Parenchymal Enhancement Quantified Using a Fully Automated Method at MRI: The IMAGINE Study. Radiology 2023; 308:e230367. [PMID: 37750771 PMCID: PMC10546291 DOI: 10.1148/radiol.230367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 09/27/2023]
Abstract
Background Background parenchymal enhancement (BPE) at breast MRI has been associated with increased breast cancer risk in several independent studies. However, variability of subjective BPE assessments have precluded its use in clinical practice. Purpose To examine the association between fully objective measures of BPE at MRI and odds of breast cancer. Materials and Methods This prospective case-control study included patients who underwent a bilateral breast MRI examination and were receiving care at one of three centers in the United States from November 2010 to July 2017. Breast volume, fibroglandular tissue (FGT) volume, and BPE were quantified using fully automated software. Fat volume was defined as breast volume minus FGT volume. BPE extent was defined as the proportion of FGT voxels with enhancement of 20% or more. Spearman rank correlation between quantitative BPE extent and Breast Imaging Reporting and Data System (BI-RADS) BPE categories assigned by an experienced board-certified breast radiologist was estimated. With use of multivariable logistic regression, breast cancer case-control status was regressed on tertiles (low, moderate, and high) of BPE, FGT volume, and fat volume, with adjustment for covariates. Results In total, 536 case participants with breast cancer (median age, 48 years [IQR, 43-55 years]) and 940 cancer-free controls (median age, 46 years [IQR, 38-55 years]) were included. BPE extent was positively associated with BI-RADS BPE (rs = 0.54; P < .001). Compared with low BPE extent (range, 2.9%-34.2%), high BPE extent (range, 50.7%-97.3%) was associated with increased odds of breast cancer (odds ratio [OR], 1.74 [95% CI: 1.23, 2.46]; P for trend = .002) in a multivariable model also including FGT volume (OR, 1.39 [95% CI: 0.97, 1.98]) and fat volume (OR, 1.46 [95% CI: 1.04, 2.06]). The association of high BPE extent with increased odds of breast cancer was similar for premenopausal and postmenopausal women (ORs, 1.75 and 1.83, respectively; interaction P = .73). Conclusion Objectively measured BPE at breast MRI is associated with increased breast cancer odds for both premenopausal and postmenopausal women. Clinical trial registration no. NCT02301767 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bokacheva in this issue.
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Affiliation(s)
- Gordon P. Watt
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Snekha Thakran
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Janice S. Sung
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Maxine S. Jochelson
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Marc B. I. Lobbes
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Susan P. Weinstein
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Angela R. Bradbury
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Saundra S. Buys
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Elizabeth A. Morris
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Aditya Apte
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Prusha Patel
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Meghan Woods
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Xiaolin Liang
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Malcolm C. Pike
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Despina Kontos
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Jonine L. Bernstein
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
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Kuang S, Woodruff HC, Granzier R, van Nijnatten TJA, Lobbes MBI, Smidt ML, Lambin P, Mehrkanoon S. MSCDA: Multi-level semantic-guided contrast improves unsupervised domain adaptation for breast MRI segmentation in small datasets. Neural Netw 2023; 165:119-134. [PMID: 37285729 DOI: 10.1016/j.neunet.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
Deep learning (DL) applied to breast tissue segmentation in magnetic resonance imaging (MRI) has received increased attention in the last decade, however, the domain shift which arises from different vendors, acquisition protocols, and biological heterogeneity, remains an important but challenging obstacle on the path towards clinical implementation. In this paper, we propose a novel Multi-level Semantic-guided Contrastive Domain Adaptation (MSCDA) framework to address this issue in an unsupervised manner. Our approach incorporates self-training with contrastive learning to align feature representations between domains. In particular, we extend the contrastive loss by incorporating pixel-to-pixel, pixel-to-centroid, and centroid-to-centroid contrasts to better exploit the underlying semantic information of the image at different levels. To resolve the data imbalance problem, we utilize a category-wise cross-domain sampling strategy to sample anchors from target images and build a hybrid memory bank to store samples from source images. We have validated MSCDA with a challenging task of cross-domain breast MRI segmentation between datasets of healthy volunteers and invasive breast cancer patients. Extensive experiments show that MSCDA effectively improves the model's feature alignment capabilities between domains, outperforming state-of-the-art methods. Furthermore, the framework is shown to be label-efficient, achieving good performance with a smaller source dataset. The code is publicly available at https://github.com/ShengKuangCN/MSCDA.
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Affiliation(s)
- Sheng Kuang
- The D-Lab, Department of Precision Medicine, GROW - School or Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School or Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Renee Granzier
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School or Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Siamak Mehrkanoon
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands.
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19
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Lobbes MBI, Neeter LMFH, Raat F, Turk K, Wildberger JE, van Nijnatten TJA, Nelemans PJ. The performance of contrast-enhanced mammography and breast MRI in local preoperative staging of invasive lobular breast cancer. Eur J Radiol 2023; 164:110881. [PMID: 37201248 DOI: 10.1016/j.ejrad.2023.110881] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Breast MRI is considered the best modality for preoperative staging of invasive lobular carcinoma (ILC). However, contrast-enhanced mammography (CEM) shows comparable diagnostic performance to MRI, but evidence of CEM's accuracy in women diagnosed with ILC is scant. We aimed to retrospectively evaluate CEM and MRI accuracy in preoperative staging of ILC. METHODS ILC cases diagnosed between 2013 and 2021 were collected. For both modalities, tumour diameter was extracted from the reports. Bland-Altman plots were used to assess discrepancies between size measurements according to imaging and histopathological findings. CEM and MRI's ability to detect multifocal/contralateral cancer was expressed as sensitivity, specificity, and diagnostic odds ratios (DORs). Pairwise comparison of women undergoing both CEM and MRI was not performed. RESULTS 305 ILC-cases fulfilled preset inclusion criteria. Mean age was 63.7 years. Preoperative staging was performed using MRI or CEM in 266 (87.2%) and 77 (25.2%) cases, respectively. MRI and CEM overestimated tumour size by 1.5 and 2.1 mm, respectively. Sensitivity to detect multifocal disease was higher for MRI than for CEM (86% versus 78%), but specificity was lower for MRI (79% versus 92%). For detection of contralateral breast cancer, sensitivity for MRI was 96% versus 88% for CEM, and specificity was 92% and 99%, respectively. For both indications, DOR was higher for CEM, but differences were non-significant (p = 0.56 and p = 0.78). CONCLUSION CEM and MRI overestimate ILC size with comparable systematic and random errors. MRI's higher sensitivity for detection of multifocal/contralateral cancers is accompanied by lower specificity, but discriminative ability for both modalities was non-significant.
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Affiliation(s)
- Marc B I Lobbes
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Lidewij M F H Neeter
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Frank Raat
- Laurentius Hospital, Department of Radiology, P.O. Box 920, 6040AX Roermond, the Netherlands.
| | - Kim Turk
- Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands.
| | - Joachim E Wildberger
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Thiemo J A van Nijnatten
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Patricia J Nelemans
- Maastricht University, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
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20
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van Nijnatten TJA, Lobbes MBI, Cozzi A, Patel BK, Zuley ML, Jochelson MS. Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:3-6. [PMID: 36448912 PMCID: PMC11025563 DOI: 10.2214/ajr.22.28567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound and comparable diagnostic performance to MRI for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited because of a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These factors include the following: the risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments needed when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently mitigate or are expected to mitigate these factors are also highlighted.
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Affiliation(s)
- Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Beuque MPL, Lobbes MBI, van Wijk Y, Widaatalla Y, Primakov S, Majer M, Balleyguier C, Woodruff HC, Lambin P. Combining Deep Learning and Handcrafted Radiomics for Classification of Suspicious Lesions on Contrast-enhanced Mammograms. Radiology 2023; 307:e221843. [PMID: 37338353 DOI: 10.1148/radiol.221843] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background Handcrafted radiomics and deep learning (DL) models individually achieve good performance in lesion classification (benign vs malignant) on contrast-enhanced mammography (CEM) images. Purpose To develop a comprehensive machine learning tool able to fully automatically identify, segment, and classify breast lesions on the basis of CEM images in recall patients. Materials and Methods CEM images and clinical data were retrospectively collected between 2013 and 2018 for 1601 recall patients at Maastricht UMC+ and 283 patients at Gustave Roussy Institute for external validation. Lesions with a known status (malignant or benign) were delineated by a research assistant overseen by an expert breast radiologist. Preprocessed low-energy and recombined images were used to train a DL model for automatic lesion identification, segmentation, and classification. A handcrafted radiomics model was also trained to classify both human- and DL-segmented lesions. Sensitivity for identification and the area under the receiver operating characteristic curve (AUC) for classification were compared between individual and combined models at the image and patient levels. Results After the exclusion of patients without suspicious lesions, the total number of patients included in the training, test, and validation data sets were 850 (mean age, 63 years ± 8 [SD]), 212 (62 years ± 8), and 279 (55 years ± 12), respectively. In the external data set, lesion identification sensitivity was 90% and 99% at the image and patient level, respectively, and the mean Dice coefficient was 0.71 and 0.80 at the image and patient level, respectively. Using manual segmentations, the combined DL and handcrafted radiomics classification model achieved the highest AUC (0.88 [95% CI: 0.86, 0.91]) (P < .05 except compared with DL, handcrafted radiomics, and clinical features model, where P = .90). Using DL-generated segmentations, the combined DL and handcrafted radiomics model showed the highest AUC (0.95 [95% CI: 0.94, 0.96]) (P < .05). Conclusion The DL model accurately identified and delineated suspicious lesions on CEM images, and the combined output of the DL and handcrafted radiomics models achieved good diagnostic performance. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bahl and Do in this issue.
