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Qian N, Jiang W, Wu X, Zhang N, Yu H, Guo Y. Lesion attention guided neural network for contrast-enhanced mammography-based biomarker status prediction in breast cancer. Comput Methods Programs Biomed 2024; 250:108194. [PMID: 38678959 DOI: 10.1016/j.cmpb.2024.108194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Accurate identification of molecular biomarker statuses is crucial in cancer diagnosis, treatment, and prognosis. Studies have demonstrated that medical images could be utilized for non-invasive prediction of biomarker statues. The biomarker status-associated features extracted from medical images are essential in developing medical image-based non-invasive prediction models. Contrast-enhanced mammography (CEM) is a promising imaging technique for breast cancer diagnosis. This study aims to develop a neural network-based method to extract biomarker-related image features from CEM images and evaluate the potential of CEM in non-invasive biomarker status prediction. METHODS An end-to-end learning convolutional neural network with the whole breast images as inputs was proposed to extract CEM features for biomarker status prediction in breast cancer. The network focused on lesion regions and flexibly extracted image features from lesion and peri‑tumor regions by employing supervised learning with a smooth L1-based consistency constraint. An image-level weakly supervised segmentation network based on Vision Transformer with cross attention to contrast images of breasts with lesions against the contralateral breast images was developed for automatic lesion segmentation. Finally, prediction models were developed following further selection of significant features and the implementation of random forest-based classification. Results were reported using the area under the curve (AUC), accuracy, sensitivity, and specificity. RESULTS A dataset from 1203 breast cancer patients was utilized to develop and evaluate the proposed method. Compared to the method without lesion attention and with only lesion regions as inputs, the proposed method performed better at biomarker status prediction. Specifically, it achieved an AUC of 0.71 (95 % confidence interval [CI]: 0.65, 0.77) for Ki-67 and 0.73 (95 % CI: 0.65, 0.80) for human epidermal growth factor receptor 2 (HER2). CONCLUSIONS A lesion attention-guided neural network was proposed in this work to extract CEM image features for biomarker status prediction in breast cancer. The promising results demonstrated the potential of CEM in non-invasively predicting the biomarker statuses in breast cancer.
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Affiliation(s)
- Nini Qian
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Wei Jiang
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China; Department of Radiotherapy, Yantai Yuhuangding Hospital, Shandong 264000, China
| | - Xiaoqian Wu
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Ning Zhang
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Hui Yu
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China
| | - Yu Guo
- Department of Biomedical Engineering, Medical School, Tianjin University, Tianjin 300072, China; State Key Laboratory of Advanced Medical Materials and Devices, Tianjin University, Tianjin, China.
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Helal M, Khaled R, Alfarghaly O, Mokhtar O, Elkorany A, Fahmy A, El Kassas H. Validation of artificial intelligence contrast mammography in diagnosis of breast cancer: Relationship to histopathological results. Eur J Radiol 2024; 173:111392. [PMID: 38428255 DOI: 10.1016/j.ejrad.2024.111392] [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: 06/14/2023] [Revised: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Contrast-enhanced mammography (CEM) is used for characterization of breast lesions with increased diagnostic accuracy compared to digital mammography (DM). Artificial intelligence (AI) approaches are emerging with accuracies equal to an average radiologist. However, most studies trained deep learning (DL) models on DM images and there is a paucity in literature for discovering the application of AI using CEM. OBJECTIVES To develop and test a DL model that classifies CEM images and produces corresponding highlights of lesions detected. METHODS Fully annotated 2006 images of 326 females available from the previously published Categorized Digital Database for Contrast Enhanced Mammography images (CDD-CESM) were used for training. We developed a DL multiview contrast mammography model (MVCM) for classification of CEM low energy and recombined images. An external test set of 288 images of 37 females not included in the training was used for validation. Correlation with histopathological results and follow-up was considered the standard reference. The study protocol was approved by the Institutional Review Board and patient informed consent was obtained. RESULTS Assessment was done on an external test set of 37 females (mean age, 51.31 years ± 11.07 [SD]) with AUC-ROC for AI performance 0.936; (95 % CI: 0.898, 0.973; p < 0.001) and the best cut off value for prediction of malignancy using AI score = 0.28. Findings were then correlated with histopathological results and follow up which revealed a sensitivity of 75 %, specificity 96.3 %, total accuracy of 90.1 %, positive predictive value (PPV) 87.1 %, and negative predictive value (NPV) 92 %, p-value (<0.001). Diagnostic indices of radiologists were sensitivity 88.9 %, specificity 92.6 %, total accuracy 91.7 %, PPV 80 %, and NPV 96.2 %, p-value (<0.001). CONCLUSION A deep learning multiview CEM model was developed and evaluated in a cohort of female participants and showed promising results in detecting breast cancer. This warrants further studies, external training, and validation.
