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Alvarenga P, Park JY, Pinto R, Parente D, Lajkosz K, Westergard S, Ghai S, Kim R, Kulkarni S, Au F, Chamadoira J, Freitas V. Decoding the Prevalent High-Risk Breast Cancers: Demographics, Pathological, Imaging Insights, and Long-Term Outcome. Can Assoc Radiol J 2024:8465371241253254. [PMID: 38795027 DOI: 10.1177/08465371241253254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
Objective: To investigate the features and outcomes of breast cancer in high-risk subgroups. Materials and Methods: REB approved an observational study of women diagnosed with breast cancer from 2010 to 2019. Three radiologists, using the BI-RADS lexicon, blindly reviewed mammogram and MRI screenings without a washout period. Consensus was reached with 2 additional reviewers. Inter-rater agreement was measured by Fleiss Kappa. Statistical analysis included Mann-Whitney U, Chi-square tests for cohort analysis, and Kaplan-Meier for survival rates, with a Cox model for comparative analysis using gene mutation as a reference. Results: The study included 140 high-risk women, finding 155 malignant lesions. Significant age differences noted: chest radiation therapy (median age 44, IQR: 37.0-46.2), gene mutation (median age 49, IQR: 39.8-58.0), and familial risk (median age 51, IQR: 44.5-56.0) (P = .007). Gene mutation carriers had smaller (P = .01), higher-grade tumours (P = .002), and more triple-negative ER- (P = .02), PR- (P = .002), and HER2- (P = .02) cases. MRI outperformed mammography in all subgroups. Substantial to near-perfect inter-rater agreement observed. Over 10 years, no deaths occurred in chest radiation group, with no significant survival difference between gene mutation and familial risk groups, HR = 0.93 (95% CI: 0.27, 3.26), P = .92. Conclusion: The study highlights the importance of age and specific tumour characteristics in identifying high-risk breast cancer subgroups. MRI is confirmed as an effective screening tool. Despite the aggressive nature of cancers in gene mutation carriers, early detection is crucial for survival outcomes. These insights, while necessitating further validation with larger studies, advocate for a move toward personalized medical care, strengthening the existing healthcare guidelines.
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Affiliation(s)
- Pedro Alvarenga
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Renata Pinto
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shelley Westergard
- Average and High-Risk Ontario Breast Screening Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Sandeep Ghai
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Raymond Kim
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Sinai Health System, Hospital for Sick Children, Ontario Institute for Cancer Research, University of Toronto, Toronto, ON, Canada
| | - Supriya Kulkarni
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Frederick Au
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Juliana Chamadoira
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Vivianne Freitas
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Greenwood HI, Dodelzon K. Screening in Women With BRCA Mutations Revisited. JOURNAL OF BREAST IMAGING 2024; 6:4-13. [PMID: 38166173 DOI: 10.1093/jbi/wbad093] [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: 07/27/2023] [Indexed: 01/04/2024]
Abstract
Patients with BRCA1 or BRCA2 gene mutations are at high risk for the development of breast cancer. This article reviews the current evidence for breast cancer screening of patients with BRCA1 or BRCA2 pathogenic gene mutations if they have not undergone prophylactic mastectomy. It will review the current evidence-based imaging recommendations for different modalities and ages of screening initiation in screening this patient population at high risk. Special considerations in transgender BRCA1 and BRCA2 mutation carriers are also discussed.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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3
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Fakhril-din Z, Kiss K, Lund EL, Jørgensen JS, Heegaard S. Adenocarcinoma in situ (ductal type) ex pleomorphic adenoma of the lacrimal gland. Am J Ophthalmol Case Rep 2023; 31:101855. [PMID: 37229514 PMCID: PMC10203733 DOI: 10.1016/j.ajoc.2023.101855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose To present the clinical and histopathological characteristics of a rare case of ductal carcinoma in situ ex pleomorphic adenoma in the lacrimal gland. Observations A 73-years-old Caucasian female presented with complaints of double vision and pain in the left eye region. Clinical examination revealed ptosis and exophthalmos of the left eye as well as diplopia on downward gaze. Magnetic resonance imaging of the left orbit demonstrated a 17 × 22 mm homogeneous tumor in the left lacrimal fossa. The tumor was excised in toto. Histopathological examination revealed a pleomorphic adenoma with ductal structures with benign looking epithelial cells, surrounded by myoepithelial cells. Tumor areas with cribriform architecture consisting of ductal structures with abnormal luminal epithelial cells and intact myoepithelial cell layer were also present. The surgical margins were clear. All luminal and myoepithelial cells were positive for cytokeratin 7, the luminal cells in the cribriform areas were positive for human epidermal growth factor 2 and androgen receptor. The myoepithelial cells were positive for cytokeratin 5, calponin and focally for glial fibrillar acid protein. The findings were diagnostic for ductal carcinoma in situ ex pleomorphic adenoma. Next generation sequencing Oncomine Comprehensive Assay mutation analysis found mutations in the BRCA2 (p.K3326*), BAP1 (p.S395*), and TP53 (p.E285K) genes in the ductal carcinoma in situ and BRCA2 (p.C9976A) in the pleomorphic adenoma part. Conclusion and importance To our knowledge, this tumor is only the second described ductal carcinoma in situ ex pleomorphic adenoma of the lacrimal gland.
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Affiliation(s)
- Zainab Fakhril-din
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | - Eva Løbner Lund
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark
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Shao Z, Liu P, Zhang S, Lu H. Abbreviated protocol combining quantitative diffusion-weighted imaging: a new strategy increasing diagnostic accuracy for breast magnetic resonance imaging? Gland Surg 2021; 10:2705-2714. [PMID: 34733720 DOI: 10.21037/gs-21-463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022]
Abstract
Background To compare the diagnostic accuracy of an abbreviated protocol (AP) with or without quantitative apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) and a full diagnostic protocol (FDP) in terms of the Breast Imaging Reporting and Data System (BI-RADS) classification of breast magnetic resonance imaging (MRI). Methods Our study sample consisted of 436 patients undergoing breast MRI from January to October 2015 in a clinical setting. The three reviews included a pre-contrast and the first single post-contrast T1-weighted (T1W) sequences (AP1), AP1 combined with quantitative DWI (AP2), and the FDP, the AP1 of which were assessed independently by a junior and senior radiologist. Agreement on the evaluation of the BI-RADS classifications (between the junior and senior radiologists, between AP1 and FDP, and between AP2 and FDP) was assessed using the kappa test statistic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared between AP1 and FDP plus between AP2 and FDP. Diagnostic parameters of these reviews were examined using the McNemar test. Results The study included 436 patients, with 251 breast cancers, 99 benign lesions, and 86 patients with benign or no lesions and followed up for at least 24 months. The agreement of the BI-RADS classifications between the junior and senior radiologists was very good (kappa =0.847). The agreement between AP2 and FDP (kappa =0.931) was higher than the agreement between AP1 and FDP (kappa =0.872) on evaluating the BI-RADS benign and malignant classifications. The sensitivity/specificity/PPV/NPV was 95.6%/83.8%/88.9%/93.4% for AP1, 98.0%/83.8%/89.1%/96.9% for AP2, 98.8%/83.8%/89.2%/98.1% for FDP, respectively. Conclusions The addition of quantitative DWI to the abbreviated MRI protocol based on the pre-and first post-contrast sequence improved diagnostic performance for characterizing breast lesions. Quantitative DWI may be a useful adjunct to dynamic contrast enhancement (DCE) of breast MRI.