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Affiliation(s)
- Manon P L Beuque
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Marc B I Lobbes
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Yvonka van Wijk
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Yousif Widaatalla
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Sergey Primakov
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Michael Majer
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Corinne Balleyguier
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Henry C Woodruff
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
| | - Philippe Lambin
- From the Department of Precision Medicine (M.P.L.B., Y.v.W., Y.W., S.P., H.C.W., P.L.) and Department of Radiology and Nuclear Medicine (M.B.I.L.), GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L., H.C.W., P.L.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Imaging, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France (M.M., C.B.); and Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France (C.B.)
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van Haaren ERM, Martens MH, Spiekerman van Weezelenburg MA, van Roozendaal LM, Frotscher CNA, Körver-Steeman RRM, Lobbes MBI, van Bastelaar J, Vissers YLJ, Janssen A. Combined use of magnetic seed and tracer in breast conserving surgery with sentinel lymph node biopsy for non-palpable breast lesions: A pilot study describing pitfalls and solutions. Surg Oncol 2023; 46:101905. [PMID: 36706578 DOI: 10.1016/j.suronc.2023.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/28/2022] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUNDS Traditionally, breast conserving surgery for non-palpable breast cancer is guided by wire or radioactive seed and radioactive tracer for sentinel lymph node biopsy (SLNB). Alternatively, a stain-less magnetic seed and superparamagnetic iron oxide tracer (SPIO) can be combined as a radioactive-free technique. The aim of this study was to define the pitfalls we encountered during implementation of this combined technique and provide solutions resulting in an instruction manual for a radio-active free procedure. METHODS Between January and March 2021, seventeen consecutive patients with cN0 non-palpable breast cancer were included. The magnetic seed was placed to localize the lesion and SPIO was used to identify the sentinel lymph node (SLN). A lymphoscintigraphy with Technetium-99m nano colloid was performed concomitantly in all patients as a control procedure for SPIO. Surgical outcomes are reported, including problems with placing and retrieval of the seed and SPIO and corresponding solutions. RESULTS Surgical excision was successful with invasive tumor-free margins in all patients. SLN detection was successful in 82% patients when compared to Technetium-99m. The most challenging issue was an overlapping magnetic signal of the seed and SPIO. Solutions are provided in detail. CONCLUSIONS Combined use of magnetic seed and SPIO for wide local excision and SLNB patients with non-palpable breast lesions appeared challenging due to overlapping magnetic signals. After multiple adaptations, the protocol proved to be feasible with an added advantage of eliminating the use of radioisotopes. We described the pitfalls and solutions resulting in an instruction manual for a totally radioactive-free procedure.
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Affiliation(s)
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | | | | | - Caroline N A Frotscher
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Rachel R M Körver-Steeman
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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Lobbes MBI, Jochelson MS, Neeter LMFH, Nelemans PJ. Contrast-enhanced Mammography and Breast MRI: Friends or Foes? Radiology 2022; 307:e221558. [PMID: 36413132 DOI: 10.1148/radiol.221558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Marc B. I. Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, PO Box 5500, 6130 MB Sittard-Geleen, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Maxine S. Jochelson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lidewij M. F. H. Neeter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Patricia J. Nelemans
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Simons JM, van Nijnatten TJA, van der Pol CC, van Diest PJ, Jager A, van Klaveren D, Kam BLR, Lobbes MBI, de Boer M, Verhoef C, Sars PRA, Heijmans HJ, van Haaren ERM, Vles WJ, Contant CME, Menke-Pluijmers MBE, Smit LHM, Kelder W, Boskamp M, Koppert LB, Luiten EJT, Smidt ML. Diagnostic Accuracy of Radioactive Iodine Seed Placement in the Axilla With Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer. JAMA Surg 2022; 157:991-999. [PMID: 36069889 PMCID: PMC9453629 DOI: 10.1001/jamasurg.2022.3907] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022]
Abstract
Importance Several less-invasive staging procedures have been proposed to replace axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC) in patients with initially clinically node-positive (cN+) breast cancer, but these procedures may fail to detect residual disease. Owing to the lack of high-level evidence, it is not yet clear which procedure is most optimal to replace ALND. Objective To determine the diagnostic accuracy of radioactive iodine seed placement in the axilla with sentinel lymph node biopsy (RISAS), a targeted axillary dissection procedure. Design, Setting, and Participants This was a prospective, multicenter, noninferiority, diagnostic accuracy trial conducted from March 1, 2017, to December 31, 2019. Patients were included within 14 institutions (general, teaching, and academic) throughout the Netherlands. Patients with breast cancer clinical tumor categories 1 through 4 (cT1-4; tumor diameter <2 cm and up to >5 cm or extension to the chest wall or skin) and pathologically proven positive axillary lymph nodes (ie, clinical node categories cN1, metastases to movable ipsilateral level I and/or level II axillary nodes; cN2, metastases to fixed or matted ipsilateral level I and/or level II axillary nodes; cN3b, metastases to ipsilateral level I and/or level II axillary nodes with metastases to internal mammary nodes) who were treated with NAC were eligible for inclusion. Data were analyzed from July 2020 to December 2021. Intervention Pre-NAC, the marking of a pathologically confirmed positive axillary lymph node with radioactive iodine seed (MARI) procedure, was performed and after NAC, sentinel lymph node biopsy (SLNB) combined with excision of the marked lymph node (ie, RISAS procedure) was performed, followed by ALND. Main Outcomes and Measures The identification rate, false-negative rate (FNR), and negative predictive value (NPV) were calculated for all 3 procedures: RISAS, SLNB, and MARI. The noninferiority margin of the observed FNR was 6.25% for the RISAS procedure. Results A total of 212 patients (median [range] age, 52 [22-77] years) who had cN+ breast cancer underwent the RISAS procedure and ALND. The identification rate of the RISAS procedure was 98.2% (223 of 227). The identification rates of SLNB and MARI were 86.4% (197 of 228) and 94.1% (224 of 238), respectively. FNR of the RISAS procedure was 3.5% (5 of 144; 90% CI, 1.38-7.16), and NPV was 92.8% (64 of 69; 90% CI, 85.37-97.10), compared with an FNR of 17.9% (22 of 123; 90% CI, 12.4%-24.5%) and NPV of 72.8% (59 of 81; 90% CI, 63.5%-80.8%) for SLNB and an FNR of 7.0% (10 of 143; 90% CI, 3.8%-11.6%) and NPV of 86.3% (63 of 73; 90% CI, 77.9%-92.4%) for the MARI procedure. In a subgroup of 174 patients in whom SLNB and the MARI procedure were successful and ALND was performed, FNR of the RISAS procedure was 2.5% (3 of 118; 90% CI, 0.7%-6.4%), compared with 18.6% (22 of 118; 90% CI, 13.0%-25.5%) for SLNB (P < .001) and 6.8% (8 of 118; 90% CI, 3.4%-11.9%) for the MARI procedure (P = .03). Conclusions and Relevance Results of this diagnostic study suggest that the RISAS procedure was the most feasible and accurate less-invasive procedure for axillary staging after NAC in patients with cN+ breast cancer.
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Affiliation(s)
- Janine M. Simons
- Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
- Department of Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
- GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Thiemo J. A. van Nijnatten
- GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, the Netherlands
| | - Carmen C. van der Pol
- Department of Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgical Oncology, Alrijne Hospital, Leiderdorp, the Netherlands
| | - Paul J. van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Boen L. R. Kam
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Nuclear Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - Marc B. I. Lobbes
- GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Maaike de Boer
- GROW-School for Oncology and Reproduction, Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Cees Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Paul R. A. Sars
- Department of Surgical Oncology, Bravis Hospital, Roosendaal, the Netherlands
| | - Harald J. Heijmans
- Department of Surgical Oncology, Hospital Group Twente, Breast Clinic Oost-Nederland, Hengelo, the Netherlands
| | - Els R. M. van Haaren
- Department of Surgical Oncology, Zuyderland Medical Center, Sittard, the Netherlands
| | - Wouter J. Vles
- Department of Surgical Oncology, Ikazia Hospital, Rotterdam, the Netherlands
| | | | | | - Léonie H. M. Smit
- Department of Surgical Oncology, Treant Zorggroep Hospital, Hoogeveen, the Netherlands
| | - Wendy Kelder
- Department of Surgical Oncology, Martini Hospital, Groningen, the Netherlands
| | - Marike Boskamp
- Department of Surgical Oncology, Wilhelmina Hospital, Assen, the Netherlands
| | - Linetta B. Koppert
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Ernest J. T. Luiten
- Department of Surgical Oncology, Amphia Hospital, Breda, the Netherlands
- Tawam Breast Care Center, Tawam Hospital, Al Ain, Abu Dhabi Emirate, United Arab Emirates
- Department of Surgery College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi Emirate, United Arab Emirates
| | - Marjolein L. Smidt
- GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
- Deparment of Surgical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands
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25
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de Mooij CM, Samiei S, Mitea C, Lobbes MBI, Kooreman LFS, Heuts EM, Beets-Tan RGH, van Nijnatten TJA, Smidt ML. Axillary lymph node response to neoadjuvant systemic therapy with dedicated axillary hybrid 18F-FDG PET/MRI in clinically node-positive breast cancer patients: a pilot study. Clin Radiol 2022; 77:e732-e740. [PMID: 35850866 DOI: 10.1016/j.crad.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
AIM To investigate the diagnostic performance of dedicated axillary hybrid 18F-2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in detecting axillary pathological complete response (pCR) following neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. MATERIALS AND METHODS Ten prospectively included clinically node-positive breast cancer patients underwent dedicated axillary hybrid 18F-FDG PET/MRI after completing NST followed by axillary surgery. PET images were reviewed by a nuclear medicine physician and coronal T1-weighted and T2-weighted MRI images by a radiologist. All axillary lymph nodes visible on PET/MRI were matched with those removed during axillary surgery. Diagnostic performance parameters were calculated based on patient-by-patient and node-by-node validation with histopathology of the axillary surgical specimen as the reference standard. RESULTS Six patients achieved axillary pCR at final histopathology. A total of 84 surgically harvested axillary lymph nodes were matched with axillary lymph nodes depicted on PET/MRI. Histopathological examination of the matched axillary lymph nodes resulted in 10 lymph nodes with residual axillary disease of which eight contained macrometastases and two micrometastases. The patient-by-patient analysis yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 25%, 100%, 100%, and 67%, respectively. The diagnostic performance parameters of the node-by-node analysis were 0%, 96%, 0%, and 88%, respectively. Excluding micrometastases from the node-by-node analysis increased the negative predictive value to 90%. CONCLUSION This pilot study suggests that the negative predictive value and sensitivity of dedicated axillary 18F-FDG PET/MRI are insufficiently accurate to detect axillary pCR or exclude residual axillary disease following NST in clinically node-positive breast cancer patients.