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Affiliation(s)
- Maha Helal
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Rana Khaled
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Omar Alfarghaly
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Omnia Mokhtar
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Abeer Elkorany
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Aly Fahmy
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Hebatalla El Kassas
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
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Amir T, Pinker K, Sevilimedu V, Hughes M, Keating DT, Sung JS, Jochelson MS. Contrast-Enhanced Mammography for Women with Palpable Breast Abnormalities. Acad Radiol 2024; 31:1231-1238. [PMID: 37949703 DOI: 10.1016/j.acra.2023.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/14/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE AND OBJECTIVES To examine the role of contrast-enhanced mammography (CEM) in the work-up of palpable breast abnormalities. MATERIALS AND METHODS In this single-center combination prospective-retrospective study, women with palpable breast abnormalities underwent CEM evaluation prospectively, comprising the acquisition of low energy (LE) images and recombined images (RI) which depict enhancement, followed by targeted ultrasound (US). Two independent readers retrospectively reviewed the imaging and assigned BI-RADS assessment based on LE alone, LE plus US, RI with LE plus US (CEM plus US), and RI alone. Pathology results or 1-year follow-up imaging served as the reference standard. RESULTS 237 women with 262 palpable abnormalities were included (mean age, 51 years). Of the 262 palpable abnormalities, 116/262 (44%) had no imaging correlate and 242/262 (92%) were benign. RI alone had better specificity compared to LE plus US (Reader 1, 94% versus 89% (p = 0.009); Reader 2, 93% versus 88% (p = 0.03)), better positive predictive value (Reader 1, 52% versus 42% (p = 0.04); Reader 2, 53% versus 42% (p = 0.04)), and better accuracy (Reader 1, 93% versus 89% (p = 0.05); Reader 2, 93% versus 90% (p = 0.06)). CEM plus US was not significantly different in performance metrics versus LE plus US. CONCLUSION RI had better specificity compared to LE in combination with US. There was no difference in performance between CEM plus US and LE plus US, likely reflecting the weight US carries in radiologist decision-making. However, the results indicate that the absence of enhancement on RI in the setting of palpable lesions may help avoid benign biopsies.
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Affiliation(s)
- Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.)
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.)
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, 10017, USA (V.S.)
| | - Mary Hughes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.)
| | - Delia T Keating
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.)
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.)
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA (T.A., K.P., M.H., D.T.K., J.S.S., M.S.J.).
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Terzoni A, Basile P, Gambaro AC, Attanasio S, Rampi AM, Brambilla M, Carriero A. Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging. Radiol Med 2024; 129:558-565. [PMID: 38512618 PMCID: PMC11021306 DOI: 10.1007/s11547-024-01789-9] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/15/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Breast cancer diagnosis often involves assessing the locoregional spread of the disease through MRI, as multicentricity, multifocality and/or bilaterality are increasingly common. Contrast-enhanced mammography (CEM) is emerging as a potential alternative method. This study compares the performance of CEM and MRI in preoperative staging of women with confirmed breast carcinoma. Patients were also asked to fill in a satisfaction questionnaire to rate their comfort level with each investigation. METHODS From May 1st, 2021 to May 1st, 2022, we enrolled 70 women with confirmed breast carcinoma who were candidates for surgery. For pre-operative locoregional staging, all patients underwent CEM and MRI examination, which two radiologists evaluated blindly. We further investigated all suspicious locations for disease spread, identified by both CEM and MRI, with a second-look ultrasound (US) and eventual histological examination. RESULTS In our study cohort, MRI and CEM identified 114 and 102 areas of focal contrast enhancement, respectively. A true discrepancy between MRI and CEM occurred in 9 out of 70 patients examined. MRI reported 8 additional lesions that proved to be false positives on second-look US in 6 patients, while it identified 4 lesions that were not detected by CEM and were pathological (true positives) in 3 patients. CONCLUSIONS CEM showed results comparable to MRI in the staging of breast cancer in our study population, with a high rate of patient acceptability.
