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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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2
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Franklin J, Hayes J, Knippa E, Dogan B. False negative breast cancers on imaging and associated risk factors: a single institution six-year analysis. Breast Cancer Res Treat 2024; 205:507-520. [PMID: 38483757 DOI: 10.1007/s10549-024-07259-0] [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: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE Mitigating false negative imaging studies remains an important issue given its association with worse morbidity and mortality in patients with breast cancer. We aimed to identify risk factors that predispose to false negative breast imaging exams. METHODS In an IRB-approved, HIPAA compliant retrospective study, we identified all patients who were diagnosed with breast cancer within 365 days of a negative imaging study assessed as BI-RADS 1-3 between January 1, 2014 and January 31, 2020. A matched cohort based on mammographic breast density was created from randomly selected studies with BI-RADS 4-5 designation that yielded breast cancer at pathology within the same time frame. Patient and cancer characteristics, prior personal history of breast cancer and gene mutation status were collected from patient charts. Pearson chi-squared and Student's t-test on two independent groups with significance at < 0.05 was used for statistical analysis. RESULTS We identified 155 false negative studies of 129 missed cancers and 128 breast density matched true positive cancers. False negative studies were screening mammograms in 57.42% (89/155), diagnostic mammograms in 29.68% (46/155), ultrasounds in 6.45% (10/155) and MRIs in 6.45% (10/155). Rates of personal (41.09% vs. 18.75%, p < 0.001) and family history of breast cancer (68.22% vs. 49.21%, p = 0.002) were higher in the false negative cohort and remained significant when asymptomatic MRI-detected cancers were removed. CONCLUSION Our findings suggest that supplemental screening may be useful in breast cancer survivors.
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Affiliation(s)
- Jordan Franklin
- The University of Texas Southwestern Medical Center Medical School, Dallas, TX, USA.
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
| | - Jody Hayes
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily Knippa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Başak Dogan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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3
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Niell BL, Jochelson MS, Amir T, Brown A, Adamson M, Baron P, Bennett DL, Chetlen A, Dayaratna S, Freer PE, Ivansco LK, Klein KA, Malak SF, Mehta TS, Moy L, Neal CH, Newell MS, Richman IB, Schonberg M, Small W, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update. J Am Coll Radiol 2024; 21:S126-S143. [PMID: 38823941 DOI: 10.1016/j.jacr.2024.02.019] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | | | - Tali Amir
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann Brown
- Panel Vice Chair, University of Cincinnati, Cincinnati, Ohio
| | - Megan Adamson
- Clinica Family Health, Lafayette, Colorado; American Academy of Family Physicians
| | - Paul Baron
- Lenox Hill Hospital, Northwell Health, New York, New York; American College of Surgeons
| | | | - Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Sandra Dayaratna
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Linda Moy
- NYU Clinical Cancer Center, New York, New York
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Ilana B Richman
- Yale School of Medicine, New Haven, Connecticut; Society of General Internal Medicine
| | - Mara Schonberg
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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4
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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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Camps-Herrero J, Pijnappel R, Balleyguier C. MR-contrast enhanced mammography (CEM) for follow-up of breast cancer patients: a "pros and cons" debate. Eur Radiol 2024:10.1007/s00330-024-10684-w. [PMID: 38488968 DOI: 10.1007/s00330-024-10684-w] [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: 08/10/2023] [Revised: 01/07/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
Women with a personal history of breast cancer (PHBC) are at an increased risk of either a local recurrence or a new primary breast cancer. Thus, surveillance is essential for the detection of recurrent disease at the earliest possible stage, allowing for prompt treatment, and potentially improving overall survival. Nowadays, mammography follow-up is the only surveillance imaging technique recommended by international guidelines. Nevertheless, sensitivity of mammography is lower after breast cancer treatment, particularly during the first 5 years, due to increased density or post-treatment changes. Contrast-enhanced breast imaging techniques, such as MRI or contrast-enhanced mammography (CEM), are very sensitive to detect malignant enhancement, especially in dense breasts. This Special Report will provide arguments in favor of and against breast cancer follow-up with MRI or CEM, in a debate style between experts in Breast Imaging. Finally, the scientific points of pros and cons arguments will be summarized to help objectively decide the best follow-up strategy for women with a personal history of breast cancer. CLINICAL RELEVANCE STATEMENT: A personalized approach to follow-up imaging after conservative breast cancer treatment could optimize patient outcomes, using mammography as a baseline for most patients, and MRI or CEM selectively in patients with higher risks for a recurrence. KEY POINTS: • Women with a personal history of breast cancer are at an increased risk of either a local recurrence or a new primary breast cancer. • Breast cancer survivors may benefit from additional imaging with MRI/CEM, in case of increased risk of a second breast cancer, with dense breasts or a cancer diagnosis before age 50 years. • As survival after local recurrence seems to depend on the initial stage at diagnosis, imaging should be more focused on detecting tumors in the earliest stages.
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Affiliation(s)
| | - Ruud Pijnappel
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France.
- BIOMAPS, UMR 1281, Université Paris-Saclay, 94800, Villejuif, France.
