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Ulu Öztürk F, Tezcan Ş, Uslu N. How to manage type 2 curve dilemma in dynamic contrast-enhanced magnetic resonance imaging of the breast: diffusion-weighted imaging or early phase enhancement kinetics? Acta Radiol 2024; 65:341-349. [PMID: 38193154 DOI: 10.1177/02841851231219675] [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: 01/10/2024]
Abstract
BACKGROUND Type 2 time-intensity curves can indicate both malignant and benign breast lesions in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). PURPOSE To investigate whether diffusion-weighted imaging (DWI) or early phase kinetics of DCE-MRI is practical to discriminate breast masses that depict type 2 curve in DCE-MRI. MATERIAL AND METHODS We retrospectively included 107 lesions in 97 patients with type 2 curves in DCE-MRI. Morphological characteristics, early phase dynamic parameters on DCE-MRI, and apparent diffusion coefficient (ADC) values on DWI were evaluated. Diagnostic thresholds of ADC and early phase maximum enhancement ratio (EPMER) to distinguish between benign and malignant masses were calculated. Strongest predictors of malignancy were determined to build the most effective diagnostic model. RESULTS DWI, EPMER, and all morphological features were found statistically significant to discriminate malignancy (P <0.05). The thresholds of ADC and EPMER were assigned as 1.0 ×10-3 mm2/s and 72%, respectively. The sensitivity and specificity were 80% and 97% for ADC, and 93% and 60% for EPMER, respectively. Two models were established. Model 1 comprised ADC and the lesion margin. Model 2 consisted of ADC, margin, and EPMER with a high specificity (99%) and positive predictive value (97%). CONCLUSION When combined with DWI, early phase wash-in data provide diagnostic improvement of breast masses presenting type 2 curve in the late phase of DCE-MRI, especially for specificity. Future studies are required to support our findings for the need of a cross-validation.
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Affiliation(s)
- Funda Ulu Öztürk
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
| | - Şehnaz Tezcan
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
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Liu Y, Jia X, Zhao J, Peng Y, Yao X, Hu X, Cui J, Chen H, Chen X, Wu J, Hong N, Wang S, Wang Y. A Machine Learning-Based Unenhanced Radiomics Approach to Distinguishing Between Benign and Malignant Breast Lesions Using T2-Weighted and Diffusion-Weighted MRI. J Magn Reson Imaging 2023. [PMID: 37933890 DOI: 10.1002/jmri.29111] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Breast MRI has been recommended as supplemental screening tool to mammography and breast ultrasound of breast cancer by international guidelines, but its long examination time and use of contrast material remains concerning. PURPOSE To develop an unenhanced radiomics model with using non-gadolinium based sequences for detecting breast cancer based on T2-weighted (T2W) and diffusion-weighted (DW) MRI. STUDY TYPE Retrospective analysis followed by retrospective and prospective cohorts study. POPULATION 1760 patients: Of these, 1293 for model construction (n = 775 for training and 518 for validation). The remaining patients for model testing in internal retrospective (n = 167), internal prospective (n = 188), and external retrospective (n = 112) cohorts. FIELD STRENGTH/SEQUENCE 3.0T MR scanners from two institution. T2WI, DWI, and first contrast-enhanced T1-weighted sequence. ASSESSMENT AUCs in distinguishing breast cancer were compared between combined model with gadolinium agent sequence and unenhanced model. Subsequently, the AUCs in testing cohorts of unenhanced model was compared with two radiologists' diagnosis for this research. Finally, patient subgroup analysis in testing cohorts was performed based on clinical subgroups and different types of malignancies. STATISTICAL TESTS Mann-Whitney U test, Kruskal-Wallis H test, chi-square test, weighted kappa test, and DeLong's test. RESULTS The unenhanced radiomics model performed best under Gaussian process (GP) classifiers (AUC: training, 0.893; validation, 0.848) compared to support vector machine (SVM) and logistic, showing favorable prediction in testing cohorts (AUCs, 0.818-0.840). The AUCs for the unenhanced radiomics model were not statistically different in five cohorts from those of the combined radiomics model (P, 0.317-0.816), as well as the two radiologists (P, 0.181-0.918). The unenhanced radiomics model was least successful in identifying ductal carcinoma in situ, whereas did not show statistical significance in other subgroups. DATA CONCLUSION An unenhanced radiomics model based on T2WI and DWI has comparable diagnostic accuracy to the combined model using the gadolinium agent. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yulu Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Xiaoxuan Jia
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Jiaqi Zhao
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, China
| | - Yuan Peng
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Xun Yao
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Xuege Hu
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Jingjing Cui