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Affiliation(s)
- Andrea Terzoni
- Scuola di Specializzazione Radiodiagnostica, University of Piemonte Orientale, Novara, Italy.
| | - Paola Basile
- Scuola di Specializzazione Radiodiagnostica, University of Piemonte Orientale, Novara, Italy
| | | | | | | | - Marco Brambilla
- Health Physics Department, University Hospital, Novara, Italy
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Ghetti C, Ortenzia O, Pagan L, Golinelli P, Nitrosi A, Sghedoni R, Ravaglia V, Verzellesi L, Angelini L, Venturi G, Berardi P, Acchiappati D, Bertolini M. Physical and dosimetric characterisation of different Contrast-Enhanced digital mammographic systems: A multicentric study. Phys Med 2024; 120:103334. [PMID: 38520889 DOI: 10.1016/j.ejmp.2024.103334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE Contrast-enhanced digital mammography (CEDM) is a relatively new imaging technique recombining low- and high-energy mammograms to emphasise iodine contrast. This work aims to perform a multicentric physical and dosimetric characterisation of four state-of-the-art CEDM systems. METHODS We evaluated tube output, half-value-layer (HVL) for low- and high-energy and average glandular dose (AGD) in a wide range of equivalent breast thicknesses. CIRS phantom 022 was used to estimate the overall performance of a CEDM examination in the subtracted image in terms of the iodine difference signal (S). To calculate dosimetric impact of CEDM examination, we collected 4542 acquisitions on patients. RESULTS Even if CEDM acquisition strategies differ, all the systems presented a linear behaviour between S and iodine concentration. The curve fit slopes expressed in PV/mg/cm2 were in the range [92-97] for Fujifilm, [31-32] for GE Healthcare, [35-36] for Hologic, and [114-130] for IMS. Dosimetric data from patients were matched with AGD values calculated using equivalent PMMA thicknesses. Fujifilm exhibited the lowest values, while GE Healthcare showed the highest. CONCLUSION The subtracted image showed the ability of all the systems to give important information about the linearity of the signal with the iodine concentrations. All the patient-collected doses were under the AGD EUREF 2D Acceptable limit, except for patients with thicknesses ≤35 mm belonging to GE Healthcare and Hologic, which were slightly over. This work demonstrates the importance of testing each CEDM system to know how it performs regarding dose and the relationship between PV and iodine concentration.
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Affiliation(s)
- Caterina Ghetti
- Medical Physics Unit - University Hospital of Parma, Parma, Italy
| | - Ornella Ortenzia
- Medical Physics Unit - University Hospital of Parma, Parma, Italy.
| | - Laura Pagan
- Medical Physics Unit - AUSL-IRCCS of Bologna, Bologna, Italy
| | | | - Andrea Nitrosi
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Laura Verzellesi
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Paola Berardi
- Medical Physics Unit - AUSL-IRCCS of Bologna, Bologna, Italy
| | | | - Marco Bertolini
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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van Nijnatten TJA, Morscheid S, Baltzer PAT, Clauser P, Alcantara R, Kuhl CK, Wildberger JE. Contrast-enhanced breast imaging: Current status and future challenges. Eur J Radiol 2024; 171:111312. [PMID: 38237520 DOI: 10.1016/j.ejrad.2024.111312] [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: 12/21/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Contrast-enhanced breast MRI and recently also contrast-enhanced mammography (CEM) are available for breast imaging. The aim of the current overview is to explore existing evidence and ongoing challenges of contrast-enhanced breast imaging. METHODS This narrative provides an introduction to the contrast-enhanced breast imaging modalities breast MRI and CEM. Underlying principle, techniques and BI-RADS reporting of both techniques are described and compared, and the following indications and ongoing challenges are discussed: problem-solving, high-risk screening, supplemental screening in women with extremely dense breast tissue, breast implants, neoadjuvant systemic therapy (NST) response monitoring, MRI-guided and CEM- guided biopsy. RESULTS Technique and reporting for breast MRI are standardised, for the newer CEM standardisation is in progress. Similarly, compared to other modalities, breast MRI is well established as superior for problem-solving, screening women at high risk, screening women with extremely dense breast tissue or with implants; and for monitoring response to NST. Furthermore, MRI-guided biopsy is a reliable technique with low long-term false negative rates. For CEM, data is as yet either absent or limited, but existing results in these settings are promising. CONCLUSION Contrast-enhanced breast imaging achieves highest diagnostic performance and should be considered essential. Of the two contrast-enhanced modalities, evidence of breast MRI superiority is ample, and preliminary results on CEM are promising, yet CEM warrants further study.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - S Morscheid
