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Wunderle M, Heindl F, Behrens AS, Häberle L, Hack CC, Heusinger K, Huebner H, Gass P, Ruebner M, Schulz-Wendtland R, Erber R, Hartmann A, Beckmann MW, Dougall WC, Press MF, Fasching PA, Emons J. Correlation of RANK and RANKL with mammographic density in primary breast cancer patients. Arch Gynecol Obstet 2024:10.1007/s00404-024-07495-1. [PMID: 38836929 DOI: 10.1007/s00404-024-07495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE The receptor activator of nuclear factor kappa B (RANK) and its ligand (RANKL) have been shown to promote proliferation of the breast and breast carcinogenesis. The objective of this analysis was to investigate whether tumor-specific RANK and RANKL expression in patients with primary breast cancer is associated with high percentage mammographic density (PMD), which is a known breast cancer risk factor. METHODS Immunohistochemical staining of RANK and RANKL was performed in tissue microarrays (TMAs) from primary breast cancer samples of the Bavarian Breast Cancer Cases and Controls (BBCC) study. For RANK and RANKL expression, histochemical scores (H scores) with a cut-off value of > 0 vs 0 were established. PMD was measured in the contralateral, non-diseased breast. Linear regression models with PMD as outcome were calculated using common predictors of PMD (age at breast cancer diagnosis, body mass index (BMI) and parity) and RANK and RANKL H scores. Additionally, Spearman rank correlations (ρ) between PMD and RANK and RANKL H score were performed. RESULTS In the final cohort of 412 patients, breast cancer-specific RANK and RANKL expression was not associated with PMD (P = 0.68). There was no correlation between PMD and RANK H score (Spearman's ρ = 0.01, P = 0.87) or RANKL H score (Spearman's ρ = 0.04, P = 0.41). RANK expression was highest in triple-negative tumors, followed by HER2-positive, luminal B-like and luminal A-like tumors, while no subtype-specific expression of RANKL was found. CONCLUSION Results do not provide evidence for an association of RANK and RANKL expression in primary breast cancer with PMD.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Annika S Behrens
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Institute of Diagnostic Radiology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Ramona Erber
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Institute of Pathology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Arndt Hartmann
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Institute of Pathology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - William C Dougall
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4702, Australia
- Hematology and Oncology Research, Amgen, Inc, Seattle, WA, 98119, USA
| | - Michael F Press
- Department of Pathology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany.
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany.
| | - Julius Emons
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
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Bhattacharjee A, Walsh D, Dasari P, Hodson LJ, Edwards S, White SJ, Turnbull D, Ingman WV. Factors Associated with Increased Knowledge about Breast Density in South Australian Women Undergoing Breast Cancer Screening. Cancers (Basel) 2024; 16:893. [PMID: 38473255 DOI: 10.3390/cancers16050893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Background: There is growing awareness of breast density in women attending breast cancer screening; however, it is unclear whether this awareness is associated with increased knowledge. This study aims to evaluate breast density knowledge among Australian women attending breast cancer screening. Method: This cross-sectional study was conducted on women undergoing breast cancer screening at The Queen Elizabeth Hospital Breast/Endocrine outpatient department. Participants were provided with a questionnaire to assess knowledge, awareness, and desire to know their own breast density. Result: Of the 350 women who participated, 61% were familiar with 'breast density' and 57% had 'some knowledge'. Prior breast density notification (OR = 4.99, 95% CI = 2.76, 9.03; p = 0.004), awareness (OR = 4.05, 95% CI = 2.57, 6.39; p = 0.004), younger age (OR = 0.97, 95% CI = 0.96, 0.99; p = 0.02), and English as the language spoken at home (OR = 3.29, 95% CI = 1.23, 8.77; p = 0.02) were independent predictors of 'some knowledge' of breast density. A significant proportion of participants (82%) expressed desire to ascertain their individual breast density. Conclusions: While knowledge of breast density in this Australian cohort is generally quite low, we have identified factors associated with increased knowledge. Further research is required to determine optimal interventions to increase breast density knowledge.