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Affiliation(s)
- C M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - S Samiei
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - C Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - L F S Kooreman
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Pathology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - E M Heuts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R G H Beets-Tan
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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26
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Granzier RWY, Ibrahim A, Primakov S, Keek SA, Halilaj I, Zwanenburg A, Engelen SME, Lobbes MBI, Lambin P, Woodruff HC, Smidt ML. Test-Retest Data for the Assessment of Breast MRI Radiomic Feature Repeatability. J Magn Reson Imaging 2021; 56:592-604. [PMID: 34936160 PMCID: PMC9544420 DOI: 10.1002/jmri.28027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Radiomic features extracted from breast MRI have potential for diagnostic, prognostic, and predictive purposes. However, before they can be used as biomarkers in clinical decision support systems, features need to be repeatable and reproducible. Objective Identify repeatable radiomics features within breast tissue on prospectively collected MRI exams through multiple test–retest measurements. Study Type Prospective. Population 11 healthy female volunteers. Field Strength/Sequence 1.5 T; MRI exams, comprising T2‐weighted turbo spin‐echo (T2W) sequence, native T1‐weighted turbo gradient‐echo (T1W) sequence, diffusion‐weighted imaging (DWI) sequence using b‐values 0/150/800, and corresponding derived ADC maps. Assessment 18 MRI exams (three test–retest settings, repeated on 2 days) per healthy volunteer were examined on an identical scanner using a fixed clinical breast protocol. For each scan, 91 features were extracted from the 3D manually segmented right breast using Pyradiomics, before and after image preprocessing. Image preprocessing consisted of 1) bias field correction (BFC); 2) z‐score normalization with and without BFC; 3) grayscale discretization using 32 and 64 bins with and without BFC; and 4) z‐score normalization + grayscale discretization using 32 and 64 bins with and without BFC. Statistical Tests Features' repeatability was assessed using concordance correlation coefficient(CCC) for each pair, i.e. each MRI was compared to each of the remaining 17 MRI with a cut‐off value of CCC > 0.90. Results Images without preprocessing produced the highest number of repeatable features for both T1W sequence and ADC maps with 15 of 91 (16.5%) and 8 of 91 (8.8%) repeatable features, respectively. Preprocessed images produced between 4 of 91 (4.4%) and 14 of 91 (15.4%), and 6 of 91 (6.6%) and 7 of 91 (7.7%) repeatable features, respectively for T1W and ADC maps. Z‐score normalization produced highest number of repeatable features, 26 of 91 (28.6%) in T2W sequences, in these images, no preprocessing produced 11 of 91 (12.1%) repeatable features. Data Conclusion Radiomic features extracted from T1W, T2W sequences and ADC maps from breast MRI exams showed a varying number of repeatable features, depending on the sequence. Effects of different preprocessing procedures on repeatability of features were different for each sequence. Level of Evidence 2 Technical Efficacy Stage 1
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Affiliation(s)
- R W Y Granzier
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - A Ibrahim
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Hospital Center Universitaire De Liege, Liege, Belgium.,Department of Nuclear Medicine and Comprehensive diagnostic center Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany
| | - S Primakov
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - S A Keek
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - I Halilaj
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Health Innovation Ventures, Maastricht, The Netherlands
| | - A Zwanenburg
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - S M E Engelen
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M B I Lobbes
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - P Lambin
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H C Woodruff
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,The D-Lab, Department of Precision Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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27
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Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, Cozzi A, de Andrade DA, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Sacchetto D, Scaperrotta GP, Schiaffino S, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G. Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA). Eur Radiol 2021; 32:1611-1623. [PMID: 34643778 PMCID: PMC8831264 DOI: 10.1007/s00330-021-08240-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. METHODS This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. RESULTS Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). CONCLUSIONS Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. KEY POINTS • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.
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Affiliation(s)
- Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. .,Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
| | - Rubina M Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | | | | | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Università degli Studi di Palermo, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Daniela Sacchetto
- Kiwifarm S.R.L, La Morra, Italy.,Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy.,CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
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Eijkelboom AH, de Munck L, Lobbes MBI, van Gils CH, Wesseling J, Westenend PJ, Guerrero Paez C, Pijnappel RM, Verkooijen HM, Broeders MJM, Siesling S. Impact of the suspension and restart of the Dutch breast cancer screening program on breast cancer incidence and stage during the COVID-19 pandemic. Prev Med 2021; 151:106602. [PMID: 34217417 PMCID: PMC9755636 DOI: 10.1016/j.ypmed.2021.106602] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/09/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic forced the Dutch national breast screening program to a halt in week 12, 2020. In week 26, the breast program was resumed at 40% capacity, which increased to 60% in week 34. We examined the impact of the suspension and restart of the screening program on the incidence of screen-detected and non-screen-detected breast cancer. We selected women aged 50-74, diagnosed during weeks 2-35 of 2018 (n = 7250), 2019 (n = 7302), or 2020 (n = 5306), from the Netherlands Cancer Registry. Weeks 2-35 were divided in seven periods, based on events occurring at the start of the COVID-19 pandemic. Incidence of screen-detected and non-screen-detected tumors was calculated overall and by age group, cT-stage, and cTNM-stage for each period in 2020, and compared to the incidence in the same period of 2018/2019 (averaged). The incidence of screen-detected tumors decreased during weeks 12-13, reached almost zero during weeks 14-25, and increased during weeks 26-35. Incidence of non-screen-detected tumors decreased to a lesser extent during weeks 12-16. The decrease in incidence was seen in all age groups and mainly occurred for cTis, cT1, DCIS, and stage I tumors. Due to the suspension of the breast cancer screening program, and the restart at reduced capacity, the incidence of screen-detected breast tumors decreased by 67% during weeks 9-35 2020, which equates to about 2000 potentially delayed breast cancer diagnoses. Up to August 2020 there was no indication of a shift towards higher stage breast cancers after restart of the screening.
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Affiliation(s)
- Anouk H Eijkelboom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center Sittard-Geleen, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6220 ER Maastricht, the Netherlands.
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands.
| | - Jelle Wesseling
- Divisions of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Pieter J Westenend
- Laboratory of Pathology, Karel Lotsyweg 145, 3318 AL Dordrecht, the Netherlands.
| | - Cristina Guerrero Paez
- Dutch Breast Cancer Society (BVN), Godebaldkwartier 363, 3511 DT Utrecht, the Netherlands.
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands.
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
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Wolfs JAGN, Qiu SS, Lobbes MBI, Bijkerk E, van der Hulst RRWJ, Keuter XHA. Visualization of Both the Superficial and Deep Lymphatic System of the Upper Extremity Using Magnetic Resonance Lymphography. Lymphat Res Biol 2021; 20:275-281. [PMID: 34491853 DOI: 10.1089/lrb.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: The lymphatic system consists of the superficial and deep lymphatic system. Several diagnostic methods are used to assess the lymphatic system. Lymphoscintigraphy and indocyanine green lymphography are widely applied, both showing disadvantages, such as a poor resolution and lack of field of view. Magnetic resonance lymphography (MRL) shows satisfactory temporal and spatial resolution. The aim of this study was to assess both the superficial and deep lymphatic system in the upper extremity of healthy subjects, using an MRL protocol. Methods and Results: Ten healthy volunteers underwent an MRL examination, using a three Tesla MRI unit. Water-soluble gadolinium was used as a contrast agent. MRL images were evaluated by an experienced radiologist on image quality, enhancement of veins and lymphatic vessels, and characteristics of the latter. Overall image quality was good to excellent. In all subjects, veins and lymphatic vessels could be distinguished. Superficial and deep lymphatic vessels were seen in 9 out of 10 subjects. Lymphatic vessels with a diameter between 0.9 and 4.3 mm were measured. Both veins and lymphatic vessels showed their characteristic appearance. Enhancement of veins was seen directly after contrast agent injection, which decreased over time. Lymphatic vessel enhancement slowly increased over time. Mean total MRL examination (room) time was 110 minutes (81 minutes scan time). Conclusions: The MRL protocol accurately visualizes both deep and superficial lymphatic vessels showing their characteristic appearances with high spatial resolution, indicating the MRL can be of value in diagnosing and staging peripheral lymphedema.
