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Groheux D, Vaz SC, Ulaner GA, Cook GJR, Woll JPP, Mann RM, Poortmans P, Cardoso F, Jacene H, Graff SL, Rubio IT, Peeters MJV, Dibble EH, de Geus-Oei LF. Joint EANM-SNMMI guidelines on the role of 2-[ 18F]FDG PET/CT in no special type breast cancer: differences and agreements with European and American guidelines. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06694-x. [PMID: 38693453 DOI: 10.1007/s00259-024-06694-x] [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: 05/03/2024]
Affiliation(s)
- David Groheux
- Nuclear Medicine Department, Saint-Louis Hospital, Paris, France.
- University Paris-Diderot, INSERM U976, Paris, France.
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
| | - Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK
- King's College London and Guy's & St Thomas' PET Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Ritse M Mann
- Radiology Department, Radboud UMC, Nijmegen, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center at Brown University, Providence, RI, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Cancer Center Clinica Universidad de Navarra, Madrid, Spain
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
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van der Voort A, Louis FM, van Ramshorst MS, Kessels R, Mandjes IA, Kemper I, Agterof MJ, van der Steeg WA, Heijns JB, van Bekkum ML, Siemerink EJ, Kuijer PM, Scholten A, Wesseling J, Vrancken Peeters MJTFD, Mann RM, Sonke GS. MRI-guided optimisation of neoadjuvant chemotherapy duration in stage II-III HER2-positive breast cancer (TRAIN-3): a multicentre, single-arm, phase 2 study. Lancet Oncol 2024; 25:603-613. [PMID: 38588682 DOI: 10.1016/s1470-2045(24)00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Patients with stage II-III HER2-positive breast cancer have good outcomes with the combination of neoadjuvant chemotherapy and HER2-targeted agents. Although increasing the number of chemotherapy cycles improves pathological complete response rates, early complete responses are common. We investigated whether the duration of chemotherapy could be tailored on the basis of radiological response. METHODS TRAIN-3 is a single-arm, phase 2 study in 43 hospitals in the Netherlands. Patients with stage II-III HER2-positive breast cancer aged 18 years or older and a WHO performance status of 0 or 1 were enrolled. Patients received neoadjuvant chemotherapy consisting of paclitaxel (80 mg/m2 of body surface area on day 1 and 8 of each 21 day cycle), trastuzumab (loading dose on day 1 of cycle 1 of 8 mg/kg bodyweight, and then 6 mg/kg on day 1 on all subsequent cycles), and carboplatin (area under the concentration time curve 6 mg/mL per min on day 1 of each 3 week cycle) and pertuzumab (loading dose on day 1 of cycle 1 of 840 mg, and then 420 mg on day 1 of each subsequent cycle), all given intravenously. The response was monitored by breast MRI every three cycles and lymph node biopsy. Patients underwent surgery when a complete radiological response was observed or after a maximum of nine cycles of treatment. The primary endpoint was event-free survival at 3 years; however, follow-up for the primary endpoint is ongoing. Here, we present the radiological and pathological response rates (secondary endpoints) of all patients who underwent surgery and the toxicity data for all patients who received at least one cycle of treatment. Analyses were done in hormone receptor-positive and hormone receptor-negative patients separately. This trial is registered with ClinicalTrials.gov, number NCT03820063, recruitment is closed, and the follow-up for the primary endpoint is ongoing. FINDINGS Between April 1, 2019, and May 12, 2021, 235 patients with hormone receptor-negative cancer and 232 with hormone receptor-positive cancer were enrolled. Median follow-up was 26·4 months (IQR 22·9-32·9) for patients who were hormone receptor-negative and 31·6 months (25·6-35·7) for patients who were hormone receptor-positive. Overall, the median age was 51 years (IQR 43-59). In 233 patients with hormone receptor-negative tumours, radiological complete response was seen in 84 (36%; 95% CI 30-43) patients after one to three cycles, 140 (60%; 53-66) patients after one to six cycles, and 169 (73%; 66-78) patients after one to nine cycles. In 232 patients with hormone receptor-positive tumours, radiological complete response was seen in 68 (29%; 24-36) patients after one to three cycles, 118 (51%; 44-57) patients after one to six cycles, and 138 (59%; 53-66) patients after one to nine cycles. Among patients with a radiological complete response after one to nine cycles, a pathological complete response was seen in 147 (87%; 95% CI 81-92) of 169 patients with hormone receptor-negative tumours and was seen in 73 (53%; 44-61) of 138 patients with hormone receptor-positive tumours. The most common grade 3-4 adverse events were neutropenia (175 [37%] of 467), anaemia (75 [16%]), and diarrhoea (57 [12%]). No treatment-related deaths were reported. INTERPRETATION In our study, a third of patients with stage II-III hormone receptor-negative and HER2-positive breast cancer had a complete pathological response after only three cycles of neoadjuvant systemic therapy. A complete response on breast MRI could help identify early complete responders in patients who had hormone receptor negative tumours. An imaging-based strategy might limit the duration of chemotherapy in these patients, reduce side-effects, and maintain quality of life if confirmed by the analysis of the 3-year event-free survival primary endpoint. Better monitoring tools are needed for patients with hormone receptor-positive and HER2-positive breast cancer. FUNDING Roche Netherlands.
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Affiliation(s)
- Anna van der Voort
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Fleur M Louis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Mette S van Ramshorst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rob Kessels
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ingrid A Mandjes
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Inge Kemper
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Mariette J Agterof
- Department of Medical Oncology, St Antonius Hospital, Nieuwegein, Netherlands
| | | | - Joan B Heijns
- Department of Medical Oncology, Amphia, Breda, Netherlands
| | | | - Ester J Siemerink
- Department of Medical Oncology, Ziekenhuisgroep Twente, Hengelo, Netherlands
| | | | - Astrid Scholten
- Department of Radiation, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology and Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Pathology, University Medical Centre, Leiden, Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Medical Imaging, Radboud University Medical Center, Amsterdam, Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Medical Oncology, Amsterdam University Medical Centre, Amsterdam, Netherlands.
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Marcon M, Fuchsjäger MH, Clauser P, Mann RM. ESR Essentials: screening for breast cancer - general recommendations by EUSOBI. Eur Radiol 2024:10.1007/s00330-024-10740-5. [PMID: 38656711 DOI: 10.1007/s00330-024-10740-5] [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: 10/12/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/26/2024]
Abstract
Breast cancer is the most frequently diagnosed cancer in women accounting for about 30% of all new cancer cases and the incidence is constantly increasing. Implementation of mammographic screening has contributed to a reduction in breast cancer mortality of at least 20% over the last 30 years. Screening programs usually include all women irrespective of their risk of developing breast cancer and with age being the only determining factor. This approach has some recognized limitations, including underdiagnosis, false positive cases, and overdiagnosis. Indeed, breast cancer remains a major cause of cancer-related deaths in women undergoing cancer screening. Supplemental imaging modalities, including digital breast tomosynthesis, ultrasound, breast MRI, and, more recently, contrast-enhanced mammography, are available and have already shown potential to further increase the diagnostic performances. Use of breast MRI is recommended in high-risk women and women with extremely dense breasts. Artificial intelligence has also shown promising results to support risk categorization and interval cancer reduction. The implementation of a risk-stratified approach instead of a "one-size-fits-all" approach may help to improve the benefit-to-harm ratio as well as the cost-effectiveness of breast cancer screening. KEY POINTS: Regular mammography should still be considered the mainstay of the breast cancer screening. High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or US if MRI is not available. Women need to participate actively in the decision to undergo personalized screening. KEY RECOMMENDATIONS: Mammography is an effective imaging tool to diagnose breast cancer in an early stage and to reduce breast cancer mortality (evidence level I). Until more evidence is available to move to a personalized approach, regular mammography should be considered the mainstay of the breast cancer screening. High-risk women should start screening earlier; first with yearly breast MRI which can be supplemented by yearly or biennial mammography starting at 35-40 years old (evidence level I). Breast MRI screening should be also offered to women with extremely dense breasts (evidence level I). If MRI is not available, ultrasound can be performed as an alternative, although the added value of supplemental ultrasound regarding cancer detection remains limited. Individual screening recommendations should be made through a shared decision-making process between women and physicians.
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Affiliation(s)
- Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute of Radiology, Hospital Lachen, Oberdorfstrasse 41, 8853, Lachen, Switzerland.
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - 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, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Ritse M Mann
- Department of Diagnostic Imaging, Radboud University Medical Centre, Geert Grotteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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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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Alaeikhanehshir S, Voets MM, van Duijnhoven FH, Lips EH, Groen EJ, van Oirsouw MCJ, Hwang SE, Lo JY, Wesseling J, Mann RM, Teuwen J. Application of deep learning on mammographies to discriminate between low and high-risk DCIS for patient participation in active surveillance trials. Cancer Imaging 2024; 24:48. [PMID: 38576031 PMCID: PMC10996224 DOI: 10.1186/s40644-024-00691-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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Ductal Carcinoma In Situ (DCIS) can progress to invasive breast cancer, but most DCIS lesions never will. Therefore, four clinical trials (COMET, LORIS, LORETTA, AND LORD) test whether active surveillance for women with low-risk Ductal carcinoma In Situ is safe (E. S. Hwang et al., BMJ Open, 9: e026797, 2019, A. Francis et al., Eur J Cancer. 51: 2296-2303, 2015, Chizuko Kanbayashi et al. The international collaboration of active surveillance trials for low-risk DCIS (LORIS, LORD, COMET, LORETTA), L. E. Elshof et al., Eur J Cancer, 51, 1497-510, 2015). Low-risk is defined as grade I or II DCIS. Because DCIS grade is a major eligibility criteria in these trials, it would be very helpful to assess DCIS grade on mammography, informed by grade assessed on DCIS histopathology in pre-surgery biopsies, since surgery will not be performed on a significant number of patients participating in these trials. OBJECTIVE To assess the performance and clinical utility of a convolutional neural network (CNN) in discriminating high-risk (grade III) DCIS and/or Invasive Breast Cancer (IBC) from low-risk (grade I/II) DCIS based on mammographic features. We explored whether the CNN could be used as a decision support tool, from excluding high-risk patients for active surveillance. METHODS In this single centre retrospective study, 464 patients diagnosed with DCIS based on pre-surgery biopsy between 2000 and 2014 were included. The collection of mammography images was partitioned on a patient-level into two subsets, one for training containing 80% of cases (371 cases, 681 images) and 20% (93 cases, 173 images) for testing. A deep learning model based on the U-Net CNN was trained and validated on 681 two-dimensional mammograms. Classification performance was assessed with the Area Under the Curve (AUC) receiver operating characteristic and predictive values on the test set for predicting high risk DCIS-and high-risk DCIS and/ or IBC from low-risk DCIS. RESULTS When classifying DCIS as high-risk, the deep learning network achieved a Positive Predictive Value (PPV) of 0.40, Negative Predictive Value (NPV) of 0.91 and an AUC of 0.72 on the test dataset. For distinguishing high-risk and/or upstaged DCIS (occult invasive breast cancer) from low-risk DCIS a PPV of 0.80, a NPV of 0.84 and an AUC of 0.76 were achieved. CONCLUSION For both scenarios (DCIS grade I/II vs. III, DCIS grade I/II vs. III and/or IBC) AUCs were high, 0.72 and 0.76, respectively, concluding that our convolutional neural network can discriminate low-grade from high-grade DCIS.