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Affiliation(s)
- Avisak Bhattacharjee
- Discipline of Surgical Specialties, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, SA 5011, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia
| | - David Walsh
- Discipline of Surgical Specialties, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, SA 5011, Australia
| | - Pallave Dasari
- Discipline of Surgical Specialties, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, SA 5011, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia
| | - Leigh J Hodson
- Discipline of Surgical Specialties, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, SA 5011, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia
| | - Suzanne Edwards
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - Sarah J White
- Centre for Social Impact, University of New South Wales, Sydney, NSW 2052, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, SA 5005, Australia
| | - Wendy V Ingman
- Discipline of Surgical Specialties, Adelaide Medical School, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, SA 5011, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia
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3
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Yang Z, Wang N, Han R, Tang Y, Chen H, Xie Y, Wang R, Tang L. Low breast density and peritumoral edema on MR predict worse overall survival of breast cancer patients after neoadjuvant chemotherapy. Eur J Radiol 2024; 171:111294. [PMID: 38218065 DOI: 10.1016/j.ejrad.2024.111294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To investigate the relationship of pre-treatment MR image features (including breast density) and clinical-pathologic characteristics with overall survival (OS) in breast cancer patients receiving neoadjuvant chemotherapy (NAC). METHODS This retrospective study obtained an approval of the institutional review board and the written informed consents of patients were waived. From October 2013 to April 2019, 130 patients (mean age, 47.6 ± 9.4 years) were included. The univariable and multivariable Cox proportional hazards regression models were applied to analyze factors associated with OS, including MR image parameters and clinical-pathologic characteristics. RESULTS Among the 130 included patients, 11 (8.5%) patients (mean age, 48.4 ± 11.8 years) died of breast cancer recurrence or distant metastasis. The median follow-up length was 70 months (interquartile range of 60-85 months). According to the Cox regression analysis, older age (hazard ratio [HR] = 1.769, 95% confidence interval [CI]): 1.330, 2.535), higher T stage (HR = 2.490, 95%CI:2.047, 3.029), higher N stage (HR = 1.869, 95%CI:1.507, 2.317), low breast density (HR = 1.693, 95%CI:1.391, 2.060), peritumoral edema (HR = 1.408, 95%CI:1.078, 1.840), axillary lymph nodes invasion (HR = 3.118, 95%CI:2.505, 3.881) on MR were associated with worse OS (all p < 0.05). CONCLUSIONS Pre-treatment MR features and clinical-pathologic parameters are valuable for predicting long-time OS of breast cancer patients after NAC followed by surgery. Low breast density, peritumoral edema and axillary lymph nodes invasion on pre-treatment MR images were associated with worse prognosis.
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Affiliation(s)
- Zhenlu Yang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Nanzhu Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Rongcheng Han
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Yu Tang
- English Language Department, Guizhou Normal University, Guiyang, Guizhou 550000, China
| | - Hailan Chen
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Yuhong Xie
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China
| | - Lei Tang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550000, China.
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Tari DU. Breast Cancer: A Multi-Disciplinary Approach from Imaging to Therapy. Curr Oncol 2024; 31:598-602. [PMID: 38275836 PMCID: PMC10814324 DOI: 10.3390/curroncol31010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Breast cancer (BC) is the most prevalent form of cancer among women worldwide, accounting for over 2 million diagnoses annually [...].
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Affiliation(s)
- Daniele Ugo Tari
- Department of Breast Imaging, Caserta Local Health Authority, District 12 "Palazzo della Salute", 81100 Caserta, Italy
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5
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Lau HSH, Tan VKM, Tan BKT, Sim Y, Quist J, Thike AA, Tan PH, Pervaiz S, Grigoriadis A, Sabapathy K. Adipose-enriched peri-tumoral stroma, in contrast to myofibroblast-enriched stroma, prognosticates poorer survival in breast cancers. NPJ Breast Cancer 2023; 9:84. [PMID: 37863888 PMCID: PMC10589339 DOI: 10.1038/s41523-023-00590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023] Open
Abstract
Despite our understanding of the genetic basis of intra-tumoral heterogeneity, the role of stromal heterogeneity arising from an altered tumor microenvironment in affecting tumorigenesis is poorly understood. In particular, extensive study on the peri-tumoral stroma in the morphologically normal tissues surrounding the tumor is lacking. Here, we examine the heterogeneity in tumors and peri-tumoral stroma from 8 ER+/PR+/HER2- invasive breast carcinomas, through multi-region transcriptomic profiling by microarray. We describe the regional heterogeneity observed at the intrinsic molecular subtype, pathway enrichment, and cell type composition levels within each tumor and its peri-tumoral region, up to 7 cm from the tumor margins. Moreover, we identify a pro-inflammatory adipose-enriched peri-tumoral subtype which was significantly associated with poorer overall survival in breast cancer patients, in contrast to an adaptive immune cell- and myofibroblast-enriched subtype. These data together suggest that peri-tumoral heterogeneity may be an important determinant of the evolution and treatment of breast cancers.