- Department of Research and Development, United Imaging Intelligence (Beijing) Co., Ltd., Beijing, China
| | - Haoquan Chen
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Xiufeng Chen
- Department of General Surgery, Beijing Aerospace General Hospital, Beijing, China
| | - Jing Wu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Shu Wang
- Department of Breast Surgery, Peking University People's Hospital, Beijing, China
| | - Yi Wang
- Department of Radiology, Peking University People's Hospital, Beijing, China
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Douglas L, Bhattacharjee R, Fuhrman J, Drukker K, Hu Q, Edwards A, Sheth D, Giger M. U-Net breast lesion segmentations for breast dynamic contrast-enhanced magnetic resonance imaging. J Med Imaging (Bellingham) 2023; 10:064502. [PMID: 37990686 PMCID: PMC10658935 DOI: 10.1117/1.jmi.10.6.064502] [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: 03/28/2023] [Revised: 10/07/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
Purpose Given the dependence of radiomic-based computer-aided diagnosis artificial intelligence on accurate lesion segmentation, we assessed the performances of 2D and 3D U-Nets in breast lesion segmentation on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) relative to fuzzy c-means (FCM) and radiologist segmentations. Approach Using 994 unique breast lesions imaged with DCE-MRI, three segmentation algorithms (FCM clustering, 2D and 3D U-Net convolutional neural networks) were investigated. Center slice segmentations produced by FCM, 2D U-Net, and 3D U-Net were evaluated using radiologist segmentations as truth, and volumetric segmentations produced by 2D U-Net slices and 3D U-Net were compared using FCM as a surrogate reference standard. Fivefold cross-validation by lesion was conducted on the U-Nets; Dice similarity coefficient (DSC) and Hausdorff distance (HD) served as performance metrics. Segmentation performances were compared across different input image and lesion types. Results 2D U-Net outperformed 3D U-Net for center slice (DSC, HD p < 0.001 ) and volume segmentations (DSC, HD p < 0.001 ). 2D U-Net outperformed FCM in center slice segmentation (DSC p < 0.001 ). The use of second postcontrast subtraction images showed greater performance than first postcontrast subtraction images using the 2D and 3D U-Net (DSC p < 0.05 ). Additionally, mass segmentation outperformed nonmass segmentation from first and second postcontrast subtraction images using 2D and 3D U-Nets (DSC, HD p < 0.001 ). Conclusions Results suggest that 2D U-Net is promising in segmenting mass and nonmass enhancing breast lesions from first and second postcontrast subtraction MRIs and thus could be an effective alternative to FCM or 3D U-Net.
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Affiliation(s)
- Lindsay Douglas
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Roma Bhattacharjee
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Jordan Fuhrman
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Karen Drukker
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Qiyuan Hu
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Alexandra Edwards
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Deepa Sheth
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
| | - Maryellen Giger
- University of Chicago, Department of Radiology Committee on Medical Physics, Chicago, Illinois, United States
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Barkhausen J, Bischof A, Haverstock D, Klemens M, Brueggenwerth G, Weber O, Endrikat J. Diagnostic efficacy of contrast-enhanced breast MRI versus X-ray mammography in women with different degrees of breast density. Acta Radiol 2021; 62:586-593. [PMID: 32678675 DOI: 10.1177/0284185120936271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Detection of breast cancer in women with high breast densities is a clinical challenge. PURPOSE To study the influence of different degrees of breast density on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) versus X-ray mammography (XRM). MATERIAL AND METHODS We performed an additional analysis of two large Phase III clinical trials (G1; G2) which included women with histologically proven breast cancers, called "index cancers." Additional cancers were detected during image reading. We compared the sensitivity of CE-BMRI and XRM in women with different breast densities (ACR A→D; Version 5). For each study, six blinded readers evaluated the images. Results are given as the "Median Reader." RESULTS A total of 774 patients were included, 169 had additional cancers. While sensitivity of CE-BMRI for detecting all index cancers was independent of breast density (ACR A→D) (G1: 83%→83%; G2: 91%→91%) the sensitivity of XRM declined (ACR A→D) (G1: 79%→62%; G2: 82%→64%). Thus, the sensitivity difference between both imaging modalities in ACR A breasts of 3% (G1) and 9% (G2) increased to 21% (G1) and 26% (G2) in ACR D breasts. Sensitivity of CE-BMRI for detecting at least one additional cancer increased with increasing breast density (ACR A→D) (G1: 50%→73%, G2: 57%→81%). XRM's sensitivity decreased (G1: 34%→20%) or remained stable (G2: 24%→25%). CONCLUSION CE-BMRI showed significantly higher sensitivity compared to XRM.
