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Kiani P, Vatankhahan H, Zare-Hoseinabadi A, Ferdosi F, Ehtiati S, Heidari P, Dorostgou Z, Movahedpour A, Baktash A, Rajabivahid M, Khatami SH. Electrochemical biosensors for early detection of breast cancer. Clin Chim Acta 2025; 564:119923. [PMID: 39153652 DOI: 10.1016/j.cca.2024.119923] [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: 06/08/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
Breast cancer continues to be a significant contributor to global cancer deaths, particularly among women. This highlights the critical role of early detection and treatment in boosting survival rates. While conventional diagnostic methods like mammograms, biopsies, ultrasounds, and MRIs are valuable tools, limitations exist in terms of cost, invasiveness, and the requirement for specialized equipment and trained personnel. Recent shifts towards biosensor technologies offer a promising alternative for monitoring biological processes and providing accurate health diagnostics in a cost-effective, non-invasive manner. These biosensors are particularly advantageous for early detection of primary tumors, metastases, and recurrent diseases, contributing to more effective breast cancer management. The integration of biosensor technology into medical devices has led to the development of low-cost, adaptable, and efficient diagnostic tools. In this framework, electrochemical screening platforms have garnered significant attention due to their selectivity, affordability, and ease of result interpretation. The current review discusses various breast cancer biomarkers and the potential of electrochemical biosensors to revolutionize early cancer detection, making provision for new diagnostic platforms and personalized healthcare solutions.
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Affiliation(s)
- Pouria Kiani
- Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Vatankhahan
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Zare-Hoseinabadi
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Felora Ferdosi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajad Ehtiati
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parasta Heidari
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Zahra Dorostgou
- Department of Biochemistry, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
| | | | - Aria Baktash
- Department of Medicine, Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Mansour Rajabivahid
- Department of Internal Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Seyyed Hossein Khatami
- Student Research Committee, Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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2
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Seely JM, Domonkos V, Verma R. Auditing Abbreviated Breast MR Imaging: Clinical Considerations and Implications. Radiol Clin North Am 2024; 62:687-701. [PMID: 38777543 DOI: 10.1016/j.rcl.2023.12.010] [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] [Indexed: 05/25/2024]
Abstract
Abbreviated breast MR (AB-MR) imaging is a relatively new breast imaging tool, which maintains diagnostic accuracy while reducing image times compared with full-protocol breast MR (FP-MR) imaging. Breast imaging audits involve calculating individual and organizational metrics, which can be compared with established benchmarks, providing a standard against which performance can be measured. Unlike FP-MR imaging, there are no established benchmarks for AB-MR imaging but studies demonstrate comparable performance for cancer detection rate, positive predictive value 3, sensitivity, and specificity with T2. We review the basics of performing an audit, including strategies to implement if benchmarks are not being met.
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Affiliation(s)
- Jean M Seely
- Department of Radiology, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | - Victoria Domonkos
- Department of Radiology, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Raman Verma
- Department of Radiology, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. https://twitter.com/RamanVermaMD
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3
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Washington I, Palm RF, White J, Rosenberg SA, Ataya D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers (Basel) 2024; 16:2122. [PMID: 38893241 PMCID: PMC11171236 DOI: 10.3390/cancers16112122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy.
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Affiliation(s)
- Iman Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Russell F. Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Julia White
- Department of Radiation Oncology, The University of Kansas Medical Center, 4001 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Stephen A. Rosenberg
- Department of Radiation Therapy, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dana Ataya
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 10920 N. McKinley Drive, Tampa, FL 33612, USA;
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Rahman WT, Gerard S, Grundlehner P, Oudsema R, McLaughlin C, Noroozian M, Neal CH, Helvie M. Outcomes of High-Risk Breast MRI Screening in Women Without Prior History of Breast Cancer: Effectiveness Data from a Tertiary Care Center. JOURNAL OF BREAST IMAGING 2024; 6:53-63. [PMID: 38142230 DOI: 10.1093/jbi/wbad092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance outcomes of a breast MRI screening program in high-risk women without prior history of breast cancer. METHODS Retrospective cohort study of 1 405 consecutive screening breast MRI examinations in 681 asymptomatic women with high risk of breast cancer without prior history of breast cancer from January 1, 2015, to December 31, 2019. Outcomes (sensitivity, specificity, positive predictive value, negative predictive value, false-negative rate [FNR], cancer detection rate [CDR]) and characteristics of cancers were determined based on histopathology or 12-month follow-up. MRI examinations performed, BI-RADS assessments, pathology outcomes, and CDRs were analyzed overall and by age decade. Results in incidence screening round (MRI in last 18 months) and nonincidence round were compared. RESULTS Breast MRI achieved CDR 20/1000, sensitivity 93.3% (28/30), and specificity 83.4% (1 147/1375). Twenty-eight (28/1 405, CDR 20/1000) screen-detected cancers were identified: 18 (64.3%, 18/28) invasive and 10 (35.7%, 10/28) ductal carcinoma in situ. Overall, 92.9% (26/28) of all cancers were stage 0 or 1 and 89.3% (25/28) were node negative. All 14 incidence screening round malignancies were stage 0 or 1 with N0 disease. Median size for invasive carcinoma was 8.0 mm and for ductal carcinoma in situ was 9.0 mm. There were two false-negative exams for an FNR 0.1% (2/1 405). CONCLUSION High-risk screening breast MRI was effective at detecting early breast cancer and associated with favorable outcomes.