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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: 0] [Impact Index Per Article: 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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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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8
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Coffey K, Mango V. Revisiting Screening in Women With a Family History of Breast Cancer. JOURNAL OF BREAST IMAGING 2023; 5:635-645. [PMID: 38141237 DOI: 10.1093/jbi/wbad069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 12/25/2023]
Abstract
Women with a family history (FH) of breast cancer and without known genetic susceptibility represent a unique population whose lifetime probability of developing breast cancer varies widely depending on familial factors, breast density, and the risk assessment tool used. Recently updated guidelines from the American College of Radiology recommend supplemental annual screening with contrast-enhanced MRI or contrast-enhanced mammography for women with an FH who are high risk (≥20% lifetime risk) or have dense breasts. To date, most screening studies addressing outcomes in women with FH have largely included those also with confirmed or suspected gene mutations, in whom the lifetime risk is highest, with limited data for women at average to intermediate risk who are not known to be genetically susceptible and may not benefit as much from the same screening approaches. Further research focusing specifically on women with FH as the only breast cancer risk factor is warranted to refine risk assessment and optimize a multimodality personalized screening approach.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
| | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
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9
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Heller SL, Gao Y. Update on Lobular Neoplasia. Radiographics 2023; 43:e220188. [PMID: 37676825 DOI: 10.1148/rg.220188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Lobular neoplasia (LN) is a histopathologic entity that encompasses both lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). Management of LN is known to be variable and institutionally dependent. The variability in approach after a diagnosis of LN at percutaneous breast biopsy derives in part from heterogeneity in the literature, resulting in a range of reported upgrade rates to malignancy after initial identification at percutaneous biopsy, and also from historical shifts in understanding of the natural history of LN. It has become increasingly recognized that not all LN is the same and that distinct variants of LN such as pleomorphic LCIS and florid LCIS have distinct natural histories and distinct likelihoods of upgrade to malignancy. In addition, it is also increasingly understood that appropriate management of LN relies on scrupulous radiologic-pathologic correlation. This review details the imaging features and histopathologic nature of ALH, classic-type LCIS, and the LCIS variants; addresses changes in the historical understanding of this entity contributing to confusion regarding its management; and discusses the importance of performing radiologic-pathologic correlation after percutaneous biopsy to help guide appropriate management steps when LN is encountered. In addition to the short-term implications of an LN diagnosis in terms of upgrade and surgical outcomes, the long-term implications of an LN diagnosis regarding risk of developing a later breast cancer are examined. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Samantha L Heller
- From the NYU Grossman School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the NYU Grossman School of Medicine, 160 E 34th St, New York, NY 10016
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Al-Refai R, Bendari A, Morrar D, Sham S, Kataw L, Garajayev A, Hajiyeva S. Immunohistochemical Staining Characteristics of Low-Grade Invasive Ductal Carcinoma Using the ADH5 Cocktail (CK5/14, P63, and CK7/18): A Potential Interpretative Pitfall. Diagnostics (Basel) 2023; 13:2966. [PMID: 37761331 PMCID: PMC10527570 DOI: 10.3390/diagnostics13182966] [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: 06/27/2023] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Background: In our practice, the antibody cocktail ADH5 (CK5/14, p63, and CK7/18) helps with diagnostic challenges, such as identifying microinvasion and foci of invasive carcinoma, differentiating atypical ductal hyperplasia from hyperplasia of the usual type, and distinguishing basal phenotypes in triple-negative carcinomas. However, the ADH5 cocktail does have pitfalls and caveats. Methods: We describe our experience with the ADH5 cocktail of antibodies in breast pathology. Institutional knowledge and a literature search form our data sources. Results: We analyzed 44 cases. Four out of a total of 44 cases (9.1%)-two tubular carcinomas and two low-grade invasive breast carcinomas of no special type (ductal) with tubular features-showed an expected pattern of staining for ADH5 with a loss of brown (P63, CK5/14) staining around invasive glands and diffuse red (CK7/18) expression. Forty out of 44 (90.9%) cases showed an unexpected staining pattern (mixture of cytoplasmic brown and red). All 44 cases (100%) showed negative myoepithelial staining around invasive foci when separately stained for P63 and SMMH (Smooth Muscle Myosin Heavy). Conclusions: The unexpected staining pattern of ADH5 in low-grade invasive ductal carcinomas can be challenging to interpret in these lesions with low-grade cytology. The occurrence can cause confusion among users who employ multiplex stains, and it is important for users to be aware of this potential pitfall.
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Affiliation(s)
- Reham Al-Refai
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
| | - Ahmed Bendari
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
| | - Doaa Morrar
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
| | - Sunder Sham
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
| | - Layth Kataw
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
| | - Azar Garajayev
- Baku Health Center, Azerbaijan Medical University, Baku AZ1022, Azerbaijan;
| | - Sabina Hajiyeva
- Department of Pathology and Laboratory Medicine, Northwell Health Lenox Hill Hospital, New York, NY 10075, USA; (A.B.); (D.M.); (S.S.); (L.K.); (S.H.)
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11
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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12
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Urban LABD, Chala LF, Paula IBD, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, Oliveira TMGD, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e480-e488. [PMID: 37683660 PMCID: PMC10491472 DOI: 10.1055/s-0043-1772498] [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: 09/10/2023] Open
Abstract
OBJECTIVE To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. METHODS Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. RECOMMENDATIONS Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.
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Affiliation(s)
| | - Luciano Fernandes Chala
- National Mammography Commission, Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Carlos Shimizu
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | | | - Flávia Engel Aduan
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Henrique Lima Couto
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - Gustavo Machado Badan
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - José Luis Esteves Francisco
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | - Thaís Paiva Moraes
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | | | - João Emílio Peixoto
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
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Urban LABD, Chala LF, de Paula IB, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, de Oliveira TMG, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations. Radiol Bras 2023; 56:207-214. [PMID: 37829583 PMCID: PMC10567087 DOI: 10.1590/0100-3984.2023.0064-en] [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: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities.Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.
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Affiliation(s)
- Linei Augusta Brolini Delle Urban
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Luciano Fernandes Chala
- Coordinator of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Marcela Brisighelli Schaefer
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ana Lúcia Kefalás Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Carlos Shimizu
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Paula de Camargo Moraes
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Beatriz Medicis Maranhão Miranda
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Flávia Engel Aduan
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Salete de Jesus Fonseca Rego
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ellyete de Oliveira Canella
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Henrique Lima Couto
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - Gustavo Machado Badan
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - José Luis Esteves Francisco
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Thaís Paiva Moraes
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Rosangela Requi Jakubiak
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - João Emílio Peixoto
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
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14
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Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [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: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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15
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Hussein H, Abbas E, Keshavarzi S, Fazelzad R, Bukhanov K, Kulkarni S, Au F, Ghai S, Alabousi A, Freitas V. Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis. Radiology 2023; 306:e221785. [PMID: 36719288 DOI: 10.1148/radiol.221785] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background The best supplemental breast cancer screening modality in women at average risk or intermediate risk for breast cancer with dense breast and negative mammogram remains to be determined. Purpose To conduct systematic review and meta-analysis comparing clinical outcomes of the most common available supplemental screening modalities in women at average risk or intermediate risk for breast cancer in patients with dense breasts and mammography with negative findings. Materials and Methods A comprehensive search was conducted until March 12, 2020, in Medline, Epub Ahead of Print and In-Process and Other Non-Indexed Citations; Embase Classic and Embase; Cochrane Central Register of Controlled Trials; and Cochrane Database of Systematic Reviews, for Randomized Controlled Trials and Prospective Observational Studies. Incremental cancer detection rate (CDR); positive predictive value of recall (PPV1); positive predictive value of biopsies performed (PPV3); and interval CDRs of supplemental imaging modalities, digital breast tomosynthesis, handheld US, automated breast US, and MRI in non-high-risk patients with dense breasts and mammography negative for cancer were reviewed. Data metrics and risk of bias were assessed. Random-effects meta-analysis and two-sided metaregression analyses comparing each imaging modality metrics were performed (PROSPERO; CRD42018080402). Results Twenty-two studies reporting 261 233 screened patients were included. Of 132 166 screened patients with dense breast and mammography negative for cancer who met inclusion criteria, a total of 541 cancers missed at mammography were detected with these supplemental modalities. Metaregression models showed that MRI was superior to other supplemental modalities in CDR (incremental CDR, 1.52 per 1000 screenings; 95% CI: 0.74, 2.33; P < .001), including invasive CDR (invasive CDR, 1.31 per 1000 screenings; 95% CI: 0.57, 2.06; P < .001), and in situ disease (rate of ductal carcinoma in situ, 1.91 per 1000 screenings; 95% CI: 0.10, 3.72; P < .04). No differences in PPV1 and PPV3 were identified. The limited number of studies prevented assessment of interval cancer metrics. Excluding MRI, no statistically significant difference in any metrics were identified among the remaining imaging modalities. Conclusion The pooled data showed that MRI was the best supplemental imaging modality in women at average risk or intermediate risk for breast cancer with dense breasts and mammography negative for cancer. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Hooley and Butler in this issue.