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - R Alcantara
- Radiology and Nuclear Medicine Department, Hospital del Mar, Barcelona, Spain
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
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Hafez MAF, Zeinhom A, Hamed DAA, Ghaly GRM, Tadros SFK. Contrast-enhanced mammography versus breast MRI in the assessment of multifocal and multicentric breast cancer: a retrospective study. Acta Radiol 2023; 64:2868-2880. [PMID: 37674355 DOI: 10.1177/02841851231198346] [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: 09/08/2023]
Abstract
BACKGROUND Breast cancer multifocality and multicentricity diagnosis influences the surgeon's choice between applying breast conservative therapy or performing mastectomy. PURPOSE To assess the role of contrast enhanced mammography (CEM) and breast magnetic resonance imaging (MRI) in the assessment of preoperative breast cancer multifocality and multicentricity and to assess their accuracy, agreement and impact on the surgical management. MATERIAL AND METHODS The study retrospectively included cases over a 5-year period. After analysis and interpretation of suspicious breast lesions, a comparative evaluation of CEM and MRI was conducted with the assessment of diagnostic indices, including sensitivity, specificity and diagnostic accuracy. The kappa (κ) measure of agreement between both modalities was measured. The postoperative specimen pathology was the reference standard. RESULTS One hundred and twenty-two female cases with 126 breast lesions were evaluated. Specimen pathology, MRI and CEM showed a single neoplastic lesion in 67.5%, 35% and 48.5% of cases, respectively, and multiple neoplastic lesions in 32.5%, 65% and 51.6% of cases, respectively. The sensitivity, specificity and accuracy of MRI were 95.12%, 49.41%,and 64.29%, and the CEM values were 85.37%, 64.71% and 71.43%, respectively. The κ value was 0.592 with an intermediate agreement between both modalities. When comparing between both modalities, enhancing foci showed a statistically significant difference, although there were no statistically significant difference in terms of high breast density or molecular subtype. CONCLUSION In terms of breast cancer multifocality and multicentricity evaluation, MRI showed a higher sensitivity, while CEM showed a higher specificity, and there was moderate agreement between the two modalities.
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Affiliation(s)
- Mona Ahmed Fouad Hafez
- Diagnostic Radiology and Intervention Department, Faculty of Medicine-Cairo University and Baheya Foundation for Early Detection & Treatment of Breast Cancer, Giza, Egypt
| | - Asmaa Zeinhom
- Baheya Foundation for Early Detection & Treatment of Breast Cancer, Giza, Egypt
| | | | - Galal Rafik Mohamed Ghaly
- National Cancer Institute, Cairo University and Baheya Foundation For Early Detection & Treatment of Breast Cancer, Giza, Egypt
| | - Sally Fouad Kamel Tadros
- Diagnostic Radiology and Intervention Department, Faculty of Medicine-Cairo University and Baheya Foundation for Early Detection & Treatment of Breast Cancer, Giza, Egypt
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Kaiyin M, Lingling T, Leilei T, Wenjia L, Bin J. Head-to-head comparison of contrast-enhanced mammography and contrast-enhanced MRI for assessing pathological complete response to neoadjuvant therapy in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat 2023; 202:1-9. [PMID: 37615793 DOI: 10.1007/s10549-023-07034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/28/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Breast cancer patients receiving neoadjuvant therapy (NAT) are in need of a more patient-friendly imaging modality such as contrast-enhanced mammography (CEM) for monitoring therapy response. The purpose of this study was to conduct a meta-analysis to compare the diagnostic performances of CEM and contrast-enhanced magnetic resonance imaging (CE-MRI) for assessing pathological complete response (pCR) in these patients. METHODS The PubMed, Embase, and Cochrane Library databases were searched through March 2023 to identify studies reporting a head-to-head comparison of CEM and CE-MRI in detecting pCR in breast cancer patients receiving NAT. Pooled diagnostic performance was calculated using a bivariate random-effects model, and an AUC was derived for each test from hierarchic summary ROC analysis. RESULTS Six studies with 328 patients were included. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 93% (95% CI 84-97%), 68% (95% CI 60-76%), and 29.29 (95% CI 11.41-75.18) for CEM versus 84% (95% CI 62-95%), 80% (95% CI 71-87%), and 21.39 (95% CI 5.94-77.13) for CE-MRI. The AUC was 0.85 (95% CI 0.82-0.88) for CEM and 0.85 (95% CI 0.82-0.88) for CE-MRI. CONCLUSION This meta-analysis of head-to-head comparison studies showed that CEM provides an equivalent diagnostic accuracy to CE-MRI in identification of pCR in breast cancer patients receiving NAT. The results support the increasing use of CEM in this setting and would encourage future studies to validate CEM as a suitable replacement for MRI.