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Affiliation(s)
- Joost A G N Wolfs
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Shan S Qiu
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Geleen, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ennie Bijkerk
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Xavier H A Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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den Dekker BM, Bakker MF, de Lange SV, Veldhuis WB, van Diest PJ, Duvivier KM, Lobbes MBI, Loo CE, Mann RM, Monninkhof EM, Veltman J, Pijnappel RM, van Gils CH. Reducing False-Positive Screening MRI Rate in Women with Extremely Dense Breasts Using Prediction Models Based on Data from the DENSE Trial. Radiology 2021; 301:283-292. [PMID: 34402665 DOI: 10.1148/radiol.2021210325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background High breast density increases breast cancer risk and lowers mammographic sensitivity. Supplemental MRI screening improves cancer detection but increases the number of false-positive screenings. Thus, methods to distinguish true-positive MRI screening results from false-positive ones are needed. Purpose To build prediction models based on clinical characteristics and MRI findings to reduce the rate of false-positive screening MRI findings in women with extremely dense breasts. Materials and Methods Clinical characteristics and MRI findings in Dutch breast cancer screening participants (age range, 50-75 years) with positive first-round MRI screening results (Breast Imaging Reporting and Data System 3, 4, or 5) after a normal screening mammography with extremely dense breasts (Volpara density category 4) were prospectively collected within the randomized controlled Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial from December 2011 through November 2015. In this secondary analysis, prediction models were built using multivariable logistic regression analysis to distinguish true-positive MRI screening findings from false-positive ones. Results Among 454 women (median age, 52 years; interquartile range, 50-57 years) with a positive MRI result in a first supplemental MRI screening round, 79 were diagnosed with breast cancer (true-positive findings), and 375 had false-positive MRI results. The full prediction model (area under the receiver operating characteristics curve [AUC], 0.88; 95% CI: 0.84, 0.92), based on all collected clinical characteristics and MRI findings, could have prevented 45.5% (95% CI: 39.6, 51.5) of false-positive recalls and 21.3% (95% CI: 15.7, 28.3) of benign biopsies without missing any cancers. The model solely based on readily available MRI findings and age had a comparable performance (AUC, 0.84; 95% CI: 0.79, 0.88; P = .15) and could have prevented 35.5% (95% CI: 30.4, 41.1) of false-positive MRI screening results and 13.0% (95% CI: 8.8, 18.6) of benign biopsies. Conclusion Prediction models based on clinical characteristics and MRI findings may be useful to reduce the false-positive first-round screening MRI rate and benign biopsy rate in women with extremely dense breasts. Clinical trial registration no. NCT01315015 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Imbriaco in this issue.
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Affiliation(s)
- Bianca M den Dekker
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Marije F Bakker
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Stéphanie V de Lange
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Wouter B Veldhuis
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Paul J van Diest
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Katya M Duvivier
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Marc B I Lobbes
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Claudette E Loo
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Ritse M Mann
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Evelyn M Monninkhof
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Jeroen Veltman
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Ruud M Pijnappel
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
| | - Carla H van Gils
- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
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- From the Department of Radiology (B.M.d.D., S.V.d.L., W.B.V., R.M.P.), Julius Center for Health Sciences and Primary Care (M.F.B., S.V.d.L., E.M.M., C.H.v.G.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and GROW School for Oncology and Developmental Biology, Maastricht University, and Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (C.E.L.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, Ziekenhuisgroep Twente, Almelo, the Netherlands (J.V.); and Dutch Expert Center for Screening, Nijmegen, the Netherlands (R.M.P.)
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Raat HPJ, Lobbes MBI, Veldhuis WB. [Are The Netherlands ready for personalized breast cancer screening? Abbreviated breast MRI and contrast-enhanced mammography for screening in women with dense breasts]. Ned Tijdschr Geneeskd 2021; 165:D5936. [PMID: 34346656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
One-size-fits-all breast cancer screening no longer reflects the current state of knowledge and technology. 8% of the participants in the Dutch Breastcancer Screening Program have extremely dense breasts, which is coupled to a strongly increased risk of breast cancer. In addition, for this group of approximately 80,000 women per year, mammography is only 60% sensitive. The DENSE trial showed that supplemental MRI after a negative mammogram reduced the number of interval cancers by more than 80%. The Dutch Health Council however subsequently recommended to consider contrast-enhanced mammography (CEM) as a screening tool. At the request of the Ministry of Health-Welfare and Sport, simultaneous research is being set up to study both CEM and the introduction of CEM and "accelerated" (abbreviated) MRI. This article explains the differences between the two techniques and discusses the role both could play in screening this large group of women when politicians give green light.
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Affiliation(s)
- H P J Raat
- Laurentius Ziekenhuis, afd. Medische Beeldvorming, Roermond
| | - M B I Lobbes
- Zuyderland Medisch Centrum, afd. Medische Beeldvorming, Sittard-Geleen
| | - W B Veldhuis
- Universitair Medisch Centrum Utrecht, divisie Beeld, Utrecht
- Contact: W. B. Veldhuis
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Granzier RWY, Ibrahim A, Primakov SP, Samiei S, van Nijnatten TJA, de Boer M, Heuts EM, Hulsmans FJ, Chatterjee A, Lambin P, Lobbes MBI, Woodruff HC, Smidt ML. MRI-Based Radiomics Analysis for the Pretreatment Prediction of Pathologic Complete Tumor Response to Neoadjuvant Systemic Therapy in Breast Cancer Patients: A Multicenter Study. Cancers (Basel) 2021; 13:cancers13102447. [PMID: 34070016 PMCID: PMC8157878 DOI: 10.3390/cancers13102447] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/23/2022] Open
Abstract
This retrospective study investigated the value of pretreatment contrast-enhanced Magnetic Resonance Imaging (MRI)-based radiomics for the prediction of pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients. A total of 292 breast cancer patients, with 320 tumors, who were treated with neo-adjuvant systemic therapy and underwent a pretreatment MRI exam were enrolled. As the data were collected in two different hospitals with five different MRI scanners and varying acquisition protocols, three different strategies to split training and validation datasets were used. Radiomics, clinical, and combined models were developed using random forest classifiers in each strategy. The analysis of radiomics features had no added value in predicting pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients compared with the clinical models, nor did the combined models perform significantly better than the clinical models. Further, the radiomics features selected for the models and their performance differed with and within the different strategies. Due to previous and current work, we tentatively attribute the lack of improvement in clinical models following the addition of radiomics to the effects of variations in acquisition and reconstruction parameters. The lack of reproducibility data (i.e., test-retest or similar) meant that this effect could not be analyzed. These results indicate the need for reproducibility studies to preselect reproducible features in order to properly assess the potential of radiomics.
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Affiliation(s)
- Renée W. Y. Granzier
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Correspondence: ; Tel.: +31-43-388-1575
| | - Abdalla Ibrahim
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liège and GIGA CRC-In Vivo Imaging, University of Liège, 4000 Liege, Belgium
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital RWTH Aachen University, 52074 Aachen, Germany
| | - Sergey P. Primakov
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Sanaz Samiei
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| | - Thiemo J. A. van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
| | - Maaike de Boer
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Esther M. Heuts
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
| | - Frans-Jan Hulsmans
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands;
| | - Avishek Chatterjee
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Philippe Lambin
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marc B. I. Lobbes
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands;
| | - Henry C. Woodruff
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (A.I.); (S.P.P.); (M.d.B.); (A.C.); (P.L.); (M.B.I.L.); (H.C.W.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein L. Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (E.M.H.); (M.L.S.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands;
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Eijkelboom AH, de Munck L, Vrancken Peeters MJTFD, Broeders MJM, Strobbe LJA, Bos MEMM, Schmidt MK, Guerrero Paez C, Smidt ML, Bessems M, Verloop J, Linn S, Lobbes MBI, Honkoop AH, van den Bongard DHJG, Westenend PJ, Wesseling J, Menke-van der Houven van Oordt CW, Tjan-Heijnen VCG, Siesling S. Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study. J Hematol Oncol 2021; 14:64. [PMID: 33865430 PMCID: PMC8052935 DOI: 10.1186/s13045-021-01073-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. METHODS Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2-17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. RESULTS Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2-8: 2.04, ORwks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12-13: 0.52) or by breast conserving surgery (ORwks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9-11: 0.59, ORwks12-13: 0.66), but more likely for those diagnosed at the end (ORwks14-17: 1.31). Primary hormonal treatment was more common (ORwks2-8: 1.23, ORwks9-11: 1.92, ORwks12-13: 3.01). Only women diagnosed in weeks 2-8 of 2020 experienced treatment delays. CONCLUSION The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.
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Affiliation(s)
- Anouk H Eijkelboom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Cristina Guerrero Paez
- Dutch Breast Cancer Society (BVN), Godebaldkwartier 363, 3511 DT, Utrecht, The Netherlands
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, Univeristeitssingel 40, 6220 ER, Maastricht, the Netherlands
| | - Maud Bessems
- Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Janneke Verloop
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Sabine Linn
- Division of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Development Biology, Maastricht University, Univeristeitssingel 40, 6220 ER, Maastricht, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Dr. H. van der Hoffplein 1, 6162 BG, Geleen, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | - Pieter J Westenend
- Laboratory of Pathology, Karel Lotsyweg 145, 3318 AL, Dordrecht, The Netherlands
| | - Jelle Wesseling
- Division of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C Willemien Menke-van der Houven van Oordt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
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Abstract
Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics.