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Affiliation(s)
- Zhenzhen Shao
- Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Peifang Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Shuping Zhang
- Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute, and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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5
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Obdeijn IM, Mann RM, Loo CCE, Lobbes M, Voormolen EMC, van Deurzen CHM, de Bock G, Hooning MJ. The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers. Breast Cancer Res Treat 2020; 181:581-588. [PMID: 32333294 PMCID: PMC7220868 DOI: 10.1007/s10549-020-05642-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/10/2020] [Indexed: 01/17/2023]
Abstract
Purpose BRCA2 mutation carriers are offered annual breast screening with MRI and mammography. The aim of this study was to investigate the supplemental value of mammographic screening over MRI screening alone. Methods In this multicenter study, proven BRCA2 mutation carriers, who developed breast cancer during screening using both digital mammography and state-of-art breast MRI, were identified. Clinical data were reviewed to classify cases in screen-detected and interval cancers. Imaging was reviewed to assess the diagnostic value of mammography and MRI, using the Breast Imaging and Data System (BI-RADS) classification allocated at the time of diagnosis. Results From January 2003 till March 2019, 62 invasive breast cancers and 23 ductal carcinomas in situ were diagnosed in 83 BRCA2 mutation carriers under surveillance. Overall screening sensitivity was 95.2% (81/85). Four interval cancers occurred (4.7% (4/85)). MRI detected 73 of 85 breast cancers (sensitivity 85.8%) and 42 mammography (sensitivity 49.9%) (p < 0.001). Eight mammography-only lesions occurred. In 1 of 17 women younger than 40 years, a 6-mm grade 3 DCIS, retrospectively visible on MRI, was detected with mammography only in a 38-year-old woman. The other 7 mammography-only breast cancers were diagnosed in women aged 50 years and older, increasing sensitivity in this subgroup from 79.5% (35/44) to 95.5% (42/44) (p ≤ 0.001). Conclusions In BRCA2 mutation carriers younger than 40 years, the benefit of mammographic screening over MRI was very small. In carriers of 50 years and older, mammographic screening contributed significantly. Hence, we propose to postpone mammographic screening in BRCA2 mutation carriers to at least age 40.
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Affiliation(s)
- Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Claudette C E Loo
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marc Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.,Department of Radiology and Nuclear Medicine, University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Eleonora M C Voormolen
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geertruida de Bock
- Department of Epidemiology, University Medical Center, Groningen, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Karbasian N, Sohrabi S, Omofoye TS, Le-Petross H, Arun BK, Albarracin CT, Hess KR, Gutierrez-Barrera AM, Whitman GJ. Imaging Features of Triple Negative Breast Cancer and the Effect of BRCA Mutations. Curr Probl Diagn Radiol 2020; 50:303-307. [PMID: 32033821 DOI: 10.1067/j.cpradiol.2020.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/01/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study is to review the mammographic and the ultrasound features of triple negative breast cancer (TNBC) patients and to investigate the potential effect of BRCA mutations on the imaging features of these patients. METHODS One hundred and seven patients with TNBC were enrolled in a retrospective study following IRB approval and approval of waiver of informed consent. BRCA mutations were assessed using genetic testing. Imaging features on mammography and ultrasound (US) as well as pathology and clinical information were retrospectively reviewed and characterized according to the BI-RADS lexicon (fifth edition). The relationships between BRCA mutations and the imaging findings were examined. RESULTS TNBC commonly presented as an irregular mass with obscured margins on mammography and as an irregular hypoechoic mass with microlobulated or angular margins on US. Approximately two thirds of TNBC cases had a parallel orientation and approximately one third had posterior enhancement, features often associated with benign masses. There was no statistically significant difference in the mammographic and the US features of BRCA positive and BRCA negative triple negative tumors. CONCLUSION TNBC may have a parallel orientation and posterior enhancement, which are features often seen with benign masses. BRCA mutations do not affect the imaging features of triple negative breast tumors.
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Affiliation(s)
- Niloofar Karbasian
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sahand Sohrabi
- Department of Radiology, Kaiser Permanente of Northern California, Sacramento, CA
| | - Toma S Omofoye
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Huong Le-Petross
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Banu K Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Constance T Albarracin
- Department of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth R Hess
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Gary J Whitman
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX.
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7
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Skill N, Maluccio M. Contemporary paradigm for the evaluation and treatment of hereditary gastric cancer. Transl Gastroenterol Hepatol 2019; 4:14. [PMID: 30976717 DOI: 10.21037/tgh.2019.01.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the third leading cause of cancer mortality worldwide. Survival is linked to stage at diagnosis and tolerance to surgery and adjuvant therapy. The emergence of sophisticated methods to identify patients at high risk for the development of gastric cancer has given us an opportunity to eliminate a lethal disease in an identifiable patient population. Guidelines and recommendations have been established and prophylactic total gastrectomy is considered the most effective treatment. However, this requires substantial physical and emotional investment. It is imperative that patients and families are supported by genetic counseling, ongoing surveillance, and survivorship studies.
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Affiliation(s)
- Nicholas Skill
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mary Maluccio
- Indiana University School of Medicine, Indianapolis, IN, USA
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8
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Imaging Phenotypes in Women at High Risk for Breast Cancer on Mammography, Ultrasound, and Magnetic Resonance Imaging Using the Fifth Edition of the Breast Imaging Reporting and Data System. Eur J Radiol 2018; 106:150-159. [PMID: 30150038 DOI: 10.1016/j.ejrad.2018.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/21/2018] [Accepted: 07/28/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess imaging phenotypes of familial breast cancer on mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) using the fifth edition of the BI-RADS; to investigate inter-observer agreement and to correlate imaging phenotypes with risk status, histopathology, and molecular subtypes derived by immunohistochemical surrogate. MATERIALS AND METHODS Forty-nine women (BRCA-1/2 mutation carriers and women with >20% lifetime risk) were diagnosed with breast cancer within our high-risk screening program. BI-RADS MG, US, and MRI imaging descriptors were correlated with risk status, histopathology, and molecular subtypes derived by immunohistochemical surrogate. Inter-rater agreement for BI-RADS MG, US, and MRI categories was assessed. RESULTS Fifty-two breast cancers were diagnosed and 98% were detectable in at least one modality. MRI detected more cancers (P < 0.001). No lesion had benign morphology on BI-RADS. BRCA-1 had triple-negative and high-grade tumors in the posterior part and in the upper-outer quadrant (P ≤ 0.01); positive-family-history patients had intermediate-grade neoplasms (P < 0.01) in the middle part (P = 0.04) and in the upper-outer quadrants (P = 0.05). There was moderate inter-rater agreement for the assigned BI-RADS assessment for MG (k = 0.554) and MRI (k = 0.512) and substantial inter-rater agreement for US (k = 0.741). CONCLUSIONS Imaging phenotypes of familial breast cancers with BI-RADS are malignant in all imaging modalities. Risk status seems to influence cancer location.