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Affiliation(s)
- W Tania Rahman
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | | | - Paul Grundlehner
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Oudsema
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Carol McLaughlin
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Mitra Noroozian
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
- Diagnostic Radiology, Henry Ford Health System, Detroit, MI, USA
| | - Colleen H Neal
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Mark Helvie
- Department of Radiology, Division of Breast Imaging, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
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5
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Zoghbi KK, Felipe VC, Graziano L, Guatelli CS, de Souza JA, Bitencourt AGV. Analysis of the indications for and results of breast cancer screening by magnetic resonance imaging at a cancer center in Brazil. Radiol Bras 2024; 57:e20230111en. [PMID: 38993971 PMCID: PMC11235068 DOI: 10.1590/0100-3984.2023.0111-en] [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: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 07/13/2024] Open
Abstract
Objective To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.
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Affiliation(s)
- Karina Kuhl Zoghbi
- Graduate Program, A.C.Camargo Cancer Center, São Paulo, SP,
Brazil
- Hospital Saúde da Mulher, Belém, PA, Brazil
| | | | - Luciana Graziano
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo,
SP, Brazil
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6
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Klein ED, Sonnenblick EB, Sasson AL, Anderson D, Margolies LR. Breast MRI for Extent of Disease: Association of Demographic Factors and Biopsy Compliance on Surgical Decisions in Patients with BI-RADS 4 and 5 Findings. Am Surg 2023; 89:6013-6019. [PMID: 37311567 DOI: 10.1177/00031348231183116] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND The decision to pursue bilateral mastectomy without pathological confirmation of additional preoperative MRI lesions is likely multifactorial. We investigated the association of demographic factors and biopsy compliance following preoperative breast MRI with changes in surgical management in patients with newly diagnosed breast cancer. METHODS A retrospective review of BI-RADS 4 and 5 MRIs performed across a health system from March 2018 to November 2021 for assessment of disease extent and preoperative planning. Patient characteristics, including demographics, Tyrer-Cuzick risk score, pathology from index cancer and biopsy of MRI findings, and pre- and post-MRI surgical plans were recorded. Analysis compared patients who underwent biopsy with those who did not. RESULTS The final cohort included 323 patients who underwent a biopsy and 89 who did not. Of patients who underwent a biopsy, 144/323 (44.6%) had additional cancer diagnoses. MRI did not change management in 179/323 patients (55.4%) who underwent biopsy and in 44/89 patients (51.7%) who did not. Patients with a biopsy were more likely to have additional breast conservation surgery (P < .001) and patients without a biopsy were more likely to have a change in management to bilateral mastectomy P = .009). Patients without a biopsy who underwent a management change to bilateral mastectomy were significantly younger (47.2 vs 58.6; P < .001) and more likely to be white (P = .02) compared to those choosing bilateral mastectomy after biopsy. DISCUSSION Biopsy compliance is associated with changes in surgical decisions, and younger, white women are more likely to pursue aggressive surgical management without definitive pathologic diagnoses.
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Affiliation(s)
- Emma D Klein
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily B Sonnenblick
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arielle L Sasson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Anderson
- Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie R Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Wang LC, Rao S, Schacht D, Bhole S. Reducing False Negatives in Biopsy of Suspicious MRI Findings. JOURNAL OF BREAST IMAGING 2023; 5:597-610. [PMID: 38416912 DOI: 10.1093/jbi/wbad024] [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: 09/14/2022] [Indexed: 03/01/2024]
Abstract
Breast MRI is a highly sensitive imaging modality that often detects findings that are occult on mammography and US. Given the overlap in appearance of benign and malignant lesions, an accurate method of tissue sampling for MRI-detected findings is essential. Although MRI-directed US and correlation with mammography can be helpful for some lesions, a correlate is not always found. MRI-guided biopsy is a safe and effective method of tissue sampling for findings seen only on MRI. The unique limitations of this technique, however, contribute to false negatives, which can result in delays in diagnosis and adverse patient outcomes; this is of particular importance as most MRI examinations are performed in the high-risk or preoperative setting. Here, we review strategies to minimize false negatives in biopsy of suspicious MRI findings, including appropriate selection of biopsy modality, use of meticulous MRI-guided biopsy technique, management after target nonvisualization, assessment of adequate lesion sampling, and determination of radiology-pathology concordance. A proposed management algorithm for MRI-guided biopsy results will also be discussed.
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Affiliation(s)
- Lilian C Wang
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sandra Rao
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - David Schacht
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sonya Bhole
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
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8
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Neal CH. Screening Breast MRI and Gadolinium Deposition: Cause for Concern? JOURNAL OF BREAST IMAGING 2022; 4:10-18. [PMID: 38422412 DOI: 10.1093/jbi/wbab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 03/02/2024]
Abstract
Gadolinium-based contrast agents (GBCAs) have been used worldwide for over 30 years and have enabled lifesaving diagnoses. Contrast-enhanced breast MRI is frequently used as supplemental screening for women with an elevated lifetime risk of breast cancer. Data have emerged that indicate a fractional amount of administered gadolinium is retained in the bone, skin, solid organs, and brain tissues of patients with normal renal function, although there are currently no reliable data regarding the clinical or biological significance of this retention. Linear GBCAs are associated with a higher risk of gadolinium retention than macrocyclic agents. Over the course of their lives, screened women may receive high cumulative doses of GBCA. Therefore, as breast MRI screening utilization increases, thoughtful use of GBCA is indicated in this patient population.