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Affiliation(s)
- Maxine S. Jochelson
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
| | - Marc B. I. Lobbes
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
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35
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Veenhuizen SGA, de Lange SV, Bakker MF, Pijnappel RM, Mann RM, Monninkhof EM, Emaus MJ, de Koekkoek-Doll PK, Bisschops RHC, Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, Mali WPTM, van den Bosch MAAJ, van Gils CH, Veldhuis WB. Supplemental Breast MRI for Women with Extremely Dense Breasts: Results of the Second Screening Round of the DENSE Trial. Radiology 2021; 299:278-286. [PMID: 33724062 DOI: 10.1148/radiol.2021203633] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background In the first (prevalent) supplemental MRI screening round of the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial, a considerable number of breast cancers were found at the cost of an increased false-positive rate (FPR). In incident screening rounds, a lower cancer detection rate (CDR) is expected due to a smaller pool of prevalent cancers, and a reduced FPR, due to the availability of prior MRI examinations. Purpose To investigate screening performance indicators of the second round (incidence round) of the DENSE trial. Materials and Methods The DENSE trial (ClinicalTrials.gov: NCT01315015) is embedded within the Dutch population-based biennial mammography screening program for women aged 50-75 years. MRI examinations were performed between December 2011 and January 2016. Women were eligible for the second round when they again had a negative screening mammogram 2 years after their first MRI. The recall rate, biopsy rate, CDR, FPR, positive predictive values, and distributions of tumor characteristics were calculated and compared with results of the first round using 95% CIs and χ2 tests. Results A total of 3436 women (median age, 56 years; interquartile range, 48-64 years) underwent a second MRI screening. The CDR was 5.8 per 1000 screening examinations (95% CI: 3.8, 9.0) compared with 16.5 per 1000 screening examinations (95% CI: 13.3, 20.5) in the first round. The FPR was 26.3 per 1000 screening examinations (95% CI: 21.5, 32.3) in the second round versus 79.8 per 1000 screening examinations (95% CI: 72.4, 87.9) in the first round. The positive predictive value for recall was 18% (20 of 110 participants recalled; 95% CI: 12.1, 26.4), and the positive predictive value for biopsy was 24% (20 of 84 participants who underwent biopsy; 95% CI: 16.0, 33.9), both comparable to that of the first round. All tumors in the second round were stage 0-I and node negative. Conclusion The incremental cancer detection rate in the second round was 5.8 per 1000 screening examinations-compared with 16.5 per 1000 screening examinations in the first round. This was accompanied by a strong reduction in the number of false-positive results. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issue.
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Affiliation(s)
- Stefanie G A Veenhuizen
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Stéphanie V de Lange
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Marije F Bakker
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Ruud M Pijnappel
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Ritse M Mann
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Evelyn M Monninkhof
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Marleen J Emaus
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Petra K de Koekkoek-Doll
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Robertus H C Bisschops
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Marc B I Lobbes
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Mathijn D F de Jong
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Katya M Duvivier
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Jeroen Veltman
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Nico Karssemeijer
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Harry J de Koning
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Paul J van Diest
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Willem P T M Mali
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Maurice A A J van den Bosch
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Carla H van Gils
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | - Wouter B Veldhuis
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
| | -
- From the Julius Center for Health Sciences and Primary Care (S.G.A.V., S.V.d.L., M.F.B., E.M.M., C.H.v.G.), Department of Radiology (S.V.d.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.v.d.B., W.B.V.), and Department of Pathology (P.J.v.D.), University Medical Center Utrecht, Utrecht University, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; Dutch Expert Centre for Screening, Nijmegen, the Netherlands (R.M.P.); Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (R.M.M., N.K.); Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands (P.K.d.K.D.); Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.H.C.B.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (M.B.I.L.); Department of Medical Imaging, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.D.F.d.J.); Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K.M.D.); Department of Radiology, Hospital Group Twente (ZGT), Almelo, the Netherlands (J.V.); and Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (H.J.d.K.)
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Samiei S, Granzier RWY, Ibrahim A, Primakov S, Lobbes MBI, Beets-Tan RGH, van Nijnatten TJA, Engelen SME, Woodruff HC, Smidt ML. Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer. Cancers (Basel) 2021; 13:cancers13040757. [PMID: 33673071 PMCID: PMC7917661 DOI: 10.3390/cancers13040757] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51-68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41-0.74 and 0.48-0.89 in the training cohorts, respectively, and between 0.30-0.98 and 0.37-0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.
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Affiliation(s)
- Sanaz Samiei
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (S.M.E.E.); (M.L.S.)
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Renée W. Y. Granzier
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (S.M.E.E.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Correspondence: ; Tel.: +31-43-388-1575
| | - Abdalla Ibrahim
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Hospital Center Universitaire de Liege, Rue de Gaillarmont 600, 4030 Liege, Belgium
- Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Sergey Primakov
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marc B. I. Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Regina G. H. Beets-Tan
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Thiemo J. A. van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
| | - Sanne M. E. Engelen
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (S.M.E.E.); (M.L.S.)
| | - Henry C. Woodruff
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (A.I.); (S.P.); (M.B.I.L.); (T.J.A.v.N.); (H.C.W.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- The D-Lab, Department of Precision Medicine, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein L. Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; (S.S.); (S.M.E.E.); (M.L.S.)
- GROW-School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
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Geuzinge HA, Obdeijn IM, Rutgers EJT, Saadatmand S, Mann RM, Oosterwijk JC, Tollenaar RAEM, de Roy van Zuidewijn DBW, Lobbes MBI, van 't Riet M, Hooning MJ, Ausems MGEM, Loo CE, Wesseling J, Luiten EJT, Zonderland HM, Verhoef C, Heijnsdijk EAM, Tilanus-Linthorst MMA, de Koning HJ. Cost-effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk. JAMA Oncol 2021; 6:1381-1389. [PMID: 32729887 DOI: 10.1001/jamaoncol.2020.2922] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance For women with a 20% or more familial risk of breast cancer without a known BRCA1/2 (BRCA1, OMIM 113705; and BRCA2, OMIM 114480) or TP53 (OMIM 151623) variant, screening guidelines vary substantially, and cost-effectiveness analyses are scarce. Objective To assess the cost-effectiveness of magnetic resonance imaging (MRI) screening strategies for women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. Design, Setting, and Participants In this economic evaluation, conducted from February 1, 2019, to May 25, 2020, microsimulation modeling was used to estimate costs and effectiveness on a lifetime horizon from age 25 years until death of MRI screening among a cohort of 10 million Dutch women with a 20% or more familial risk for breast cancer without a known BRCA1/2 or TP53 variant. A Dutch screening setting was modeled. Most data were obtained from the randomized Familial MRI Screening (FaMRIsc) trial, which included Dutch women aged 30 to 55 years. A health care payer perspective was applied. Interventions Several screening protocols with varying ages and intervals including those of the randomized FaMRIsc trial, consisting of the mammography (Mx) protocol (annual mammography and clinical breast examination) and the MRI protocol (annual MRI and clinical breast examination plus biennial mammography). Main Outcomes and Measures Costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated and discounted by 3%. A threshold of €22 000 (US $24 795.87) per QALY was applied. Results This economic evaluation modeling study estimated that, on a lifetime horizon per 1000 women with the Mx protocol of the FaMRIsc trial, 346 breast cancers would be detected, and 49 women were estimated to die from breast cancer, resulting in 22 885 QALYs and total costs of €7 084 767 (US $7 985 134.61). The MRI protocol resulted in 79 additional QALYs and additional €2 657 266 (US $2 994 964.65). Magnetic resonance imaging performed only every 18 months between the ages of 35 and 60 years followed by the national screening program was considered optimal, with an ICER of €21 380 (US $24 097.08) compared with the previous nondominated strategy in the ranking, when applying the National Institute for Health and Care Excellence threshold. Annual screening alternating MRI and mammography between the ages of 35 and 60 years, followed by the national screening program, gave similar outcomes. Higher thresholds would favor annual MRI screening. The ICER was most sensitive to the unit cost of MRI and the utility value for ductal carcinoma in situ and localized breast cancer. Conclusions and Relevance This study suggests that MRI screening every 18 months between the ages of 35 and 60 years for women with a family history of breast cancer is cost-effective within the National Institute for Health and Care Excellence threshold for all densities. Higher thresholds would favor annual MRI screening. These outcomes support a change of current screening guidelines for this specific risk group and support MRI screening.