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Affiliation(s)
- Heba Hussein
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Engy Abbas
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Sareh Keshavarzi
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Rouhi Fazelzad
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Karina Bukhanov
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Supriya Kulkarni
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Frederick Au
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Sandeep Ghai
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Abdullah Alabousi
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
| | - Vivianne Freitas
- From the Joint Department of Medical Imaging-Breast Division, University of Toronto, University Health Network, Sinai Health System, Women's College Hospital, 610 University Ave, Toronto, ON, Canada M5G 2M9 (H.H., E.A., K.B., S. Kulkarni, F.A., S.G., V.F.); Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom (H.H.); Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada (S. Keshavarzi); Department of Library and Information Services, University Health Network-Princess Margaret Cancer Centre, Toronto, Canada (R.F.); and Faculty of Health Sciences, Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, Canada (A.A.)
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16
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Laws A, Katlin F, Hans M, Graichen M, Kantor O, Minami C, Bychkovsky BL, Pace LE, Scheib R, Garber JE, King TA. Screening MRI Does Not Increase Cancer Detection or Result in an Earlier Stage at Diagnosis for Patients with High-Risk Breast Lesions: A Propensity Score Analysis. Ann Surg Oncol 2023; 30:68-77. [PMID: 36171529 DOI: 10.1245/s10434-022-12568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Guidelines recommend consideration of screening MRI for patients with high-risk breast lesions (HRLs), acknowledging limited data for this moderate-risk population. METHODS This study identified patients with atypical ductal/lobular hyperplasia (ADH/ALH), lobular carcinoma in situ, (LCIS) or both evaluated at our high-risk clinic. Patients were categorized as having received screening mammography (MMG) alone vs. MMG and breast MRI (MMG+MRI). Inverse probability weighting based on propensity scores (PS) representing likelihood of MRI use was applied to Kaplan-Meier and Cox regression analyses to determine cancer detection and biopsy rates by screening group. RESULTS Among 908 eligible patients, 699 (77%) patients with available follow-up data were analyzed (542 with ADH/ALH and 157 with LCIS). Of the 699 patients, 540 (77%) received MMG alone, and 159 (23%) received MMG + MRI. The median follow-up period was 25 months, during which a median of two MRIs were performed. After PS-weighting, the characteristics of each screening group were well-balanced with respect to age, race, body mass index (BMI), menopausal status, breast density, family history, HRL type, and chemoprevention use. The 4 year breast cancer detection rate was 3.6% with both MMG alone and MMG+MRI (p = 0.89). The breast biopsy rates were significantly higher with MMG+MRI (30.5% vs12.6%; hazard ratio [HR], 2.67; p < 0.001). All breast cancers were clinically node-negative and pathologic stage 0 or 1. Among five cancers in the MMG+MRI group, two were MRI-detected, two were MMG-detected, and one was detected on clinical exam. CONCLUSIONS Screening MRI did not improve cancer detection, and cancer characteristics were favorable whether screened with MMG alone or MMG + MRI. These findings question the benefit of MRI for patients with HRL, although longer-term follow-up study is needed.
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Affiliation(s)
- Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Fisher Katlin
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Marybeth Hans
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Graichen
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Christina Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brittany L Bychkovsky
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, MA, USA.,Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rochelle Scheib
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy E Garber
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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17
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Meng X, Fan J, Yu H, Mu J, Li Z, Yang A, Liu B, Lv K, Ai D, Lin Y, Song H, Fu T, Xiao D, Ma G, Yang J, Gu Y. Volume-awareness and outlier-suppression co-training for weakly-supervised MRI breast mass segmentation with partial annotations. Knowl Based Syst 2022. [DOI: 10.1016/j.knosys.2022.109988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Di Maria S, Vedantham S, Vaz P. Breast dosimetry in alternative X-ray-based imaging modalities used in current clinical practices. Eur J Radiol 2022; 155:110509. [PMID: 36087425 PMCID: PMC9851082 DOI: 10.1016/j.ejrad.2022.110509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023]
Abstract
In X-ray breast imaging, Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT), are the standard and largely used techniques, both for diagnostic and screening purposes. Other techniques, such as dedicated Breast Computed Tomography (BCT) and Contrast Enhanced Mammography (CEM) have been developed as an alternative or a complementary technique to the established ones. The performance of these imaging techniques is being continuously assessed to improve the image quality and to reduce the radiation dose. These imaging modalities are predominantly used in the diagnostic setting to resolve incomplete or indeterminate findings detected with conventional screening examinations and could potentially be used either as an adjunct or as a primary screening tool in select populations, such as for women with dense breasts. The aim of this review is to describe the radiation dosimetry for these imaging techniques, and to compare the mean glandular dose with standard breast imaging modalities, such as DM and DBT.
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Affiliation(s)
- S Di Maria
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066 Bobadela LRS, Portugal.