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Affiliation(s)
- Min Kaiyin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Tong Lingling
- Department of Gynecology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tang Leilei
- Department of Imaging, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Li Wenjia
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
| | - Ji Bin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
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Wang Z, Zhang H, Lin F, Zhang R, Ma H, Shi Y, Yang P, Zhang K, Zhao F, Mao N, Xie H. Intra- and Peritumoral Radiomics of Contrast-Enhanced Mammography Predicts Axillary Lymph Node Metastasis in Patients With Breast Cancer: A Multicenter Study. Acad Radiol 2023; 30 Suppl 2:S133-S142. [PMID: 37088646 DOI: 10.1016/j.acra.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 04/25/2023]
Abstract
RATIONALE AND OBJECTIVES This multicenter study aimed to explore the feasibility of radiomics based on intra- and peritumoral regions on preoperative breast cancer contrast-enhanced mammography (CEM) to predict axillary lymph node (ALN) metastasis. MATERIALS AND METHODS A total of 809 patients with preoperative breast cancer CEM images from two centers were retrospectively recruited. Least absolute shrinkage and selection operator (LASSO) regression was used to select radiomics features extracted from CEM images in regions of the tumor and peritumoral area of five and ten mm as well as construct radiomics signature. A nomogram, including the optimal radiomics signature and clinicopathological factors, was then constructed. Nomogram performance was evaluated using AUC and compared with breast radiologists directly. RESULTS In the internal testing set, AUCs of peritumoral signatures decreased when the peritumoral area increased and signaturetumor + 10mm demonstrated the best performance with an AUC of 0.712. The nomogram incorporating signaturetumor + 10mm, tumor diameter, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and CEM-reported lymph node status yielded maximum AUCs of 0.753 and 0.732 in internal and external testing sets, respectively. Moreover, the nomogram outperformed radiologists and improved diagnostic performance of radiologists. CONCLUSION The nomogram based on CEM intra- and peritumoral regions may provide a noninvasive auxiliary tool to guide treatment strategy of ALN metastasis in breast cancer.
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Affiliation(s)
- Zhongyi Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000
| | - Haicheng Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000
| | - Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000; Institute of medical imaging, Binzhou Medical University, Yantai, Shandong, P. R. China, 264000
| | - Ran Zhang
- Artificial Intelligence and Clinical Innovation Institute, Huiying Medical Technology Co., Ltd, P. R. China, 100192
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000
| | - Ping Yang
- Department of Pathology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong, P. R. China, 264000
| | - Kun Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, Shandong, P. R. China, 264000
| | - Feng Zhao
- School of Compute Science and Technology, Shandong Technology and Business University, Yantai, Shandong, People's Republic of China, 264000
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, No. 20 Yuhuangding east road, Yantai, Shandong, P. R. China, 264000.