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MESH Headings
- Humans
- Female
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Retrospective Studies
- Deep Learning
- Patient Participation
- Watchful Waiting
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Mammography
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
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Affiliation(s)
- Sena Alaeikhanehshir
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Surgery, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Madelon M Voets
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Health Services and Technology Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Esther H Lips
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Emma J Groen
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Shelley E Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joseph Y Lo
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jelle Wesseling
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Pathology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ritse M Mann
- Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Radiation Oncology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, USA.
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
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Cozzi A, Pinker K, Hidber A, Zhang T, Bonomo L, Lo Gullo R, Christianson B, Curti M, Rizzo S, Del Grande F, Mann RM, Schiaffino S. BI-RADS Category Assignments by GPT-3.5, GPT-4, and Google Bard: A Multilanguage Study. Radiology 2024; 311:e232133. [PMID: 38687216 DOI: 10.1148/radiol.232133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Background The performance of publicly available large language models (LLMs) remains unclear for complex clinical tasks. Purpose To evaluate the agreement between human readers and LLMs for Breast Imaging Reporting and Data System (BI-RADS) categories assigned based on breast imaging reports written in three languages and to assess the impact of discordant category assignments on clinical management. Materials and Methods This retrospective study included reports for women who underwent MRI, mammography, and/or US for breast cancer screening or diagnostic purposes at three referral centers. Reports with findings categorized as BI-RADS 1-5 and written in Italian, English, or Dutch were collected between January 2000 and October 2023. Board-certified breast radiologists and the LLMs GPT-3.5 and GPT-4 (OpenAI) and Bard, now called Gemini (Google), assigned BI-RADS categories using only the findings described by the original radiologists. Agreement between human readers and LLMs for BI-RADS categories was assessed using the Gwet agreement coefficient (AC1 value). Frequencies were calculated for changes in BI-RADS category assignments that would affect clinical management (ie, BI-RADS 0 vs BI-RADS 1 or 2 vs BI-RADS 3 vs BI-RADS 4 or 5) and compared using the McNemar test. Results Across 2400 reports, agreement between the original and reviewing radiologists was almost perfect (AC1 = 0.91), while agreement between the original radiologists and GPT-4, GPT-3.5, and Bard was moderate (AC1 = 0.52, 0.48, and 0.42, respectively). Across human readers and LLMs, differences were observed in the frequency of BI-RADS category upgrades or downgrades that would result in changed clinical management (118 of 2400 [4.9%] for human readers, 611 of 2400 [25.5%] for Bard, 573 of 2400 [23.9%] for GPT-3.5, and 435 of 2400 [18.1%] for GPT-4; P < .001) and that would negatively impact clinical management (37 of 2400 [1.5%] for human readers, 435 of 2400 [18.1%] for Bard, 344 of 2400 [14.3%] for GPT-3.5, and 255 of 2400 [10.6%] for GPT-4; P < .001). Conclusion LLMs achieved moderate agreement with human reader-assigned BI-RADS categories across reports written in three languages but also yielded a high percentage of discordant BI-RADS categories that would negatively impact clinical management. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Andrea Cozzi
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Katja Pinker
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Andri Hidber
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Tianyu Zhang
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Luca Bonomo
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Roberto Lo Gullo
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Blake Christianson
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Marco Curti
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Stefania Rizzo
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Filippo Del Grande
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Ritse M Mann
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
| | - Simone Schiaffino
- From the Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland (A.C., L.B., M.C., S.R., F.D.G., S.S.); Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (K.P., R.L.G., B.C.); Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (A.H., S.R., F.D.G., S.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (T.Z., R.M.M.); Department of Diagnostic Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (T.Z., R.M.M.); and GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (T.Z.)
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7
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Siebers CCN, Appelman L, Appelman PTM, Go S, van Oirsouw MCJ, Broeders MJM, Mann RM. Women's Experiences with Digital Breast Tomosynthesis and Targeted Breast Ultrasound for Focal Breast Complaints: A Survey Study. J Womens Health (Larchmt) 2024; 33:499-501. [PMID: 38386779 DOI: 10.1089/jwh.2023.0502] [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] [Indexed: 02/24/2024] Open
Abstract
Background: Owing to its high sensitivity, as concluded in the Breast UltraSound Trial (BUST), targeted ultrasound (US) now seems a promising accurate stand-alone modality for diagnostic evaluation of breast complaints. This approach implies omission of bilateral digital breast tomosynthesis (DBT) in women with clearly benign US findings. Within BUST, radiologists started with US followed by DBT. This side-study investigates women's experiences with DBT, their main motivation to undergo diagnostic imaging, and their view on US as a stand-alone modality. Methods: A subset of BUST participants completed a questionnaire on their DBT experiences, reason for undergoing diagnostic assessment, and view on US-only diagnostics. Responses were analyzed with descriptive statistics and logistic regression analyses. Results: In total, 778 of 838 women (response rate 92.8%) were included (M = 47, SD = 11.16). Of them, 16.8% reported no burden of DBT, 33.5% slight burden, 31.0% moderate, and 12.7% severe burden. Furthermore, 13% reported no pain, 35.3% slight pain, 33.2% moderate, and 11.3% severe pain. Moreover, 88.3% indicated that the most important reason for breast assessment was explanation of their complaint and to rule out breast cancer, whereas 3.2% wanted to "check" both breasts. And 82.4% reported satisfaction with US only in case of a nonmalignancy. Conclusions: Our study shows that most women in the diagnostic setting experience at least slight-to-moderate DBT-related burden and pain, and that explanation for their symptoms is their main interest. Also, the majority report satisfaction with US only in case of nonmalignant findings. However, exploration of women's perspectives outside this study is needed as our participants all underwent both examinations.
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Affiliation(s)
- Carmen C N Siebers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter T M Appelman
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Shirley Go
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Marja C J van Oirsouw
- Patient advocate on behalf of the Dutch Breast Cancer Society (Borstkankervereniging Nederland), Utrecht, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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8
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Zhang T, Mann RM. Contrast-enhanced mammography: better with AI? Eur Radiol 2024; 34:914-916. [PMID: 37667143 DOI: 10.1007/s00330-023-10190-5] [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: 08/04/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Tianyu Zhang
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands.
- GROW School for Oncology and Development Biology, Maastricht University, Maastricht, The Netherlands.
| | - Ritse M Mann
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands.
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9
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Kočo L, Siebers CCN, Schlooz M, Meeuwis C, Oldenburg HSA, Prokop M, Mann RM. The Facilitators and Barriers of the Implementation of a Clinical Decision Support System for Breast Cancer Multidisciplinary Team Meetings-An Interview Study. Cancers (Basel) 2024; 16:401. [PMID: 38254891 PMCID: PMC10813995 DOI: 10.3390/cancers16020401] [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: 12/07/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AI-driven clinical decision support systems (CDSSs) hold promise for multidisciplinary team meetings (MDTMs). This study aimed to uncover the hurdles and aids in implementing CDSSs during breast cancer MDTMs. METHODS Twenty-four core team members from three hospitals engaged in semi-structured interviews, revealing a collective interest in experiencing CDSS workflows in clinical practice. All interviews were audio recorded, transcribed verbatim and analyzed anonymously. A standardized approach, 'the framework method', was used to create an analytical framework for data analysis, which was performed by two independent researchers. RESULTS Positive aspects included improved data visualization, time-saving features, automated trial matching, and enhanced documentation transparency. However, challenges emerged, primarily concerning data connectivity, guideline updates, the accuracy of AI-driven suggestions, and the risk of losing human involvement in decision making. Despite the complexities involved in CDSS development and integration, clinicians demonstrated enthusiasm to explore its potential benefits. CONCLUSIONS Acknowledging the multifaceted nature of this challenge, insights into the barriers and facilitators identified in this study offer a potential roadmap for smoother future implementations. Understanding these factors could pave the way for more effective utilization of CDSSs in breast cancer MDTMs, enhancing patient care through informed decision making.
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Affiliation(s)
- Lejla Kočo
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carmen C. N. Siebers
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carla Meeuwis
- Department of Radiology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands;
| | - Hester S. A. Oldenburg
- Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mathias Prokop
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ritse M. Mann
- Department of Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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10
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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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Kočo L, Balkenende L, Appelman L, Moman MR, Sponsel A, Schimanski M, Prokop M, Mann RM. Optimized, Person-Centered Workflow Design for a High-Throughput Breast MRI Screening Facility-A Simulation Study. Invest Radiol 2024:00004424-990000000-00188. [PMID: 38193779 DOI: 10.1097/rli.0000000000001059] [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] [Indexed: 01/10/2024]
Abstract
OBJECTIVES This project aims to model an optimal scanning environment for breast magnetic resonance imaging (MRI) screening based on real-life data to identify to what extent the logistics of breast MRI can be optimized. MATERIALS AND METHODS A novel concept for a breast MRI screening facility was developed considering layout of the building, workflow steps, used resources, and MRI protocols. The envisioned screening facility is person centered and aims for an efficient workflow-oriented design. Real-life data, collected from existing breast MRI screening workflows, during 62 scans in 3 different hospitals, were imported into a 3D simulation software for designing and testing new concepts. The model provided several realistic, virtual, logistical pathways for MRI screening and their outcome measures: throughput, waiting times, and other relevant variables. RESULTS The total average appointment time in the baseline scenario was 25:54 minutes, with 19:06 minutes of MRI room occupation. Simulated improvements consisted of optimizing processes and resources, facility layout, and scanning protocol. In the simulation, time spent in the MRI room was reduced by introducing an optimized facility layout, dockable tables, and adoption of an abbreviated MRI scanning protocol. The total average appointment time was reduced to 19:36 minutes, and in this scenario, the MRI room was occupied for 06:21 minutes. In the most promising scenario, screening of about 68 people per day (10 hours) on a single MRI scanner could be feasible, compared with 36 people per day in the baseline scenario. CONCLUSIONS This study suggests that by optimizing workflow MRI for breast screening total appointment duration and MRI occupation can be reduced. A throughput of up to 6 people per hour may be achieved, compared with 3 people per hour in the current setup.
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Affiliation(s)
- Lejla Kočo
- From the Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (L.K., L.A., M.P., R.M.M.); Department of Radiology, The Netherlands Cancer Institute (Antoni van Leeuwenhoek), Amsterdam, the Netherlands (L.B., R.M.M.); Department of Radiology, Alexander Monro Hospital, Bilthoven, the Netherlands (L.A., M.R.M.); and Siemens Healthcare GmbH, Erlangen, Germany (A.S., M.S.)