| | - S Vedantham
- Department of Medical Imaging, The University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, USA
| | - P Vaz
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Campus Tecnológico e Nuclear, Estrada Nacional 10, km 139,7, 2695-066 Bobadela LRS, Portugal
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19
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Kim SY, Cho N, Hong H, Lee Y, Yoen H, Kim YS, Park AR, Ha SM, Lee SH, Chang JM, Moon WK. Abbreviated Screening MRI for Women with a History of Breast Cancer: Comparison with Full-Protocol Breast MRI. Radiology 2022; 305:36-45. [PMID: 35699580 DOI: 10.1148/radiol.213310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Few studies have compared abbreviated breast MRI with full-protocol MRI in women with a personal history of breast cancer (PHBC), and they have not adjusted for confounding variables. Purpose To compare abbreviated breast MRI with full-protocol MRI in women with PHBC by using propensity score matching to adjust for confounding variables. Materials and Methods In this single-center retrospective study, women with PHBC who underwent full-protocol MRI (January 2008-August 2017) or abbreviated MRI (September 2017-April 2019) were identified. With use of a propensity score-matched cohort, screening performances were compared between the two MRI groups with the McNemar test or a propensity score-adjusted generalized estimating equation. The coprimary analyses were sensitivity and specificity. The secondary analyses were the cancer detection rate, interval cancer rate, positive predictive value for biopsies performed (PPV3), and Breast Imaging Reporting and Data System (BI-RADS) category 3 short-term follow-up rate. Results There were 726 women allocated to each MRI group (mean age ± SD, 50 years ± 8 for both groups). Abbreviated MRI and full-protocol MRI showed comparable sensitivity (15 of 15 cancers [100%; 95% CI: 78, 100] vs nine of 13 cancers [69%; 95% CI: 39, 91], respectively; P = .17). Abbreviated MRI showed higher specificity than full-protocol MRI (660 of 711 examinations [93%; 95% CI: 91, 95] vs 612 of 713 examinations [86%; 95% CI: 83, 88], respectively; P < .001). The cancer detection rate (21 vs 12 per 1000 examinations), interval cancer rate (0 vs five per 1000 examinations), and PPV3 (61% [14 of 23 examinations] vs 41% [nine of 22 examinations]) were comparable (all P < .05). The BI-RADS category 3 short-term follow-up rate of abbreviated MRI was less than half that of full-protocol MRI (5% [36 of 726 examinations] vs 12% [84 of 726 examinations], respectively; P < .001). Ninety-three percent (14 of 15) of cancers detected at abbreviated MRI were node-negative T1-invasive cancers (n = 6) or ductal carcinoma in situ (n = 8). Conclusion Abbreviated breast MRI showed comparable sensitivity and superior specificity to full-protocol MRI in breast cancer detection in women with a personal history of breast cancer. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Soo-Yeon Kim
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Nariya Cho
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Hyunsook Hong
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Youkyoung Lee
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Heera Yoen
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Yeon Soo Kim
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Ah Reum Park
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Min Ha
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Hyun Lee
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Jung Min Chang
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Woo Kyung Moon
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
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20
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Jing X, Wielema M, Cornelissen LJ, van Gent M, Iwema WM, Zheng S, Sijens PE, Oudkerk M, Dorrius MD, van Ooijen PMA. Using deep learning to safely exclude lesions with only ultrafast breast MRI to shorten acquisition and reading time. Eur Radiol 2022; 32:8706-8715. [PMID: 35614363 DOI: 10.1007/s00330-022-08863-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the feasibility of automatically identifying normal scans in ultrafast breast MRI with artificial intelligence (AI) to increase efficiency and reduce workload. METHODS In this retrospective analysis, 837 breast MRI examinations performed on 438 women from April 2016 to October 2019 were included. The left and right breasts in each examination were labelled normal (without suspicious lesions) or abnormal (with suspicious lesions) based on final interpretation. Maximum intensity projection (MIP) images of each breast were then used to train a deep learning model. A high sensitivity threshold was calculated based on the detection trade - off (DET) curve on the validation set. The performance of the model was evaluated by receiver operating characteristic analysis of the independent test set. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with the high sensitivity threshold were calculated. RESULTS The independent test set consisted of 178 examinations of 149 patients (mean age, 44 years ± 14 [standard deviation]). The trained model achieved an AUC of 0.81 (95% CI: 0.75-0.88) on the independent test set. Applying a threshold of 0.25 yielded a sensitivity of 98% (95% CI: 90%; 100%), an NPV of 98% (95% CI: 89%; 100%), a workload reduction of 15.7%, and a scan time reduction of 16.6%. CONCLUSION This deep learning model has a high potential to help identify normal scans in ultrafast breast MRI and thereby reduce radiologists' workload and scan time. KEY POINTS • Deep learning in TWIST may eliminate the necessity of additional sequences for identifying normal breasts during MRI screening. • Workload and scanning time reductions of 15.7% and 16.6%, respectively, could be achieved with the cost of 1 (1 of 55) false negative prediction.
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Affiliation(s)
- Xueping Jing
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Mirjam Wielema
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Ludo J Cornelissen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Margo van Gent
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Willie M Iwema
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
| | - Sunyi Zheng
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Paul E Sijens
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen and Institute of Diagnostic Accuracy, Wiersmastraat 5, 9713, GH, Groningen, The Netherlands
| | - Monique D Dorrius
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology, and Data Science Center in Health (DASH), Machine Learning Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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21
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Houser M, Barreto D, Mehta A, Brem RF. Current and Future Directions of Breast MRI. J Clin Med 2021; 10:5668. [PMID: 34884370 PMCID: PMC8658585 DOI: 10.3390/jcm10235668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI) is the most sensitive exam for detecting breast cancer. The American College of Radiology recommends women with 20% or greater lifetime risk of developing breast cancer be screened annually with MRI. However, other high-risk populations would also benefit. Hartmann et al. reported women with atypical hyperplasia have nearly a 30% incidence of breast cancer at 25-year follow-up. Women with dense breast tissue have up to a 4-fold increased risk of breast cancer when compared to average-risk women; their cancers are more likely to be mammographically occult. Because multiple cohorts of women are at high risk for developing breast cancer, there has been a movement to develop an abbreviated MRI (abMRI) protocol to expand the availability of MRI screening. Studies on abMRI effectiveness have been promising, with Weinstein et al. demonstrating a cancer detection rate of 27.4/1000 in women with dense breasts after a negative digital breast tomosynthesis. Breast MRI is also used to evaluate the extent of disease as part of preoperative assessment in women with newly diagnosed breast cancer, and to assess a patient's response to neoadjuvant chemotherapy. This paper aims to explore the current uses of MRI and propose future indications and directions.
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Affiliation(s)
- Margaret Houser
- George Washington University Hospital, Washington, DC 20037, USA;
| | - David Barreto
- George Washington University Medical Faculty Associates, Washington, DC 20037, USA; (D.B.); (A.M.)
| | - Anita Mehta
- George Washington University Medical Faculty Associates, Washington, DC 20037, USA; (D.B.); (A.M.)
| | - Rachel F. Brem
- George Washington University Medical Faculty Associates, Washington, DC 20037, USA; (D.B.); (A.M.)
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22
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Implementation of Abbreviated Breast MRI for Screening: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 218:202-212. [PMID: 34378397 DOI: 10.2214/ajr.21.26349] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abbreviated breast MRI (AB-MRI) is being rapidly adopted to harness the high sensitivity of screening MRI while addressing issues related to access, cost, and workflow. The successful implementation of an ABI-MRI program requires collaboration across administrative, operational, financial, technical, and clinical providers. Institutions must be thoughtful in defining AB-MRI patient eligibility and providing recommendations for screening intervals, as existing practices are heterogeneous. Similarly, there is no universally accepted AB-MRI protocol, though guiding principles should harmonize abbreviated and full protocols while being mindful of scan duration and table time. The interpretation of AB-MRI will be a new experience for many radiologists and may require a phased rollout as well as a careful audit of performance metrics over time to ensure benchmark metrics are achieved. AB-MRI finances, which are driven by patient self-payment, will require buy-in from hospital administration with the recognition that downstream revenues will be needed to support initial costs. Finally, successful startup of an AB-MRI program requires active engagement with the larger community of patients and referring providers. As AB-MRI becomes more widely accepted and available, best practices and community standards will continue to evolve to ensure high quality patient care.