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Affiliation(s)
- Hannah Si Hui Lau
- Divisions of Cellular & Molecular Research, National Cancer Centre Singapore, Singapore, 168583, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Veronique Kiak Mien Tan
- Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore
| | - Benita Kiat Tee Tan
- Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, 544886, Singapore
| | - Yirong Sim
- Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore
| | - Jelmar Quist
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aye Aye Thike
- Division of Pathology, Singapore General Hospital, Singapore, 169856, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, 169856, Singapore
| | - Shazib Pervaiz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Anita Grigoriadis
- Cancer Bioinformatics, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kanaga Sabapathy
- Divisions of Cellular & Molecular Research, National Cancer Centre Singapore, Singapore, 168583, Singapore.
- School of Biological Sciences, Nanyang Technological University, Singapore, 637551, Singapore.
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Behrens A, Fasching PA, Schwenke E, Gass P, Häberle L, Heindl F, Heusinger K, Lotz L, Lubrich H, Preuß C, Schneider MO, Schulz-Wendtland R, Stumpfe FM, Uder M, Wunderle M, Zahn AL, Hack CC, Beckmann MW, Emons J. Predicting mammographic density with linear ultrasound transducers. Eur J Med Res 2023; 28:384. [PMID: 37770952 PMCID: PMC10537934 DOI: 10.1186/s40001-023-01327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments. METHODS We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON® 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models. RESULTS Gray level bins and PMD correlated to a certain extent. Spearman's ρ ranged from - 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R2, 0.255). Overall, ultrasound images from the VOLUSON® 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms. CONCLUSIONS In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
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Affiliation(s)
- Annika Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Hannah Lubrich
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline Preuß
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael O Schneider
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna L Zahn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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7
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Zdanowski A, Sartor H, Feldt M, Skarping I. Mammographic density in relation to breast cancer recurrence and survival in women receiving neoadjuvant chemotherapy. Front Oncol 2023; 13:1177310. [PMID: 37388229 PMCID: PMC10304818 DOI: 10.3389/fonc.2023.1177310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The association between mammographic density (MD) and breast cancer (BC) recurrence and survival remains unclear. Patients receiving neoadjuvant chemotherapy (NACT) are in a vulnerable situation with the tumor within the breast during treatment. This study evaluated the association between MD and recurrence/survival in BC patients treated with NACT. Methods Patients with BC treated with NACT in Sweden (2005-2016) were retrospectively included (N=302). Associations between MD (Breast Imaging-Reporting and Data System (BI-RADS) 5th Edition) and recurrence-free/BC-specific survival at follow-up (Q1 2022) were addressed. Hazard ratios (HRs) for recurrence/BC-specific survival (BI-RADS a/b/c vs. d) were estimated using Cox regression analysis and adjusted for age, estrogen receptor status, human epidermal growth factor receptor 2 status, axillary lymph node status, tumor size, and complete pathological response. Results A total of 86 recurrences and 64 deaths were recorded. The adjusted models showed that patients with BI-RADS d vs. BI-RADS a/b/c had an increased risk of recurrence (HR 1.96 (95% confidence interval (CI) 0.98-3.92)) and an increased risk of BC-specific death (HR 2.94 (95% CI 1.43-6.06)). Conclusion These findings raise questions regarding personalized follow-up for BC patients with extremely dense breasts (BI-RADS d) pre-NACT. More extensive studies are required to confirm our findings.