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Affiliation(s)
- Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Arpad Bischof
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | | | - Mark Klemens
- Bayer AG, General Clinical Imaging Services, 13353, Germany
| | | | - Olaf Weber
- Bayer AG, Radiology R&D, Berlin, Germany
- Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
| | - Jan Endrikat
- Bayer AG, Radiology R&D, Berlin, Germany
- University Medical School of Saarland, Dept of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany
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Matich A, Sud S, Buxi TBS, Dogra V. Idiopathic Granulomatous Mastitis and its Mimics on Magnetic Resonance Imaging: A Pictorial Review of Cases from India. J Clin Imaging Sci 2020; 10:53. [PMID: 33024608 PMCID: PMC7533078 DOI: 10.25259/jcis_112_2019] [Citation(s) in RCA: 2] [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: 08/01/2019] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast, which is benign but potentially morbid. Mammographic and sonographic findings have been well characterized, but magnetic resonance imaging (MRI) findings have been less thoroughly documented. The objective of this study was to demonstrate characteristic findings for IGM and its mimics via a retrospective review. Material and Methods: Breast MRI examinations performed at Sir Ganga Ram Hospital in New Delhi, India between 2014 and 2019 were retrospectively reviewed to identify cases in which a pattern suggestive of granulomatous mastitis was seen. Cases of known malignancy were excluded. Any available breast pathology results were then obtained, and cases with presumptive or definitive diagnoses were compiled for analysis. Results: Overall, cases identified with characteristic imaging findings and confirmed diagnosis included seven cases of IGM, four cases of invasive ductal carcinoma, two cases of tuberculous mastitis, one case of non- tuberculous infectious mastitis, one case of foreign body mastitis, and one case of eosinophilc mastitis. One case of IGM with masses rather than of non-mass enhancement was also identified. Conclusion: In our review, cases with clustered ring enhancement were found to have inflammatory, idiopathic, infectious and malignant etiologies. While, these etiologies can only be reliably differentiated on pathology, familiarity with the pattern and an awareness of the differential may lead to decreased morbidity due to delays in diagnosis.
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Affiliation(s)
- Alison Matich
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
| | - Seema Sud
- Departments of Magnetic Resonance Imaging and Computed Tomography, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - T B S Buxi
- Departments of Magnetic Resonance Imaging and Computed Tomography, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, United States
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Saphier N, Kondraciuk J, Morris E, Bernard-Davila B, Mango V. Preoperative Localization of Breast MRI Lesions: MRI-guided Marker Placement With Radioactive Seed Localization as an Alternative to MRI-guided Wire Localization. J Breast Imaging 2020; 2:250-258. [PMID: 33554114 DOI: 10.1093/jbi/wbaa012] [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: 08/07/2019] [Indexed: 11/14/2022]
Abstract
Objective Preoperative MRI-guided wire localization (MWL) presents challenges to both the physician and patient. In this study, we examined the efficiency and outcome of MRI-guided marker placement followed by mammographic-guided radioactive seed localization (MMP/RSL) as an alternative localization method. The primary outcome parameter was pathology upon excision. The secondary outcome parameters were total procedure time and clinical indication for localization. Methods A retrospective review of a large tertiary cancer center's breast imaging database was performed. Records of 21 patients with MMP/RSL (24 markers) from August 2013 to January 2019 were compared with 34 patients receiving MWL (48 wires) from January 2016 to January 2019. Multiple factors, including age, prelocalization pathology, postsurgical pathology, concordance, re-excision rates, and total procedure time required for each technique, were compared. Univariate and descriptive statistical analyses were performed. Results Mean patient age in years (MMP/RSL = 54.1 ± 13.1, MWL = 55.1 ± 10.8, P = 0.389), time in MR scanner in minutes (MMP/RSL = 31.7 ± 12.0, MWL = 35.8 ± 13.1, P = 0.678), and postsurgical pathology malignancy rates (MMP/RSL = 71.4%, MWL = 65.7%, P = 0.7715) were similar without statistically significant differences. As expected, the mean total procedure time was slightly longer without a statistically significant difference (47.3 ± 19.8 min versus 35.8 ± 13.1 min, P = 0.922) for the MMP/RSL group. All patients in both groups underwent successful localization with 100% radiologic-pathology concordance. Re-excision rates were lower for the MMP/RSL group (9.5%) versus the MWL group (16.7%); however, they were not found to be statistically significant (P = 0.7104). Conclusion MMP/RSL is a feasible alternative to MWL and may alleviate many challenges presented by MWL. Further studies are needed.