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23
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Shi Y, Qi YF, Lan GY, Wu Q, Ma B, Zhang XY, Ji RY, Ma YJ, Hong Y. Three-dimensional MR Elastography Depicts Liver Inflammation, Fibrosis, and Portal Hypertension in Chronic Hepatitis B or C. Radiology 2021; 301:154-162. [PMID: 34374594 DOI: 10.1148/radiol.2021202804] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The value of measuring mechanical properties to categorize various pathophysiologic states of the liver is as yet undetermined in chronic hepatitis B (CHB) or C (CHC). Purpose To evaluate multiparametric three-dimensional (3D) MR elastography as a means of detecting early necroinflammation, distinguishing necroinflammation from fibrosis, and gauging the severity of portal hypertension (PH) in CHB or CHC. Materials and Methods From January 2015 to September 2019, participants with CHB or CHC were prospectively enrolled from a single institution and were divided into two groups: those with liver biopsy and no evidence of PH (group 1) and those with PH and a hepatic venous pressure gradient (HVPG) measurement (group 2). For group 3, healthy volunteers were separately recruited from a nearby community. Multiple viscoelastic parameters (shear stiffness [SS], storage modulus, loss modulus, and damping ratio [DR]) were determined at 3D MR elastography at 60 Hz, and multivariable logistic or linear regression analysis was used to assess associations of mechanical parameters with histologic scores and HVPG. Results A total of 155 participants (median age, 41 years [interquartile range, 32-48 years]; 85 women) were in group 1 (training set: n = 78, validation set: n = 77), 85 participants (median age, 57 years [interquartile range, 43-61 years]; 51 women) in group 2, and 60 healthy volunteers (median age, 49 years [interquartile range, 27-64 years]; 38 men) in group 3. The liver DR was higher in participants with necroinflammation (DR, 0.13 ± 0.03) versus those without (at liver fibrosis stage F0) (DR, 0.10 ± 0.02; P < .001). Liver DR and SS together performed well in the diagnosis of necroinflammation (area under the receiver operating characteristic curve [AUC], 0.88 [95% CI: 0.79, 0.96]) and the scoring of moderate to severe activity (AUC, 0.88 [95% CI: 0.81, 0.95]) in the validation data set. Liver DR (regression coefficient [β] = -30.3 [95% CI: -58.0, -2.5]; P = .03) and splenic SS (β = 2.3 [95% CI: 1.7, 2.9]; P < .001) were independently associated with HVPG. Conclusion Three-dimensional MR elastography may detect early necroinflammation, distinguish necroinflammation from liver fibrosis, and correlate with hepatic venous pressure gradient in chronic hepatitis B and C. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Reeder in this issue.
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Affiliation(s)
- Yu Shi
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Ya-Fei Qi
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Gong-Yu Lan
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Qijun Wu
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Bing Ma
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Xian-Yi Zhang
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Ruo-Yun Ji
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Yu-Jia Ma
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
| | - Yang Hong
- From the Departments of Radiology (Y.S., G.Y.L., X.Y.Z., R.Y.J., Y.J.M.), Pathology (Y.F.Q.), Clinical Epidemiology (Q.W.), and Neurosurgery (Y.H.), Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, People's Republic of China; and Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China (B.M.)
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Characterizing Errors in Pharmacokinetic Parameters from Analyzing Quantitative Abbreviated DCE-MRI Data in Breast Cancer. ACTA ACUST UNITED AC 2021; 7:253-267. [PMID: 34201654 PMCID: PMC8293327 DOI: 10.3390/tomography7030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
This study characterizes the error that results when performing quantitative analysis of abbreviated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data of the breast with the Standard Kety-Tofts (SKT) model and its Patlak variant. More specifically, we used simulations and patient data to determine the accuracy with which abbreviated time course data could reproduce the pharmacokinetic parameters, Ktrans (volume transfer constant) and ve (extravascular/extracellular volume fraction), when compared to the full time course data. SKT analysis of simulated abbreviated time courses (ATCs) based on the imaging parameters from two available datasets (collected with a 3T MRI scanner) at a temporal resolution of 15 s (N = 15) and 7.23 s (N = 15) found a concordance correlation coefficient (CCC) greater than 0.80 for ATCs of length 3.0 and 2.5 min, respectively, for the Ktrans parameter. Analysis of the experimental data found that at least 90% of patients met this CCC cut-off of 0.80 for the ATCs of the aforementioned lengths. Patlak analysis of experimental data found that 80% of patients from the 15 s resolution dataset and 90% of patients from the 7.27 s resolution dataset met the 0.80 CCC cut-off for ATC lengths of 1.25 and 1.09 min, respectively. This study provides evidence for both the feasibility and potential utility of performing a quantitative analysis of abbreviated breast DCE-MRI in conjunction with acquisition of current standard-of-care high resolution scans without significant loss of information in the community setting.
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25
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Kim GR, Cho N, Kim SY, Han W, Moon WK. Interval Cancers after Negative Supplemental Screening Breast MRI Results in Women with a Personal History of Breast Cancer. Radiology 2021; 300:314-323. [PMID: 34100684 DOI: 10.1148/radiol.2021203074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There are few interval cancer studies of incident screening MRI for women with a personal history of breast cancer (PHBC). Purpose To evaluate the performance measures of screening breast MRI in women with a PHBC across multiple rounds and to identify subgroups who might be more at risk for interval cancer. Materials and Methods Between January 2008 and March 2019, consecutive screening breast MRI studies for women who had undergone breast-conserving surgery because of breast cancer were retrospectively identified. Inclusion criteria were negative or benign findings at mammography with US, availability of at least 1 year of follow-up data, and examinations having been performed within 12 months after the initial cancer surgery. Performance measures were calculated for each round. Multivariable logistic regression analysis was performed to determine factors associated with the risk of interval cancer. Results Among the 6603 MRI examinations for 2809 women (median age, 47 years; interquartile range, 42-53 years), the cancer detection rate was 8.3 per 1000 screening examinations (55 of 6603 examinations) and the interval cancer rate was 1.5 per 1000 screening examinations (10 of 6603 examinations). The sensitivity and specificity were 85% (55 of 65 examinations; 95% CI: 76, 93) and 88.3% (5775 of 6538 examinations; 95% CI: 87.6, 89.1), respectively. At multivariable analysis, interval cancers were associated with a first-degree family history of breast cancer (odds ratio [OR], 5.4; 95% CI: 1.3, 22.5; P = .02), estrogen receptor- and progesterone receptor-negative primary cancers (OR, 3.6; 95% CI: 1.1, 12.2; P = .04), and moderate or marked background parenchymal enhancement (OR, 10.8; 95% CI: 3.3, 35.7; P < .001). Conclusion Performance of screening breast MRI in women with a personal history of breast cancer was sustained across multiple rounds, and a first-degree family history of breast cancer, estrogen receptor- and progesterone receptor-negative primary cancers, and moderate or marked background parenchymal enhancement at MRI were independently associated with the risk of developing interval cancers. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Slanetz in this issue.