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Comparison of detectability of breast cancer by abbreviated breast MRI based on diffusion-weighted images and postcontrast MRI. Jpn J Radiol 2018; 36:331-339. [PMID: 29582348 DOI: 10.1007/s11604-018-0731-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the detectability of unenhanced abbreviated magnetic resonance imaging (MRI) based on diffusion-weighted imaging (DWI) and abbreviated postcontrast MRI for breast cancer. METHODS The study population consisted of 87 patients undergoing breast MRI between December 2016 and March 2017 in a clinical setting. All breast MRIs were performed using a 1.5-T MRI scanner with a 16-channel breast radiofrequency coil. The abbreviated protocols based on DWI (AP1) and postcontrast MRI (AP2) were assessed independently by two radiologists. Sensitivity and specificity were calculated. Receiver operating characteristic analysis was performed and the areas under the curves (AUCs) were compared between AP1 and AP2. RESULTS The study included 87 patients with 89 breast cancer lesions ≤ 2 cm in diameter. The sensitivity/specificity for AP1 and AP2 for reader 1 was 89.9/97.6% and 95.5/90.6%, respectively, and those for reader 2 was 95.5/94.1% and 98.9/94.1%, respectively. The AUCs for AP1 and AP2 for reader 1 were 0.9629 and 0.9640 (p = 0.95), respectively, and those for reader 2 were 0.9755 and 0.9843 (p = 0.46), respectively. CONCLUSIONS The detectability of the unenhanced abbreviated protocol based on DWI would be comparable to that of abbreviated postcontrast MRI for breast cancer.
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Lee MV, Katabathina VS, Bowerson ML, Mityul MI, Shetty AS, Elsayes KM, Balachandran A, Bhosale PR, McCullough AE, Menias CO. BRCA-associated Cancers: Role of Imaging in Screening, Diagnosis, and Management. Radiographics 2017; 37:1005-1023. [PMID: 28548905 DOI: 10.1148/rg.2017160144] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Harmful mutations of the BRCA tumor suppressor genes result in a greater lifetime risk for malignancy-breast and ovarian cancers in particular. An increased risk for male breast, fallopian tube, primary peritoneal, pancreatic, prostate, and colon cancers also has been reported. The BRCA gene is inherited in an autosomal dominant pattern and tends to be highly penetrant; thus, there is an increased incidence of these cancers in affected families. Compared with sporadic tumors, BRCA-associated malignancies have unique manifestations, clinical features, and pathologic profiles. Manifestation at an early patient age, high-grade tumors, and an aggressive clinical course are common features of BRCA-associated malignancies. Understanding the behavior of these cancers aids in identification of affected individuals and families, who can then make informed decisions regarding their future health. Enhanced screening, prophylactic surgery, and chemoprevention are options for managing cancer risk factors in these individuals. Imaging has an important role in the screening, evaluation, staging, and follow-up of BRCA-associated malignancies. Supplemental screening of BRCA mutation carriers often begins at an early age and is critical for early and accurate cancer diagnoses. The authors review the etiopathogenesis and imaging features of BRCA-associated malignancies, the importance of a multidisciplinary approach to determining the diagnosis, and the treatment of patients who have these mutations to improve their outcomes. © RSNA, 2017.
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Affiliation(s)
- Michelle V Lee
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Venkata S Katabathina
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Michyla L Bowerson
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Marina I Mityul
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Anup S Shetty
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Khaled M Elsayes
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Aparna Balachandran
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Priya R Bhosale
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Ann E McCullough
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
| | - Christine O Menias
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.V.L., M.I.M., A.S.S.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.L.B.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., A.B., P.R.B.); and Departments of Pathology (A.E.M.) and Radiology (C.O.M.), Mayo Clinic, Scottsdale, Ariz
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Krammer J, Pinker-Domenig K, Robson ME, Gönen M, Bernard-Davila B, Morris EA, Mangino DA, Jochelson MS. Breast cancer detection and tumor characteristics in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2017; 163:565-571. [PMID: 28343309 DOI: 10.1007/s10549-017-4198-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe imaging findings, detection rates, and tumor characteristics of breast cancers in a large series of patients with BRCA1 and BRCA2 mutations to potentially streamline screening strategies. METHODS An IRB-approved, HIPAA-compliant retrospective analysis of 496 BRCA mutation carriers diagnosed with breast carcinoma from 1999 to 2013 was performed. Institutional database and electronic medical records were reviewed for mammography and MRI imaging. Patient and tumor characteristics including age at diagnosis, tumor histology, grade, receptor, and nodal status were recorded. RESULTS Tumors in BRCA1 mutation carriers were associated exhibited significantly higher nuclear and histological grade compared to BRCA2 (p < 0.001). Triple-negative tumors were more frequent in BRCA1 mutation carriers, whereas hormone receptor-positive tumors were more frequent in BRCA2 mutation carriers (p < 0.001). BRCA2 mutation carriers more frequently presented with ductal carcinoma in situ (DCIS) alone 14% (35/246) and cancers more frequently exhibiting calcifications (p < 0.001). Mammography detected fewer cancers in BRCA1 mutation carriers compared to BRCA2 (p = 0.04): 81% (186/231) BRCA1 versus 89% (212/237) BRCA2. MRI detected 99% cancers in each group. Mammography detected cancer in two patients with false-negative MRI (1 invasive cancer, 1 DCIS). Detection rates on both mammography and MRI did not significantly differ for women over 40 years and women below 40 years. CONCLUSIONS Breast cancers in BRCA1 mutation carriers are associated with more aggressive tumor characteristics compared to BRCA2 and are less well seen on mammography. Mammography rarely identified cancers not visible on MRI. Thus, the omission of mammography in BRCA1 mutation carriers screened with MRI can be considered.
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Affiliation(s)
- Julia Krammer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Katja Pinker-Domenig
- Division of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University Vienna, Vienna, Austria
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mark E Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Blanca Bernard-Davila
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Elizabeth A Morris
- Breast Imaging Service, Breast Imaging Section, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Debra A Mangino
- Risk Assessment, Imaging, Surveillance & Education (RISE) Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Maxine S Jochelson
- Breast Imaging Service, Breast Imaging Section, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA.