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12
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van Leeuwen MM, Doyle S, van den Belt-Dusebout AW, van der Mierden S, Loo CE, Mann RM, Teuwen J, Wesseling J. Clinicopathological and prognostic value of calcification morphology descriptors in ductal carcinoma in situ of the breast: a systematic review and meta-analysis. Insights Imaging 2023; 14:213. [PMID: 38051355 DOI: 10.1186/s13244-023-01529-z] [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: 05/12/2023] [Accepted: 09/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Calcifications on mammography can be indicative of breast cancer, but the prognostic value of their appearance remains unclear. This systematic review and meta-analysis aimed to evaluate the association between mammographic calcification morphology descriptors (CMDs) and clinicopathological factors. METHODS A comprehensive literature search in Medline via Ovid, Embase.com, and Web of Science was conducted for articles published between 2000 and January 2022 that assessed the relationship between CMDs and clinicopathological factors, excluding case reports and review articles. The risk of bias and overall quality of evidence were evaluated using the QUIPS tool and GRADE. A random-effects model was used to synthesize the extracted data. This systematic review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS Among the 4715 articles reviewed, 29 met the inclusion criteria, reporting on 17 different clinicopathological factors in relation to CMDs. Heterogeneity between studies was present and the overall risk of bias was high, primarily due to small, inadequately described study populations. Meta-analysis demonstrated significant associations between fine linear calcifications and high-grade DCIS [pooled odds ratio (pOR), 4.92; 95% confidence interval (CI), 2.64-9.17], (comedo)necrosis (pOR, 3.46; 95% CI, 1.29-9.30), (micro)invasion (pOR, 1.53; 95% CI, 1.03-2.27), and a negative association with estrogen receptor positivity (pOR, 0.33; 95% CI, 0.12-0.89). CONCLUSIONS CMDs detected on mammography have prognostic value, but there is a high level of bias and variability between current studies. In order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary. CRITICAL RELEVANCE STATEMENT Mammographic calcification morphology descriptors (CMDs) have prognostic value, but in order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary. SYSTEMATIC REVIEW REGISTRATION CRD42022341599 KEY POINTS: • Mammographic calcifications can be indicative of breast cancer. • The prognostic value of mammographic calcifications is still unclear. • Specific mammographic calcification morphologies are related to lesion aggressiveness. • Variability between studies necessitates standardization in calcification evaluation to achieve clinical utility.
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Affiliation(s)
- Merle M van Leeuwen
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Shannon Doyle
- Division of Radiation Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Stevie van der Mierden
- Scientific Information Services, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Claudette E Loo
- Department of Radiology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Imaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jonas Teuwen
- Division of Radiation Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Imaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands.
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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13
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Mann RM. Breast screening: "If you really want to see it, you just make an MRI". Eur Radiol 2023; 33:8410-8412. [PMID: 38041388 DOI: 10.1007/s00330-023-09890-9] [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: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
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van der Hoogt KJJ, Schipper RJ, Wessels R, Ter Beek LC, Beets-Tan RGH, Mann RM. Breast DWI Analyzed Before and After Gadolinium Contrast Administration-An Intrapatient Analysis on 1.5 T and 3.0 T. Invest Radiol 2023; 58:832-841. [PMID: 37389456 DOI: 10.1097/rli.0000000000000999] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Diffusion-weighted magnetic resonance imaging (MRI) is gaining popularity as an addition to standard dynamic contrast-enhanced breast MRI. Although adding diffusion-weighted imaging (DWI) to the standard protocol design would require increased scanning-time, implementation during the contrast-enhanced phase could offer a multiparametric MRI protocol without any additional scanning time. However, gadolinium within a region of interest (ROI) might affect assessments of DWI. This study aims to determine if acquiring DWI postcontrast, incorporated in an abbreviated MRI protocol, would statistically significantly affect lesion classification. In addition, the effect of postcontrast DWI on breast parenchyma was studied. MATERIALS AND METHODS Screening or preoperative MRIs (1.5 T/3 T) were included for this study. Diffusion-weighted imaging was acquired with single-shot spin echo-echo planar imaging before and at approximately 2 minutes after gadoterate meglumine injection. Apparent diffusion coefficients (ADCs) based on 2-dimensional ROIs of fibroglandular tissue, as well as benign and malignant lesions at 1.5 T/3.0 T, were compared with a Wilcoxon signed rank test. Diffusivity levels were compared between precontrast and postcontrast DWI with weighted κ. An overall P ≤ 0.05 was considered statistically significant. RESULTS No significant changes were observed in ADC mean after contrast administration in 21 patients with 37 ROI of healthy fibroglandular tissue and in the 93 patients with 93 (malignant and benign) lesions. This effect remained after stratification on B 0 . In 18% of all lesions, a diffusion level shift was observed, with an overall weighted κ of 0.75. CONCLUSIONS This study supports incorporating DWI at 2 minutes postcontrast when ADC is calculated based on b150-b800 with 15 mL 0.5 M gadoterate meglumine in an abbreviated multiparametric MRI protocol without requiring extra scan time.
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Affiliation(s)
- Kay J J van der Hoogt
- From the Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands (K.J.J.H., R.-J.S., R.W., R.G.H.B., R.M.M.); GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands (K.J.J.H., R.G.H.B.); Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands (R.-J.S.); Department of Medical Physics, the Netherlands Cancer Institute, Amsterdam, the Netherlands (L.C.B.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (R.M.M.); and Danish Colorectal Cancer Unit South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark (R.G.H.B.)
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15
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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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Michalopoulou E, Clauser P, Gilbert FJ, Pijnappel RM, Mann RM, Baltzer PAT, Chen Y, Fallenberg EM. A survey by the European Society of Breast Imaging on radiologists' preferences regarding quality assurance measures of image interpretation in screening and diagnostic mammography. Eur Radiol 2023; 33:8103-8111. [PMID: 37481690 PMCID: PMC10598074 DOI: 10.1007/s00330-023-09973-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Quality assurance (QA) of image interpretation plays a key role in screening and diagnostic mammography, maintaining minimum standards and supporting continuous improvement in interpreting images. However, the QA structure across Europe shows considerable variation. The European Society of Breast Imaging (EUSOBI) conducted a survey among the members to collect information on radiologists' preferences regarding QA measures in mammography. MATERIALS AND METHODS An anonymous online survey consisting of 25 questions was distributed to all EUSOBI members and national breast radiology bodies in Europe. The questions were designed to collect demographic characteristics, information on responders' mammography workload and data about QA measures currently used in their country. Data was analysed using descriptive statistical analysis, the χ2 test, linear regression, and Durbin-Watson statistic test. RESULTS In total, 251 breast radiologists from 34 countries completed the survey. Most respondents were providing both screening and symptomatic services (137/251, 54.6%), working in an academic hospital (85/251, 33.9%) and reading 1000-4999 cases per year (109/251, 43.4%). More than half of them (133/251, 53%) had established QA measures in their workplace. Although less than one-third (71/251, 28.3%) had to participate in regular performance testing, the vast majority (190/251, 75.7%) agreed that a mandatory test would be helpful to improve their skills. CONCLUSION QA measures were in place for more than half of the respondents working in screening and diagnostic mammography to evaluate their breast imaging performance. Although there were substantial differences between countries, the importance of having QA in the workplace and implemented was widely acknowledged by radiologists. CLINICAL RELEVANCE STATEMENT Although several quality assurance (QA) measures of image interpretation are recommended by European bodies or national organisations, the QA in mammography is quite heterogenous between countries and reporting settings, and not always actively implemented across Europe. KEY POINTS The first survey that presents radiologists' preferences regarding QA measures of image interpretation in mammography. Quality assurance measures in the workplace are better-established for breast screening compared to diagnostic mammography. Radiologists consider that performance tests would help to improve their mammography interpretation skills.
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Affiliation(s)
- Eleni Michalopoulou
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Fiona J Gilbert
- Department of Radiology, Clinical School, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ruud M Pijnappel
- University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584, Utrecht, CX, The Netherlands
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538, Nijmegen, SW, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Centre, 6525, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Yan Chen
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, München, Germany
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Mann RM, Teuwen J. Beyond the AJR: A Breakthrough in the Use of Artificial Intelligence for Mammography in Screening for Breast Cancer. AJR Am J Roentgenol 2023. [PMID: 37850578 DOI: 10.2214/ajr.23.30359] [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: 10/19/2023]
Affiliation(s)
- Ritse M Mann
- Department of medical imaging, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jonas Teuwen
- Department of medical imaging, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of radiation oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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18
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Schmitz RSJM, Engelhardt EG, Gerritsma MA, Sondermeijer CMT, Verschuur E, Houtzager J, Griffioen R, Retèl V, Bijker N, Mann RM, van Duijnhoven F, Wesseling J, Bleiker EMA. Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial. Eur J Cancer 2023; 192:113276. [PMID: 37657228 PMCID: PMC10632767 DOI: 10.1016/j.ejca.2023.113276] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) can progress to invasive breast cancer (IBC), but most DCIS lesions remain indolent. However, guidelines recommend surgery, often supplemented by radiotherapy. This implies overtreatment of indolent DCIS. The non-randomised patient preference LORD-trial tests whether active surveillance (AS) for low-risk DCIS is safe, by giving women with low-risk DCIS a choice between AS and conventional treatment (CT). Here, we aim to describe how participants are distributed among both trial arms, identify their motives for their preference, and assess factors associated with their choice. METHODS Data were extracted from baseline questionnaires. Descriptive statistics were used to assess the distribution and characteristics of participants; thematic analyses to extract self-reported reasons for the choice of trial arm, and multivariable logistic regression analyses to investigate associations between patient characteristics and chosen trial arm. RESULTS Of 377 women included, 76% chose AS and 24% CT. Most frequently cited reasons for AS were "treatment is not (yet) necessary" (59%) and trust in the AS-plan (39%). Reasons for CT were cancer worry (51%) and perceived certainty (29%). Women opting for AS more often had lower educational levels (OR 0.45; 95% confidence interval [CI], 0.22-0.93) and more often reported experiencing shared decision making (OR 2.71; 95% CI, 1.37-5.37) than women choosing CT. CONCLUSION The LORD-trial is the first to offer women with low-risk DCIS a choice between CT and AS. Most women opted for AS and reported high levels of trust in the safety of AS. Their preferences highlight the necessity to establish the safety of AS for low-risk DCIS.
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Affiliation(s)
- Renée S J M Schmitz
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Ellen Verschuur
- Dutch Breast Cancer Society ('Borstkanker Vereniging Nederland'), Utrecht, the Netherlands
| | - Julia Houtzager
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rosalie Griffioen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands.
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19
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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20
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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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21
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Zhang T, Tan T, Wang X, Gao Y, Han L, Balkenende L, D'Angelo A, Bao L, Horlings HM, Teuwen J, Beets-Tan RGH, Mann RM. RadioLOGIC, a healthcare model for processing electronic health records and decision-making in breast disease. Cell Rep Med 2023; 4:101131. [PMID: 37490915 PMCID: PMC10439251 DOI: 10.1016/j.xcrm.2023.101131] [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: 01/20/2023] [Revised: 05/26/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
Digital health data used in diagnostics, patient care, and oncology research continue to accumulate exponentially. Most medical information, and particularly radiology results, are stored in free-text format, and the potential of these data remains untapped. In this study, a radiological repomics-driven model incorporating medical token cognition (RadioLOGIC) is proposed to extract repomics (report omics) features from unstructured electronic health records and to assess human health and predict pathological outcome via transfer learning. The average accuracy and F1-weighted score for the extraction of repomics features using RadioLOGIC are 0.934 and 0.934, respectively, and 0.906 and 0.903 for the prediction of breast imaging-reporting and data system scores. The areas under the receiver operating characteristic curve for the prediction of pathological outcome without and with transfer learning are 0.912 and 0.945, respectively. RadioLOGIC outperforms cohort models in the capability to extract features and also reveals promise for checking clinical diagnoses directly from electronic health records.