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Affiliation(s)
- Ga Ram Kim
- From the Departments of Radiology (G.R.K., N.C., S.Y.K., W.K.M.) and Surgery (W.H.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.)
| | - Nariya Cho
- From the Departments of Radiology (G.R.K., N.C., S.Y.K., W.K.M.) and Surgery (W.H.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.)
| | - Soo-Yeon Kim
- From the Departments of Radiology (G.R.K., N.C., S.Y.K., W.K.M.) and Surgery (W.H.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.)
| | - Wonshik Han
- From the Departments of Radiology (G.R.K., N.C., S.Y.K., W.K.M.) and Surgery (W.H.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.)
| | - Woo Kyung Moon
- From the Departments of Radiology (G.R.K., N.C., S.Y.K., W.K.M.) and Surgery (W.H.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea (G.R.K.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (N.C., S.Y.K., W.K.M.)
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26
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Samreen N, Mercado C, Heacock L, Chacko C, Partridge SC, Chhor C. Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques. JOURNAL OF BREAST IMAGING 2021; 3:387-398. [PMID: 38424773 DOI: 10.1093/jbi/wbaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 03/02/2024]
Abstract
Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.
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Affiliation(s)
- Naziya Samreen
- New York University, Department of Radiology, Garden City, NY, USA
| | - Cecilia Mercado
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Laura Heacock
- NYU School of Medicine, Department of Radiology, New York, NY, USA
| | - Celin Chacko
- New York University, Department of Radiology, Garden City, NY, USA
| | | | - Chloe Chhor
- NYU School of Medicine, Department of Radiology, New York, NY, USA
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27
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Osei KV, Mehta AK, Thigpen DM, Rapelyea J, Friedman S, Brem RF. Abbreviated Breast MRI for Screening High-risk Women: Comparison with the Full Clinical Protocol. JOURNAL OF BREAST IMAGING 2021; 3:196-200. [PMID: 38424819 DOI: 10.1093/jbi/wbaa101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare cancer detection rate (CDR), patient recall, and interpretation time of a full protocol MRI (fpMRI) to an abbreviated MRI protocol (abMRI) in high-risk women. METHODS This retrospective study was approved by the IRB. All sequential high-risk screening MRI examinations performed between January 1, 2013, and December 31, 2016, were included. Breast radiologists reviewed patient history, prior images, and abMRI images and recorded their interpretation. Time for interpretation reflected review of the MRI study but not dictation or report generation. Following a minimum 30-day washout period, radiologists interpreted the fpMRI, with interpretation and timing recorded. Data collected included CDR, interpretation time, and patient recall rate. Statistical analyses utilized were Cohen's kappa coefficient, Student's t-test, and McNemar's test. RESULTS Included were 334 MRI examinations of 286 women. Interpretation time was 60.7 seconds for the abMRI compared to 99.4 seconds for the fpMRI, with an average difference of 38.7 ± 5.4 seconds per patient (P < 0.0001). Recall rates were comparable: the abMRI recall rate was 82/334 (24.6%) and the fpMRI 81/334 (24.3%). All five cancers included were detected by both protocols with equal recall rate. However, there were more recommendations for biopsy with the fpMRI, although this difference was not statistically significant. CONCLUSION The abMRI demonstrated comparable CDR to fpMRI, with shortened interpretation time and similar recall rates. Implementing an abMRI to screen high-risk women reduces imaging and interpretation time, thereby improving cost-effectiveness and the patient experience without reduction in cancer detection.
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Affiliation(s)
- Kendrah V Osei
- The George Washington University, School of Medicine & Health Sciences, Washington, DC
| | - Anita K Mehta
- The George Washington University, Department of Radiology, Washington, DC
| | - Denise M Thigpen
- The George Washington University, Department of Radiology, Washington, DC
| | - Jocelyn Rapelyea
- The George Washington University, Department of Radiology, Washington, DC
| | - Steven Friedman
- The George Washington University, Department of Statistics, Washington, DC
- New York University School of Medicine, Department of Population Health, New York, NY
| | - Rachel F Brem
- The George Washington University, Department of Radiology, Washington, DC
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28
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Fujioka T, Mori M, Oyama J, Kubota K, Yamaga E, Yashima Y, Katsuta L, Nomura K, Nara M, Oda G, Nakagawa T, Tateishi U. Investigating the Image Quality and Utility of Synthetic MRI in the Breast. Magn Reson Med Sci 2021; 20:431-438. [PMID: 33536401 PMCID: PMC8922358 DOI: 10.2463/mrms.mp.2020-0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose Synthetic MRI reconstructs multiple sequences in a single acquisition. In the
present study, we aimed to compare the image quality and utility of
synthetic MRI with that of conventional MRI in the breast. Methods We retrospectively collected the imaging data of 37 women (mean age: 55.1
years; range: 20–78 years) who had undergone both synthetic and
conventional MRI of T2-weighted, T1-weighted, and fat-suppressed
(FS)-T2-weighted images. Two independent breast radiologists evaluated the
overall image quality, anatomical sharpness, contrast between tissues, image
homogeneity, and presence of artifacts of synthetic and conventional MRI on
a 5-point scale (5 = very good to 1 =
very poor). The interobserver agreement between the
radiologists was evaluated using weighted kappa. Results For synthetic MRI, the acquisition time was 3 min 28 s. On the 5-point scale
evaluation of overall image quality, although the scores of synthetic
FS-T2-weighted images (4.01 ± 0.56) were lower than that of
conventional images (4.95 ± 0.23; P < 0.001),
the scores of synthetic T1- and T2-weighted images (4.95 ± 0.23 and
4.97 ± 0.16) were comparable with those of conventional images (4.92
± 0.27 and 4.97 ± 0.16; P = 0.484 and
1.000, respectively). The kappa coefficient of conventional MRI was fair
(0.53; P < 0.001), and that of conventional MRI was
fair (0.46; P < 0.001). Conclusion The image quality of synthetic T1- and T2-weighted images was similar to that
of conventional images and diagnostically acceptable, whereas the quality of
synthetic T2-weighted FS images was inferior to conventional images.
Although synthetic MRI images of the breast have the potential to provide
efficient image diagnosis, further validation and improvement are required
for clinical application.
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Affiliation(s)
- Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Kazunori Kubota
- Department of Diagnostic Radiology, Tokyo Medical and Dental University.,Department of Radiology, Dokkyo Medical University
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Yuka Yashima
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Leona Katsuta
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Kyoko Nomura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
| | - Miyako Nara
- Department of Diagnostic Radiology, Tokyo Medical and Dental University.,Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University
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29
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[Diagnosis of breast diseases in a certified breast center]. Radiologe 2021; 61:137-149. [PMID: 33404685 DOI: 10.1007/s00117-020-00791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
The beginning of the 21st century has seen immense improvements in the quality of diagnosis and treatment of breast cancer due to several, simultaneous developments. In particular, the introduction of a certification program from the German Cancer Society based on level III guidelines has enhanced the transparency and quality of treatment of breast diseases for all actors. As a result, patients have benefited from intensified cooperation especially between core disciplines in breast disease, gynecology, pathology, and radiology. The standardized and synoptic reading of multiple diagnostic modalities has enabled precise sampling of histologic specimen, which has improved prognosis and the successful individualization of therapy. In this article the benefits of breast cancer diagnosis and therapy in a certified breast center are illustrated using four case examples.