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Affiliation(s)
- Colleen H Neal
- ProMedica Toledo Hospital, ProMedica Breast Care, Toledo, OH, USA
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Bhushan A, Gonsalves A, Menon JU. Current State of Breast Cancer Diagnosis, Treatment, and Theranostics. Pharmaceutics 2021; 13:723. [PMID: 34069059 PMCID: PMC8156889 DOI: 10.3390/pharmaceutics13050723] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is one of the leading causes of cancer-related morbidity and mortality in women worldwide. Early diagnosis and effective treatment of all types of cancers are crucial for a positive prognosis. Patients with small tumor sizes at the time of their diagnosis have a significantly higher survival rate and a significantly reduced probability of the cancer being fatal. Therefore, many novel technologies are being developed for early detection of primary tumors, as well as distant metastases and recurrent disease, for effective breast cancer management. Theranostics has emerged as a new paradigm for the simultaneous diagnosis, imaging, and treatment of cancers. It has the potential to provide timely and improved patient care via personalized therapy. In nanotheranostics, cell-specific targeting moieties, imaging agents, and therapeutic agents can be embedded within a single formulation for effective treatment. In this review, we will highlight the different diagnosis techniques and treatment strategies for breast cancer management and explore recent advances in breast cancer theranostics. Our main focus will be to summarize recent trends and technologies in breast cancer diagnosis and treatment as reported in recent research papers and patents and discuss future perspectives for effective breast cancer therapy.
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Affiliation(s)
- Arya Bhushan
- Ladue Horton Watkins High School, St. Louis, MO 63124, USA;
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
| | - Andrea Gonsalves
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
| | - Jyothi U. Menon
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA;
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10
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Lam DL, Lee JM. Breast Magnetic Resonance Imaging Audit: Pitfalls, Challenges, and Future Considerations. Radiol Clin North Am 2020; 59:57-65. [PMID: 33223000 DOI: 10.1016/j.rcl.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Breast magnetic resonance (MR) imaging is the most sensitive imaging modality for breast cancer detection and guidelines recommend its use, in addition to screening mammography, for high-risk women. The most recent American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) manual coordinated cross-modality BI-RADS terminology and established an outcome monitoring section that helps guide a medical imaging outcomes audit. This article provides a framework for performing a breast MR imaging audit in clinical practice, incorporating ACR BI-RADS guidance and more recently published data, clarifies common pitfalls, and discusses audit challenges related to evolving clinical practice.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109, USA.
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109, USA
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Strigel RM, Bravo E, Tevaarwerk AJ, Anderson BM, Stella AL, Neuman HB. Development and Implementation of an Algorithm to Guide MRI Screening in Patients With a Personal History of Treated Breast Cancer. Clin Breast Cancer 2020; 21:26-30. [PMID: 33162349 DOI: 10.1016/j.clbc.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Limited data exist to guide appropriate use of magnetic resonance imaging (MRI) screening in women with a personal history of breast cancer. We developed an algorithm to inform the use of MRI screening in patients with a personal history, implemented it, and evaluated initial implementation at our community and academic practice sites. PATIENTS AND METHODS A multidisciplinary committee of providers developed the initial algorithm on the basis of available literature and consensus. To evaluate projected MRI utilization based on the initial algorithm and inform algorithm revision, charts of patients < 80 years of age diagnosed and treated in 2010 with stage 0-III breast cancer (n = 236) were reviewed. The revised algorithm was implemented into the electronic medical record (September 2013). Thirteen months after implementation (2014-2015), chart review of patients with a personal history of breast cancer who underwent screening MRI was performed to assess algorithm adherence. RESULTS Before algorithm development, 9% (20/236) of patients received MRI screening (6 genetic mutation/family history, 4 occult primary, 8 young age/breast density, 2 unknown). Use of MRI screening was projected to increase to 25% with algorithm implementation. In postimplementation review, we identified 183 patients with a personal history of breast cancer who underwent screening MRI, with 94% algorithm adherence. CONCLUSION We successfully developed and implemented an algorithm to guide MRI screening in patients with a personal breast cancer history. Clinicians can use this algorithm to guide patient discussions regarding the utility of MRI screening. Further prospective study, including cancer detection rates, biopsy rate, and mortality, are necessary to confirm the algorithm's usefulness.
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Affiliation(s)
- Roberta M Strigel
- Department of Radiology, University of Wisconsin, Madison, WI; Department of Medical Physics, University of Wisconsin, Madison, WI; Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Erin Bravo
- Department of Radiology, University of Wisconsin, Madison, WI
| | - Amye J Tevaarwerk
- Carbone Cancer Center, University of Wisconsin, Madison, WI; Department of Medicine, University of Wisconsin, Madison, WI
| | - Bethany M Anderson
- Carbone Cancer Center, University of Wisconsin, Madison, WI; Department of Human Oncology, University of Wisconsin, Madison, WI
| | - Amy L Stella
- Carbone Cancer Center, University of Wisconsin, Madison, WI; Department of Medicine, University of Wisconsin, Madison, WI
| | - Heather B Neuman
- Carbone Cancer Center, University of Wisconsin, Madison, WI; Department of Surgery, University of Wisconsin, Madison, WI.