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Affiliation(s)
- Tianyu Zhang
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Development Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
| | - Tao Tan
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Faculty of Applied Sciences, Macao Polytechnic University, Macao 999078, China.
| | - Xin Wang
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Development Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
| | - Yuan Gao
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Development Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
| | - Luyi Han
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
| | - Luuk Balkenende
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
| | - Anna D'Angelo
- Dipartimento di diagnostica per immagini, Radioterapia, Oncologia ed ematologia, Fondazione Universitaria A. Gemelli, IRCCS Roma, Roma, Italy
| | - Lingyun Bao
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hugo M Horlings
- Division of Pathology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Jonas Teuwen
- Department of Radiation Oncology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Development Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands
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22
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Schiaffino S, Pinker K, Cozzi A, Magni V, Athanasiou A, Baltzer PAT, Camps Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Gilbert FJ, Helbich T, Kilburn-Toppin F, Kuhl CK, Lesaru M, Mann RM, Panizza P, Pediconi F, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Pijnappel RM. European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision. Insights Imaging 2023; 14:126. [PMID: 37466753 DOI: 10.1186/s13244-023-01453-2] [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: 03/01/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023] Open
Abstract
Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - 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.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Pascal A T Baltzer
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Thomas Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Elfgen C, Leo C, Kubik-Huch RA, Muenst S, Schmidt N, Quinn C, McNally S, van Diest PJ, Mann RM, Bago-Horvath Z, Bernathova M, Regitnig P, Fuchsjäger M, Schwegler-Guggemos D, Maranta M, Zehbe S, Tausch C, Güth U, Fallenberg EM, Schrading S, Kothari A, Sonnenschein M, Kampmann G, Kulka J, Tille JC, Körner M, Decker T, Lax SF, Daniaux M, Bjelic-Radisic V, Kacerovsky-Strobl S, Condorelli R, Gnant M, Varga Z. Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Virchows Arch 2023:10.1007/s00428-023-03566-x. [PMID: 37330436 DOI: 10.1007/s00428-023-03566-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.
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Affiliation(s)
- Constanze Elfgen
- Breast-Center Zurich, Zurich, Switzerland.
- University of Witten-Herdecke, Witten, Germany.
| | - Cornelia Leo
- Breast Center, Kantonsspital Baden, Baden, Switzerland
| | | | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Noemi Schmidt
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Cecily Quinn
- Irish National Breast Screening Program & Department of Histopathology, St. Vincent's University Hospital Dublin and School of Medicine, University College Dublin, Dublin, Ireland
| | - Sorcha McNally
- Radiology Department, St. Vincent University Hospital, Dublin, Ireland
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maria Bernathova
- Department of Radiology and Nuclear Medicine, Medical University Vienna, Vienna, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | | | - Martina Maranta
- Department of Gynecology, County Hospital Chur, Chur, Switzerland
| | - Sabine Zehbe
- Radiology Section, Breast Center Stephanshorn, St. Gallen, Switzerland
| | | | - Uwe Güth
- Breast-Center Zurich, Zurich, Switzerland
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Simone Schrading
- Department of Radiology, County Hospital Lucerne, Lucerne, Switzerland
| | - Ashutosh Kothari
- Breast Surgery Unit, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | | | - Gert Kampmann
- Centro di Radiologia e Senologia Luganese, Lugano, Switzerland
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University Budapest, Budapest, Hungary
| | | | | | - Thomas Decker
- Breast Pathology, Reference Centers Mammography Münster, University Hospital Münster, Münster, Germany
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, and School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Martin Daniaux
- BrustGesundheitZentrum Tirol, University Hospital Innsbruck, Innsbruck, Austria
| | - Vesna Bjelic-Radisic
- University of Witten-Herdecke, Witten, Germany
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Witten, Germany
| | | | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
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24
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Warne MSJ, Neelamraju C, Strauss J, Turner RDR, Smith RA, Mann RM. Estimating the aquatic risk from exposure to up to twenty-two pesticide active ingredients in waterways discharging to the Great Barrier Reef. Sci Total Environ 2023:164632. [PMID: 37295533 DOI: 10.1016/j.scitotenv.2023.164632] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Pesticides decrease the quality of water reaching the Great Barrier Reef (GBR), Australia. Up to 86 pesticide active ingredients (PAIs) were monitored between July 2015 to end of June 2018 at 28 sites in waterways that discharge to the GBR. Twenty-two frequently detected PAIs were selected to calculate their combined risk when they co-occur in water samples. Species sensitivity distributions (SSDs) for the 22 PAIs to fresh and marine species were developed. The SSDs, the multi-substance potentially affected fraction (msPAF) method, Independent Action model of joint toxicity and a Multiple Imputation method were combined to convert measured PAI concentration data to estimates of the Total Pesticide Risk for the 22 PAIs (TPR22) expressed as the average percentage of species affected during the wet season (i.e., 182 days). The TPR22 and percent contribution of active ingredients of Photosystem II inhibiting herbicides, Other Herbicides, and Insecticides to the TPR22 were estimated. The TPR22 ranged from <1 % to 42 % of aquatic species being affected. Approximately 85 % of the TPR22 estimates were >1 % - meaning they did not meet the Reef 2050 Water Quality Improvement Plan's pesticide target for waters entering the GBR. There were marked spatial differences in TPR22 estimates - regions dominated by grazing had lower estimates while those with sugar cane tended to have higher estimates. On average, active ingredients of PSII herbicides contributed 39 % of the TPR22, the active ingredients of Other Herbicides contributed ~36 % and of Insecticides contributed ~24 %. Nine PAIs (diuron, imidacloprid, metolachlor, atrazine, MCPA, imazapic, metsulfuron, triclopyr and ametryn) were responsible for >97 % of TPR22 across all the monitored waterways.
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Affiliation(s)
- M St J Warne
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland, Australia; Department of Environment and Science, Brisbane, Queensland, Australia; Centre for Agroecology, Water and Resilience, Coventry University, West Midlands, United Kingdom.
| | - C Neelamraju
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland, Australia; Department of Environment and Science, Brisbane, Queensland, Australia
| | - J Strauss
- Department of Environment and Science, Brisbane, Queensland, Australia
| | - R D R Turner
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland, Australia; Department of Environment and Science, Brisbane, Queensland, Australia; Institute for Future Environments, Queensland University of Technology, Brisbane, Queensland, Australia
| | - R A Smith
- Department of Environment and Science, Brisbane, Queensland, Australia
| | - R M Mann
- Department of Environment and Science, Brisbane, Queensland, Australia
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25
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Mann RM, Sechopoulos I. Risk Prediction in Mammography: Detecting Cancers before They Become Clinically Apparent. Radiology 2023; 307:e231137. [PMID: 37310245 DOI: 10.1148/radiol.231137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ritse M Mann
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (R.M.M., I.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Technical Medical Centre, University of Twente, Enschede, the Netherlands (I.S.); and Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Ioannis Sechopoulos
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands (R.M.M., I.S.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Technical Medical Centre, University of Twente, Enschede, the Netherlands (I.S.); and Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
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26
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Yoon JH, Strand F, Baltzer PAT, Conant EF, Gilbert FJ, Lehman CD, Morris EA, Mullen LA, Nishikawa RM, Sharma N, Vejborg I, Moy L, Mann RM. Standalone AI for Breast Cancer Detection at Screening Digital Mammography and Digital Breast Tomosynthesis: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e222639. [PMID: 37219445 PMCID: PMC10315526 DOI: 10.1148/radiol.222639] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [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: 10/14/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
Background There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically evaluate the performance of AI before it can become a modality used for independent mammographic interpretation. Purpose To evaluate the reported standalone performances of AI for interpretation of digital mammography and digital breast tomosynthesis (DBT). Materials and Methods A systematic search was conducted in PubMed, Google Scholar, Embase (Ovid), and Web of Science databases for studies published from January 2017 to June 2022. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) values were reviewed. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Comparative (QUADAS-2 and QUADAS-C, respectively). A random effects meta-analysis and meta-regression analysis were performed for overall studies and for different study types (reader studies vs historic cohort studies) and imaging techniques (digital mammography vs DBT). Results In total, 16 studies that include 1 108 328 examinations in 497 091 women were analyzed (six reader studies, seven historic cohort studies on digital mammography, and four studies on DBT). Pooled AUCs were significantly higher for standalone AI than radiologists in the six reader studies on digital mammography (0.87 vs 0.81, P = .002), but not for historic cohort studies (0.89 vs 0.96, P = .152). Four studies on DBT showed significantly higher AUCs in AI compared with radiologists (0.90 vs 0.79, P < .001). Higher sensitivity and lower specificity were seen for standalone AI compared with radiologists. Conclusion Standalone AI for screening digital mammography performed as well as or better than radiologists. Compared with digital mammography, there is an insufficient number of studies to assess the performance of AI systems in the interpretation of DBT screening examinations. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Scaranelo in this issue.
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Affiliation(s)
- Jung Hyun Yoon
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Fredrik Strand
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Pascal A. T. Baltzer
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Emily F. Conant
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Fiona J. Gilbert
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Constance D. Lehman
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Elizabeth A. Morris
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Lisa A. Mullen
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Robert M. Nishikawa
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Nisha Sharma
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Ilse Vejborg
- From the Department of Radiology, Severance Hospital, Research
Institute of Radiological Science, Yonsei University, College of Medicine, 50
Yonsei-ro, Seodaemun-gu, 03722 Seoul, Korea (J.H.Y.); Department of Oncology and
Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of
Radiology, Unit of Breast Imaging, Karolinska University Hospital, Stockholm,
Sweden (F.S.); Department of Biomedical Imaging and Image-guided Therapy,
Medical University of Vienna, Vienna, Austria (P.A.T.B.); Department of
Radiology, University of Pennsylvania, Philadelphia, Pa (E.F.C.); Department of
Radiology, University of Cambridge, Cambridge, UK (F.J.G.); Department of
Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
(C.D.L.); Department of Radiology, University of California Davis, Davis, Calif
(E.A.M.); Department of Radiology, Breast Imaging Division, Johns Hopkins
Medicine, Baltimore, Md (L.A.M.); Department of Radiology, University of
Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, Pa (R.M.N.); Department of
Radiology, St James Hospital, Leeds, UK (N.S.); Department of Breast
Examinations, Copenhagen University Hospital Herlev-Gentofte, Copenhagen,
Denmark (I.V.); Department of Radiology, Laura and Isaac Perlmutter Cancer
Center, Center for Biomedical Imaging, Center for Advanced Imaging Innovation
and Research, New York University Grossman School of Medicine, New York, NY
(L.M.); Department of Medical Imaging, Radboud University Medical Center,
Nijmegen, the Netherlands (R.M.M.); and Department of Radiology, Netherlands
Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | | | | |
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27
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Appelman L, Siebers CCN, Appelman PTM, Go HLS, Broeders MJM, van Oirsouw MCJ, Bult P, Mann RM. US and Digital Breast Tomosynthesis in Women with Focal Breast Complaints: Results of the Breast US Trial (BUST). Radiology 2023; 307:e220361. [PMID: 37014237 DOI: 10.1148/radiol.220361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Background Digital breast tomosynthesis (DBT) followed by targeted US is commonly performed to evaluate women with localized breast complaints. However, the added value of DBT in addition to targeted US is unknown. Omitting DBT may be cost-effective and improve patient comfort but may miss potential breast cancer. Purpose To assess whether an imaging protocol consisting of targeted US alone may be feasible for the diagnostic work-up of women with localized symptoms and to assess the supplemental value of DBT in this reversed setting. Materials and Methods This prospective study enrolled consecutive women aged 30 years or older with focal breast complaints in three hospitals in the Netherlands between September 2017 and June 2019. In all participants, first, targeted US was evaluated, and if needed, biopsy was performed, followed by DBT. The primary outcome was the frequency of breast cancer detected with DBT when US was negative. Secondary outcomes were frequency of cancer detected with DBT elsewhere in the breast and combined overall sensitivity of US plus DBT. The reference standard was 1 year follow-up or histopathologic examination. Results There were 1961 women (mean age ± SD, 47 years ± 12) enrolled. Based on initial US alone, 1587 participants (81%) had normal or benign findings and 1759 (90%) had a definitive accurate diagnosis. In total, 204 breast cancers were detected during initial work-up. The frequency of malignancy was 10% (192 of 1961 participants) with US (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT depicted three unobserved malignant lesions at the complaint site and 0.41% (eight of 1961 participants) of incidental malignant findings in participants without symptomatic cancer. Conclusion Compared with combined US and DBT, US was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints. The rate of cancer detection of cancers elsewhere in the breast with DBT is comparable to cancer detection rate of screening mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Newell in this issue.