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Affiliation(s)
- H Amarens Geuzinge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Emiel J T Rutgers
- Department of Surgery, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Sepideh Saadatmand
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Hospital, Nijmegen, the Netherlands.,Department of Radiology and Nuclear Medicine, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jan C Oosterwijk
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Genetics, Groningen University, University Medical Centre Groningen, Groningen, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Claudette E Loo
- Department of Radiology and Nuclear Medicine, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jelle Wesseling
- Department of Pathology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Harmien M Zonderland
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cees Verhoef
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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van Nijnatten TJA, van Tiel LPT, Voogd AC, Groothuis-Oudshoorn CGM, Siesling S, Lobbes MBI. The effect of breast MRI on disease-free and overall survival in breast cancer patients: a retrospective population-based study. Breast Cancer Res Treat 2020; 184:951-963. [PMID: 32930928 PMCID: PMC7655574 DOI: 10.1007/s10549-020-05906-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023]
Abstract
Purpose To evaluate the effect of breast MRI on overall survival (OS) and disease-free survival (DFS) of patients with invasive breast cancer in the Netherlands. Methods We selected all women from the Netherlands Cancer Registry diagnosed with invasive breast cancer (a) between 2011 and 2013 for the OS-cohort and (b) in the first quarter of 2012 for the DFS-cohort. The study population was subdivided into an MRI and non-MRI group. In addition, subgroups were created according to breast cancer subtype: invasive carcinoma of no special type (NST) versus invasive lobular carcinoma (ILC). OS and DFS were compared between the MRI and non-MRI group using the Kaplan–Meier method and the log-rank test. Cox proportional hazard regression analysis was performed to estimate hazard ratios (HR) with a 95% confidence interval (CI). To account for missing data, multiple imputation was performed. Results Of the 31,756 patients included in the OS-cohort (70% non-MRI and 30% MRI), 27,752 (87%) were diagnosed with invasive carcinoma NST and 4004 (13%) with ILC. Of the 2464 patients included in the DFS-cohort (72% non-MRI and 28% MRI), 2161 (88%) were diagnosed with invasive carcinoma NST and 303 (12%) with ILC. The distribution of breast MRI use was significantly lower over different age categories, from 49.0% aged < 50 to 16.5% aged > 70. Multivariable Cox regression showed that breast MRI was not significantly associated with OS overall (HR 0.91, 95%-CI 0.74–1.11, p = 0.35), nor in the different histological subtypes. Multivariable Cox regression analysis showed that breast MRI was also not significantly associated with DFS (HR 1.16, 95%-CI 0.81–1.67), nor in the different histological subtypes. Conclusion Use of breast MRI was not significantly associated with an improved OS or DFS in patients treated with primary surgery. Electronic supplementary material The online version of this article (10.1007/s10549-020-05906-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - L P T van Tiel
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - A C Voogd
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - S Siesling
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
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Miseré RML, Wolfs JAGN, Lobbes MBI, van der Hulst RRWJ, Qiu SS. A systematic review of magnetic resonance lymphography for the evaluation of peripheral lymphedema. J Vasc Surg Venous Lymphat Disord 2020; 8:882-892.e2. [PMID: 32417145 DOI: 10.1016/j.jvsv.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Visualization of the lymphatic system is necessary for both early diagnosis and associated treatments. A promising imaging modality is magnetic resonance lymphography (MRL). The aim of this review was to summarize different MRL protocols, to assess the clinical value in patients with peripheral lymphedema, and to define minimal requirements necessary for visualization of lymphatics. METHODS A systematic literature search was conducted in PubMed, Embase, and the Cochrane Library in December 2018. Studies performing MRL in patients with peripheral lymphedema or healthy participants were included. Study design, population, etiology, duration of lymphedema, clinical staging, contrast agent, dose, injection site, and technical magnetic resonance imaging details were analyzed. No meta-analyses were performed because of different study aims and heterogeneity of the study populations. RESULTS Twenty-five studies involving 1609 patients with both primary lymphedema (n = 669) and secondary lymphedema (n = 657) were included. Upper and lower limbs were examined in 296 and 602 patients, respectively. Twenty-two studies used a gadolinium-based contrast agent that was injected intracutaneously or subcutaneously in the interdigital web spaces. Contrast-enhanced T1-weighted combined with T2-weighted protocols were most frequently used. T1-weighted images showed lymphatics in 63.3% to 100%, even in vessels with a diameter of ≥0.5 mm. Dermal backflow and a honeycomb pattern were clearly recognized. CONCLUSIONS MRL identifies superficial lymphatic vessels with a diameter of ≥0.5 mm with high sensitivity and specificity and accurately shows abnormal lymphatics and lymphatic drainage patterns. Therefore, MRL could be of clinical value in both early and advanced stages of peripheral lymphedema. Minimum requirements of an MRL protocol should consist of a gadolinium-based contrast-enhanced T1-weighted gradient-recalled echo sequence combined with T2-weighted magnetic resonance imaging, with acquisition at least 30 minutes after injection of contrast material.
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Affiliation(s)
- Renée M L Miseré
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost A G N Wolfs
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Geleen, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Shan S Qiu
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Samiei S, Smidt ML, Vanwetswinkel S, Engelen SME, Schipper RJ, Lobbes MBI, van Nijnatten TJA. Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer. Eur Radiol 2020; 30:4212-4222. [PMID: 32221685 PMCID: PMC7338810 DOI: 10.1007/s00330-020-06760-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
Objectives To investigate whether breast MRI has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Methods Forty-seven patients were included. All had undergone both breast MRI and dedicated axillary MRI, followed by surgery. All included breast MRI exams had complete field of view (FOV) of the axillary region. First, unenhanced T2-weighted (T2W) and subsequent diffusion-weighted (DW) images of both MRI exams were independently analyzed by two breast radiologists using a confidence scale and compared to histopathology. ADC values were measured by two researchers independently. Diagnostic performance parameters were calculated on a patient-by-patient basis. Results T2W breast MRI had the following diagnostic performance: sensitivity of 50.0% and 62.5%, specificity of 92.3%, PPV of 57.1% and 62.5%, NPV of 90.0% and 92.3%, and AUC of 0.72 for reader 1 and 0.78 for reader 2. T2W dedicated axillary MRI had the following diagnostic performance: sensitivity of 37.5% and 62.5%, specificity of 82.1% and 92.3%, PPV of 44.6% and 50.0%, NPV of 87.8% and 91.4%, and AUC of 0.65 for reader 1 and 0.73 for reader 2. In both evaluations, addition of DW images resulted in comparable diagnostic performance. For both breast MRI and dedicated axillary MRI, there was no significant difference between mean ADC values of benign and malignant lymph nodes. Conclusions T2W breast MRI with complete FOV of the axillary region has comparable diagnostic performance as T2W dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Optimization of T2W breast MRI protocol by including a complete FOV of the axillary region can, therefore, be recommended in clinical practice. Key Points • Breast MRI with complete field of view of the axillary region has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. • Optimization of breast MRI protocol by including a complete field of view of the axillary region is recommended in clinical practice. • For both breast MRI and dedicated axillary MRI, DW imaging (including ADC measurements) is of no added value.
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Affiliation(s)
- Sanaz Samiei
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Sigrid Vanwetswinkel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sanne M E Engelen
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Robert-Jan Schipper
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, Borbély K, Brkljacic B, Carbonaro LA, Clauser P, Cassano E, Colin C, Esen G, Evans A, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Heywang-Köbrunner SH, Herranz M, Kinkel K, Kilburn-Toppin F, Kuhl CK, Lesaru M, Lobbes MBI, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Schiaffino S, Sella T, Thomassin-Naggara I, Tardivon A, Ongeval CV, Wallis MG, Zackrisson S, Forrai G, Herrero JC, Sardanelli F. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2020; 11:12. [PMID: 32025985 PMCID: PMC7002629 DOI: 10.1186/s13244-019-0803-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.
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Affiliation(s)
- Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Luca A Carbonaro
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Enrico Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Gul Esen
- School of Medicine, Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Eva M Fallenberg
- Diagnostic and Interventional Breast Imaging, Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | | | - Michel Herranz
- CyclotronUnit, GALARIA-SERGAS, Nuclear Medicine Department and Molecular ImagingGroup, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224 Chêne-Bougeries, Genève, Switzerland
| | - Fleur Kilburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Marc B I Lobbes
- Department of Radiology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, PO Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unit of Radiodiagnostics ASL AT, Via Conte Verde 125, 14100, Asti, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie, Paris, France
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | | | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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de Boer M, van Middelkoop M, Hauptmann M, van der Bijl N, Bosmans JAW, Hendriks-Brouwer N, Schop SJ, de Boer JP, Hijmering NJ, Overbeek LIH, Lobbes MBI, Klazen CAH, de Jong D, Rakhorst HA, van der Hulst RRWJ, van Leeuwen FE. Breast Implant Prevalence in the Dutch Female Population Assessed by Chest Radiographs. Aesthet Surg J 2020; 40:156-164. [PMID: 31242279 PMCID: PMC7006872 DOI: 10.1093/asj/sjz136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Breast implant-related health problems are a subject of fierce debate. Reliable population-based estimates of implant prevalence rates are not available, however, due to a lack of historical registries and incomplete sales data, precluding absolute risk assessments. OBJECTIVES This study aimed to describe the methodology of a novel procedure to determine Dutch breast implant prevalence based on the evaluation of routine chest radiographs. METHODS The validity of the new method was first examined in a separate study. Eight reviewers examined a series of 180 chest radiographs with (n = 60) or without (n = 120) a breast implant confirmed by a computed tomography or magnetic resonance imaging scan. After a consensus meeting with best-performing expert reviewers, we reviewed 3000 chest radiographs of women aged 20 to 70 years in 2 large regional hospitals in the Netherlands in 2015. To calculate the national breast implant prevalence, regional prevalence variations were corrected utilizing the National Breast Cancer Screening Program. RESULTS Eight reviewers scored with a median sensitivity of 71.7% (range, 41.7%-85.0%) and a median specificity of 94.6% (range, 73.4%-97.5%). After a consensus meeting and a reevaluation by best-performing expert reviewers, sensitivity was 79.9% and specificity was 99.2%. The estimated national prevalence of breast implants among women between 20 and 70 years was 3.0%, ranging from 1.7% at 21 to 30 years to 3.9% between 51 and 60 years. CONCLUSIONS The novel method in this study was validated with a high sensitivity and specificity, resulting in accurate prevalence estimates and providing the opportunity to conduct absolute risk assessment studies on the health consequences of breast implants. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Mintsje de Boer
- Department of Plastic, Reconstructive, and Hand Surgery of Maastricht University Medical Center, Maastricht, Netherlands
- Dutch BIA-ALCL Consortium
| | - Michele van Middelkoop
- Department of Plastic, Reconstructive, and Hand Surgery of the Medical Spectrum Twente, Enschede, Netherlands
| | - Michael Hauptmann
- Division of Epidemiology of the Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Jorn A W Bosmans
- Department of Plastic, Reconstructive, and Hand Surgery of Maastricht University Medical Center, Maastricht, Netherlands
| | - Narda Hendriks-Brouwer
- Department of Plastic, Reconstructive, and Hand Surgery of the Medical Spectrum Twente, Enschede, Netherlands
| | - Sijmen J Schop
- Department of Plastic, Reconstructive, and Hand Surgery of Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Paul de Boer
- Division of Epidemiology of the Netherlands Cancer Institute, Amsterdam, Netherlands
- Dutch BIA-ALCL Consortium
| | | | - Lucy I H Overbeek
- Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, Netherlands
| | - Marc B I Lobbes
- Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Daphne de Jong
- Division of Pathology, VU University Medical Center
- Dutch BIA-ALCL Consortium
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive, and Hand Surgery of Maastricht University Medical Center, Maastricht, Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery of Maastricht University Medical Center, Maastricht, Netherlands
- Dutch BIA-ALCL Consortium
| | - Flora E van Leeuwen
- Division of Epidemiology of the Netherlands Cancer Institute, Amsterdam, Netherlands
- Dutch BIA-ALCL Consortium
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43
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Bakker MF, de Lange SV, Pijnappel RM, Mann RM, Peeters PHM, Monninkhof EM, Emaus MJ, Loo CE, Bisschops RHC, Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, Mali WPTM, van den Bosch MAAJ, Veldhuis WB, van Gils CH. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 2019; 381:2091-2102. [PMID: 31774954 DOI: 10.1056/nejmoa1903986] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. METHODS In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period. RESULTS The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening. CONCLUSIONS The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. (Funded by the University Medical Center Utrecht and others; DENSE ClinicalTrials.gov number, NCT01315015.).