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Affiliation(s)
- Nicole Saphier
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Jessica Kondraciuk
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Elizabeth Morris
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
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Henderson LM, Ichikawa L, Buist DSM, Lee JM, Bush M, Johnson D, Onega T, Nekhlyudov L, Kerlikowske K, Miglioretti DL, Sprague BL, Wernli KJ. Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer. J Gen Intern Med 2019; 34:2098-2106. [PMID: 31410813 PMCID: PMC6816668 DOI: 10.1007/s11606-019-05181-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/21/2019] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND National patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge. OBJECTIVE To describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6 months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type. DESIGN Longitudinal study using cross-sectional data. SETTING Breast Cancer Surveillance Consortium breast imaging facilities. PARTICIPANTS 19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6 months (interquartile range, 22.1-60.7). MAIN MEASURES Breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type. KEY RESULTS Among women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1 year to 72.2% after 5 years; MRIs, 54.8% at 1 year to 78.6% after 5 years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6 months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations. CONCLUSION In women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.
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Affiliation(s)
- Louise M Henderson
- Department of Radiology, The University of North Carolina Chapel Hill NC, Chapel Hill, NC, 27599-7515, USA.
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Mary Bush
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dianne Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Koori N, Kurata K, Nihashi T, Noda S, Mashita Y. [Comparison of Kinetic Curve between Gadodiamide Hydrate and Gadobutrol on Breast Dynamic Contrast-enhanced Magnetic Resonance Imaging in Invasive Ductal Carcinoma]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:1313-1318. [PMID: 30464099 DOI: 10.6009/jjrt.2018_jsrt_74.11.1313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/11/2022]
Abstract
The shape of the kinetic curve for gadobutrol is reportedly different compared with that for other conventional contrast agents. We speculate that the shape of gadobutrol kinetic curve may be influenced by different magnetic resonance imaging (MRI) protocols and evaluation methods. The purpose of our study was to assess the influence between gadobutrol and other conventional contrast agent (gadodiamide hydrate) on the kinetic curve in invasive ductal carcinoma (IDC). We assessed 139 women of IDC in this study. Gadodiamide hydrate (2 ml/s) was administered to 69 women, and gadobutrol (1 ml/s) was administrated to 70 women, both contrast agents at 0.1 mmol/kg BW. When the kinetic curves of contrast agents were evaluated between by Breast Imaging Reporting and Data System (BI-RADS) 4th edition and BI-RADS 5th edition, suggested that the analysis method of BI-RADS may affect. Patient group who were administered gadobutrol demonstrated a lower washout rate when compared with patient group who were administered gadodiamide hydrate administration (P<0.01). These results suggest that the kinetic curve characteristics of gadobutrol are an important consideration in diagnosis. Therefore, it is necessary to perform image diagnosis by considering the influence of the contrast agent and the analysis method, when image diagnostic doctor perform image diagnosis.
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Affiliation(s)
- Norikazu Koori
- Department of Radiology, Komaki City Hospital.,Graduate School of Medical Science, Kanazawa University
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White MC, Soman A, Weinberg CR, Rodriguez JL, Sabatino SA, Peipins LA, DeRoo L, Nichols HB, Hodgson ME, Sandler DP. Factors associated with breast MRI use among women with a family history of breast cancer. Breast J 2018; 24:764-771. [PMID: 29781100 DOI: 10.1111/tbj.13063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/03/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022]
Abstract
Although annual breast magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer as an adjunct to screening mammography, breast MRI use remains low. We examined factors associated with breast MRI use in a cohort of women with a family history of breast cancer but no personal cancer history. Study participants came from the Sister Study cohort, a nationwide, prospective study of women with at least 1 sister who had been diagnosed with breast cancer but who themselves had not ever had breast cancer (n = 17 894). Participants were surveyed on breast cancer beliefs, cancer worry, breast MRI use, provider communication, and genetic counseling and testing. Logistic regression was used to assess factors associated with having a breast MRI overall and for those at high risk. Breast MRI was reported by 16.1% and was more common among younger women and those with higher incomes. After adjustment for demographics, ever use of breast MRI was associated with actual and perceived risk. Odds ratios (OR) were 12.29 (95% CI, 8.85-17.06), 2.48 (95% CI, 2.27-2.71), and 2.50 (95% CI, 2.09-2.99) for positive BRCA1/2 test, lifetime breast cancer risk ≥ 20%, and being told by a health care provider of higher risk, respectively. Women who believed they had much higher risk than others or had higher level of worry were twice as likely to have had breast MRI; OR = 2.23 (95% CI, 1.82-2.75) and OR = 1.76 (95% CI, 1.52-2.04). Patterns were similar among women at high risk. Breast cancer risk, provider communication, and personal beliefs were determinants of breast MRI use. To support shared decisions about the use of breast MRI, women could benefit from improved understanding of the chances of getting breast cancer and increased quality of provider communications.