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Lobig F, Caleyachetty A, Forrester L, Morris E, Newstead G, Harris J, Blankenburg M. Performance of Supplemental Imaging Modalities for Breast Cancer in Women With Dense Breasts: Findings From an Umbrella Review and Primary Studies Analysis. Clin Breast Cancer 2023:S1526-8209(23)00088-5. [PMID: 37202338 DOI: 10.1016/j.clbc.2023.04.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/28/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023]
Abstract
Breast cancer screening performance of supplemental imaging modalities by breast density and breast cancer risk has not been widely studied, and the optimal choice of modality for women with dense breasts remains unclear in clinical practice and guidelines. This systematic review aimed to assess breast cancer screening performance of supplemental imaging modalities for women with dense breasts, by breast cancer risk. Systematic reviews (SRs) in 2000 to 2021, and primary studies in 2019 to 2021, on outcomes of supplemental screening modalities (digital breast tomography [DBT], MRI (full/abbreviated protocol), contrast enhanced mammography (CEM), ultrasound (hand-held [HHUS]/automated [ABUS]) in women with dense breasts (BI-RADS C&D) were identified. None of the SRs analyzed outcomes by cancer risk. Meta-analysis of the primary studies was not feasible due to lack of studies (MRI, CEM, DBT) or methodological heterogeneity (ultrasound); therefore, findings were summarized narratively. For average risk, a single MRI trial reported a superior screening performance (higher cancer detection rate [CDR] and lower interval cancer rate [ICR]) compared to HHUS, ABUS and DBT. For intermediate risk, ultrasound was the only modality assessed, but accuracy estimates ranged widely. For mixed risk, a single CEM study reported the highest CDR, but included a high proportion of women with intermediate risk. This systematic review does not allow a complete comparison of supplemental screening modalities for dense breast populations by breast cancer risk. However, the data suggest that MRI and CEM might generally offer superior screening performance versus other modalities. Further studies of screening modalities are urgently required.
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Affiliation(s)
| | | | | | - Elizabeth Morris
- University of California Davis, Department of Radiology, Sacramento, CA 95817, USA
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11
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Yang ML, Bhimani C, Roth R, Germaine P. Contrast enhanced mammography: focus on frequently encountered benign and malignant diagnoses. Cancer Imaging 2023; 23:10. [PMID: 36691077 PMCID: PMC9872331 DOI: 10.1186/s40644-023-00526-1] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.
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Affiliation(s)
- Mindy L. Yang
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA ,Present address: SimonMed Imaging, 6900 E Camelback Road, Suite 700, Scottsdale, AZ 85251 USA
| | - Chandni Bhimani
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA ,Present address: Atlantic Medical Imaging, Bayport One Office Building, 8025 Black Horse Pike, Suite 300, West Atlantic City, NJ 08232 USA
| | - Robyn Roth
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| | - Pauline Germaine
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
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12
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Hogan MP, Amir T, Mango VL, Morris EA, Jochelson MS. Feasibility of contrast-enhanced mammography in women with breast implants. Clin Imaging 2023; 93:31-33. [PMID: 36371851 PMCID: PMC10445338 DOI: 10.1016/j.clinimag.2022.10.012] [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: 06/30/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/03/2022]
Abstract
Contrast-enhanced mammography (CEM) may provide an alternative to magnetic resonance imaging as a diagnostic exam in women with known or suspected breast cancer or as a screening exam in women at increased risk of breast cancer. Women with breast augmentation, either for oncologic or cosmetic reasons, may fall into this increased risk population and need safe and effective screening and diagnostic imaging tools. Here, we present our clinical practice data in order to demonstrate the feasibility of CEM in women with breast implants. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective review of our tertiary cancer center's database yielded 104 women with breast implants who underwent 198 CEM exams from November 2014 to March 2020. All 198/198 (100%) exams were successfully completed in 104 women. Exam indications included: 174/198 (88%) screening due to increased risk, 10/198 (5%) to evaluate a palpable abnormality, 9/198 (<5%) to evaluate disease extent following neoadjuvant chemotherapy for a known breast malignancy, and 5/198 (<3%) for a 6-month follow-up. 97/104 (93%) women had dense breasts. Routine and implant-displaced low-energy views were obtained with contrast-enhanced images obtained on displaced views for all patients. 197/198 (99.5%) exams yielded no complications. In one exam, the patient experienced mild vasovagal symptoms following the administration of contrast. In conclusion, it is feasible to utilize CEM in both diagnostic and screening capacities in women with breast implants.