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Affiliation(s)
- Marije F Bakker
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Stéphanie V de Lange
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Ruud M Pijnappel
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Ritse M Mann
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Petra H M Peeters
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Evelyn M Monninkhof
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Marleen J Emaus
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Claudette E Loo
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Robertus H C Bisschops
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Marc B I Lobbes
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Matthijn D F de Jong
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Katya M Duvivier
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Jeroen Veltman
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Nico Karssemeijer
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Harry J de Koning
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Paul J van Diest
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Willem P T M Mali
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Maurice A A J van den Bosch
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Wouter B Veldhuis
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
| | - Carla H van Gils
- From the Julius Center for Health Sciences and Primary Care (M.F.B., S.V.L., P.H.M.P., E.M.M., C.H.G.) and the Departments of Radiology (S.V.L., R.M.P., M.J.E., W.P.T.M.M., M.A.A.J.B., W.B.V.) and Pathology (P.J.D.), University Medical Center Utrecht, Utrecht University, Utrecht, the Dutch Expert Center for Screening (R.M.P.) and the Department of Radiology, Radboud University Nijmegen Medical Center (R.M.M., N.K.), Nijmegen, the Department of Radiology, Antoni van Leeuwenhoek Hospital (C.E.L.), and the Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam (K.M.D.), Amsterdam, the Department of Radiology, Albert Schweitzer Hospital, Dordrecht (R.H.C.B.), the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, and the Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen (M.B.I.L.), the Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch (M.D.F.J.), the Department of Radiology, Hospital Group Twente, Almelo (J.V.), and the Department of Public Health, Erasmus Medical Center, Rotterdam (H.J.K.) - all in the Netherlands; and the Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London (P.H.M.P.)
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Samiei S, van Nijnatten TJA, van Beek HC, Polak MPJ, Maaskant-Braat AJG, Heuts EM, van Kuijk SMJ, Schipper RJ, Lobbes MBI, Smidt ML. Diagnostic performance of axillary ultrasound and standard breast MRI for differentiation between limited and advanced axillary nodal disease in clinically node-positive breast cancer patients. Sci Rep 2019; 9:17476. [PMID: 31767929 PMCID: PMC6877558 DOI: 10.1038/s41598-019-54017-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/07/2019] [Indexed: 01/13/2023] Open
Abstract
Preoperative differentiation between limited (pN1; 1–3 axillary metastases) and advanced (pN2–3; ≥4 axillary metastases) nodal disease can provide relevant information regarding surgical planning and guiding adjuvant radiation therapy. The aim was to evaluate the diagnostic performance of preoperative axillary ultrasound (US) and breast MRI for differentiation between pN1 and pN2–3 in clinically node-positive breast cancer. A total of 49 patients were included with axillary metastasis confirmed by US-guided tissue sampling. All had undergone breast MRI between 2008–2014 and subsequent axillary lymph node dissection. Unenhanced T2-weighted MRI exams were reviewed by two radiologists independently. Each lymph node on the MRI exams was scored using a confidence scale (0–4) and compared with histopathology. Diagnostic performance parameters were calculated for differentiation between pN1 and pN2–3. Interobserver agreement was determined using Cohen’s kappa coefficient. At final histopathology, 67.3% (33/49) and 32.7% (16/49) of patients were pN1 and pN2–3, respectively. Breast MRI was comparable to US in terms of accuracy (MRI reader 1 vs US, 71.4% vs 69.4%, p = 0.99; MRI reader 2 vs US, 73.5% vs 69.4%, p = 0.77). In the case of 1–3 suspicious lymph nodes, pN2–3 was observed in 30.4% on US (positive predictive value (PPV) 69.6%) and in 22.2–24.3% on MRI (PPV 75.7–77.8%). In the case of ≥4 suspicious lymph nodes, pN1 was observed in 33.3% on US (negative predictive value (NPV) 66.7%) and in 38.5–41.7% on MRI (NPV 58.3–61.5%). Interobserver agreement was considered good (k = 0.73). In clinically node-positive patients, the diagnostic performance of axillary US and breast MRI is comparable and limited for accurate differentiation between pN1 and pN2–3. Therefore, there seems no added clinical value of preoperative breast MRI regarding nodal staging in patients with positive axillary US.
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Affiliation(s)
- S Samiei
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands. .,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H C van Beek
- Department of Radiology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - M P J Polak
- Department of Radiology, Maxima Medical Centre, Eindhoven, The Netherlands
| | | | - E M Heuts
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - R J Schipper
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Lobbes MBI, Hecker J, Houben IPL, Pluymakers R, Jeukens C, Laji UC, Gommers S, Wildberger JE, Nelemans PJ. Evaluation of single-view contrast-enhanced mammography as novel reading strategy: a non-inferiority feasibility study. Eur Radiol 2019; 29:6211-6219. [PMID: 31073859 PMCID: PMC6795610 DOI: 10.1007/s00330-019-06215-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines recommend screening of high-risk women using breast magnetic resonance imaging (MRI). Contrast-enhanced mammography (CEM) has matured, providing excellent diagnostic accuracy. To lower total radiation dose, evaluation of single-view (1 V) CEM exams might be considered instead of double-view (2 V) readings as an alternative reading strategy in women who cannot undergo MRI. METHODS This retrospective non-inferiority feasibility study evaluates whether the use of 1 V results in an acceptable sensitivity for detecting breast cancer (non-inferiority margin, - 10%). CEM images from May 2013 to December 2017 were included. 1 V readings were performed by consensus opinion of three radiologists, followed by 2 V readings being performed after 6 weeks. Cases were considered "malignant" if the final BI-RADS score was ≥ 4, enabling calculation of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Histopathological results or follow-up served as a gold standard. RESULTS A total of 368 cases were evaluated. Mean follow-up for benign or negative cases was 20.9 months. Sensitivity decreased by 9.6% from 92.9 to 83.3% when only 1 V was used for evaluation (p < 0.001). The lower limit of the 90% confidence interval around the difference in sensitivity between 1 V and 2 V readings was - 15% and lies below the predefined non-inferiority margin of - 10%. Hence, non-inferiority of 1 V to 2 V reading cannot be concluded. AUC for 1 V was significantly lower, 0.861 versus 0.899 for 2 V (p = 0.0174). CONCLUSION Non-inferiority of 1 V evaluations as an alternative reading strategy to standard 2 V evaluations could not be concluded. 1 V evaluations had lower diagnostic performance compared with 2 V evaluations. KEY POINTS • To lower radiation exposure used in contrast-enhanced mammography, we studied a hypothetical alternative strategy: single-view readings (1 V) versus (standard) double-view readings (2 V). • Based on our predefined margin of - 10%, non-inferiority of 1 V could not be concluded. • 1 V evaluation is not recommended as an alternative reading strategy to lower CEM-related radiation exposure.
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Affiliation(s)
- M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - J Hecker
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - I P L Houben
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R Pluymakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - C Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - U C Laji
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - P J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
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de Boer M, van Leeuwen FE, Hauptmann M, Overbeek LIH, de Boer JP, Hijmering NJ, Sernee A, Klazen CAH, Lobbes MBI, van der Hulst RRWJ, Rakhorst HA, de Jong D. Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast. JAMA Oncol 2019; 4:335-341. [PMID: 29302687 DOI: 10.1001/jamaoncol.2017.4510] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Breast implants are among the most commonly used medical devices. Since 2008, the number of women with breast implants diagnosed with anaplastic large-cell lymphoma in the breast (breast-ALCL) has increased, and several reports have suggested an association between breast implants and risk of breast-ALCL. However, relative and absolute risks of breast-ALCL in women with implants are still unknown, precluding evidence-based counseling about implants. Objective To determine relative and absolute risks of breast-ALCL in women with breast implants. Design, Setting, and Participants Through the population-based nationwide Dutch pathology registry we identified all patients diagnosed with primary non-Hodgkin lymphoma in the breast between 1990 and 2016 and retrieved clinical data, including breast implant status, from the treating physicians. We estimated the odds ratio (OR) of ALCL associated with breast implants in a case-control design, comparing implant prevalence between women with breast-ALCL and women with other types of breast lymphoma. Cumulative risk of breast-ALCL was derived from the age-specific prevalence of breast implants in Dutch women, estimated from an examination of 3000 chest x-rays and time trends from implant sales. Main Outcomes and Measures Relative and absolute risks of breast-ALCL in women with breast implants. Results Among 43 patients with breast-ALCL (median age, 59 years), 32 had ipsilateral breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2). Implants among breast-ALCL cases were more often macrotextured (23 macrotextured of 28 total implants of known type, 82%) than expected (49 193 sold macrotextured implants of total sold 109 449 between 2010 and 2015, 45%) based on sales data (P < .001). The estimated prevalence of breast implants in women aged 20 to 70 years was 3.3%. Cumulative risks of breast-ALCL in women with implants were 29 per million at 50 years and 82 per million at 70 years. The number of women with implants needed to cause 1 breast-ALCL case before age 75 years was 6920. Conclusions and Relevance Breast implants are associated with increased risk of breast-ALCL, but the absolute risk remains small. Our results emphasize the need for increased awareness among the public, medical professionals, and regulatory bodies, promotion of alternative cosmetic procedures, and alertness to signs and symptoms of breast-ALCL in women with implants.