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Affiliation(s)
- Mary C White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Ashwini Soman
- Information Systems, Northrop Grumman Corporation, Atlanta, GA, USA
| | - Clarice R Weinberg
- Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lisa DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veteran Affairs and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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11
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Ballesio L, Gigli S, Di Pastena F, Giraldi G, Manganaro L, Anastasi E, Catalano C. Magnetic resonance imaging tumor regression shrinkage patterns after neoadjuvant chemotherapy in patients with locally advanced breast cancer: Correlation with tumor biological subtypes and pathological response after therapy. Tumour Biol 2017; 39:1010428317694540. [PMID: 28347225 DOI: 10.1177/1010428317694540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 12/19/2022] Open
Abstract
The objective of this study is to analyze magnetic resonance imaging shrinkage pattern of tumor regression after neoadjuvant chemotherapy and to evaluate its relationship with biological subtypes and pathological response. We reviewed the magnetic resonance imaging studies of 51 patients with single mass-enhancing lesions (performed at time 0 and at the II and last cycles of neoadjuvant chemotherapy). Tumors were classified as Luminal A, Luminal B, HER2+, and Triple Negative based on biological and immunohistochemical analysis after core needle biopsy. We classified shrinkage pattern, based on tumor regression morphology on magnetic resonance imaging at the II cycle, as concentric, nodular, and mixed. We assigned a numeric score (0: none; 1: low; 2: medium; 3: high) to the enhancement intensity decrease. Pathological response on the surgical specimen was classified as complete (grade 5), partial (grades 4-3), and non-response (grades 1-2) according to Miller and Payne system. Fisher test was used to relate shrinkage pattern with biological subtypes and final pathological response. Seventeen patients achieved complete response, 25 partial response, and 9 non-response. A total of 13 lesions showed nodular pattern, 20 concentric, and 18 mixed. We found an association between concentric pattern and HER2+ (p < 0.001) and mixed pattern and Luminal A lesions (p < 0.001). We observed a statistical significant correlation between concentric pattern and complete response (p < 0.001) and between mixed pattern and non-response (p = 0.005). Enhancement intensity decrease 3 was associated with complete response (p < 0.001). Shrinkage pattern and enhancement intensity decrease may serve as early response indicators after neoadjuvant chemotherapy. Shrinkage pattern correlates with tumor biological subtypes.
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Affiliation(s)
- Laura Ballesio
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Silvia Gigli
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Francesca Di Pastena
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Guglielmo Giraldi
- 2 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Lucia Manganaro
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
| | - Emanuela Anastasi
- 3 Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- 1 Department of Radiological Oncological and Anatomopathological Sciences, Sapienza University of Rome and Umberto I Hospital, Rome, Italy
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Leddy R, Irshad A, Hewett L, Collins H, Vento F, Ackerman S, Lewis M. Effects of Neoadjuvant Chemotherapy on Benign Breast Lesions Compared to Cancers: Should an Additional Lesion on Magnetic Resonance Imaging Responding Similar to Cancer after Neoadjuvant Chemotherapy be Viewed with Suspicion? J Clin Imaging Sci 2016; 6:39. [PMID: 27833781 PMCID: PMC5041378 DOI: 10.4103/2156-7514.190899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/17/2016] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Determining the effects of neoadjuvant chemotherapy (NAC) on benign breast lesions and to evaluate their response in comparison to breast cancers. METHODS A retrospective analysis performed on breast cancer patients between 2008 and 2014 to identify patients who had a pre- and post-NAC magnetic resonance imaging (MRI) and biopsy-proven benign lesions. Pre- and post-NAC size and intensity of enhancement of benign lesions and cancers were measured. Breast glandularity and background enhancement were graded. A 2 × 2 repeated measures ANOVAs and Sidak post hoc tests were conducted for multiple comparisons. Paired t-tests were conducted to examine changes over time, and two-tailed P values were reported. RESULTS The effects of NAC in 38 cancers were compared to the effects of NAC in 47 benign lesions in these patients. From pre- to post-NAC, the mean size (cm) of malignant lesions on MRI decreased from 4.09 (±standard deviation [SD] 2.51) to 1.54 (±SD 2.32), (P < 0.001); the mean size (cm) of benign lesions decreased from 0.83 (±SD 0.54 cm) to 0.28 (±SD 0.51), (P < 0.001). Both benign and malignant lesions decreased in size after