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Ramón Y Cajal T, Chirivella I, Miranda J, Teule A, Izquierdo Á, Balmaña J, Sánchez-Heras AB, Llort G, Fisas D, Lope V, Hernández-Agudo E, Juan-Fita MJ, Tena I, Robles L, Guillén-Ponce C, Pérez-Segura P, Luque-Molina MS, Hernando-Polo S, Salinas M, Brunet J, Salas-Trejo MD, Barnadas A, Pollán M. Mammographic density and breast cancer in women from high risk families. Breast Cancer Res 2015; 17:93. [PMID: 26163143 PMCID: PMC4499171 DOI: 10.1186/s13058-015-0604-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Mammographic density (MD) is one of the strongest determinants of sporadic breast cancer (BC). In this study, we compared MD in BRCA1/2 mutation carriers and non-carriers from BRCA1/2 mutation-positive families and investigated the association between MD and BC among BRCA1/2 mutation carriers per type of mutation and tumor subtype. Methods The study was carried out in 1039 female members of BRCA1 and BRCA2 mutation-positive families followed at 16 Spanish Genetic Counseling Units. Participants’ density was scored retrospectively from available mammograms by a single blinded radiologist using a 5-category scale (<10 %, 10-25 %, 25-50 %, 50-75 %, >75 %). In BC cases, we selected mammograms taken prior to diagnosis or from the contralateral breast, whereas, in non-cases, the last screening mammogram was evaluated. MD distribution in carriers and non-carriers was compared using ordinal logistic models, and the association between MD and BC in BRCA1/2 mutation carriers was studied using logistic regression. Huber-White robust estimators of variance were used to take into account correlations between family members. A similar multinomial model was used to explore this association by BC subtype. Results We identified and scored mammograms from 341 BRCA1, 350 BRCA2 mutation carriers and 229 non-carriers. Compared to non-carriers, MD was significantly lower among BRCA2 mutation carriers (odds ratio (OR) =0.71; P-value=0.04), but not among BRCA1 carriers (OR=0.84; P-value=0.33). MD was associated with subsequent development BC (OR per category of MD=1.45; 95 % confidence interval=1.18-1.78, P-value<0.001), with no significant differences between BRCA1 and BRCA2 mutation carriers (P-value=0.48). Finally, no statistically significant differences were observed in the association of MD with specific BC subtypes. Conclusions Our study, the largest to date on this issue, confirms that MD is an independent risk factor for all BC subtypes in either BRCA1 and BRCA2 mutation carriers, and should be considered a phenotype risk marker in this context.
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Affiliation(s)
| | - Isabel Chirivella
- Medical Oncology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain.
| | - Josefa Miranda
- Foundation General Directorate Public Health and Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO - Public Health, Valencia, Spain.
| | - Alexandre Teule
- Hereditary Cancer Program, Catalan Institue of Oncology-IDIBELL, Barcelona, Spain.
| | - Ángel Izquierdo
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBGI, Girona, Spain.
| | - Judith Balmaña
- Medical Oncology Deartment, Hospital Vall Hebron/Vall Hebron Institute of Oncology, Barcelona, Spain.
| | | | - Gemma Llort
- Genetic Counseling Unit, Corporació Sanitaria Parc tauli, Consorci Sanitari de Terrassa, Terrasa, Spain.
| | - David Fisas
- Medical Oncology Department, Hospital Santa Creu I Sant Pau, Barcelona, Spain.
| | - Virginia Lope
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain. .,Consortium Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
| | - Elena Hernández-Agudo
- Breast Cancer Unit, Clinical Research Programme, Spanish National Cancer Center (CNIO), Madrid, Spain.
| | - María José Juan-Fita
- Medical Oncology Department, Foundation of the Valencian Oncologic Institute, Valencia, Spain.
| | - Isabel Tena
- Medical Oncology Department, Hospital Provincial de Castellón, Castellón, Spain.
| | - Luis Robles
- Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain.
| | - Carmen Guillén-Ponce
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - Pedro Pérez-Segura
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | - Mónica Salinas
- Hereditary Cancer Program, Catalan Institue of Oncology-IDIBELL, Barcelona, Spain.
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBGI, Girona, Spain. .,Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain.
| | - María Dolores Salas-Trejo
- Foundation General Directorate Public Health and Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO - Public Health, Valencia, Spain.
| | - Agustí Barnadas
- Medical Oncology Department, Hospital Santa Creu I Sant Pau, Barcelona, Spain.
| | - Marina Pollán
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029, Madrid, Spain. .,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain. .,Consortium Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Madrid, Spain.
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Abstract
Ultrasound (US)-guided interventional procedures are routinely performed for lesions visualized on US and are the standard of care in the diagnosis and management of breast disease. When performed correctly, these procedures are safe, minimally invasive, and have a high diagnostic accuracy comparable to surgical biopsy. The most commonly performed US-guided procedures include fine-needle aspiration, core needle biopsy, and preoperative wire localization. The success of these procedures depends on a thorough understanding of the indications, strong technical skills, and appropriate postbiopsy management. This article reviews the indications and techniques for US-guided interventional procedures. Concordance of imaging and pathology results, potential challenges, and associated complications are also discussed.
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Gierach GL, Li H, Loud JT, Greene MH, Chow CK, Lan L, Prindiville SA, Eng-Wong J, Soballe PW, Giambartolomei C, Mai PL, Galbo CE, Nichols K, Calzone KA, Olopade OI, Gail MH, Giger ML. Relationships between computer-extracted mammographic texture pattern features and BRCA1/2 mutation status: a cross-sectional study. Breast Cancer Res 2014. [PMID: 25159706 DOI: 10.1186/preaccept-1744229618121391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mammographic density is similar among women at risk of either sporadic or BRCA1/2-related breast cancer. It has been suggested that digitized mammographic images contain computer-extractable information within the parenchymal pattern, which may contribute to distinguishing between BRCA1/2 mutation carriers and non-carriers. METHODS We compared mammographic texture pattern features in digitized mammograms from women with deleterious BRCA1/2 mutations (n = 137) versus non-carriers (n = 100). Subjects were stratified into training (107 carriers, 70 non-carriers) and testing (30 carriers, 30 non-carriers) datasets. Masked to mutation status, texture features were extracted from a retro-areolar region-of-interest in each subject's digitized mammogram. Stepwise linear regression analysis of the training dataset identified variables to be included in a radiographic texture analysis (RTA) classifier model aimed at distinguishing BRCA1/2 carriers from non-carriers. The selected features were combined using a Bayesian Artificial Neural Network (BANN) algorithm, which produced a probability score rating the likelihood of each subject's belonging to the mutation-positive group. These probability scores were evaluated in the independent testing dataset to determine whether their distribution differed between BRCA1/2 mutation carriers and non-carriers. A receiver operating characteristic analysis was performed to estimate the model's discriminatory capacity. RESULTS In the testing dataset, a one standard deviation (SD) increase in the probability score from the BANN-trained classifier was associated with a two-fold increase in the odds of predicting BRCA1/2 mutation status: unadjusted odds ratio (OR) = 2.00, 95% confidence interval (CI): 1.59, 2.51, P = 0.02; age-adjusted OR = 1.93, 95% CI: 1.53, 2.42, P = 0.03. Additional adjustment for percent mammographic density did little to change the OR. The area under the curve for the BANN-trained classifier to distinguish between BRCA1/2 mutation carriers and non-carriers was 0.68 for features alone and 0.72 for the features plus percent mammographic density. CONCLUSIONS Our findings suggest that, unlike percent mammographic density, computer-extracted mammographic texture pattern features are associated with carrying BRCA1/2 mutations. Although still at an early stage, our novel RTA classifier has potential for improving mammographic image interpretation by permitting real-time risk stratification among women undergoing screening mammography.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm, 7-E108, Bethesda 20892-9774, MD, USA.