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Affiliation(s)
- Linda Appelman
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Carmen C N Siebers
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Peter T M Appelman
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - H L Shirley Go
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Mireille J M Broeders
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Marja C J van Oirsouw
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Peter Bult
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
| | - Ritse M Mann
- From the Department of Radiology and Nuclear Medicine (L.A., C.C.N.S., R.M.M.), Radboud Institute for Health Sciences (M.J.M.B.), and Department of Pathology (P.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology, St Antonius Hospital, Utrecht, the Netherlands (P.T.M.A.); Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (H.L.S.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B.); Dutch Breast Cancer Society (Borstkankervereniging), Utrecht, the Netherlands (M.C.J.v.O.); and Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.)
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28
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Zhang T, Tan T, Han L, Appelman L, Veltman J, Wessels R, Duvivier KM, Loo C, Gao Y, Wang X, Horlings HM, Beets-Tan RGH, Mann RM. Predicting breast cancer types on and beyond molecular level in a multi-modal fashion. NPJ Breast Cancer 2023; 9:16. [PMID: 36949047 PMCID: PMC10033710 DOI: 10.1038/s41523-023-00517-2] [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: 05/27/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023] Open
Abstract
Accurately determining the molecular subtypes of breast cancer is important for the prognosis of breast cancer patients and can guide treatment selection. In this study, we develop a deep learning-based model for predicting the molecular subtypes of breast cancer directly from the diagnostic mammography and ultrasound images. Multi-modal deep learning with intra- and inter-modality attention modules (MDL-IIA) is proposed to extract important relations between mammography and ultrasound for this task. MDL-IIA leads to the best diagnostic performance compared to other cohort models in predicting 4-category molecular subtypes with Matthews correlation coefficient (MCC) of 0.837 (95% confidence interval [CI]: 0.803, 0.870). The MDL-IIA model can also discriminate between Luminal and Non-Luminal disease with an area under the receiver operating characteristic curve of 0.929 (95% CI: 0.903, 0.951). These results significantly outperform clinicians' predictions based on radiographic imaging. Beyond molecular-level test, based on gene-level ground truth, our method can bypass the inherent uncertainty from immunohistochemistry test. This work thus provides a noninvasive method to predict the molecular subtypes of breast cancer, potentially guiding treatment selection for breast cancer patients and providing decision support for clinicians.
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Affiliation(s)
- Tianyu Zhang
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Tao Tan
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Faculty of Applied Sciences, Macao Polytechnic University, 999078, Macao SAR, China.
| | - Luyi Han
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Linda Appelman
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jeroen Veltman
- Department of Radiology, Hospital Group Twente (ZGT), Almelo, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Ronni Wessels
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Katya M Duvivier
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Claudette Loo
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Yuan Gao
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Xin Wang
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Hugo M Horlings
- Division of Pathology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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van der Voort A, van Ramshorst MS, Kessels R, Mandjes IA, Kemper I, Agterof MJ, van der Steeg WA, Heijns JB, van Bekkum ML, Siemerink EJ, Kuijer PM, Scholten A, Wesseling J, Peeters MJTV, Mann RM, Sonke GS. Abstract PD18-06: Image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer: radiologic and pathologic complete response (pCR) rates in the multicenter phase 2 TRAIN-3 study (BOOG 2018-01). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd18-06] [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] [Indexed: 03/06/2023]
Abstract
Abstract
Background pCR rates in stage II – III HER2-positive breast cancer have greatly improved since the addition of HER2 targeted agents to neoadjuvant chemotherapy and are associated with excellent long-term survival. While longer treatment regimens increase pCR rate, early complete responses are also common. We evaluated an image-guided approach to tailor chemotherapy duration based on the identification of early complete responders.
Methods 45 hospitals across the Netherlands participated in the phase 2 TRAIN-3 trial. Patients received neoadjuvant systemic treatment consisting of paclitaxel, trastuzumab, carboplatin and pertuzumab (PTC-Ptz). Response to treatment was monitored every three cycles and patients were referred for surgery in case of a radiologic complete response (rCR) or after a maximum of 9 cycles. RCR was defined as the absence of pathological enhancement on MRI breast plus negative vacuum assisted core biopsies in case of hormone-receptor positive (HR+) tumors. In addition, negative fine needle aspiration or lymph node biopsy was required in patients with nodal involvement at baseline. The primary endpoint was 3-year event-free survival (EFS). Here, we report locally assessed rCR and pCR rates after 3, 6 and 9 cycles, the negative predictive value of rCR assessment and the incidence of adverse events (AEs). Analyses are stratified by HR-status.
Results We included 467 patients between April 2019 and May 2021. Median age was 51 years, 69% had stage II disease and 232 had HR+ tumors. 33.6% of HR- patients and 15.5% of HR+ patients achieved pCR after 3 cycles of PTC-Ptz (see table). The NPV was higher in HR- patients and independent of the number of cycles. AE evaluation is currently ongoing.
Conclusion Three cycles of PTC-Ptz induce an early pCR in one in three HR- and one in six HR+ tumors in patients with stage II-III HER2+ breast cancer. Dynamic contrast enhanced MRI-based response evaluation identifies these patients with ±87% certainty in HR- disease and ±58% in HR+ disease. Continuation of PTC-Ptz after 6 cycles further improves pCR rates and can be considered to reduce the need for adjuvant T-DM1. Efficacy and safety of this image-guided approach to tailor treatment duration need to be confirmed with follow-up in EFS and OS analyses.
Table 1: Cumulative rCR & pCR according to HR-status *Including patients who underwent surgery for other reasons than rCR
Citation Format: Anna van der Voort, Mette S. van Ramshorst, Rob Kessels, Ingrid A. Mandjes, Inge Kemper, Mariëtte J. Agterof, Wim A. van der Steeg, Joan B. Heijns, Marlies L. van Bekkum, Ester J. Siemerink, Philomeen M. Kuijer, Astrid Scholten, Jelle Wesseling, Marie-Jeanne T.F.D. Vrancken Peeters, Ritse M. Mann, Gabe S. Sonke. Image-guided optimization of neoadjuvant chemotherapy duration in stage II and III HER2-positive breast cancer: radiologic and pathologic complete response (pCR) rates in the multicenter phase 2 TRAIN-3 study (BOOG 2018-01) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-06.
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Schmitz RS, Engelhardt EG, Gerritsma MA, Sondermeijer CM, Alaeikhanehshir S, Verschuur E, van Oirsouw M, Houtzager J, Griffioen R, Bijker N, Mann RM, van Duijnhoven F, Wesseling J, Bleiker E. Abstract P6-05-11: Active surveillance versus conventional treatment in low-risk DCIS; women’s preferences in the LORD trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-11] [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] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Ductal carcinoma in situ (DCIS) is a potential precursor to breast cancer. Its incidence has increased multifold with the introduction of breast cancer screening and makes for 20% of all malignant breast lesions in women. DCIS has the potential to progress into invasive breast cancer. However, the majority of DCIS lesions are indolent and will never progress during the patient’s lifetime. Consequently, there is a growing concern of overdiagnosis and overtreatment for women with DCIS. The LORD trial is a non-randomized, patient preference trial comparing active surveillance to conventional treatment (i.e., breast conserving surgery with or without radiotherapy or mastectomy). The primary outcome of this trial is the percentage of women without an occurrence of ipsilateral invasive breast cancer after 10 years of follow up. Within the patient preference design, women are free to opt for either treatment arm. In addition to active surveillance of the DCIS, quality of life (QOL) of women included in the LORD trial is also actively monitored. The aims of this study were to: a) describe the distribution of participants within the treatment arms, b) identify women’s motives to opt for their preferred treatment arm, and c) assess factors associated with a preference for either treatment arm. Methods: Data from the baseline patient QOL questionnaire was collected. This questionnaire was completed after the women’s diagnosis and first consultation with their physician. Descriptive statistics were used to assess the distribution in both treatment arms. Thematic analyses were used to describe self-reported reasons for treatment selection derived from the open-ended question about treatment preference. Multivariable logistic regression analyses were used to assess associations between the patient characteristics and their preferred treatment arm. Results: In total 384 women completed the baseline questionnaire, of which 376 entered their final treatment decision. Of these women, 287 (76%) opted for active surveillance and 89 (24%) for conventional treatment. Most frequently cited reason for opting for active surveillance was that treatment was not yet necessary (55%). Also, patients’ reasons for preferring active surveillance alluded to a high level of trust in the active surveillance plan (24%) and that disease progression could be picked up and treated in a timely manner (14%). Furthermore, 11% of patients cited the advice of their healthcare professional as a reason for opting for active surveillance and 8% cited reasons relating to altruism. Most reported reasons for opting for the conventional treatment arm were avoiding unnecessary risks (26%), avoiding cancer worry (18%), the notion that what doesn’t belong, should be removed from the body (18%) and a need for closure (13%). In multivariable logistic regression analyses, high level of education (OR 2.17; 95%CI 1.09-4.38) and higher knowledge score (OR 1.8; 95%CI 1.07-3.02) were associated with a preference for conventional treatment. Furthermore, women opting for active surveillance more often reported the decision to be a shared decision between them and their healthcare professional (OR 2.30; 95%CI 1.18-4.47) compared to women who chose conventional treatment, who more often reported decision-making to be patient-driven. Age and tolerance of uncertainty were not significantly associated with treatment preference. Conclusion: The LORD trial is the first to actively offer women with low-risk DCIS a choice between conventional treatment and active surveillance. Within this trial, most women opt for active surveillance, even though clinical guidelines still recommend treatment for all women with DCIS. Women with low-risk DCIS report high levels of trust in their physicians and the safety of active surveillance. Their preferences also highlight the necessity to proof that de-escalating treatment of low-risk DCIS is safe.
Citation Format: Renée S. Schmitz, Ellen G. Engelhardt, Miranda A. Gerritsma, Carine M. Sondermeijer, Sena Alaeikhanehshir, Ellen Verschuur, Marja van Oirsouw, Julia Houtzager, Rosalie Griffioen, Nina Bijker, Ritse M. Mann, Frederieke van Duijnhoven, Jelle Wesseling, Eveline Bleiker. Active surveillance versus conventional treatment in low-risk DCIS; women’s preferences in the LORD trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-11.