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30
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Bahl M, Mercaldo S, McCarthy AM, Lehman CD. Imaging Surveillance of Breast Cancer Survivors with Digital Mammography versus Digital Breast Tomosynthesis. Radiology 2020; 298:308-316. [PMID: 33350890 DOI: 10.1148/radiol.2020201854] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Among breast cancer survivors, detecting a breast cancer when it is asymptomatic (rather than symptomatic) improves survival; thus, imaging surveillance in these patients is warranted. Digital breast tomosynthesis (DBT) is used for screening, but data on DBT for surveillance in this high-risk population are limited. Purpose To determine whether DBT leads to improved screening performance metrics when compared with two-dimensional digital mammography among breast cancer survivors. Materials and Methods In this study, screening mammograms obtained in breast cancer survivors before and after DBT implementation were retrospectively reviewed (March 2008-February 2011 for the digital mammography group; January 2013-December 2017 for the DBT group). Mammograms were interpreted by breast imaging radiologists with the assistance of computer-aided detection. Performance metrics and tumor characteristics between the groups were compared using multivariable logistic regression models. Results The digital mammography and DBT groups were composed of 9019 and 22 887 mammographic examinations, respectively, in 8170 women (mean age, 62 years ± 12 [standard deviation]). In the DBT group, the abnormal interpretation rate was lower (5.8% [1331 of 22 887 examinations] vs 6.2% [563 of 9019 examinations]; odds ratio [OR], 0.80; 95% CI: 0.71, 0.91; P = .001) and specificity was higher (95.0% [21 502 of 22 644 examinations] vs 94.7% [8424 of 8891 examinations]; OR, 1.23; 95% CI: 1.07, 1.41; P = .003) than in the digital mammography group. The cancer detection rates did not differ (8.3 per 1000 examinations with DBT vs 10.6 with digital mammography; OR, 0.76; 95% CI: 0.57, 1.02; P = .07). The proportions of screening-detected invasive cancers, versus in situ cancers, were similar (74% [140 of 189 cancers] in the DBT group vs 72% [69 of 96 cancers] in the digital mammography group; P = .69). Of 86 interval cancers, 58% (50 of 86 cancers) manifested with symptoms, and 33% (28 of 86 cancers) were detected at screening MRI. Conclusion Among breast cancer survivors, screening with digital breast tomosynthesis led to fewer false-positive results and higher specificity but did not affect cancer detection. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Hooley and Butler in this issue.
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Affiliation(s)
- Manisha Bahl
- From the Departments of Radiology (M.B., S.M., C.D.L.) and Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240; Boston, MA 02114
| | - Sarah Mercaldo
- From the Departments of Radiology (M.B., S.M., C.D.L.) and Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240; Boston, MA 02114
| | - Anne Marie McCarthy
- From the Departments of Radiology (M.B., S.M., C.D.L.) and Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240; Boston, MA 02114
| | - Constance D Lehman
- From the Departments of Radiology (M.B., S.M., C.D.L.) and Medicine (A.M.M.), Massachusetts General Hospital, 55 Fruit St, WAC 240; Boston, MA 02114
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31
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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: 0.5] [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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32
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Cozzi A, Schiaffino S, Giorgi Rossi P, Sardanelli F. Breast cancer screening: in the era of personalized medicine, age is just a number. Quant Imaging Med Surg 2020; 10:2401-2407. [PMID: 33269240 DOI: 10.21037/qims-2020-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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33
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Gluskin J, Rossi Saccarelli C, Avendano D, Marino MA, Bitencourt AGV, Pilewskie M, Sevilimedu V, Sung JS, Pinker K, Jochelson MS. Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery. Cancers (Basel) 2020; 12:cancers12123495. [PMID: 33255412 PMCID: PMC7760311 DOI: 10.3390/cancers12123495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer survivors are at risk for recurrence, and the early detection of recurrence improves survival. Therefore, imaging surveillance is performed for women who have breast-conserving surgery. The aim of our retrospective study was to compare routine mammography with contrast-enhanced mammography in the screening (asymptomatic) post-treatment setting. We confirmed that when screening women with breast conservation surgery, contrast-enhanced mammography had a higher cancer detection rate (15.4/1000) and positive predictive value of biopsies (42.9%) than full-field digital mammography (6.2/1000 and 37.5%, respectively). Abstract To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.
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Affiliation(s)
- Jill Gluskin
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP 01308-050, Brazil
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, 64718 Nuevo Leon, Mexico
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, 64718 Messina, Italy
| | - Almir G. V. Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP 01509-010, Brazil
| | - Melissa Pilewskie
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Janice S. Sung
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
| | - Maxine S. Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.G.); (C.R.S.); (D.A.); (M.A.M.); (A.G.V.B.); (J.S.S.); (K.P.)
- Correspondence: ; Tel.: +1-646-888-4507
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Polat DS, Schopp JG, Arjmandi F, Porembka J, Sarode V, Farr D, Xi Y, Dogan BE. Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions. Breast Cancer Res Treat 2020; 185:479-494. [PMID: 33010022 DOI: 10.1007/s10549-020-05947-1] [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: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. METHODS In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. RESULTS Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic) CONCLUSION: Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.
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Affiliation(s)
- Dogan S Polat
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jennifer G Schopp
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Firouzeh Arjmandi
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Porembka
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Venetia Sarode
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deborah Farr
- Department of Surgery, Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Basak E Dogan
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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35
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Cyr AE, Sharma R. Forewarned Is Forearmed: Can Better Patient Counseling Increase MRI Utilization in High-Risk Women? Ann Surg Oncol 2020; 27:3567-3569. [DOI: 10.1245/s10434-020-08910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022]
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36
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Wernli KJ, Callaway KA, Henderson LM, Kerlikowske K, Lee JM, Ross‐Degnan D, Wallace JK, Wharam JF, Zhang F, Stout NK. Trends in screening breast magnetic resonance imaging use among US women, 2006 to 2016. Cancer 2020; 126:5293-5302. [DOI: 10.1002/cncr.33140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/05/2020] [Accepted: 06/27/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute Seattle Washington
| | - Katherine A. Callaway
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Louise M. Henderson
- Department of Radiology University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Karla Kerlikowske
- Department of Medicine University of California at San Francisco San Francisco California
- Department of Epidemiology and Biostatistics University of California at San Francisco San Francisco California
- General Internal Medicine Section Department of Veterans Affairs University of California at San Francisco San Francisco California
| | - Janie M. Lee
- Department of Radiology University of Washington Seattle Washington
| | - Dennis Ross‐Degnan
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Jamie K. Wallace
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - J. Frank Wharam
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Fang Zhang
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Natasha K. Stout
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
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37
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Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer 2020; 28:1195-1211. [PMID: 32959120 DOI: 10.1007/s12282-020-01157-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this article is to overview the existing breast cancer screening guidelines for women at high risk from world-leading specialty societies. Accumulation of evidence and development of accessible genetic testing strategies have changed the idea of breast cancer screening for high-risk women. Personalized tailor-made screening adjusted for risk factors has been conducted in accordance with guidelines. The use of imaging modalities other than mammography including contrast-enhanced MRI and other various strategies for improving screening are discussed. The present review also mentions the existing challenges in high-risk screening and the latest information based on two large-scale studies.