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16
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Gierach GL, Li H, Loud JT, Greene MH, Chow CK, Lan L, Prindiville SA, Eng-Wong J, Soballe PW, Giambartolomei C, Mai PL, Galbo CE, Nichols K, Calzone KA, Olopade OI, Gail MH, Giger ML. Relationships between computer-extracted mammographic texture pattern features and BRCA1/2 mutation status: a cross-sectional study. Breast Cancer Res 2014; 16:424. [PMID: 25159706 PMCID: PMC4268674 DOI: 10.1186/s13058-014-0424-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/31/2014] [Indexed: 12/24/2022] Open
Abstract
Introduction Mammographic density is similar among women at risk of either sporadic or BRCA1/2-related breast cancer. It has been suggested that digitized mammographic images contain computer-extractable information within the parenchymal pattern, which may contribute to distinguishing between BRCA1/2 mutation carriers and non-carriers. Methods We compared mammographic texture pattern features in digitized mammograms from women with deleterious BRCA1/2 mutations (n = 137) versus non-carriers (n = 100). Subjects were stratified into training (107 carriers, 70 non-carriers) and testing (30 carriers, 30 non-carriers) datasets. Masked to mutation status, texture features were extracted from a retro-areolar region-of-interest in each subject’s digitized mammogram. Stepwise linear regression analysis of the training dataset identified variables to be included in a radiographic texture analysis (RTA) classifier model aimed at distinguishing BRCA1/2 carriers from non-carriers. The selected features were combined using a Bayesian Artificial Neural Network (BANN) algorithm, which produced a probability score rating the likelihood of each subject’s belonging to the mutation-positive group. These probability scores were evaluated in the independent testing dataset to determine whether their distribution differed between BRCA1/2 mutation carriers and non-carriers. A receiver operating characteristic analysis was performed to estimate the model’s discriminatory capacity. Results In the testing dataset, a one standard deviation (SD) increase in the probability score from the BANN-trained classifier was associated with a two-fold increase in the odds of predicting BRCA1/2 mutation status: unadjusted odds ratio (OR) = 2.00, 95% confidence interval (CI): 1.59, 2.51, P = 0.02; age-adjusted OR = 1.93, 95% CI: 1.53, 2.42, P = 0.03. Additional adjustment for percent mammographic density did little to change the OR. The area under the curve for the BANN-trained classifier to distinguish between BRCA1/2 mutation carriers and non-carriers was 0.68 for features alone and 0.72 for the features plus percent mammographic density. Conclusions Our findings suggest that, unlike percent mammographic density, computer-extracted mammographic texture pattern features are associated with carrying BRCA1/2 mutations. Although still at an early stage, our novel RTA classifier has potential for improving mammographic image interpretation by permitting real-time risk stratification among women undergoing screening mammography. Electronic supplementary material The online version of this article (doi:10.1186/s13058-014-0424-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rm, 7-E108, Bethesda 20892-9774, MD, USA.
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Evans DG, Gareth ED, Kesavan N, Nisha K, Lim Y, Yit L, Gadde S, Soujanye G, Hurley E, Emma H, Massat NJ, Maxwell AJ, Ingham S, Sarah I, Eeles R, Rosalind E, Leach MO, Howell A, Anthony H, Duffy SW, Stephen D. MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat 2014; 145:663-72. [PMID: 24687378 DOI: 10.1007/s10549-014-2931-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Women with a genetic predisposition to breast cancer tend to develop the disease at a younger age with denser breasts making mammography screening less effective. The introduction of magnetic resonance imaging (MRI) for familial breast cancer screening programs in recent years was intended to improve outcomes in these women. We aimed to assess whether introduction of MRI surveillance improves 5- and 10-year survival of high-risk women and determine the accuracy of MRI breast cancer detection compared with mammography-only or no enhanced surveillance and compare size and pathology of cancers detected in women screened with MRI + mammography and mammography only. We used data from two prospective studies where asymptomatic women with a very high breast cancer risk were screened by either mammography alone or with MRI also compared with BRCA1/2 carriers with no intensive surveillance. 63 cancers were detected in women receiving MRI + mammography and 76 in women receiving mammography only. Sensitivity of MRI + mammography was 93 % with 63 % specificity. Fewer cancers detected on MRI were lymph node positive compared to mammography/no additional screening. There were no differences in 10-year survival between the MRI + mammography and mammography-only groups, but survival was significantly higher in the MRI-screened group (95.3 %) compared to no intensive screening (73.7 %; p = 0.002). There were no deaths among the 21 BRCA2 carriers receiving MRI. There appears to be benefit from screening with MRI, particularly in BRCA2 carriers. Extended follow-up of larger numbers of high-risk women is required to assess long-term survival.
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Affiliation(s)
| | - Evans D Gareth
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, M23 9LT, UK,
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Alonso Roca S, Jiménez Arranz S, Delgado Laguna A, Quintana Checa V, Grifol Clar E. Breast cancer screening in high risk populations. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leconte I, Abraham C, Galant C, Sy M, Berlière M, Fellah L. Fibroadenoma: Can fine needle aspiration biopsy avoid short term follow-up? Diagn Interv Imaging 2012; 93:750-6. [DOI: 10.1016/j.diii.2012.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alonso Roca S, Jiménez Arranz S, Delgado Laguna AB, Quintana Checa V, Grifol Clar E. [Breast cancer screening in high risk populations]. RADIOLOGIA 2012; 54:490-502. [PMID: 22579381 DOI: 10.1016/j.rx.2011.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 11/28/2022]
Abstract
We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).