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12
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Hayward JH, Ray KM, Price ER, Sickles EA, Conlon K, Lobach I, Joe BN, Lee AY. Performance of screening MRI in high risk patients at initial versus subsequent screen. Clin Imaging 2020; 66:87-92. [DOI: 10.1016/j.clinimag.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
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13
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Ha SM, Chang JM, Lee SH, Kim ES, Kim SY, Cho N, Moon WK. Diffusion-weighted MRI at 3.0 T for detection of occult disease in the contralateral breast in women with newly diagnosed breast cancer. Breast Cancer Res Treat 2020; 182:283-297. [PMID: 32447596 DOI: 10.1007/s10549-020-05697-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Diffusion-weighted magnetic resonance imaging (DW-MRI) offers unenhanced method to detect breast cancer without cost and safety concerns associated with dynamic contrast-enhanced (DCE) MRI. Our purpose was to evaluate the performance of DW-MRI at 3.0T in detection of clinically and mammographically occult contralateral breast cancer in patients with unilateral breast cancer. METHODS Between 2017 and 2018, 1130 patients (mean age 53.3 years; range 26-84 years) with newly diagnosed unilateral breast cancer who underwent breast MRI and had no abnormalities on clinical and mammographic examinations of contralateral breast were included. Three experienced radiologists independently reviewed DW-MRI (b = 0 and 1000 s/mm2) and DCE-MRI and assigned a BI-RADS category. Using histopathology or 1-year clinical follow-up, performance measures of DW-MRI were compared with DCE-MRI. RESULTS A total of 21 (1.9%, 21/1130) cancers were identified (12 ductal carcinoma in situ and 9 invasive ductal carcinoma; mean invasive tumor size, 8.0 mm) in the contralateral breast. Cancer detection rate of DW-MRI was 13-15 with mean of 14 per 1000 examinations (95% confidence interval [CI] 9-23 per 1000 examinations), which was lower than that of DCE-MRI (18-19 with mean of 18 per 1000 examinations, P = 0.01). A lower abnormal interpretation rate (14.0% versus 17.0%, respectively, P < 0.001) with higher specificity (87.3% versus 84.6%, respectively, P < 0.001) but lower sensitivity (77.8% versus 96.8%, respectively, P < 0.001) was noted for DW-MRI compared to DCE-MRI. CONCLUSIONS DW-MRI at 3.0T has the potential as a cost-effective tool for evaluation of contralateral breast in women with newly diagnosed breast cancer.
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Affiliation(s)
- Su Min Ha
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Eun Sil Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
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14
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Outcome of Screening MRI in Premenopausal Women as a Function of the Week of the Menstrual Cycle. AJR Am J Roentgenol 2020; 214:1175-1181. [DOI: 10.2214/ajr.18.19960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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15
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Ruiz-Flores L, Whitman GJ, Le-Petross HTC, Hess KR, Parikh JR. Variation in Technical Quality of Breast MRI. Acad Radiol 2020; 27:468-475. [PMID: 31371208 DOI: 10.1016/j.acra.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) quality may vary across the United States. Our aim was to investigate the quality of outside breast MRIs presenting for second opinion at a tertiary cancer center following implementation of the American College of Radiology (ACR) Breast MRI Accreditation Program. MATERIALS AND METHODS We retrospectively reviewed the technical quality of the MRI studies of 100 consecutive cases submitted for second opinion in 2013. The image quality was blindly reviewed per ACR Breast MRI Accreditation Program by three fellowship-trained breast radiologists and one breast imaging fellow. RESULTS In total, 88 of the 100 cases were referred from facilities in the United States. Sixty (68%) of the 88 cases had at least one technical deficiency. In 10 cases (11%), more than five different technical deficiencies occurred. The most frequently encountered deficiencies were related to artifacts (74%), with shimming (N = 17) and motion (N = 16) being the most common. In total, 38% of cases (N = 33) had a deficient T2-weighted sequence, mostly due to low signal to noise ratio (N = 25). A total of 27% cases (N = 24) had deficiencies in the delayed phase postcontrast T1-weighted sequence, mainly due to low signal to noise ratio (N = 21) and 23% had deficiencies in the early phase postcontrast T1-weighted sequence, predominantly due to low signal to noise ratio as well. (N = 19). CONCLUSION Our study demonstrates variability of breast MRI quality across the United States. Radiologists should become familiar with the requirements of the ACR breast MRI accreditation program and strive to meet the expected standards in order to enhance patient quality and safety.
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Affiliation(s)
- Lorell Ruiz-Flores
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030.
| | - Gary J Whitman
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - H T Carissa Le-Petross
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay R Parikh
- Section of Breast Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX 77030
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Lam DL, Smith J, Partridge SC, Kim A, Javid SH, Hippe DS, Lehman CD, Lee JM, Rahbar H. The Impact of Preoperative Breast MRI on Surgical Management of Women with Newly Diagnosed Ductal Carcinoma In Situ. Acad Radiol 2020; 27:478-486. [PMID: 31281083 DOI: 10.1016/j.acra.2019.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/03/2019] [Accepted: 05/18/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Use of preoperative breast MRI (pMRI) to evaluate ductal carcinoma in situ (DCIS) extent is controversial due to limited data on its impact on surgical management. We sought to evaluate the effect of pMRI on surgical management of women with core needle biopsy (CNB)-diagnosed pure DCIS at a multidisciplinary academic institution. MATERIALS AND METHODS This retrospective study included all women with CNB-diagnosed DCIS (1/2004-12/2013) without prior ipsilateral breast cancer and who underwent surgery within 180 days of diagnosis. Patient features, number of CNBs and surgeries, and single successful breast conserving surgery (BCS) rate were compared between pMRI and no-pMRI cohorts. Number of surgeries and single BCS success rates were also compared to published US (SEER) and Danish National Registry data. RESULTS Among the 373 women included, no clinical differences were identified between the pMRI (n = 332) and no-pMRI (n = 41) cohorts (p > 0.05). The pMRI group experienced a higher additional CNB rate (30% vs. 7%, p = 0.002) but fewer total surgeries (mean = 1.2 vs. 1.5, p < 0.001) than the no-pMRI group. Among the 245 women for whom BCS was attempted, the pMRI cohort underwent fewer mean surgeries (1.3 vs. 1.7, p < 0.001) with a greater single successful BCS rate (77% vs. 43%, p < 0.001). Compared to published data, women with pMRI who underwent BCS experienced fewer surgeries (difference (Δ) = -0.22 vs. -0.17, p < 0.001) with a higher single successful BCS rate (Δ = +20% vs. +14%, p < 0.001). CONCLUSION pMRI may improve surgical management of DCIS at multidisciplinary centers with breast cancer specialists.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109.