NAC, the size reduction in malignant lesions was significantly greater than benign lesions. From pre- to post-NAC, the mean lesion enhancement of the malignant lesions (scale 1-4) decreased from 3.43 (±SD 0.80) to 1.02 (±SD 1.34); the mean lesion enhancement of benign lesions decreased from 2.96 (±SD 1.04) to 0.98 (±SD 1.51). For both benign and malignant lesions, there was a significant overall reduction in enhancement after NAC from moderate at pre-NAC to minimal at post-NAC, P < 0.001. There was no overall difference in the enhancement of cancers (mean = 2.22, SD = 0.79) versus benign lesions (mean = 1.97, SD = 1.08), (P = 0.23). There was no significant change in glandularity from pretherapy (mean = 3.11, SD = 0.84) to posttherapy (mean = 3.13, SD = 0.82), P < 0.001. CONCLUSION Similar to cancers, benign breast lesions also show a significant decrease in size and enhancement after NAC; however, the decrease in size is less compared to cancers.
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Affiliation(s)
- Rebecca Leddy
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Abid Irshad
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lara Hewett
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Heather Collins
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Frank Vento
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Susan Ackerman
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Madelene Lewis
- Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA
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Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Minuk T, Chambers S, Sussman J. A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer. Breast Cancer (Auckl) 2016; 10:53-60. [PMID: 27226720 PMCID: PMC4871200 DOI: 10.4137/bcbcr.s38432] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Breast magnetic resonance imaging (MRI) is considered a more sensitive diagnostic test for detecting invasive breast cancer than mammography or breast ultrasound. Breast MRI may be particularly useful in younger premenopausal women with higher density breast tissue for differentiating between dense fibroglandular breast tissue and breast malignancies. The main objective of this study was to determine the impact of preoperative breast MRI on surgical decision-making in young women with breast cancer. METHODS A retrospective review of patients with newly diagnosed invasive breast cancer and age of ≤50 years was performed. All patients underwent physical examination, preoperative mammogram, breast ultrasound, and bilateral breast MRI. Two breast cancer surgeons reviewed the preoperative mammogram report, breast ultrasound report, and physical examination summary and were asked if they would recommend a lumpectomy, a quandrantectomy, or a mastectomy. A few weeks later, the two surgeons were shown the same information with the breast MRI report and were asked what type of surgery they would now recommend. In each case, MRI was classified by two adjudicators as having affected the surgical outcome in a positive, negative, or neutral fashion. A positive impact was defined as the situation where breast MRI detected additional disease that was not found on physical examination, mammogram, or breast ultrasound and led to an appropriate change in surgical management. A negative impact was defined as the situation where breast MRI led the surgeon to recommend more extensive surgery, with less extensive disease actually found at pathology. No impact was defined as the situation where MRI findings did not alter surgical recommendations or outcomes. RESULTS Of 37 patients whose charts were reviewed, five patients were deemed to be ineligible due to having received neoadjuvant chemotherapy, having previous breast implants, or having had their tumor fully excised during biopsy. In total, 32 patients met the inclusion criteria of this study and were appropriate for analysis. The median age of our study patient population was 42 years. The pathologic diagnosis was invasive ductal carcinoma in 91% (29/32) of patients and invasive lobular carcinoma in 9% (3/32) of patients. For surgeon A, clinical management was altered in 21/32 (66%) patients, and for surgeon B, management was altered in 13/32 (41%) patients. The most common change in surgical decision-making after breast MRI was from breast-conserving surgery to a mastectomy. Mastectomy rates were similar between both surgeons after breast MRI. After reviewing the pathology results and comparing them with the breast MRI results, it was determined that breast MRI led to a positive outcome in 13/32 (41%) patients. Breast MRI led to no change in surgical management in 15/32 (47%) patients and resulted in a negative change in surgical management in 4/32 (13%) patients. Bilateral breast MRI detected a contralateral breast cancer in 2/32 (6%) patients. CONCLUSIONS Preoperative breast MRI alters surgical management in a significant proportion of younger women diagnosed with breast cancer. Prospective studies are needed to confirm these findings and to help determine if this change in surgical decision-making will result in improved local control.