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Affiliation(s)
- S Alonso Roca
- Sección de mama, Servicio de Diagnóstico por Imagen, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
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Lee JM, McMahon PM, Kong CY, Kopans DB, Ryan PD, Ozanne EM, Halpern EF, Gazelle GS. Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene mutation carriers. Radiology 2010; 254:793-800. [PMID: 20177093 DOI: 10.1148/radiol.09091086] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the clinical effectiveness and cost-effectiveness of screening strategies in which MR imaging and screen-film mammography were used, alone and in combination, in women with BRCA1 mutations. MATERIALS AND METHODS Because this study did not involve primary data collection from individual patients, institutional review board approval was not needed. By using a simulation model, we compared three annual screening strategies for a cohort of 25-year-old BRCA1 mutation carriers, as follows: (a) screen-film mammography, (b) MR imaging, and (c) combined MR imaging and screen-film mammography (combined screening). The model was used to estimate quality-adjusted life-years (QALYs) and lifetime costs. Incremental cost-effectiveness ratios were calculated. Input parameters were obtained from the medical literature, existing databases, and calibration. Costs (2007 U.S. dollars) and quality-of-life adjustments were derived from Medicare reimbursement rates and the medical literature. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates on model results. RESULTS In the base-case analysis, annual combined screening was most effective (44.62 QALYs), and had the highest cost ($110973), followed by annual MR imaging alone (44.50 QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336). Adding annual MR imaging to annual mammographic screening cost $69125 for each additional QALY gained. Sensitivity analysis indicated that, when the screening MR imaging cost increased to $960 (base case, $577), or breast cancer risk by age 70 years decreased below 58% (base case, 65%), or the sensitivity of combined screening decreased below 76% (base case, 94%), the cost of adding MR imaging to mammography exceeded $100000 per QALY. CONCLUSION Annual combined screening provides the greatest life expectancy and is likely cost-effective when the value placed on gaining an additional QALY is in the range of $50000-$100000. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1.
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Affiliation(s)
- Janie M Lee
- Department of Radiology, Institute for Technology Assessment, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA.
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Maxwell A, Pearson J. Criteria for the safe avoidance of needle sampling in young women with solid breast masses. Clin Radiol 2010; 65:218-22. [DOI: 10.1016/j.crad.2009.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 11/12/2009] [Accepted: 11/25/2009] [Indexed: 12/26/2022]
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Gierach GL, Loud JT, Chow CK, Prindiville SA, Eng-Wong J, Soballe PW, Giambartolomei C, Mai PL, Galbo CE, Nichols K, Calzone KA, Vachon C, Gail MH, Greene MH. Mammographic density does not differ between unaffected BRCA1/2 mutation carriers and women at low-to-average risk of breast cancer. Breast Cancer Res Treat 2010; 123:245-55. [PMID: 20130984 DOI: 10.1007/s10549-010-0749-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 11/26/2022]
Abstract
Elevated mammographic density (MD) is one of the strongest risk factors for sporadic breast cancer. Epidemiologic evidence suggests that MD is, in part, genetically determined; however, the relationship between MD and BRCA1/2 mutation status is equivocal. We compared MD in unaffected BRCA1/2 mutation carriers enrolled in the U.S. National Cancer Institute's Clinical Genetics Branch's Breast Imaging Study (n = 143) with women at low-to-average breast cancer risk enrolled in the same study (n = 29) or the NCI/National Naval Medical Center's Susceptibility to Breast Cancer Study (n = 90). The latter were BRCA mutation-negative members of mutation-positive families or women with no prior breast cancer, a Pedigree Assessment Tool score <8 (i.e., low risk of a hereditary breast cancer syndrome) and a Gail score <1.67. A single experienced mammographer measured MD using a computer-assisted thresholding method. We collected standard breast cancer risk factor information in both studies. Unadjusted mean percent MD was higher in women with BRCA1/2 mutations compared with women at low-to-average breast cancer risk (37.3% vs. 33.4%; P = 0.04), but these differences disappeared after adjusting for age and body mass index (34.9% vs. 36.3%; P = 0.43). We explored age at menarche, nulliparity, age at first birth, menopausal status, number of breast biopsies, and exposure to exogenous hormonal agents as potential confounders of the MD and BRCA1/2 association. Taking these factors into account did not significantly alter the results of the age/body mass index-adjusted analysis. Our results do not provide support for an independent effect of BRCA1/2 mutation status on mammographic density.
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Affiliation(s)
- Gretchen L Gierach
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Office of Preventive Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Arazi-Kleinman T, Causer PA, Jong RA, Hill K, Warner E. Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-risk population? Clin Radiol 2009; 64:1166-74. [PMID: 19913125 DOI: 10.1016/j.crad.2009.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 08/02/2009] [Accepted: 08/06/2009] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) computer-aided detection (CAD) for breast MRI screen-detected lesions recommended for biopsy in a high-risk population. MATERIAL AND METHODS Fifty-six consecutive Breast Imaging Reporting and Data System (BI-RADS) 3-5 lesions with histopathological correlation [nine invasive cancers, 13 ductal carcinoma in situ (DCIS) and 34 benign] were retrospectively evaluated using a breast MRI CAD prototype (CAD-Gaea). CAD evaluation was performed separately and in consensus by two radiologists specializing in breast imaging, blinded to the histopathology. Thresholds of 50, 80, and 100% and delayed enhancement were independently assessed with CAD. Lesions were rated as malignant or benign according to threshold and delayed enhancement only and in combination. Sensitivities, specificities, and negative predictive values (NPV) were determined for CAD assessments versus pathology. Initial MRI BI-RADS interpretation without CAD versus CAD assessments were compared using paired binary diagnostic tests. RESULTS Threshold levels for lesion enhancement were: 50% to include all malignant (and all benign) lesions; and 100% for all invasive cancer and high-grade DCIS. Combined use of threshold and enhancement patterns for CAD assessment was best (73% sensitivity, 56% specificity and 76% NPV for all cancer). Sensitivities and NPV were better for invasive cancer (100%/100%) than for all malignancies (54%/76%). Radiologists' MRI interpretation was more sensitive than CAD (p=0.05), but less specific (p=0.001) for cancer detection. CONCLUSION The breast MRI CAD system used could not improve the radiologists' accuracy for distinguishing all malignant from benign lesions, due to the poor sensitivity for DCIS detection.
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Affiliation(s)
- T Arazi-Kleinman
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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Hamilton LJ, Evans AJ, Cornford EJ, Rakha EA, Ellis IO, Foulkes WD. Will MRI screening deliver the expected survival advantage in BRCA 1 carriers? Clin Radiol 2009; 64:1045-7. [PMID: 19822236 DOI: 10.1016/j.crad.2009.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 11/26/2022]
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Lapierre-Combes M, Rousset J, Combes E, Chinelatto S, Dupré PF, André V. [Retrospective study conducted in northern Finistère about the role of breast MRI in normal breast screening, experience in 51 patients]. ACTA ACUST UNITED AC 2009; 37:401-9. [PMID: 19403322 DOI: 10.1016/j.gyobfe.2009.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study the role and indications of breast MRI in normal breast screening. PATIENTS AND METHODS Retrospective study of 51 patients (mean age of 51 years) conducted in northern Finistère. Each patient had a normal (BI-RADS 1 or 2) breast screening (mammography and echography). Four indications for MRI were chosen: screening of high-risk patients, high-density breasts, radio-clinical discordance, and breasts prostheses. Breast MRI were reviewed according to BI-RADS classification. Abnormalities categorized in BI-RADS 4 or 5 were confirmed histologically. RESULTS Thirteen patients underwent histological analysis. Nine invasive carcinomas were identified (six invasive lobular carcinomas (ILC), two mixed carcinomas, one invasive ductal carcinoma). For these patients, the reason for performing MRI was a radio-clinical discordance. DISCUSSION AND CONCLUSION The study demonstrates the breast MRI value for radio-clinical discordance and the key role of MRI in diagnostic challenge of ILC. In literature review, MRI has a role even if breast screening is normal: radio-clinical discordance, screening of patients with high-risk, breasts prostheses in certain cases. Breast density comes as an additional criteria to perform this exam.