| | - Jacob Smith
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Adrienne Kim
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, Washington
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109
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Burk KS, Edmonds CE, Mercaldo SF, Lehman CD, Sippo DA. The Effect of Prior Comparison MRI on Interpretive Performance of Screening Breast MRI. JOURNAL OF BREAST IMAGING 2020; 2:36-42. [PMID: 38425000 DOI: 10.1093/jbi/wbz076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the effect of prior comparison MRI on interpretive performance of screening breast MRI. METHODS After institutional review board approval, all screening breast MRI examinations performed from January 2011 through December 2014 were retrospectively reviewed. Screening performance metrics were estimated and compared for exams with and without a prior comparison MRI, using logistic regression models to adjust for age and screening indication (BRCA mutation or thoracic radiation versus breast cancer history versus high-risk lesion history versus breast cancer family history). RESULTS Most exams, 4509 (87%), had a prior comparison MRI (incidence round), while 661 (13%) did not (prevalence round). Abnormal interpretation rate (6% vs 20%, P < 0.01), biopsy rate (3% vs 9%, P < 0.01), and false-positive biopsy recommendation rate per 1000 exams (21 vs 71, P < 0.01) were significantly lower in the incidence rounds compared to the prevalence rounds, while specificity was significantly higher (95% vs 81%, P < 0.01). There was no difference in cancer detection rate (CDR) per 1000 exams (12 vs 20, P = 0.1), positive predictive value of biopsies performed (PPV3) (35% vs 23%, P = 0.1), or sensitivity (86% vs 76%, P = 0.4). CONCLUSION Presence of a prior comparison significantly improves incidence round screening breast MRI examination performance compared with prevalence round screening. Consideration should be given to updating the BI-RADS breast MRI screening benchmarks and auditing prevalence and incidence round examinations separately.
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Affiliation(s)
- Kristine S Burk
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Sarah F Mercaldo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Dorothy A Sippo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
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18
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Frequency and Cancer Yield of BI-RADS Category 3 Lesions Detected at High-Risk Screening Breast MRI. AJR Am J Roentgenol 2020; 214:240-248. [DOI: 10.2214/ajr.19.21778] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Luo J, Hippe DS, Rahbar H, Parsian S, Rendi MH, Partridge SC. Diffusion tensor imaging for characterizing tumor microstructure and improving diagnostic performance on breast MRI: a prospective observational study. Breast Cancer Res 2019; 21:102. [PMID: 31484577 PMCID: PMC6727336 DOI: 10.1186/s13058-019-1183-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) can increase breast MRI diagnostic specificity due to the tendency of malignancies to restrict diffusion. Diffusion tensor imaging (DTI) provides further information over conventional DWI regarding diffusion directionality and anisotropy. Our study evaluates DTI features of suspicious breast lesions detected on MRI to determine the added diagnostic value of DTI for breast imaging. Methods With IRB approval, we prospectively enrolled patients over a 3-year period who had suspicious (BI-RADS category 4 or 5) MRI-detected breast lesions with histopathological results. Patients underwent multiparametric 3 T MRI with dynamic contrast-enhanced (DCE) and DTI sequences. Clinical factors (age, menopausal status, breast density, clinical indication, background parenchymal enhancement) and DCE-MRI lesion parameters (size, type, presence of washout, BI-RADS category) were recorded prospectively by interpreting radiologists. DTI parameters (apparent diffusion coefficient [ADC], fractional anisotropy [FA], axial diffusivity [λ1], radial diffusivity [(λ2 + λ3)/2], and empirical difference [λ1 − λ3]) were measured retrospectively. Generalized estimating equations (GEE) and least absolute shrinkage and selection operator (LASSO) methods were used for univariate and multivariate logistic regression, respectively. Diagnostic performance was internally validated using the area under the curve (AUC) with bootstrap adjustment. Results The study included 238 suspicious breast lesions (95 malignant, 143 benign) in 194 women. In univariate analysis, lower ADC, axial diffusivity, and radial diffusivity were associated with malignancy (OR = 0.37–0.42 per 1-SD increase, p < 0.001 for each), as was higher FA (OR = 1.45, p = 0.007). In multivariate analysis, LASSO selected only ADC (OR = 0.41) as a predictor for a DTI-only model, while both ADC (OR = 0.41) and FA (OR = 0.88) were selected for a model combining clinical and imaging parameters. Post-hoc analysis revealed varying association of FA with malignancy depending on the lesion type. The combined model (AUC = 0.81) had a significantly better performance than Clinical/DCE-MRI-only (AUC = 0.76, p < 0.001) and DTI-only (AUC = 0.75, p = 0.002) models. Conclusions DTI significantly improves diagnostic performance in multivariate modeling. ADC is the most important diffusion parameter for distinguishing benign and malignant breast lesions, while anisotropy measures may help further characterize tumor microstructure and microenvironment.
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Affiliation(s)
- Jing Luo
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Sana Parsian
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA
| | - Mara H Rendi
- Department of Pathology, University of Washington School of Medicine, 1959 NE Pacific St. Box 356100, Seattle, WA, 98195, USA
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA, 98109, USA. .,Department of Radiology, Seattle Cancer Care Alliance, 1144 Eastlake Ave E, LG2-200, PO Box 19023, Seattle, WA, 98109, USA.
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20
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Panigrahi B, Harvey SC, Mullen LA, Falomo E, Di Carlo P, Lee B, Myers KS. Characteristics and Outcomes of BI-RADS 3 Lesions on Breast MRI. Clin Breast Cancer 2019; 19:e152-e159. [DOI: 10.1016/j.clbc.2018.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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21
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Rahbar H, Zhang Z, Chenevert TL, Romanoff J, Kitsch AE, Hanna LG, Harvey SM, Moy L, DeMartini WB, Dogan B, Yang WT, Wang LC, Joe BN, Oh KY, Neal CH, McDonald ES, Schnall MD, Lehman CD, Comstock CE, Partridge SC. Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702). Clin Cancer Res 2019; 25:1756-1765. [PMID: 30647080 DOI: 10.1158/1078-0432.ccr-18-2967] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives.Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. RESULTS Of 107 women enrolled, 67 patients (median age 49, range 24-75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n = 63) or 5 (n = 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm2/s) than benign lesions [1.21 × 10-3 vs.1.47 × 10-3; P < 0.0001; area under ROC curve = 0.75; 95% confidence interval (CI) 0.65-0.84]. In centralized analysis, application of an ADC threshold (1.53 × 10-3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%-31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 × 10-3 mm2/s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. CONCLUSIONS DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.