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Affiliation(s)
- Som D Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Nicole Hodgson
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada.; St. Joseph's Hospital, Hamilton, ON, Canada
| | | | - Terry Minuk
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Shelley Chambers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Bozkurt Bostan T, Koç G, Sezgin G, Altay C, Fazıl Gelal M, Oyar O. Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions. Balkan Med J 2016; 33:294-300. [PMID: 27308073 DOI: 10.5152/balkanmedj.2016.141007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 08/17/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has become a diagnostic and problem solving method for the breast examinations in addition to conventional breast examination methods. Diffusion-weighted imaging (DWI) adds valuable information to conventional MRI. AIMS Our aim was to show the impact of apparent diffusion coefficient (ADC) values acquired with DWI to differentiate benign and malignant breast lesions. STUDY DESIGN Diagnostic accuracy study. METHODS Forty-six women with 58 breast masses (35 malignant, 23 benign) were examined on a 1.5 T clinical MRI scanner. The morphologic characteristics of the lesions on conventional MRI sequences and contrast uptake pattern were assessed. ADC values of both lesions and normal breast parenchyma were measured. The ADC values obtained were statistically compared with the histopathologic results using Paired Samples t-Test. RESULTS Multiple lesions were detected in 12 (26%) of the patients, while only one lesion was detected in 34 (74%). Overall, 35 lesions out of 58 were histopathologically proven to be malignant. In the dynamic contrast-enhanced series, 5 of the malignant lesions were type 1, while 8 benign lesions revealed either type 2 or 3 time signal intensity curves (85% sensitivity, 56% spesifity). Mean ADC values were significantly different in malignant vs. benign lesions. (1.04±0.29×10(-3) cm(2)/sec vs. 1.61±0.50×10(-3) cm(2)/sec for the malignant and benign lesions, respectively, p=0.03). A cut-off value of 1.30×10(-3) mm(2)/sec for ADC detected with receiver operating characteristic analysis yielded 89.1% sensitivity and 100% specificity for the differentiation between benign and malignant lesions. CONCLUSION ADC values improve the diagnostic accuracy of solid breast lesions when evaluated with the conventional MRI sequences. Therefore, DWI should be incorporated to routine breast MRI protocol.
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Affiliation(s)
- Tuğba Bozkurt Bostan
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
| | - Gonca Koç
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
| | - Gülten Sezgin
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
| | - Canan Altay
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
| | - M Fazıl Gelal
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
| | - Orhan Oyar
- Department of Radiology, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital
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Henderson LM, Weiss J, Hubbard RA, O'Donoghue C, DeMartini WB, Buist DS, Kerlikowske K, Goodrich M, Virnig B, Tosteson AN, Lehman CD, Onega T. Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer. Breast J 2016; 22:24-34. [PMID: 26511204 PMCID: PMC4718842 DOI: 10.1111/tbj.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions.
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Affiliation(s)
| | - Julie Weiss
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Rebecca A. Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | | | | | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California at San Francisco, San Francisco, CA
| | - Martha Goodrich
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Beth Virnig
- School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Anna N.A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Constance D. Lehman
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, NH
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Abstract
Metaplastic carcinoma of the breast is an uncommon type of malignancy that is aggressive but can mimic other benign breast neoplastic processes on imaging. We present a case of a young female patient who presented with a rapidly progressing metaplastic carcinoma with osteoclastic giant cells subtype. There have been only very rare published reports of this pathologic subtype of metaplastic carcinoma containing osteoclastic giant cells.