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Affiliation(s)
- M Lapierre-Combes
- Service d'imagerie médicale, hôpital d'instruction des armées Clermont-Tonnerre, BP 41, 29240 Brest Armées, France.
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Peters G, Anderson J, Longman G, Thomson J, Taylor D, Bennett M, Wylie E, Goldblatt J, Chan A, Saunders C. Magnetic resonance findings in women at high risk for developing breast cancer: an Australian feasibility study. J Med Imaging Radiat Oncol 2008; 52:29-35. [PMID: 18373823 DOI: 10.1111/j.1440-1673.2007.01907.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In younger women at high risk for developing breast cancer the value of mammography is limited by a higher prevalence of breast tissue density, low rate of DCIS in gene carriers, faster growing tumours and concerns over radiation exposure. We report on our experience of MR screening in high risk patients over a three year period. Women at high risk of developing breast cancer were offered an MRI scan and an Ultrasound in addition to their annual mammogram for two years. The following MR-protocol was used: pre-contrast T2 STIR sequence and pre contrast 3D FLASH sequence, post contrast axial dynamic 3D FLASH sequence. Seventy two women consented to participate in this study. One hundred thirty nine breast MRI examinations were performed. Two pre-cancerous lesions and an axillary lymph node metastasis were found, but the majority of the lesions were benign. Difficulties in screening young women at high risk are discussed in this paper. In our study three lesions of significance were detected. Two lesions were precancerous thus curable. The recall rates show the difficult nature of screening younger breasts. MRI generated more findings judged as uncertain, so short term-term follow up studies or MR-guided biopsy techniques are required.
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Affiliation(s)
- G Peters
- Schools of Surgery and Pathology, University of Western Australia, and Sir Charles Gairdner Hospital, Perth, WA, Australia.
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Veltman J, Mann R, Kok T, Obdeijn IM, Hoogerbrugge N, Blickman JG, Boetes C. Breast tumor characteristics of BRCA1 and BRCA2 gene mutation carriers on MRI. Eur Radiol 2008; 18:931-8. [PMID: 18270717 PMCID: PMC2292493 DOI: 10.1007/s00330-008-0851-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 11/07/2007] [Accepted: 12/18/2007] [Indexed: 12/12/2022]
Abstract
The appearance of malignant lesions in BRCA1 and BRCA2 mutation carriers (BRCA-MCs) on mammography and magnetic resonance imaging (MRI) was evaluated. Thus, 29 BRCA-MCs with breast cancer were retrospectively evaluated and the results compared with an age, tumor size and tumor type matched control group of 29 sporadic breast cancer cases. Detection rates on both modalities were evaluated. Tumors were analyzed on morphology, density (mammography), enhancement pattern and kinetics (MRI). Overall detection was significantly better with MRI than with mammography (55/58 vs 44/57, P = 0.021). On mammography, lesions in the BRCA-MC group were significantly more described as rounded (12//19 vs 3/13, P = 0.036) and with sharp margins (9/19 vs 1/13, P = 0.024). On MRI lesions in the BRCA-MC group were significantly more described as rounded (16/27 vs 7/28, P = 0.010), with sharp margins (20/27 vs 7/28, P < 0.001) and with rim enhancement (7/27 vs 1/28, P = 0.025). No significant difference was found for enhancement kinetics (P = 0.667). Malignant lesions in BRCA-MC frequently have morphological characteristics commonly seen in benign lesions, like a rounded shape or sharp margins. This applies for both mammography and MRI. However the possibility of MRI to evaluate the enhancement pattern and kinetics enables the detection of characteristics suggestive for a malignancy.
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Affiliation(s)
- J Veltman
- 430 Department of Radiology, University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Wang Y, Ikeda DM, Narasimhan B, Longacre TA, Bleicher RJ, Pal S, Jackman RJ, Jeffrey SS. Estrogen Receptor–Negative Invasive Breast Cancer: Imaging Features of Tumors with and without Human Epidermal Growth Factor Receptor Type 2 Overexpression. Radiology 2008; 246:367-75. [DOI: 10.1148/radiol.2462070169] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Colin C, Prince V. Modalités de dépistage radiologique devant un risque familial identifié de cancer du sein. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)92168-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bradbury AR, Olopade OI. Genetic susceptibility to breast cancer. Rev Endocr Metab Disord 2007; 8:255-67. [PMID: 17508290 DOI: 10.1007/s11154-007-9038-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 04/09/2007] [Indexed: 12/14/2022]
Abstract
Deleterious mutations in two breast and ovarian cancer susceptibility genes, BRCA1 and BRCA2 have been identified in breast and ovarian cancer families. Women with a BRCA1 or BRCA2 mutation are candidates for additional risk reduction measures such as intensive screening, prophylactic surgery or chemoprevention. Additional susceptibility genes have been identified, including PTEN, ATM, TP53, CHEK2, CASP8, PBRL and BRIP1. Yet, many women with a personal or family history suggestive of a hereditary susceptibility to breast cancer undergo genetic testing and no significant genetic alteration is found. Thus, there are other susceptibility genes that have not been identified, and it is likely that the remaining familial contribution to breast cancer will be explained by the presence of multiple low penetrance alleles that coexist to confer high penetrance risks (a polygenic model). The American Cancer Society has identified cancer prevention as a key component of cancer management and there is interest in developing individualized cancer prevention focused on identifying high risk individuals who are most likely to benefit from more aggressive risk reduction measures. Breast cancer risk assessment and genetic counseling are currently provided by genetic counselors, oncology nurse specialist, geneticists, medical and surgical oncologists, gynecologists and other health care professionals, often working within a multidisciplinary clinical setting. Current methods for risk assessment and predictive genetic testing have limitations and improvements in molecular testing and risk assessment tools is necessary to maximize individual breast cancer risk assessment and to fulfill the promise of cancer prevention.
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Affiliation(s)
- Angela R Bradbury
- Section of Hematology-Oncology, University of Chicago, Chicago, IL, USA.