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Affiliation(s)
- Renée S. Schmitz
- 1Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
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Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [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: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Tan T, Rodriguez-Ruiz A, Zhang T, Xu L, Beets-Tan RGH, Shen Y, Karssemeijer N, Xu J, Mann RM, Bao L. Multi-modal artificial intelligence for the combination of automated 3D breast ultrasound and mammograms in a population of women with predominantly dense breasts. Insights Imaging 2023; 14:10. [PMID: 36645507 PMCID: PMC9842825 DOI: 10.1186/s13244-022-01352-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/09/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To assess the stand-alone and combined performance of artificial intelligence (AI) detection systems for digital mammography (DM) and automated 3D breast ultrasound (ABUS) in detecting breast cancer in women with dense breasts. METHODS 430 paired cases of DM and ABUS examinations from a Asian population with dense breasts were retrospectively collected. All cases were analyzed by two AI systems, one for DM exams and one for ABUS exams. A selected subset (n = 152) was read by four radiologists. The performance of AI systems was based on analysis of the area under the receiver operating characteristic curve (AUC). The maximum Youden's index and its associated sensitivity and specificity were also reported for each AI systems. Detection performance of human readers in the subcohort of the reader study was measured in terms of sensitivity and specificity. RESULTS The performance of the AI systems in a multi-modal setting was significantly better when the weights of AI-DM and AI-ABUS were 0.25 and 0.75, respectively, than each system individually in a single-modal setting (AUC-AI-Multimodal = 0.865; AUC-AI-DM = 0.832, p = 0.026; AUC-AI-ABUS = 0.841, p = 0.041). The maximum Youden's index for AI-Multimodal was 0.707 (sensitivity = 79.4%, specificity = 91.2%). In the subcohort that underwent human reading, the panel of four readers achieved a sensitivity of 93.2% and specificity of 32.7%. AI-multimodal achieves superior or equal sensitivity as single human readers at the same specificity operating points on the ROC curve. CONCLUSION Multimodal (ABUS + DM) AI systems for detecting breast cancer in women with dense breasts are a potential solution for breast screening in radiologist-scarce regions.
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Affiliation(s)
- Tao Tan
- grid.430814.a0000 0001 0674 1393Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,Faculty of Applied Science, Macao Polytechnic University, Macao, 999078 China
| | | | - Tianyu Zhang
- grid.430814.a0000 0001 0674 1393Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lin Xu
- grid.440637.20000 0004 4657 8879School of Information Science and Technology, ShanghaiTech University, Shanghai, 201210 China
| | - Regina G. H. Beets-Tan
- grid.430814.a0000 0001 0674 1393Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Development Biology, Maastricht University, P. O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Yingzhao Shen
- grid.13402.340000 0004 1759 700XAffiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Xueshi Road, Hubin Street, Shangcheng District, Hangzhou, 310006 Zhejiang China
| | - Nico Karssemeijer
- grid.10417.330000 0004 0444 9382Department of Diagnostic Imaging, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jun Xu
- grid.260478.f0000 0000 9249 2313Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology, Nanjing, 210044 China
| | - Ritse M. Mann
- grid.430814.a0000 0001 0674 1393Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Diagnostic Imaging, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lingyun Bao
- grid.13402.340000 0004 1759 700XAffiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Xueshi Road, Hubin Street, Shangcheng District, Hangzhou, 310006 Zhejiang China
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Caballo M, Sanderink WBG, Han L, Gao Y, Athanasiou A, Mann RM. Four-Dimensional Machine Learning Radiomics for the Pretreatment Assessment of Breast Cancer Pathologic Complete Response to Neoadjuvant Chemotherapy in Dynamic Contrast-Enhanced MRI. J Magn Reson Imaging 2023; 57:97-110. [PMID: 35633290 PMCID: PMC10083908 DOI: 10.1002/jmri.28273] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 04/11/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer response to neoadjuvant chemotherapy (NAC) is typically evaluated through the assessment of tumor size reduction after a few cycles of NAC. In case of treatment ineffectiveness, this results in the patient suffering potentially severe secondary effects without achieving any actual benefit. PURPOSE To identify patients achieving pathologic complete response (pCR) after NAC by spatio-temporal radiomic analysis of dynamic contrast-enhanced (DCE) MRI images acquired before treatment. STUDY TYPE Single-center, retrospective. POPULATION A total of 251 DCE-MRI pretreatment images of breast cancer patients. FIELD STRENGTH/SEQUENCE 1.5 T/3 T, T1-weighted DCE-MRI. ASSESSMENT Tumor and peritumoral regions were segmented, and 348 radiomic features that quantify texture temporal variation, enhancement kinetics heterogeneity, and morphology were extracted. Based on subsets of features identified through forward selection, machine learning (ML) logistic regression models were trained separately with all images and stratifying on cancer molecular subtype and validated with leave-one-out cross-validation. STATISTICAL TESTS Feature significance was assessed using the Mann-Whitney U-test. Significance of the area under the receiver operating characteristics (ROC) curve (AUC) of the ML models was assessed using the associated 95% confidence interval (CI). Significance threshold was set to 0.05, adjusted with Bonferroni correction. RESULTS Nine features related to texture temporal variation and enhancement kinetics heterogeneity were significant in the discrimination of cases achieving pCR vs. non-pCR. The ML models achieved significant AUC of 0.707 (all cancers, n = 251, 59 pCR), 0.824 (luminal A, n = 107, 14 pCR), 0.823 (luminal B, n = 47, 15 pCR), 0.844 (HER2 enriched, n = 25, 11 pCR), 0.803 (triple negative, n = 72, 19 pCR). DATA CONCLUSIONS Differences in imaging phenotypes were found between complete and noncomplete responders. Furthermore, ML models trained per cancer subtype achieved high performance in classifying pCR vs. non-pCR cases. They may, therefore, have potential to help stratify patients according to the level of response predicted before treatment, pending further validation with larger prospective cohorts. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Marco Caballo
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Luyi Han
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yuan Gao
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Siebers CCN, Appelman L, van Oirsouw MCJ, Appelman PTM, Go S, Mann RM. The Effect of Targeted Ultrasound as Primary Imaging Modality on Quality of Life in Women with Focal Breast Complaints: A Comparative Cohort Study. J Womens Health (Larchmt) 2023; 32:71-77. [PMID: 36318794 DOI: 10.1089/jwh.2022.0078] [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] [Indexed: 11/06/2022] Open
Abstract
Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.
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Affiliation(s)
- Carmen C N Siebers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marja C J van Oirsouw
- Patient Advocate on Behalf of the Dutch Breast Cancer Society (Borstkanker Vereniging Nederland), Utrecht, The Netherlands
| | - Peter T M Appelman
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Shirley Go
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kočo L, Siebers CCN, Schlooz M, Meeuwis C, Oldenburg HSA, Prokop M, Mann RM. Mapping Current Organizational Structure and Improvement Points of Breast Cancer Multidisciplinary Team Meetings - An Interview Study. J Multidiscip Healthc 2022; 15:2421-2430. [PMID: 36304726 PMCID: PMC9596230 DOI: 10.2147/jmdh.s380293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of the study was to map current organization, and document potential improvement points of breast cancer multidisciplinary team meetings (MDTMs), in order to support the optimization of the present breast cancer MDTM organization. Methods From January 2019 to February 2021, 24 core team members of the breast cancer multidisciplinary team (MDT) in three hospitals were interviewed. Semi-structured interviews were performed based on an interview guide. All interviews were recorded and transcribed verbatim. Deductive coding was performed on the transcripts by two independent researchers. The codes were organized in categories and themes. Results In total 24 healthcare professionals; surgeons, medical oncologists, radiotherapists, pathologists, radiologists, and specialized nurses, from three different hospitals were interviewed. According to the participants, improving efficiency before and during MDTMs is possible by ensuring proper preparation of attendees, implementing more structure during discussions, improving access to and availability of patient data and optimizing general meeting discipline. Conclusion Preparation, structure, data availability and meeting discipline were highlighted as essential factors for efficient breast cancer MDTM improvement. These topics seem to be applicable to other types of oncology MDTMs as well. Improving MDTM efficiency on the long term ensures high-quality discussions for all breast cancer patients.
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Affiliation(s)
- Lejla Kočo
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence: Lejla Kočo, Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands, Tel +31 24 361 87 66, Email
| | - Carmen C N Siebers
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carla Meeuwis
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hester S A Oldenburg
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mathias Prokop
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Hoxhaj A, Drissen MM, Vos JR, Bult P, Mann RM, Hoogerbrugge N. The yield and effectiveness of breast cancer surveillance in women with PTEN Hamartoma Tumor Syndrome. Cancer 2022; 128:2883-2891. [PMID: 36533707 PMCID: PMC9543294 DOI: 10.1002/cncr.34326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women with PTEN Hamartoma Tumor Syndrome (PHTS) are offered breast cancer (BC) surveillance because of an increased BC lifetime risk. Surveillance guidelines are, however, expert opinion-based because of a lack of data. We aimed to assess the yield and effectiveness of BC surveillance and the prevalence and type of breast disease in women with PHTS. METHODS Sixty-five women with PHTS who visited our center between 2001 and 2021 were included. Surveillance consisted of annual magnetic resonance imaging (MRI) and mammography from ages 25 and 30 years, respectively. RESULTS Thirty-nine women enrolled in the BC surveillance program (median age at first examination, 38 years [range, 24-70]) and underwent 156 surveillance rounds. Surveillance led to detection of BC in 7/39 women (cancer detection rate [CDR], 45/1000 rounds) and benign breast lesions (BBLs) in 11/39 women. Overall sensitivity2 (which excludes prophylactic-mastectomy detected BCs) was 100%, whereas sensitivity2 of mammography and MRI alone was 50% and 100%, respectively. Overall specificity was higher in follow-up rounds (86%) versus first rounds (71%). Regardless of surveillance, 21/65 women developed 35 distinct BCs (median age at first diagnosis, 40 years [range, 24-59]) and 23/65 developed 89 BBLs (median age at first diagnosis, 38 years [range, 15-61]). Surveillance-detected BCs were all T1 and N0, whereas outside surveillance-detected BCs were more often ≥T2 (60%) and N+ (45%) (p < .005). CONCLUSIONS The findings show that annual BC surveillance with MRI starting at age 25 years enables detection of early-stage BCs. Performance measures of surveillance and CDR were both high. BBLs were commonly present, underlining the importance of evaluation of all lesions independently. LAY SUMMARY Breast cancer surveillance leads to decreased tumor stage and improved survival. Breast cancer surveillance with breast magnetic resonance imaging from age 25 years onward is recommended.
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Affiliation(s)
- Alma Hoxhaj
- Department of ImagingRadboud University Medical CenterNijmegenThe Netherlands,Department of Radiology and Nuclear Medicinethe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands,Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Meggie M.C.M. Drissen
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Janet R. Vos
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network Genetic Tumour Risk Syndromes (ERN GENTURIS)NijmegenThe Netherlands
| | - Peter Bult
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Ritse M. Mann
- Department of ImagingRadboud University Medical CenterNijmegenThe Netherlands,Department of Radiology and Nuclear Medicinethe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network Genetic Tumour Risk Syndromes (ERN GENTURIS)NijmegenThe Netherlands,Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
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Samperna R, Moriakov N, Karssemeijer N, Teuwen J, Mann RM. Exploiting the Dixon Method for a Robust Breast and Fibro-Glandular Tissue Segmentation in Breast MRI. Diagnostics (Basel) 2022; 12:diagnostics12071690. [PMID: 35885594 PMCID: PMC9324146 DOI: 10.3390/diagnostics12071690] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022] Open
Abstract
Automatic breast and fibro-glandular tissue (FGT) segmentation in breast MRI allows for the efficient and accurate calculation of breast density. The U-Net architecture, either 2D or 3D, has already been shown to be effective at addressing the segmentation problem in breast MRI. However, the lack of publicly available datasets for this task has forced several authors to rely on internal datasets composed of either acquisitions without fat suppression (WOFS) or with fat suppression (FS), limiting the generalization of the approach. To solve this problem, we propose a data-centric approach, efficiently using the data available. By collecting a dataset of T1-weighted breast MRI acquisitions acquired with the use of the Dixon method, we train a network on both T1 WOFS and FS acquisitions while utilizing the same ground truth segmentation. Using the “plug-and-play” framework nnUNet, we achieve, on our internal test set, a Dice Similarity Coefficient (DSC) of 0.96 and 0.91 for WOFS breast and FGT segmentation and 0.95 and 0.86 for FS breast and FGT segmentation, respectively. On an external, publicly available dataset, a panel of breast radiologists rated the quality of our automatic segmentation with an average of 3.73 on a four-point scale, with an average percentage agreement of 67.5%.