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Affiliation(s)
- Kathleen Khong
- Department of Radiology, University of California, Davis Medical Center, Sacramento, USA
| | - Yanhong Zhang
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, USA
| | - Mary Tomic
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, USA
| | - Karen Lindfors
- Department of Radiology, University of California, Davis Medical Center, Sacramento, USA
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Alcantara D, Leal MP, García-Bocanegra I, García-Martín ML. Molecular imaging of breast cancer: present and future directions. Front Chem 2014; 2:112. [PMID: 25566530 PMCID: PMC4270251 DOI: 10.3389/fchem.2014.00112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 10/15/2014] [Accepted: 12/01/2014] [Indexed: 12/21/2022] Open
Abstract
Medical imaging technologies have undergone explosive growth over the past few decades and now play a central role in clinical oncology. But the truly transformative power of imaging in the clinical management of cancer patients lies ahead. Today, imaging is at a crossroads, with molecularly targeted imaging agents expected to broadly expand the capabilities of conventional anatomical imaging methods. Molecular imaging will allow clinicians to not only see where a tumor is located in the body, but also to visualize the expression and activity of specific molecules (e.g., proteases and protein kinases) and biological processes (e.g., apoptosis, angiogenesis, and metastasis) that influence tumor behavior and/or response to therapy. Breast cancer, the most common cancer among women and a research area where our group is actively involved, is a very heterogeneous disease with diverse patterns of development and response to treatment. Hence, molecular imaging is expected to have a major impact on this type of cancer, leading to important improvements in diagnosis, individualized treatment, and drug development, as well as our understanding of how breast cancer arises.
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Affiliation(s)
- David Alcantara
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Manuel Pernia Leal
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Irene García-Bocanegra
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Maria L García-Martín
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
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Chikarmane SA, Gombos EC, Jagadeesan J, Raut C, Jagannathan JP. MRI findings of radiation-associated angiosarcoma of the breast (RAS). J Magn Reson Imaging 2014; 42:763-70. [PMID: 25504856 DOI: 10.1002/jmri.24822] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 08/12/2014] [Accepted: 11/17/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the magnetic resonance imaging (MRI) characteristics of radiation-associated breast angiosarcomas (RAS). MATERIALS AND METHODS In this Institutional Review board (IRB)-approved retrospective study, 57 women were diagnosed with pathologically confirmed RAS during the study period (January 1999 to May 2013). Seventeen women underwent pretreatment breast MRI (prior to surgical resection or chemotherapy), of which 16 studies were available for review. Imaging features, including all available mammograms, ultrasounds, and breast MRIs, of these patients were evaluated by two radiologists independently and correlated with clinical management and outcomes. RESULTS The median age of patients at original breast cancer diagnosis was 69.3 years (range 42-84 years), with average time from initial radiation therapy to diagnosis of RAS of 7.3 years (range 5.1-9.5 years). Nine women had mammograms (9/16, 56%) and six had breast ultrasound (US) (6/16, 38%) prior to MRI, which demonstrated nonsuspicious findings in 5/9 mammograms and 3/6 ultrasounds. Four patients had distinct intraparenchymal masses on mammogram and MRI. MRI findings included diffuse T2 high signal skin thickening (16/16, 100%). Nearly half (7/16, 44%) of patients had T2 low signal intensity lesions; all lesions rapidly enhanced on postcontrast T1 -weighted imaging. All women underwent surgical resection, with 8/16 (50%) receiving neoadjuvant chemotherapy. Four women died during the study period. CONCLUSION Clinical, mammographic, and sonographic findings of RAS are nonspecific and may be occult on conventional breast imaging; MRI findings of RAS include rapidly enhancing dermal and intraparenchymal lesions, some of which are low signal on T2 weighted imaging.
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Affiliation(s)
- Sona A Chikarmane
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eva C Gombos
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Imaging, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jayender Jagadeesan
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chandrajit Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jyothi P Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Destounis SV, Arieno AL, Morgan RC. Importance of presurgical breast MRI in patients 60 years of age and older. J Clin Imaging Sci 2014; 4:46. [PMID: 25250195 PMCID: PMC4168544 DOI: 10.4103/2156-7514.139736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/20/2014] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
Abstract
Objective: To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI) in women 60 years of age and older. Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results. Results: Of 1268 exams performed in this population, 272 (21.5%) patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%), benign findings in 127 (47%), and atypia in 31 (11%). Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy. Conclusions: Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268) and atypia in 2.4% (n = 31/1268). A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268). These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.
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Laguna AD, Arranz SJ, Checa VQ, Roca SA, Jiménez DE, Oliver-Goldaracena J. Sonographic findings of additional malignant lesions in breast carcinoma seen by second look ultrasound. J Clin Imaging Sci 2011; 1:34. [PMID: 21966631 PMCID: PMC3177465 DOI: 10.4103/2156-7514.82338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 04/15/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
Objective: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. Materials and Methods: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. Results: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. Conclusions: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.
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Affiliation(s)
- Ana Delgado Laguna
- Department of Radiology, Alcorcon University Hospital Foundation, Madrid, Spain
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