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Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Seattle, Washington.
| | - Zheng Zhang
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Averi E Kitsch
- University of Washington School of Medicine, Seattle, Washington
| | - Lucy G Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara M Harvey
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Linda Moy
- New York University School of Medicine, New York, New York
| | - Wendy B DeMartini
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Wei T Yang
- MD Anderson Cancer Center, Houston, Texas
| | - Lilian C Wang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bonnie N Joe
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Karen Y Oh
- Oregon Health Sciences University, Portland, Oregon
| | - Colleen H Neal
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth S McDonald
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Constance D Lehman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Mootz AR, Madhuranthakam AJ, Doğan B. Changing Paradigms in Breast Cancer Screening: Abbreviated Breast MRI. Eur J Breast Health 2019; 15:1-6. [PMID: 30816364 DOI: 10.5152/ejbh.2018.4402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/02/2018] [Indexed: 01/07/2023]
Abstract
Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for breast cancer detection. In this review we discuss the vastly superior performance of MRI compared to traditional breast cancer screening modalities of mammography, tomosynthesis and ultrasound. We discuss an abbreviated breast MRI (AB-MRI) protocol utilizing Dixon sequences which is compliant with American College of Radiology (ACR) guidelines for accreditation of breast MRI but with significantly reduced scan times. Adaptation of such an AB-MRI protocol significantly increases patient throughput and may allow MRI to serve as a stand- alone breast cancer screening tool.
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Affiliation(s)
- Ann R Mootz
- Department of Radiology, University of Texas Southwestern Medical School, Texas, USA
| | | | - Başak Doğan
- Department of Radiology, University of Texas Southwestern Medical School, Texas, USA
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23
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Covington MF, Young CA, Appleton CM. American College of Radiology Accreditation, Performance Metrics, Reimbursement, and Economic Considerations in Breast MR Imaging. Magn Reson Imaging Clin N Am 2018; 26:303-314. [PMID: 29622136 DOI: 10.1016/j.mric.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Accreditation through the American College of Radiology (ACR) Breast Magnetic Resonance Imaging Accreditation Program is necessary to qualify for reimbursement from Medicare and many private insurers and provides facilities with peer review on image acquisition and clinical quality. Adherence to ACR quality control and technical practice parameter guidelines for breast MR imaging and performance of a medical outcomes audit program will maintain high-quality imaging and facilitate accreditation. Economic factors likely to influence the practice of breast MR imaging include cost-effectiveness, competition with lower-cost breast-imaging modalities, and price transparency, all of which may lower the cost of MR imaging and allow for greater utilization.
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Affiliation(s)
- Matthew F Covington
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110, USA
| | - Catherine A Young
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110, USA
| | - Catherine M Appleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110, USA.
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Panigrahi B, Mullen L, Falomo E, Panigrahi B, Harvey S. An Abbreviated Protocol for High-risk Screening Breast Magnetic Resonance Imaging: Impact on Performance Metrics and BI-RADS Assessment. Acad Radiol 2017; 24:1132-1138. [PMID: 28506511 DOI: 10.1016/j.acra.2017.03.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Annual breast magnetic resonance imaging (MRI) is recommended to screen high-risk populations for breast cancer, although costs are significant. This study assesses the performance of an abbreviated MRI protocol as a resource-efficient approach for screening patients at high-risk of breast cancer, and assesses whether the abbreviated protocol alters the assigned Breast Imaging Reporting and Data System (BI-RADS) category. MATERIALS AND METHODS This is a prospective paired cohort study performed in an academic ambulatory setting. MRI images of women at high risk of breast cancer were reviewed using an abbreviated MRI protocol, followed by an immediate review of additional sequences included in a full diagnostic protocol. BI-RADS assessments, including all changes and interpretation times, were recorded for both the abbreviated and full protocol reviews. Cancer detection rate, positive predictive value 3 (PPV3), sensitivity, and specificity were calculated. RESULTS A total of 1052 MRI cases were reviewed. The cancer detection rate was 13.3 per 1000 with a PPV3 of 30.4% based on the full protocol. Review of sequences included in the full protocol resulted in a change in the final BI-RADS assessments in 3.4% of the cases, the majority of which did not change clinical management with respect to biopsy. The sensitivity and specificity of the abbreviated and full protocols were not significantly different. CONCLUSIONS This pilot study of an abbreviated MRI protocol demonstrates effective performance in cancer detection. BI-RADS assessments were rarely altered with the additional information afforded by the full protocol. The abbreviated protocol holds promise for resource-efficient breast cancer screening in high-risk women.
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Affiliation(s)
- Babita Panigrahi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, 601 North Caroline St., Suite 4120E, Baltimore, MD 21287
| | - Lisa Mullen
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, 601 North Caroline St., Suite 4120E, Baltimore, MD 21287
| | - Eniola Falomo
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, 601 North Caroline St., Suite 4120E, Baltimore, MD 21287
| | | | - Susan Harvey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, 601 North Caroline St., Suite 4120E, Baltimore, MD 21287.