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Affiliation(s)
- Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victoria L Mango
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, UC Davis Health, Davis, CA, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Phillips J, U Achibiri J, Kim G, Quintana LM, J Mehta R, S Mehta T. Characterization of True and False Positive Findings on Contrast-Enhanced Mammography. Acad Radiol 2022; 29:1672-1681. [PMID: 35190261 DOI: 10.1016/j.acra.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this paper is to characterize true and false positive findings on contrast-enhanced mammography (CEM) and correlate enhancement pattern and method of detection with pathology outcomes. MATERIALS AND METHODS This was an IRB-approved retrospective review of diagnostic CEM performed from December 2015 through December 2019 for which biopsy was recommended. Background parenchymal enhancement, tissue density, finding features, pathologic/clinical outcomes, and method of detection were captured. CEM includes low-energy images (LE), similar to standard 2D mammography, and recombined images (RI) that show enhancement. 'MG-detected' findings were identified on mammography or LE. 'RI-detected' findings were identified due to enhancement on RI. The positive predictive value (PPV2) was calculated on a per-case and a per-finding level. Comparisons were performed using Pearson chi-square and Fisher exact tests. RESULTS One hundred sixty CEM cases with 220 findings were evaluated with a case PPV2 of 58.1%. 32.3% (71/220) of lesions were RI-detected. The PPV2 of RI-detected enhancement was 40.8% with subanalysis revealing PPV2 of 22.2%, 32%, and 51.4% for foci, NME, and masses, respectively. The PPV2 of MG-detected enhancement was 73.5% with subanalysis revealing PPV2 of 50%, 54.1%, and 83.8% for foci, NME, and masses, respectively. There were 100 false positives findings, 42 of which were RI-detected. CONCLUSION PPV2 of diagnostic CEM is within the range of other diagnostic breast imaging exams. However false positives remain a challenge, especially for RI-detected findings. Additional efforts to improve specificity of RI-detected findings are worthwhile.
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Affiliation(s)
- Jordana Phillips
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Janeiro U Achibiri
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Geunwon Kim
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Liza M Quintana
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA.
| | - Rashmi J Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center - radiology dept., Pathology, Boston MA
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14
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Abstract
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
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15
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Abstract
Breast cancer is a heterogeneous disease nowadays, including different biological subtypes with a variety of possible treatments, which aim to achieve the best outcome in terms of response to therapy and overall survival. In recent years breast imaging has evolved considerably, and the ultimate goal is to predict these strong phenotypic differences noninvasively. Indeed, breast cancer multiparametric studies can highlight not only qualitative imaging parameters, as the presence/absence of a likely malignant finding, but also quantitative parameters, suggesting clinical-pathological features through the evaluation of imaging biomarkers. A further step has been the introduction of artificial intelligence and in particular radiogenomics, that investigates the relationship between breast cancer imaging characteristics and tumor molecular, genomic and proliferation features. In this review, we discuss the main techniques currently in use for breast imaging, their respective fields of use and their technological and diagnostic innovations.
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Affiliation(s)
- Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" - University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" - University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" - University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
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16
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Abstract
BACKGROUND Contrast-enhanced spectral mammography (CESM) may help to determine the malignancy potential of lesions according to the degree of enhancement. PURPOSE To investigate the correlation between the degree of contrast enhancement of the lesions in contrast-enhanced spectral mammography (CESM) and the final histopathological diagnosis in patients with BI-RADS 4 and 5 lesions. MATERIAL AND METHODS CESM was performed in 128 patients who had BI-RADS 4 and 5 lesions on mammography and underwent histopathological examination. A total of 128 index lesions were scored using a 4-point scale regarding the degree of contrast enhancement (0 = no contrast enhancement, 1 = minimal, 2 = moderate, 3 = marked), a score of 2 and 3 was accepted as suggestive of malignancy. The study was approved in our institutional scientific committee. RESULTS In total, 76 (59.4%) of the lesions had benign histopathological results, whereas 52 of them had malignant results. Contrast enhancement was not observed in 22.7% of the lesions while 24.2% had minimal enhancement, 18.8% had moderate enhancement, and 34.4% had marked enhancement in CESM. The sensitivity of the degree of contrast enhancement in CESM was 98.1%, when the specificity was 77.6%, positive predictive value was 75%, negative predictive value was 98.3%, and accuracy was 85.9%. CONCLUSION This study demonstrated that the degree of contrast enhancement of the lesions in CESM may be used in daily practice with easily performing a visual scale in predicting the malignancy potential of the lesions.