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Cen C, Chun J, Schnabel F. Management of women at increased risk for breast cancer secondary to high-risk proliferative lesions and family history of the disease. Breast J 2020; 26:1543-1548. [PMID: 32741042 DOI: 10.1111/tbj.13964] [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: 12/31/2019] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
Women with breast biopsies showing high-risk proliferative lesions such as atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) have an increased risk of developing breast cancer. Other factors including age, family history of breast cancer, and extent of AH may play a role in increasing breast cancer risk. In addition to women with AH, there is a subset of women with a positive family history of breast cancer, without a known germline mutation, which places them also at an increased risk for breast cancer. Clinical management, screening, chemoprevention, and surgical risk-reduction are discussed in this review to inform the management of these high-risk women. Advanced imaging technology, pharmacologic research into different targets, and innovations in breast reconstruction are changing the way in which patients are counseled of their individual risk.
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Affiliation(s)
- Cindy Cen
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Jennifer Chun
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Freya Schnabel
- Department of Surgery, New York University Langone Health, New York, NY, USA
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Laws A, Mulvey TM, Jalbert N, Dalton S, Kantor O, Harris KA, Krag KJ, Walsh EP, Coopey SB. Baseline Screening MRI Uptake and Findings in Women with ≥ 20% Lifetime Risk of Breast Cancer. Ann Surg Oncol 2020; 27:3595-3602. [PMID: 32683633 DOI: 10.1245/s10434-020-08853-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/18/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The American Cancer Society recommends screening magnetic resonance imaging (MRI) for patients with a ≥ 20% lifetime breast cancer risk. This study assesses the outcomes of baseline MRI screens in women from a high-risk breast clinic (HRBC). METHODS We retrospectively reviewed patients from our institution's HRBC, excluding those with prior breast cancer and predisposing genetic mutations. Screening MRI was recommended for a lifetime risk of ≥ 20% using the Tyrer-Cuzick model. We determined baseline MRI results, biopsy rates, and frequency of MRI-detected high-risk lesions (HRLs) and breast cancers. RESULTS Overall, 319 women attended our HRBC; median age was 48 years and 4.7% had prior atypia/lobular carcinoma in situ. Screening MRI was recommended for 282 patients, of whom 196 (69.5%) completed a baseline screen. A Breast Imaging-Reporting and Data System (BIRADS) 3 or 4 finding occurred in 19.6% of patients; 23 (12.3%) required 6-month follow-up MRI, 16 (8.6%) underwent core biopsy, and 4 (2.1%) underwent excisional biopsy after initial core. An additional 7 (3.7%) patients had a non-breast incidental finding. An HRL was identified in 2 (1.1%) patients (atypical ductal and lobular hyperplasia, respectively), and 2 (1.1%) were diagnosed with T1N0 breast cancers. CONCLUSIONS In the setting of an HRBC, 70% of women with a ≥ 20% lifetime risk of breast cancer pursued screening MRI when recommended. On baseline screen, the rate of MRI-detected breast cancer was low (1%); however, malignancies were mammographically occult and identified at an early stage. Despite a low cancer rate, nearly one in four women required additional diagnostic investigation. Prescreening counselling should include a discussion of this possibility, and longer-term follow-up of screening MRI is needed in this high-risk population.
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Affiliation(s)
- Alison Laws
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Therese M Mulvey
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nicole Jalbert
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Dalton
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Interventional Radiology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Olga Kantor
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine A Harris
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Karen J Krag
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth P Walsh
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Surveillance for second breast cancer events in women with a personal history of breast cancer using breast MRI: a systematic review and meta-analysis. Breast Cancer Res Treat 2020; 181:255-268. [PMID: 32303988 DOI: 10.1007/s10549-020-05637-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Women with personal history of breast cancer (PHBC) are currently recommended to receive annual mammography for surveillance of breast cancer recurrence or new primary. However, given issues in accuracy with mammography, there is a need for evolving evidence-based surveillance recommendations with supplemental imaging. In this systematic review, we compiled and compared existing studies that describe the test performance of surveillance breast MRI among women with PHBC. METHODS We searched PubMed and EMBASE using MeSH terms for studies (2000-2019) that described the diagnostic characteristics of breast MRI in women with PHBC. Search results were reviewed and included based on PICOTS criteria; quality of included articles was assessed using QUADAS-2. Meta-analysis of single proportions was conducted for diagnostic characteristics of breast MRI, including tests of heterogeneity. RESULTS Our review included 11 articles in which unique cohorts were studied, comprised of a total of 8338 women with PHBC and 12,335 breast MRI done for the purpose of surveillance. We predict intervals (PI) for cancer detection rate per 1000 examinations (PI 9-15; I2 = 10%), recall rate (PI 5-31%; I2 = 97%), sensitivity (PI 58-95%; I2 = 47%), specificity (PI 76-97%; I2 = 97%), and PPV3 (PI 16-40%; I2 = 44%). CONCLUSIONS Studies addressing performance of breast MRI are variable and limited in population-based studies. The summary of evidence to date is insufficient to recommend for or against use of breast MRI for surveillance among women with PHBC.
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Woods RW, Salkowski LR, Elezaby M, Burnside ES, Strigel RM, Fowler AM. Image-based screening for men at high risk for breast cancer: Benefits and drawbacks. Clin Imaging 2020; 60:84-89. [PMID: 31864206 PMCID: PMC7242122 DOI: 10.1016/j.clinimag.2019.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
Male breast cancer is a rare malignancy. Due to low prevalence and limited data to support male breast cancer screening, there are currently no recommendations for image-based screening in asymptomatic men and few recommendations for men at high risk for breast cancer. However, symptomatically diagnosed cancers in men are typically advanced, suggesting that earlier detection may improve outcomes. In this article we briefly review the risk factors for male breast cancer, and discuss the potential benefits and possible drawbacks of routine image-based screening for men at high risk for breast cancer.
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Affiliation(s)
- Ryan W Woods
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Lonie R Salkowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Mai Elezaby
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
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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: 0.8] [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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