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Affiliation(s)
- Riccardo Samperna
- Department of Medical Imaging, Radboudumc, 6525 GA Nijmegen, The Netherlands; (N.M.); (N.K.); (J.T.); (R.M.M.)
- Department of Radiology, The Netherlands Cancer Institute (NKI), 1066 CX Amsterdam, The Netherlands
- Correspondence:
| | - Nikita Moriakov
- Department of Medical Imaging, Radboudumc, 6525 GA Nijmegen, The Netherlands; (N.M.); (N.K.); (J.T.); (R.M.M.)
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), 1066 CX Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Medical Imaging, Radboudumc, 6525 GA Nijmegen, The Netherlands; (N.M.); (N.K.); (J.T.); (R.M.M.)
- ScreenPoint Medical BV, 6525 EC Nijmegen, The Netherlands
| | - Jonas Teuwen
- Department of Medical Imaging, Radboudumc, 6525 GA Nijmegen, The Netherlands; (N.M.); (N.K.); (J.T.); (R.M.M.)
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), 1066 CX Amsterdam, The Netherlands
| | - Ritse M. Mann
- Department of Medical Imaging, Radboudumc, 6525 GA Nijmegen, The Netherlands; (N.M.); (N.K.); (J.T.); (R.M.M.)
- Department of Radiology, The Netherlands Cancer Institute (NKI), 1066 CX Amsterdam, The Netherlands
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Mann RM, Veldhuis WB. Contrast-enhanced Mammography: Moving Ahead with Perfusion Imaging. Radiology 2022; 305:104-106. [DOI: 10.1148/radiol.221073] [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: 11/11/2022]
Affiliation(s)
- Ritse M. Mann
- From the Department of Medical Imaging, Radboudumc, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (W.B.V.)
| | - Wouter B. Veldhuis
- From the Department of Medical Imaging, Radboudumc, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (W.B.V.)
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Mann RM, Athanasiou A, Baltzer PAT, Camps-Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Killburn-Toppin F, Lesaru M, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Gilbert FJ, Kuhl CK. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 2022; 32:4036-4045. [PMID: 35258677 PMCID: PMC9122856 DOI: 10.1007/s00330-022-08617-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [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: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. KEY POINTS: • The recommendations in Figure 1 summarize the key points of the manuscript.
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Affiliation(s)
- Ritse M Mann
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands.
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Julia Camps-Herrero
- Hospitales Ribera Salud, Avda.Cortes Valencianas, 58, 46015, Valencia, Spain
| | - 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, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine &; Klinikum Rechts der Isar, Technical University of Munich, Munich (TUM), Ismaninger Str. 22, 81675, München, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - 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, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Fleur Killburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Carol Davila University, Bucharest, Romania
| | - Pietro Panizza
- Breast Imaging Unit, 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, Netherlands
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, Netherlands
| | - 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, Währinger Gürtel 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
| | - 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
| | - 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
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße30, 52074, Aachen, Germany
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Balkenende L, Teuwen J, Mann RM. Application of Deep Learning in Breast Cancer Imaging. Semin Nucl Med 2022; 52:584-596. [PMID: 35339259 DOI: 10.1053/j.semnuclmed.2022.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Abstract
This review gives an overview of the current state of deep learning research in breast cancer imaging. Breast imaging plays a major role in detecting breast cancer at an earlier stage, as well as monitoring and evaluating breast cancer during treatment. The most commonly used modalities for breast imaging are digital mammography, digital breast tomosynthesis, ultrasound and magnetic resonance imaging. Nuclear medicine imaging techniques are used for detection and classification of axillary lymph nodes and distant staging in breast cancer imaging. All of these techniques are currently digitized, enabling the possibility to implement deep learning (DL), a subset of Artificial intelligence, in breast imaging. DL is nowadays embedded in a plethora of different tasks, such as lesion classification and segmentation, image reconstruction and generation, cancer risk prediction, and prediction and assessment of therapy response. Studies show similar and even better performances of DL algorithms compared to radiologists, although it is clear that large trials are needed, especially for ultrasound and magnetic resonance imaging, to exactly determine the added value of DL in breast cancer imaging. Studies on DL in nuclear medicine techniques are only sparsely available and further research is mandatory. Legal and ethical issues need to be considered before the role of DL can expand to its full potential in clinical breast care practice.
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Affiliation(s)
- Luuk Balkenende
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands; Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands; Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
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Wanders AJT, Mees W, Bun PAM, Janssen N, Rodríguez-Ruiz A, Dalmış MU, Karssemeijer N, van Gils CH, Sechopoulos I, Mann RM, van Rooden CJ. Interval Cancer Detection Using a Neural Network and Breast Density in Women with Negative Screening Mammograms. Radiology 2022; 303:269-275. [PMID: 35133194 DOI: 10.1148/radiol.210832] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Inclusion of mammographic breast density (BD) in breast cancer risk models improves accuracy, but accuracy remains modest. Interval cancer (IC) risk prediction may be improved by combining assessments of BD and an artificial intelligence (AI) cancer detection system. Purpose To evaluate the performance of a neural network (NN)-based model that combines the assessments of BD and an AI system in the prediction of risk of developing IC among women with negative screening mammography results. Materials and Methods This retrospective nested case-control study performed with screening examinations included women who developed IC and women with normal follow-up findings (from January 2011 to January 2015). An AI cancer detection system analyzed all studies yielding a score of 1-10, representing increasing likelihood of malignancy. BD was automatically computed using publicly available software. An NN model was trained by combining the AI score and BD using 10-fold cross-validation. Bootstrap analysis was used to calculate the area under the receiver operating characteristic curve (AUC), sensitivity at 90% specificity, and 95% CIs of the AI, BD, and NN models. Results A total of 2222 women with IC and 4661 women in the control group were included (mean age, 61 years; age range, 49-76 years). AUC of the NN model was 0.79 (95% CI: 0.77,0.81), which was higher than AUC of the AI cancer detection system or BD alone (AUC, 0.73 [95% CI: 0.71, 0.76] and 0.69 [95% CI: 0.67, 0.71], respectively; P < .001 for both). At 90% specificity, the NN model had a sensitivity of 50.9% (339 of 666 women; 95% CI: 45.2, 56.3) for prediction of IC, which was higher than that of the AI system (37.5%; 250 of 666 women; 95% CI: 33.0, 43.7; P < .001) or BD percentage alone (22.4%; 149 of 666 women; 95% CI: 17.9, 28.5; P < .001). Conclusion The combined assessment of an artificial intelligence detection system and breast density measurements enabled identification of a larger proportion of women who would develop interval cancer compared with either method alone. Published under a CC BY 4.0 license.
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Affiliation(s)
- Alexander J T Wanders
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Willem Mees
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Petra A M Bun
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Natasja Janssen
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Alejandro Rodríguez-Ruiz
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Mehmet Ufuk Dalmış
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Nico Karssemeijer
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Carla H van Gils
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Ioannis Sechopoulos
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Ritse M Mann
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
| | - Cornelis Jan van Rooden
- From the Dutch Breast Cancer Screening Program, Region South-West, Laan 20, 2512 GB, The Hague, the Netherlands (A.J.T.W., W.M., P.A.M.B., C.J.v.R.); Screen-Point Medical, Nijmegen, the Netherlands (N.J., A.R., M.U.D., N.K.); Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (N.K., I.S., R.M.M.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (C.H.v.G.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands (C.J.v.R.)
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van der Hoogt KJJ, Schipper RJ, Winter-Warnars GA, Ter Beek LC, Loo CE, Mann RM, Beets-Tan RGH. Factors affecting the value of diffusion-weighted imaging for identifying breast cancer patients with pathological complete response on neoadjuvant systemic therapy: a systematic review. Insights Imaging 2021; 12:187. [PMID: 34921645 PMCID: PMC8684570 DOI: 10.1186/s13244-021-01123-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/14/2021] [Accepted: 11/06/2021] [Indexed: 12/18/2022] Open
Abstract
This review aims to identify factors causing heterogeneity in breast DWI-MRI and their impact on its value for identifying breast cancer patients with pathological complete response (pCR) on neoadjuvant systemic therapy (NST). A search was performed on PubMed until April 2020 for studies analyzing DWI for identifying breast cancer patients with pCR on NST. Technical and clinical study aspects were extracted and assessed for variability. Twenty studies representing 1455 patients/lesions were included. The studies differed with respect to study population, treatment type, DWI acquisition technique, post-processing (e.g., mono-exponential/intravoxel incoherent motion/stretched exponential modeling), and timing of follow-up studies. For the acquisition and generation of ADC-maps, various b-value combinations were used. Approaches for drawing regions of interest on longitudinal MRIs were highly variable. Biological variability due to various molecular subtypes was usually not taken into account. Moreover, definitions of pCR varied. The individual areas under the curve for the studies range from 0.50 to 0.92. However, overlapping ranges of mean/median ADC-values at pre- and/or during and/or post-NST were found for the pCR and non-pCR groups between studies. The technical, clinical, and epidemiological heterogeneity may be causal for the observed variability in the ability of DWI to predict pCR accurately. This makes implementation of DWI for pCR prediction and evaluation based on one absolute ADC threshold for all breast cancer types undesirable. Multidisciplinary consensus and appropriate clinical study design, taking biological and therapeutic variation into account, is required for obtaining standardized, reliable, and reproducible DWI measurements for pCR/non-pCR identification.
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Affiliation(s)
- Kay J J van der Hoogt
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Robert J Schipper
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Gonneke A Winter-Warnars
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Leon C Ter Beek
- Department of Medical Physics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ritse M Mann
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Danish Colorectal Cancer Unit South, Institute of Regional Health Research, Vejle University Hospital, University of Southern Denmark, Odense, Denmark
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Gommers JJ, Voogd AC, Broeders MJ, van Breest Smallenburg V, Strobbe LJ, Donkers-van Rossum AB, van Beek HC, Mann RM, Duijm LE. Breast magnetic resonance imaging as a problem solving tool in women recalled at biennial screening mammography: A population-based study in the Netherlands. Breast 2021; 60:279-286. [PMID: 34823112 PMCID: PMC8628012 DOI: 10.1016/j.breast.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Problem solving magnetic resonance imaging (MRI) is used to exclude malignancy in women with equivocal findings on conventional imaging. However, recommendations on its use for women recalled after screening are lacking. This study evaluates the impact of problem solving MRI on diagnostic workup among women recalled from the Dutch screening program, as well as time trends and inter-hospital variation in its use. Methods Women who were recalled at screening mammography in the South of the Netherlands (2008–2017) were included. Two-year follow-up data were collected. Diagnostic-workup and accuracy of problem solving MRI were evaluated and time trends and inter-hospital variation in its use were examined. Results In the study period 16,175 women were recalled, of whom 906 underwent problem solving MRI. Almost half of the women (45.4%) who underwent problem solving MRI were referred back to the screening program without further workup. The sensitivity, specificity, and positive and negative predictive values of problem solving MRI were 98.2%, 70.0%, 31.1%, and 99.6%, respectively. The percentage of recalled women receiving problem solving MRI fluctuated over time (4.7%–7.2%) and significantly varied among hospitals (2.2%–7.0%). Conclusion The use of problem solving MRI may exclude malignancy in recalled women. The use of problem solving MRI varied over time and among hospitals, which indicates the need for guidelines on problem solving MRI. Problem solving MRI did correctly refer back women to the screening program. The sensitivity and specificity of problem solving MRI were 98.2% and 70.0%. Positive and negative predictive values of problem solving MRI were 31.1% and 99.6%. By excluding malignancy, problem solving MRI may reduce invasive diagnostic workup.