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Affiliation(s)
| | - Hanna Sartor
- Department of Translational Medicine, Diagnostic Radiology, Skåne University Hospital, Lund University, Lund/Malmö, Sweden
| | - Maria Feldt
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Ida Skarping
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
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Tari DU, Santonastaso R, De Lucia DR, Santarsiere M, Pinto F. Breast Density Evaluation According to BI-RADS 5th Edition on Digital Breast Tomosynthesis: AI Automated Assessment Versus Human Visual Assessment. J Pers Med 2023; 13:jpm13040609. [PMID: 37108994 PMCID: PMC10146726 DOI: 10.3390/jpm13040609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background: The assessment of breast density is one of the main goals of radiologists because the masking effect of dense fibroglandular tissue may affect the mammographic identification of lesions. The BI-RADS 5th Edition has revised the mammographic breast density categories, focusing on a qualitative evaluation rather than a quantitative one. Our purpose is to compare the concordance of the automatic classification of breast density with the visual assessment according to the latest available classification. Methods: A sample of 1075 digital breast tomosynthesis images from women aged between 40 and 86 years (58 ± 7.1) was retrospectively analyzed by three independent readers according to the BI-RADS 5th Edition. Automated breast density assessment was performed on digital breast tomosynthesis images with the Quantra software version 2.2.3. Interobserver agreement was assessed with kappa statistics. The distributions of breast density categories were compared and correlated with age. Results: The agreement on breast density categories was substantial to almost perfect between radiologists (κ = 0.63–0.83), moderate to substantial between radiologists and the Quantra software (κ = 0.44–0.78), and the consensus of radiologists and the Quantra software (κ = 0.60–0.77). Comparing the assessment for dense and non-dense breasts, the agreement was almost perfect in the screening age range without a statistically significant difference between concordant and discordant cases when compared by age. Conclusions: The categorization proposed by the Quantra software has shown a good agreement with the radiological evaluations, even though it did not completely reflect the visual assessment. Thus, clinical decisions regarding supplemental screening should be based on the radiologist’s perceived masking effect rather than the data produced exclusively by the Quantra software.
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Edmonds CE, O'Brien SR, Conant EF. Mammographic Breast Density: Current Assessment Methods, Clinical Implications, and Future Directions. Semin Ultrasound CT MR 2023; 44:35-45. [PMID: 36792272 DOI: 10.1053/j.sult.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mammographic breast density is widely accepted as an independent risk factor for the development of breast cancer. In addition, because dense breast tissue may mask breast malignancies, breast density is inversely related to the sensitivity of screening mammography. Given the risks associated with breast density, as well as ongoing efforts to stratify individual risk and personalize breast cancer screening and prevention, numerous studies have sought to better understand the factors that impact breast density, and to develop and implement reproducible, quantitative methods to assess mammographic density. Breast density assessments have been incorporated into risk assessment models to improve risk stratification. Recently, novel techniques for analyzing mammographic parenchymal complexity, or texture, have been explored as potential means of refining mammographic tissue-based risk assessment beyond breast density.
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Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emily F Conant
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Schulmeyer CE, Fasching PA, Häberle L, Meyer J, Schneider M, Wachter D, Ruebner M, Pöschke P, Beckmann MW, Hartmann A, Erber R, Gass P. Expression of the Immunohistochemical Markers CK5, CD117, and EGFR in Molecular Subtypes of Breast Cancer Correlated with Prognosis. Diagnostics (Basel) 2023; 13:diagnostics13030372. [PMID: 36766486 PMCID: PMC9914743 DOI: 10.3390/diagnostics13030372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Molecular-based subclassifications of breast cancer are important for identifying treatment options and stratifying the prognosis in breast cancer. This study aimed to assess the prognosis relative to disease-free survival (DFS) and overall survival (OS) in patients with triple-negative breast cancer (TNBC) and other subtypes, using a biomarker panel including cytokeratin 5 (CK5), cluster of differentiation 117 (CD117), and epidermal growth factor receptor (EGFR). This cohort-case study included histologically confirmed breast carcinomas as cohort arm. From a total of 894 patients, 572 patients with early breast cancer, sufficient clinical data, and archived tumor tissue were included. Using the immunohistochemical markers CK5, CD117, and EGFR, two subgroups were formed: one with all three biomarkers negative (TBN) and one with at least one of those three biomarkers positive (non-TBN). There were significant differences between the two biomarker subgroups (TBN versus non-TBN) in TNBC for DFS (p = 0.04) and OS (p = 0.02), with higher survival rates (DFS and OS) in the non-TBN subgroup. In this study, we found the non-TBN subgroup of TNBC lesions with at least one positive biomarker of CK5, CD117, and/or EGFR, to be associated with longer DFS and OS.