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Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI. AJR Am J Roentgenol 2017; 208:1392-1399. [PMID: 28792802 DOI: 10.2214/ajr.16.16730] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE BI-RADS for mammography and ultrasound subdivides category 4 assessments by likelihood of malignancy into categories 4A (> 2% to ≤ 10%), 4B (> 10% to ≤ 50%), and 4C (> 50% to < 95%). Category 4 is not subdivided for breast MRI because of a paucity of data. The purpose of the present study is to determine the utility of categories 4A, 4B, and 4C for MRI by calculating their positive predictive values (PPVs) and comparing them with BI-RADS-specified rates of malignancy for mammography and ultrasound. MATERIALS AND METHODS All screening breast MRI examinations performed from July 1, 2010, through June 30, 2013, were included in this study. We identified in medical records prospectively assigned MRI BI-RADS categories, including category 4 subdivisions, which are used routinely in our practice. Benign versus malignant outcomes were determined by pathologic analysis, findings from 12 months or more clinical or imaging follow-up, or a combination of these methods. Distribution of BI-RADS categories and positive predictive value level 2 (PPV2; based on recommendation for tissue diagnosis) for categories 4 (including its subdivisions) and 5 were calculated. RESULTS Of 860 screening breast MRI examinations performed for 566 women (mean age, 47 years), 82 with a BI-RADS category 4 assessment were identified. A total of 18 malignancies were found among 84 category 4 and 5 assessments, for an overall PPV2 of 21.4% (18/84). For category 4 subdivisions, PPV2s were as follows: for category 4A, 2.5% (1/40); for category 4B, 27.6% (8/29); for category 4C, 83.3% (5/6); and for category 4 (not otherwise specified), 28.6% (2/7). CONCLUSION Category 4 subdivisions for MRI yielded malignancy rates within BI-RADS-specified ranges, supporting their use for benefits to patient care and more meaningful practice audits.
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Sedora Román NI, Mehta TS, Sharpe RE, Slanetz PJ, Venkataraman S, Fein-Zachary V, Dialani V. Proposed biopsy performance benchmarks for MRI based on an audit of a large academic center. Breast J 2017; 24:319-324. [DOI: 10.1111/tbj.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Tejas S. Mehta
- Breast Imaging Department; Beth Israel Deaconess Medical Center; Boston MA USA
| | - Richard E. Sharpe
- Breast Imaging Department; Beth Israel Deaconess Medical Center; Boston MA USA
| | | | | | | | - Vandana Dialani
- Breast Imaging Department; Beth Israel Deaconess Medical Center; Boston MA USA
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Prevalence and Predictive Value of BI-RADS 3, 4, and 5 Lesions Detected on Breast MRI: Correlation with Study Indication. Acad Radiol 2017; 24:435-441. [PMID: 27955878 DOI: 10.1016/j.acra.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to determine the prevalence and predictive value of Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5 findings on breast magnetic resonance imaging (MRI) and to evaluate the impact of study indication on the predictive value of BI-RADS categories. MATERIALS AND METHODS This institutional review board approved, Health Insurance Portability and Accountability Act (HIPAA) compliant retrospective review of our breast MRI database from 2009 to 2011, of 5778 contrast-enhanced studies in 3360 patients was performed. At our institution, each breast receives an individual BI-RADS assessment. Breast MRI reports and electronic medical records were reviewed to obtain BI-RADS assessment, patient demographics, and outcomes. Univariate analysis was performed with Fisher exact and chi-square tests. RESULTS A total of 9216 BI-RADS assessments were assigned during the study period: 7879 (85.5%) BI-RADS 1 and 2, 567 (6.2%) BI-RADS 3, 715 (7.8%) BI-RADS 4, and 55 (0.6%) BI-RADS 5 assessments. The frequency of BI-RADS 3, 4, and 5 assessments was higher in studies performed for diagnostic (7.8%, 14.6%, 1.6%, respectively) than screening (5.2%, 4.0%, 0.1%) indications (P < 0.01). A total of 663 BI-RADS 4 and 5 lesions were biopsied with 209 (31.5%) malignant and 454 (68.5%) benign outcomes. The overall cancer rate for BI-RADS 3 findings was 1.9% (11 of 567) with no difference observed by study indication (diagnostic, 1.6%; screening, 2.3%; P = 0.76). The positive predictive value (PPV2) of BI-RADS 4 and 5 was higher for diagnostic (29.1%, 154 of 530) than for screening (22.9%, 55 of 240) indications. CONCLUSIONS Abnormal interpretation rates and PPV2 for MRIs performed for diagnostic indications are higher than for screening indications. Similar to mammography, breast MRI audits should be separated by study indication.
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Strigel RM, Rollenhagen J, Burnside ES, Elezaby M, Fowler AM, Kelcz F, Salkowski L, DeMartini WB. Screening Breast MRI Outcomes in Routine Clinical Practice: Comparison to BI-RADS Benchmarks. Acad Radiol 2017; 24:411-417. [PMID: 27986508 PMCID: PMC5339052 DOI: 10.1016/j.acra.2016.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The BI-RADS Atlas 5th Edition includes screening breast magnetic resonance imaging (MRI) outcome benchmarks. However, the metrics are from expert practices and clinical trials of women with hereditary breast cancer predispositions, and it is unknown if they are appropriate for routine practice. We evaluated screening breast MRI audit outcomes in routine practice across a spectrum of elevated risk patients. MATERIALS AND METHODS This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all consecutive screening breast MRI examinations from July 1, 2010 to June 30, 2013. Examination indications were categorized as gene mutation carrier (GMC), personal history (PH) breast cancer, family history (FH) breast cancer, chest radiation, and atypia/lobular carcinoma in situ (LCIS). Outcomes were determined by pathology and/or ≥12 months clinical and/or imaging follow-up. We calculated abnormal interpretation rate (AIR), cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2) and biopsy performed (PPV3), and median size and percentage of node-negative invasive cancers. RESULTS Eight hundred and sixty examinations were performed in 566 patients with a mean age of 47 years. Indications were 367 of 860 (42.7%) FH, 365 of 860 (42.4%) PH, 106 of 860 (12.3%) GMC, 14 of 860 (1.6%) chest radiation, and 8 of 22 (0.9%) atypia/LCIS. The AIR was 134 of 860 (15.6%). Nineteen cancers were identified (13 invasive, 4 DCIS, two lymph nodes), resulting in CDR of 19 of 860 (22.1 per 1000), PPV2 of 19 of 88 (21.6%), and PPV3 of 19 of 80 (23.8%). Of 13 invasive breast cancers, median size was 10 mm, and 8 of 13 were node negative (61.5%). CONCLUSIONS Performance outcomes of screening breast MRI in routine clinical practice across a spectrum of elevated risk patients met the American College of Radiology Breast Imaging Reporting and Data System benchmarks, supporting broad application of these metrics. The indication of a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screening indications.