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Affiliation(s)
- Jessie Jj Gommers
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands
| | - Mireille Jm Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Dutch Expert Center for Screening, Wijchenseweg 101, 6538, SW, Nijmegen, the Netherlands
| | | | - Luc Ja Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | | | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504, MB, Veldhoven, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Lucien Em Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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Geuzinge HA, Bakker MF, Heijnsdijk EAM, van Ravesteyn NT, Veldhuis WB, Pijnappel RM, de Lange SV, Emaus MJ, Mann RM, Monninkhof EM, de Koekkoek-Doll PK, van Gils CH, de Koning HJ. Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue. J Natl Cancer Inst 2021; 113:1476-1483. [PMID: 34585249 PMCID: PMC8562952 DOI: 10.1093/jnci/djab119] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown. METHODS We used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a willingness-to-pay threshold of €22 000. RESULTS Calibration resulted in a conservative fit of the model regarding MRI detection. Both strategies of the DENSE trial were dominated (biennial mammography; biennial mammography plus MRI). MRI alone every 4 years was cost-effective with €15 620 per QALY. Screening every 3 years with MRI alone resulted in an incremental cost-effectiveness ratio of €37 181 per QALY. All strategies with mammography and/or a 2-year interval were dominated because other strategies resulted in more additional QALYs per additional euro. Alternating mammography and MRI every 2 years was close to the efficiency frontier. CONCLUSIONS MRI screening is cost-effective for women with extremely dense breasts, when applied at a 4-year interval. For a willingness to pay more than €22 000 per QALY gained, MRI at a 3-year interval is cost-effective as well.
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Affiliation(s)
- H Amarens Geuzinge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stéphanie V de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marleen J Emaus
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Petra K de Koekkoek-Doll
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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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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Sanderink WBG, Teuwen J, Appelman L, Moy L, Heacock L, Weiland E, Sechopoulos I, Mann RM. Diffusion weighted imaging for evaluation of breast lesions: Comparison between high b-value single-shot and routine readout-segmented sequences at 3 T. Magn Reson Imaging 2021; 84:35-40. [PMID: 34560230 DOI: 10.1016/j.mri.2021.09.007] [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: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In this study, we compare readout-segmented echo-planar imaging (rs-EPI) Diffusion Weighted Imaging (DWI) to a work-in-progress single-shot EPI with modified Inversion Recovery Background Suppression (ss-EPI-mIRBS) sequence at 3 T using a b-value of 2000 s/mm2 on image quality, lesion visibility and evaluation time. METHOD From September 2017 to December 2018, 23 women (one case used for training) with known breast cancer were included in this study, after providing signed informed consent. Women were scanned with the conventional rs-EPI sequence and the work-in-progress ss-EPI-mIRBS during the same examination. Four breast radiologists (4-13 years of experience) independently scored both series for overall image quality (1: extremely poor to 9: excellent). All lesions (47 in total, 36 malignant, and 11 benign and high-risk) were evaluated for visibility (1: not visible, 2: visible if location is given, 3: visible) and probability of malignancy (BI-RADS 1 to 5). ADC values were determined by measuring signal intensity in the lesions using dynamic contrast-enhanced (DCE) images for reference. Evaluation times for all assessments were automatically recorded. Results were analyzed using the visual grading characteristics (VGC) and the resulting area under the curve (AUCVGC) method. Statistical analysis was performed in SPSS, with McNemar tests, and paired t-tests used for comparison. RESULTS No significant differences were detected between the two sequences in image quality (AUCVGC: 0.398, p = 0.087) and lesion visibility (AUCVGC: 0.534, p = 0.336) scores. Lesion characteristics (e.g benign and high-risk, versus malignant; small (≤10 mm) vs. larger (>10 mm)) did not result in different image quality or lesion visibility between sequences. Sensitivity (rs-EPI: 72.2% vs. ss-EPImIRBS: 78.5%, p = 0.108) and specificity (70.5% vs. 56.8%, p = 0.210, respectively) were comparable. In both sequences the mean ADC value was higher for benign and high-risk lesions than for malignant lesions (ss-EPI-mIRBS: p = 0.022 and rs-EPI: p = 0.055). On average, ss-EPI-mIRBS resulted in decreased overall reading time by 7.7 s/case (p = 0.067); a reduction of 17%. For malignant lesions, average reading time was significantly shorter using ss-EPI-mIRBS compared to rs-EPI (64.0 s/lesion vs. 75.9 s/lesion, respectively, p = 0.039). CONCLUSION Based on this study, the ss-EPI sequence using a b-value of 2000 s/mm2 enables for a mIRBS acquisition with quality and lesion conspicuity that is comparable to conventional rs-EPI, but with a decreased reading time.
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Affiliation(s)
- Wendelien B G Sanderink
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands.
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Linda Appelman
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands
| | - Linda Moy
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, 4(th) floor, New York, NY 10016, United States
| | - Laura Heacock
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, 4(th) floor, New York, NY 10016, United States
| | - Elisabeth Weiland
- MR Application Predevelopment, Siemens Healthcare, Allee am Roethelheimpark 2, 91052 Erlangen, Germany
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
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47
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Schiaffino S, Pinker K, Magni V, Cozzi A, Athanasiou A, Baltzer PAT, Camps Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Kilburn-Toppin F, Kuhl CK, Lesaru M, Mann RM, Panizza P, Pediconi F, Pijnappel RM, Sella T, Thomassin-Naggara I, Zackrisson S, Gilbert FJ, Sardanelli F. Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI). Insights Imaging 2021; 12:119. [PMID: 34417642 PMCID: PMC8378785 DOI: 10.1186/s13244-021-01062-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 05/17/2021] [Accepted: 07/17/2021] [Indexed: 01/12/2023] Open
Abstract
Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team.
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Affiliation(s)
- Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 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, Wien, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Wien, Austria
| | | | - 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, Wien, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich (TUM) , München , Germany
| | - Gábor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - 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, Wien, Austria
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Fundeni Institute, Bucharest, Romania
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological, and Pathological Sciences , Università degli Studi di Roma "La Sapienza" , Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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48
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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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Ayatollahi F, Shokouhi SB, Mann RM, Teuwen J. Automatic breast lesion detection in ultrafast DCE-MRI using deep learning. Med Phys 2021; 48:5897-5907. [PMID: 34370886 DOI: 10.1002/mp.15156] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE We propose a deep learning-based computer-aided detection (CADe) method to detect breast lesions in ultrafast DCE-MRI sequences. This method uses both the 3D spatial information and temporal information obtained from the early-phase of the dynamic acquisition. METHODS The proposed CADe method, based on a modified 3D RetinaNet model, operates on ultrafast T1 weighted sequences, which are preprocessed for motion compensation, temporal normalization, and are cropped before passing into the model. The model is optimized to enable the detection of relatively small breast lesions in a screening setting, focusing on detection of lesions that are harder to differentiate from confounding structures inside the breast. RESULTS The method was developed based on a dataset consisting of 489 ultrafast MRI studies obtained from 462 patients containing a total of 572 lesions (365 malignant, 207 benign) and achieved a detection rate, sensitivity, and detection rate of benign lesions of 0.90 (0.876-0.934), 0.95 (0.934-0.980), and 0.81 (0.751-0.871) at four false positives per normal breast with 10-fold cross-testing, respectively. CONCLUSIONS The deep learning architecture used for the proposed CADe application can efficiently detect benign and malignant lesions on ultrafast DCE-MRI. Furthermore, utilizing the less visible hard-to-detect lesions in training improves the learning process and, subsequently, detection of malignant breast lesions.
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Affiliation(s)
- Fazael Ayatollahi
- Electrical Engineering Department, Iran University of Science and Technology (IUST), Tehran, Iran.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shahriar B Shokouhi
- Electrical Engineering Department, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonas Teuwen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Pinto MC, Rodriguez-Ruiz A, Pedersen K, Hofvind S, Wicklein J, Kappler S, Mann RM, Sechopoulos I. Impact of Artificial Intelligence Decision Support Using Deep Learning on Breast Cancer Screening Interpretation with Single-View Wide-Angle Digital Breast Tomosynthesis. Radiology 2021; 300:529-536. [PMID: 34227882 DOI: 10.1148/radiol.2021204432] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The high volume of data in digital breast tomosynthesis (DBT) and the lack of agreement on how to best implement it in screening programs makes its use challenging. Purpose To compare radiologist performance when reading single-view wide-angle DBT images with and without an artificial intelligence (AI) system for decision and navigation support. Materials and Methods A retrospective observer study was performed with bilateral mediolateral oblique examinations and corresponding synthetic two-dimensional images acquired between June 2016 and February 2018 with a wide-angle DBT system. Fourteen breast screening radiologists interpreted 190 DBT examinations (90 normal, 26 with benign findings, and 74 with malignant findings), with the reference standard being verified by using histopathologic analysis or at least 1 year of follow-up. Reading was performed in two sessions, separated by at least 4 weeks, with a random mix of examinations being read with and without AI decision and navigation support. Forced Breast Imaging Reporting and Data System (categories 1-5) and level of suspicion (1-100) scores were given per breast by each reader. The area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity were compared between conditions by using the public-domain iMRMC software. The average reading times were compared by using the Wilcoxon signed rank test. Results The 190 women had a median age of 54 years (range, 48-63 years). The examination-based reader-averaged AUC was higher when interpreting results with AI support than when reading unaided (0.88 [95% CI: 0.84, 0.92] vs 0.85 [95% CI: 0.80, 0.89], respectively; P = .01). The average sensitivity increased with AI support (64 of 74, 86% [95% CI: 80%, 92%] vs 60 of 74, 81% [95% CI: 74%, 88%]; P = .006), whereas no differences in the specificity (85 of 116, 73.3% [95% CI: 65%, 81%] vs 83 of 116, 71.6% [95% CI: 65%, 78%]; P = .48) or reading time (48 seconds vs 45 seconds; P = .35) were detected. Conclusion Using a single-view digital breast tomosynthesis (DBT) and artificial intelligence setup could allow for a more effective screening program with higher performance, especially in terms of an increase in cancers detected, than using single-view DBT alone. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Chan and Helvie in this issue.
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Affiliation(s)
- Marta C Pinto
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Alejandro Rodriguez-Ruiz
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Kristin Pedersen
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Solveig Hofvind
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Julia Wicklein
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Steffen Kappler
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Ritse M Mann
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
| | - Ioannis Sechopoulos
- From the Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (M.C.P., R.M.M., I.S.); ScreenPoint Medical, Nijmegen, the Netherlands (A.R.R.); Cancer Registry of Norway, Oslo, Norway (K.P., S.H.); Siemens Healthcare, Forchheim, Germany (J.W., S.K.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); and the Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.)
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