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Lord SJ, Lei W, Craft P, Cawson JN, Morris I, Walleser S, Griffiths A, Parker S, Houssami N. A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer 2007; 43:1905-17. [PMID: 17681781 DOI: 10.1016/j.ejca.2007.06.007] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 06/09/2007] [Accepted: 06/20/2007] [Indexed: 11/25/2022]
Abstract
Breast magnetic resonance imaging (MRI) has been proposed as an additional screening test for young women at high risk of breast cancer in whom mammography alone has poor sensitivity. We conducted a systematic review to assess the effectiveness of adding MRI to mammography with or without breast ultrasound and clinical breast examination (CBE) in screening this population. We found consistent evidence in 5 studies that adding MRI provides a highly sensitive screening strategy (sensitivity range: 93-100%) compared to mammography alone (25-59%) or mammography plus ultrasound+/-CBE (49-67%). Meta-analysis of the three studies that compared MRI plus mammography versus mammography alone showed the sensitivity of MRI plus mammography as 94% (95%CI 86-98%) and the incremental sensitivity of MRI as 58% (95%CI 47-70%). Incremental sensitivity of MRI was lower when added to mammography plus ultrasound (44%, 95%CI 27-61%) or to the combination of mammography, ultrasound plus CBE (31-33%). Estimates of screening specificity with MRI were less consistent but suggested a 3-5-fold higher risk of patient recall for investigation of false positive results. No studies assessed as to whether adding MRI reduces patient mortality, interval or advanced breast cancer rates, and we did not find strong evidence that MRI leads to the detection of earlier stage disease. Conclusions about the effectiveness of MRI therefore depend on assumptions about the benefits of early detection from trials of mammographic screening in older average risk populations. The extent to which high risk younger women receive the same benefits from early detection and treatment of MRI-detected cancers has not yet been established.
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Affiliation(s)
- S J Lord
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 5, Building F, 88 Mallett Street, Locked Bag 77, Camperdown, New South Wales 2050, Australia.
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Mesurolle B, Kadoch L, El-Khoury M, Lisbona A, Dendukuri N, Foulkes WD. Sonographic features of breast carcinoma presenting as masses in BRCA gene mutation carriers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:817-24. [PMID: 17526613 DOI: 10.7863/jum.2007.26.6.817] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The purpose of this study was to review the sonographic features of breast cancer gene BRCA1- and BRCA2-associated breast carcinomas in comparison with "sporadic" breast carcinomas and benign breast masses. METHODS Sonograms of 233 breast masses, including 33 BRCA-associated malignant masses (BRCA1, 15; BRCA2, 18), 148 sporadic malignant masses, and 52 benign masses, were reviewed by consensus by 2 radiologists according to American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) terminology. RESULTS Most of the sporadic and BRCA1-and BRCA2-associated cancers displayed an irregular shape (91.2%, 93.3%, and 83.3%, respectively). BRCA1-associated cancers showed microlobulated margins in 53.3% versus 33.8% (sporadic) and 33.3% (BRCA2). A parallel orientation was most frequently encountered in BRCA1-associated lesions (46.7%) versus sporadic (33.8%) and BRCA2 (33.3%), whereas posterior acoustic shadowing was least frequently seen in BRCA1-associated lesions (13.3%) versus BRCA2 (16.7%) and sporadic (31.1%). Most (73.3%) of the BRCA1-associated lesions were classified as BI-RADS category 4, whereas most of the sporadic and BRCA2-associated lesions were classified as BI-RADS category 5 (66.2% and 72.2%). CONCLUSIONS Sonographic features of BRCA-associated and sporadic breast carcinomas do not differ substantially. BRCA1-associated breast carcinomas trend toward less malignant sonographic characteristics, but strict application of the BI-RADS categorizations demands that they be classified as category 4 or 5.
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Affiliation(s)
- Benoît Mesurolle
- Cedar Breast Clinic, Department of Radiology, McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec, Canada.
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Houssami N, Wilson R. Should women at high risk of breast cancer have screening magnetic resonance imaging (MRI)? Breast 2007; 16:2-4. [PMID: 17189696 DOI: 10.1016/j.breast.2006.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 12/05/2006] [Indexed: 01/15/2023] Open
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Kaas R, Kroger R, Peterse JL, Hart AAM, Muller SH. The correlation of mammographic-and histologic patterns of breast cancers in BRCA1 gene mutation carriers, compared to age-matched sporadic controls. Eur Radiol 2006; 16:2842-8. [PMID: 16924440 DOI: 10.1007/s00330-006-0385-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 06/20/2006] [Accepted: 06/27/2006] [Indexed: 11/26/2022]
Abstract
Breast cancers in BRCA1 gene mutation carriers often have specific histologic features: grade III tumors with pushing margins. Our purpose was to compare the mammographic and histologic features of breast cancers in carriers with those in age-matched sporadic controls. The features of breast cancers in 27 BRCA1 carriers found during annual surveillance were compared to those in 107 age-matched sporadic controls. The carriers had no (classic) spiculated mammographic lesions, a high percentage of well-defined masses and hardly any masses with microcalcifications, whereas the controls had significantly fewer well-defined ones and only in 27% spiculated lesions on the mammogram. The well-defined mammographic tumors correlated in 83% of the carriers and in 70% of the controls with histologic circumscribed tumor margins. Spiculated mammographic lesions in the controls were in 90% grade I or II tumors. DCIS with or without infiltration was seen in 22% of the carriers and in 45% of the controls. In conclusion, breast cancers diagnosed in BRCA1 carriers do not have classic malignant mammographic features. A minority of the young sporadic controls show the classic malignant lesion on the mammogram. Both carriers and controls generally show a good correlation between their mammographic- and histologic tumor pattern.
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Affiliation(s)
- R Kaas
- Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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Bradbury A, Olopade OI. The case for individualized screening recommendations for breast cancer. J Clin Oncol 2006; 24:3328-30. [PMID: 16801629 DOI: 10.1200/jco.2006.05.8586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Reply. AJR Am J Roentgenol 2006. [DOI: 10.2214/ajr.06.5041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Validation of transgenic models of breast cancer: ductal carcinoma in situ (DCIS) and Brca1-mutation-related breast cancer. ACTA ACUST UNITED AC 2005; 8. [PMID: 24371431 DOI: 10.1017/s1470903105003135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Available mouse models of ductal carcinoma in situ (DCIS) and BRCA1-mutation-related breast cancer are reviewed. The best validated mouse models of human DCIS are the conditional estrogen receptor α in mammary tissue (CERM) model initiated by deregulated estrogen receptor α and the serial explant mouse model initiated by p53 deficiency. At present the most useful and best validated mouse model of BRCA1-mutation-related breast cancer uses the cre-lox system to make a conditional Brca1 deletion targeted to mammary epithelial cells. The major shortcoming of the non-conditional Brca1 models is the high incidence of non-mammary tumor development. The use of mammary gland transplants or explants from these mice into nude hosts is one approach that could be used to circumvent this deficiency. Development and validation of a Brca1-mutation-related mouse model of basal cell breast cancer is an important next step.
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