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Affiliation(s)
- Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Michael Schneider
- Würzburg University Hospital, Institut für Pathologie, Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - David Wachter
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
- Institute of Pathology, Weiden Hospital, Weiden in der Oberpfalz, 92637 Weiden in der Oberpfalz, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-(0)9131-85-33553; Fax: +49-(0)9131-85-33938
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11
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Chalfant JS, Hoyt AC. Breast Density: Current Knowledge, Assessment Methods, and Clinical Implications. JOURNAL OF BREAST IMAGING 2022; 4:357-370. [PMID: 38416979 DOI: 10.1093/jbi/wbac028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 03/01/2024]
Abstract
Breast density is an accepted independent risk factor for the future development of breast cancer, and greater breast density has the potential to mask malignancies on mammography, thus lowering the sensitivity of screening mammography. The risk associated with dense breast tissue has been shown to be modifiable with changes in breast density. Numerous studies have sought to identify factors that influence breast density, including age, genetic, racial/ethnic, prepubertal, adolescent, lifestyle, environmental, hormonal, and reproductive history factors. Qualitative, semiquantitative, and quantitative methods of breast density assessment have been developed, but to date there is no consensus assessment method or reference standard for breast density. Breast density has been incorporated into breast cancer risk models, and there is growing consciousness of the clinical implications of dense breast tissue in both the medical community and public arena. Efforts to improve breast cancer screening sensitivity for women with dense breasts have led to increased attention to supplemental screening methods in recent years, prompting the American College of Radiology to publish Appropriateness Criteria for supplemental screening based on breast density.
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Affiliation(s)
- James S Chalfant
- David Geffen School of Medicine at University of California, Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
| | - Anne C Hoyt
- David Geffen School of Medicine at University of California, Los Angeles, Department of Radiological Sciences, Santa Monica, CA, USA
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12
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Pizzato M, Carioli G, Rosso S, Zanetti R, La Vecchia C. Mammographic breast density and survival in women with invasive breast cancer. Cancer Causes Control 2022; 33:1207-1213. [PMID: 35696000 DOI: 10.1007/s10552-022-01590-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We explored the under-debate association between mammographic breast density (MBD) and survival. METHODS From the Piedmont Cancer Registry, we identified 693 invasive breast cancer (BC) cases. We analyzed the overall survival in strata of MBD through the Kaplan-Meier method. Using the Cox proportional hazards model, we estimated the hazard ratios (HRs) of death; using the cause-specific hazards regression model, we estimated the HRs of BC-related and other causes of death. Models included term for Breast Imaging-Reporting and Data System (BI-RADS) MBD (categorized as BI-RADS 1 and BI-RADS 2-4) and were adjusted for selected patient and tumour characteristics. RESULTS There were 102 deaths, of which 49 were from BC. After 5 years, the overall survival was 69% in BI-RADS 1 and 88% in BI-RADS 2-4 (p < 0.01). Compared to BI-RADS 2-4, the HRs of death for BI-RADS 1 were 1.65 (95% CI 1.06-2.58) in the crude model and 1.35 (95% CI 0.84-2.16) in the fully adjusted model. Compared to BI-RADS 2-4, the fully adjusted HRs for BI-RADS 1 were 1.52 (95% CI 0.74-3.13) for BC-related death and 1.83 (95% CI 0.84-4.00) for the other causes of death. CONCLUSION Higher MBD is one of the strongest independent risk factors for BC, but it seems not to have an unfavorable impact on survival.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, Via Celoria 22, 20133, Milan, Italy
| | - Greta Carioli
- Department of Clinical Sciences and Community Health, University of Milan, Via Celoria 22, 20133, Milan, Italy.
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U, Citta` della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Zanetti
- Piedmont Cancer Registry, A.O.U, Citta` della Salute e della Scienza di Torino, Turin, Italy.,Fondo Elena Moroni for Oncology, Turin, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Via Celoria 22, 20133, Milan, Italy
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Mann RM, Athanasiou A, Baltzer PAT, Camps-Herrero J, Clauser P, Fallenberg EM, Forrai G, Fuchsjäger MH, Helbich TH, Killburn-Toppin F, Lesaru M, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Sardanelli F, Sella T, Thomassin-Naggara I, Zackrisson S, Gilbert FJ, Kuhl CK. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 2022; 32:4036-4045. [PMID: 35258677 PMCID: PMC9122856 DOI: 10.1007/s00330-022-08617-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. KEY POINTS: • The recommendations in Figure 1 summarize the key points of the manuscript.
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Affiliation(s)
- Ritse M Mann
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands.
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Julia Camps-Herrero
- Hospitales Ribera Salud, Avda.Cortes Valencianas, 58, 46015, Valencia, Spain
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Eva M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine &; Klinikum Rechts der Isar, Technical University of Munich, Munich (TUM), Ismaninger Str. 22, 81675, München, Germany
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Fleur Killburn-Toppin
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Mihai Lesaru
- Radiology and Imaging Laboratory, Carol Davila University, Bucharest, Romania
| | - Pietro Panizza
- Breast Imaging Unit, IRCCS Ospedale San Raffaele,, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Tamar Sella
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB20QQ, UK
| | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße30, 52074, Aachen, Germany
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