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Affiliation(s)
- Roberta M Strigel
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792; Department of Medical Physics, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin.
| | - Jennifer Rollenhagen
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Mai Elezaby
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792; Department of Medical Physics, University of Wisconsin, Madison, Wisconsin; Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Frederick Kelcz
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Lonie Salkowski
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792
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Quality Improvement of Breast MRI Reports With Standardized Templates for Structured Reporting. J Am Coll Radiol 2017; 14:517-520. [DOI: 10.1016/j.jacr.2016.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/21/2022]
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Radiologic-Pathologic Discordance and Outcome After MRI-Guided Vacuum-Assisted Biopsy. AJR Am J Roentgenol 2017; 208:W17-W22. [DOI: 10.2214/ajr.16.16404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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33
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de Almeida JRM, Gomes AB, Barros TP, Fahel PE, Rocha MDS. Predictive performance of BI-RADS magnetic resonance imaging descriptors in the context of suspicious (category 4) findings. Radiol Bras 2016; 49:137-43. [PMID: 27403012 PMCID: PMC4938442 DOI: 10.1590/0100-3984.2015.0021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the positive predictive value (PPV) and likelihood ratio for
magnetic resonance imaging (MRI) characteristics of category 4 lesions, as
described in the Breast Imaging Reporting and Data System
(BI-RADS®) lexicon, as well as to test the predictive
performance of the descriptors using multivariate analysis and the area
under the curve derived from a receiver operating characteristic (ROC)
curve. Materials and Methods This was a double-blind review study of 121 suspicious findings from 98 women
examined between 2009 and 2013. The terminology was based on the 2013
edition of the BI-RADS. Results Of the 121 suspicious findings, 53 (43.8%) were proven to be malignant
lesions, with no significant difference between mass and non-mass
enhancement (p = 0.846). The PPVs were highest for masses
with a spiculated margin (71%) and round shape (63%), whereas segmental
distribution achieved a high PPV (80%) for non-mass enhancement. Kinetic
analyses performed poorly, except for type 3 curves applied to masses (PPV
of 73%). Logistic regression models were significant for both patterns,
although the results were better for masses, particularly when kinetic
assessments were included (p = 0.015; pseudo
R2 = 0.48; area under the curve =
90%). Conclusion Some BI-RADS MRI descriptors have high PPV and good predictive performance-as
demonstrated by ROC curve and multivariate analysis-when applied to BI-RADS
category 4 findings. This may allow future stratification of this
category.
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Affiliation(s)
| | - André Boechat Gomes
- Physician, Department of Diagnostic Imaging, Clínica de Assistência à Mulher (CAM), Salvador, BA, Brazil
| | | | - Paulo Eduardo Fahel
- Physician, Department of Pathology, Clínica de Assistência à Mulher (CAM), Salvador, BA, Brazil
| | - Mário de Seixas Rocha
- PhD, Assistant Professor of Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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Freer PE, Niell B, Rafferty EA. Preoperative Tomosynthesis-guided Needle Localization of Mammographically and Sonographically Occult Breast Lesions. Radiology 2015; 275:377-83. [PMID: 25575115 DOI: 10.1148/radiol.14140515] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility and accuracy of digital breast tomosynthesis (DBT)-guided needle localization for DBT-detected suspicious abnormalities not visualized with other modalities and to analyze the imaging and pathologic characteristics of abnormalities detected only with DBT to determine the positive predictive value for malignancy. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A retrospective query of the imaging database identified 34 consecutive women (average age, 55 years; age range, 28-84 years) with 36 lesions who underwent DBT-guided needle localization between April 2011 and January 2013 with use of commercially available equipment. Imaging findings and medical records were reviewed. Findings that were attributable to previous surgical changes were classified as benign or probably benign and excluded from analysis because the lesions did not proceed to localization. RESULTS Architectural distortion was the imaging finding identified in all 36 abnormalities (100%). Findings from pathologic examination after the first attempt at localization were concordant with those from imaging in 35 of the 36 lesions (97%), which is suggestive of appropriate sampling. Histologic findings were malignant in 17 of the 36 lesions (47%; 95% confidence interval: 30.4%, 64.5%). Thirteen of the 17 lesions (76%; 95% confidence interval: 50.1%, 93.1%) were invasive malignancies. Twenty-two of the 36 abnormalities (61%) were either malignant or high-risk lesions (atypical ductal hyperplasia, lobular carcinoma in situ, atypical lobular hyperplasia). CONCLUSION DBT-guided needle localization is an accurate and feasible method with which to biopsy DBT-detected suspicious architectural distortions not visualized at mammography or sonography. The high risk of malignancy in abnormalities detected only with DBT (47%) confirms that routine biopsy is required for histologic analysis.
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Affiliation(s)
- Phoebe E Freer
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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