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Affiliation(s)
- Fatma Nur Soylu Boy
- Fatih Sultan Mehmet Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Kamber Goksu
- Fatih Sultan Mehmet Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Iksan Tasdelen
- Fatih Sultan Mehmet Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
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17
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Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA.
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18
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Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clin Imaging 2020; 69:269-279. [PMID: 33032103 DOI: 10.1016/j.clinimag.2020.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
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Affiliation(s)
- Julie Sogani
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
| | - Delia Keating
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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19
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Åhsberg K, Gardfjell A, Nimeus E, Rasmussen R, Behmer C, Zackrisson S, Ryden L. Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions-a feasibility study. World J Surg Oncol 2020; 18:100. [PMID: 32438917 PMCID: PMC7243325 DOI: 10.1186/s12957-020-01865-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of this feasibility study was to evaluate the added value of contrast-enhanced mammography (CEM) in preoperative staging of malignant breast lesions, beyond standard assessment with digital mammography and ultrasound, as a base for a future prospective randomized trial. MATERIALS AND METHODS Forty-seven patients, with confirmed or strongly suspected malignant breast lesions after standard assessment (digital mammography (DM) and ultrasound (US)), scheduled for primary surgery, were invited to undergo CEM as an additional preoperative procedure. The primary endpoint was change in treatment due to CEM findings, defined as mastectomy instead of partial mastectomy or contrariwise, bilateral surgery instead of unilateral or neoadjuvant treatment instead of primary surgery. Accuracy in tumour extent estimation compared to histopathology was evaluated by Bland-Altman statistics. Number of extra biopsies and adverse events were recorded. RESULTS In 10/47 patients (21%), findings from CEM affected the primary treatment. Agreement with histopathology regarding extent estimation was better for CEM (mean difference - 1.36, SD ± 18.45) in comparison with DM (- 4.18, SD ± 26.20) and US (- 8.36, SD ± 24.30). Additional biopsies were taken from 19 lesions in 13 patients. Nine biopsies showed malignant outcome. No major adverse events occurred. CONCLUSION The feasibility of preoperative additional CEM was found to be satisfactory without any serious negative effects. Results imply an added value of CEM in preoperative staging of breast cancer. Further evaluation in larger prospective randomized trials is needed. TRIAL REGISTRATION ClinicalTrials.gov, NCT03402529. Registered 18 January 2018-retrospectively registered.
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Affiliation(s)
- Kristina Åhsberg
- Department of Surgery, Halland Hospital, 301 85, Halmstad, Sweden. .,Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.
| | - Anna Gardfjell
- Department of Surgery, Blekinge Hospital, Karlskrona, Sweden
| | - Emma Nimeus
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden.,Institution of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden
| | - Rogvi Rasmussen
- Unilabs Breast Centre, Skåne University Hospital, Lund, Sweden
| | - Catharina Behmer
- Unilabs Breast Centre, Helsingborg Hospital, Helsingborg, Sweden
| | - Sophia Zackrisson
- Department of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden.,Diagnostic Radiology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lisa Ryden
- Institution of Clinical Sciences, Department of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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20
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Abstract
Screening mammography saves lives. The mainstay of screening has been mammography. Multiple alternative options, however, for supplemental imaging are now available. Some are just improved anatomic delineation whereas others include physiology added to anatomy. A third group (molecular imaging) is purely physiologic. This article describes and compares the available options and for which patient populations they should be used.
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Affiliation(s)
- Lizza Lebron-Zapata
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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21
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Abstract
Imaging plays a major role in the diagnosis, treatment, and follow-up of breast cancer. Findings that require further assessment will be detected both at screening and curative mammography. Most findings that are further worked up tend to yield benign diagnoses. Consequently, there is an ongoing search for new tools to reduce recalls and unnecessary biopsies while maintaining or improving cancer detection rates. The clinically most promising methods in this respect are described and discussed in this review.
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Affiliation(s)
- Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Maria Adele Marino
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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