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Affiliation(s)
- Mintsje de Boer
- Plastic, Reconstructive and Hand-Surgery, Maastricht University Medical Centre, School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lucy I H Overbeek
- Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nathalie J Hijmering
- Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Arthur Sernee
- Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands
| | | | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Plastic, Reconstructive and Hand-Surgery, Maastricht, University Medical Centre, School of Nutrition and Translational, Research in Metabolism, Maastricht, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente/Medisch Spectrum Twente, Enschede, the Netherlands
| | - Daphne de Jong
- Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands
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Houben IPL, Vanwetswinkel S, Kalia V, Thywissen T, Nelemans PJ, Heuts EM, Smidt ML, Meyer-Baese A, Wildberger JE, Lobbes MBI. Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol 2019; 60:1110-1117. [PMID: 30678480 PMCID: PMC6691602 DOI: 10.1177/0284185118822639] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Detecting pathological breast calcifications remains challenging. Based on recent studies, contrast-enhanced spectral mammography (CESM) was shown to be superior compared to full-field digital mammography (FFDM). Purpose To evaluate the diagnostic accuracy of CESM in suspicious breast calcifications and its impact on surgical decision-making. Material and Methods All screening recalled patients with suspicious calcifications that underwent CESM in the period October 2012 until September 2015 were included. One experienced radiologist provided a BI-RADS classification for the FFDM images only. The evaluation was repeated for the CESM exam. In a simulated tumor board meeting, two breast surgeons decided on the preferred surgical treatment (breast conservation therapy [BCT] versus mastectomy) for all malignant cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated defining BI-RADS ≥4 as being malignant. In addition, differences in surgical decision-making were analyzed and compared using McNemar’s test. Results In total, 147 women were included in this study (mean age = 61 years; age range = 49–75 years). Pathology showed 82 benign and 65 malignant lesions, of which 33 were ductal carcinomas in situ and 32 were invasive lesions. Diagnostic performances of CESM (differences compared to FFDM in brackets) were: sensitivity 93.8% (+3%), specificity 36.6% (−2.5%), PPV 54% (0%), and NPV 88.2% (+4%). Based on low-energy images, surgeons suggested BCT in 89% of the cases. Based on the CESM exam, no statistical changes in decisions were observed (86% BCT, P = 0.453). Conclusion CESM only slightly improves the diagnostic accuracy of the evaluation of breast calcifications. It is not of added value compared to FFDM in guiding surgical decision-making.
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Affiliation(s)
- Ivo PL Houben
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Vanwetswinkel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V Kalia
- Department of Radiodiagnosis, Sjúkrahúsið Akureyri, Iceland
| | - T Thywissen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - PJ Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - EM Heuts
- Department of Surgery, Maastricht, The Netherlands
| | - ML Smidt
- Department of Surgery, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Meyer-Baese
- Department of Scientific Computing, Florida State University, Tallahassee, FL, USA
| | - JE Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - MBI Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Keymeulen KBIM, Geurts SME, Lobbes MBI, Heuts EM, Duijm LEM, Kooreman LFS, Voogd AC, Tjan-Heijnen VCG. Population-based study of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ. Br J Surg 2019; 106:1488-1494. [PMID: 31386197 PMCID: PMC6790575 DOI: 10.1002/bjs.11299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/22/2019] [Accepted: 06/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Determinants of the use of breast MRI in patients with ductal carcinoma in situ (DCIS) in the Netherlands were studied, and whether using MRI influenced the rates of positive resection margins and mastectomies. METHODS All women aged less than 75 years, and diagnosed with DCIS between 2011 and 2015, were identified from the Netherlands Cancer Registry. Multivariable logistic regression analyses were performed, adjusting for incidence year, age, hospital type, DCIS grade and multifocality. RESULTS Breast MRI was performed in 2382 of 10 415 DCIS cases (22·9 per cent). In multivariable analysis, patients aged less than 50 years, those with high- or intermediate-grade DCIS and patients with multifocal disease were significantly more likely to have preoperative MRI. Patients undergoing MRI were more likely to have a mastectomy, either as first surgical treatment or following breast-conserving surgery (BCS) in the event of positive margins (odds ratio (OR) 2·11, 95 per cent c.i. 1·91 to 2·33). The risk of positive surgical margins after BCS was similar for those with versus without MRI. The secondary mastectomy rate after BCS was higher in patients who had MRI, especially in women aged less than 50 years (OR 1·94, 1·31 to 2·89). All findings were similar for low- and intermediate/high-grade DCIS. CONCLUSION Adding MRI to conventional breast imaging did not improve surgical outcome in patients diagnosed with primary DCIS. The likelihood of undergoing a mastectomy was twice as high in the MRI group, and no reduction in the risk of margin involvement was observed after BCS.
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Affiliation(s)
- K B I M Keymeulen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S M E Geurts
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - E M Heuts
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - L F S Kooreman
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A C Voogd
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - V C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Saadatmand S, Geuzinge HA, Rutgers EJT, Mann RM, de Roy van Zuidewijn DBW, Zonderland HM, Tollenaar RAEM, Lobbes MBI, Ausems MGEM, van 't Riet M, Hooning MJ, Mares-Engelberts I, Luiten EJT, Heijnsdijk EAM, Verhoef C, Karssemeijer N, Oosterwijk JC, Obdeijn IM, de Koning HJ, Tilanus-Linthorst MMA, van Deurzen CHM, Loo CE, Wesseling J, Schlooz-Vries M, van der Meij S, Mesker W, Keymeulen K, Contant C, Madsen E, Koppert LB, Rothbarth J, Veldhuis WB, Witkamp AJ, Tetteroo E, de Monye C, van Rosmalen MM, Remmelzwaal J, Gort HBW, Roi-Antonides R, Wasser MNJM, van Druten E. MRI versus mammography for breast cancer screening in women with familial risk (FaMRIsc): a multicentre, randomised, controlled trial. Lancet Oncol 2019; 20:1136-1147. [DOI: 10.1016/s1470-2045(19)30275-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/03/2023]
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50
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Samiei S, van Kaathoven BN, Boersma L, Granzier RWY, Siesling S, Engelen SME, de Munck L, van Kuijk SMJ, van der Hulst RRJW, Lobbes MBI, Smidt ML, van Nijnatten TJA. Risk of Positive Sentinel Lymph Node After Neoadjuvant Systemic Therapy in Clinically Node-Negative Breast Cancer: Implications for Postmastectomy Radiation Therapy and Immediate Breast Reconstruction. Ann Surg Oncol 2019; 26:3902-3909. [PMID: 31359276 PMCID: PMC6787110 DOI: 10.1245/s10434-019-07643-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Indexed: 12/27/2022]
Abstract
Background Residual axillary lymph node involvement after neoadjuvant systemic therapy (NST) is the determining factor for postmastectomy radiation therapy (PMRT). Preoperative identification of patients needing PMRT is essential to enable shared decision-making when choosing the optimal timing of breast reconstruction. We determined the risk of positive sentinel lymph node (SLN) after NST in clinically node-negative (cN0) breast cancer. Methods All cT1-3N0 patients treated with NST followed by mastectomy and SLNB between 2010 and 2016 were identified from the Netherlands Cancer Registry. Rate of positive SLN for different breast cancer subtypes was determined. Logistic regression analysis was performed to determine correlated clinicopathological variables with positive SLN. Results In total 788 patients were included, of whom 25.0% (197/788) had positive SLN. cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+ , and cT1-2N0 triple-negative patients had the lowest rate of positive SLN: 7.2–11.5%, 0–6.3%, and 2.9–6.2%, respectively. cT1-3N0 ER+HER2− and cT3N0 triple-negative patients had the highest rate of positive SLN: 23.8–41.7% and 30.4%, respectively. Multivariable regression analysis showed that cT2 (odds ratio [OR] 1.93; 95% confidence interval [CI] 1.01–3.96), cT3 (OR 2.56; 95% CI 1.30–5.38), grade 3 (OR 0.44; 95% CI 0.21–0.91), and ER+HER2− subtype (OR 3.94; 95% CI 1.77–8.74) were correlated with positive SLN. Conclusions In cT1-3N0 ER+HER2+, cT1-3N0 ER−HER2+, and cT1-2N0 triple-negative patients treated with NST, immediate reconstruction can be considered an acceptable option due to low risk of positive SLN. In cT1-3N0 ER+HER2− and cT3N0 triple-negative patients treated with NST, risks and benefits of immediate reconstruction should be discussed with patients due to the relatively high risk of positive SLN.
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Affiliation(s)
- S Samiei
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands. .,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - B N van Kaathoven
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - L Boersma
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Radiation Oncology, Maastricht University Medical Center+ (MAASTRO Clinic), Maastricht, The Netherlands
| | - R W Y Granzier
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - S M E Engelen
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - L de Munck
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - R R J W van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
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