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Giannotti E, Van Nijnatten TJA, Chen Y, Bicchierai G, Nori J, De Benedetto D, Lalji U, Lee AHS, James J. The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast. Clin Radiol 2024; 79:e799-e806. [PMID: 38383254 DOI: 10.1016/j.crad.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05. RESULTS One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI. CONCLUSION CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.
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Affiliation(s)
- E Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK; Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK.
| | - T J A Van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Y Chen
- University of Nottingham, School of Medicine, Division of Cancer and Stem Cells, City Hospital Campus, Nottingham, UK
| | - G Bicchierai
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - J Nori
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - D De Benedetto
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - U Lalji
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A H S Lee
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - J James
- Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK
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Helal M, Khaled R, Alfarghaly O, Mokhtar O, Elkorany A, Fahmy A, El Kassas H. Validation of artificial intelligence contrast mammography in diagnosis of breast cancer: Relationship to histopathological results. Eur J Radiol 2024; 173:111392. [PMID: 38428255 DOI: 10.1016/j.ejrad.2024.111392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/12/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Contrast-enhanced mammography (CEM) is used for characterization of breast lesions with increased diagnostic accuracy compared to digital mammography (DM). Artificial intelligence (AI) approaches are emerging with accuracies equal to an average radiologist. However, most studies trained deep learning (DL) models on DM images and there is a paucity in literature for discovering the application of AI using CEM. OBJECTIVES To develop and test a DL model that classifies CEM images and produces corresponding highlights of lesions detected. METHODS Fully annotated 2006 images of 326 females available from the previously published Categorized Digital Database for Contrast Enhanced Mammography images (CDD-CESM) were used for training. We developed a DL multiview contrast mammography model (MVCM) for classification of CEM low energy and recombined images. An external test set of 288 images of 37 females not included in the training was used for validation. Correlation with histopathological results and follow-up was considered the standard reference. The study protocol was approved by the Institutional Review Board and patient informed consent was obtained. RESULTS Assessment was done on an external test set of 37 females (mean age, 51.31 years ± 11.07 [SD]) with AUC-ROC for AI performance 0.936; (95 % CI: 0.898, 0.973; p < 0.001) and the best cut off value for prediction of malignancy using AI score = 0.28. Findings were then correlated with histopathological results and follow up which revealed a sensitivity of 75 %, specificity 96.3 %, total accuracy of 90.1 %, positive predictive value (PPV) 87.1 %, and negative predictive value (NPV) 92 %, p-value (<0.001). Diagnostic indices of radiologists were sensitivity 88.9 %, specificity 92.6 %, total accuracy 91.7 %, PPV 80 %, and NPV 96.2 %, p-value (<0.001). CONCLUSION A deep learning multiview CEM model was developed and evaluated in a cohort of female participants and showed promising results in detecting breast cancer. This warrants further studies, external training, and validation.
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Affiliation(s)
- Maha Helal
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Rana Khaled
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Omar Alfarghaly
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Omnia Mokhtar
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
| | - Abeer Elkorany
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Aly Fahmy
- Computer Science Department, Computers and Artificial Intelligence, Cairo University, Cairo 12613, Egypt.
| | - Hebatalla El Kassas
- Radiology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt.
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Lin S, Li H, Li Y, Chen Q, Ye J, Lin S, Cai S, Sun J. Diagnostic performance of contrast-enhanced mammography for suspicious findings in dense breasts: A systematic review and meta-analysis. Cancer Med 2024; 13:e7128. [PMID: 38659408 PMCID: PMC11043676 DOI: 10.1002/cam4.7128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Contrast-enhanced spectral imaging (CEM) is a new mammography technique, but its diagnostic value in dense breasts is still inconclusive. We did a systematic review and meta-analysis of studies evaluating the diagnostic performance of CEM for suspicious findings in dense breasts. MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were searched systematically until August 6, 2023. Prospective and retrospective studies were included to evaluate the diagnostic performance of CEM for suspicious findings in dense breasts. The QUADAS-2 tool was used to evaluate the quality and risk of bias of the included studies. STATA V.16.0 and Review Manager V.5.3 were used to meta-analyze the included studies. RESULTS A total of 10 studies (827 patients, 958 lesions) were included. These 10 studies reported the diagnostic performance of CEM for the workup of suspicious lesions in patients with dense breasts. The summary sensitivity and summary specificity were 0.95 (95% CI, 0.92-0.97) and 0.81 (95% CI, 0.70-0.89), respectively. Enhanced lesions, circumscribed margins, and malignancy were statistically correlated. The relative malignancy OR value of the enhanced lesions was 28.11 (95% CI, 6.84-115.48). The relative malignancy OR value of circumscribed margins was 0.17 (95% CI, 0.07-0.45). CONCLUSION CEM has high diagnostic performance in the workup of suspicious findings in dense breasts, and when lesions are enhanced and have irregular margins, they are often malignant.
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Affiliation(s)
- Shu‐ting Lin
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Hong‐jiang Li
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Yi‐zhong Li
- Department of BoneThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Qian‐qian Chen
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jia‐yi Ye
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Shu Lin
- Center of Neurological and Metabolic ResearchThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
- Department of Neuroendocrinology, Group of NeuroendocrinologyGarvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Si‐qing Cai
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jian‐guo Sun
- Department of Urinary SurgeryThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
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Coffey K, Berg WA, Dodelzon K, Jochelson MS, Mullen LA, Parikh JR, Hutcheson L, Grimm LJ. Breast Radiologists' Perceptions on the Detection and Management of Invasive Lobular Carcinoma: Most Agree Imaging Beyond Mammography Is Warranted. J Breast Imaging 2024; 6:157-165. [PMID: 38340343 PMCID: PMC10983784 DOI: 10.1093/jbi/wbad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To determine breast radiologists' confidence in detecting invasive lobular carcinoma (ILC) on mammography and the perceived need for additional imaging in screening and preoperative settings. METHODS A 16-item anonymized survey was developed, and IRB exemption obtained, by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and the Lobular Breast Cancer Alliance. The survey was emailed to 2946 radiologist SBI members on February 15, 2023. The survey recorded demographics, perceived modality-specific sensitivity for ILC to the nearest decile, and opinions on diagnosing ILC in screening and staging imaging. Five-point Likert scales were used (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). RESULTS Response rate was 12.4% (366/2946). Perceived median (interquartile range) modality-specific sensitivities for ILC were MRI 90% (80-90), contrast-enhanced mammography 80% (70-90), molecular breast imaging 80% (60-90), digital breast tomosynthesis 70% (60-80), US 60% (50-80), and 2D mammography 50% (30-60). Only 25% (85/340) respondents were confident in detecting ILC on screening mammography in dense breasts, while 67% (229/343) were confident if breasts were nondense. Most agreed that supplemental screening is needed to detect ILC in women with dense breasts (272/344, 79%) or a personal history of ILC (248/341, 73%), with 34% (118/334) indicating that supplemental screening would also benefit women with nondense breasts. Most agreed that additional imaging is needed to evaluate extent of disease in women with newly diagnosed ILC, regardless of breast density (dense 320/329, 97%; nondense 263/329, 80%). CONCLUSION Most breast radiologists felt that additional imaging beyond mammography is needed to more confidently screen for and stage ILC.
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Affiliation(s)
- Kristen Coffey
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jay R Parikh
- Division of Diagnostic Imaging, Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
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Ancona A, Telegrafo M, Fella RR, Iamele D, Cantore S, Moschetta M. CEM immediately after contrast-enhanced CT: a one-step staging of breast cancer. Eur Radiol Exp 2024; 8:32. [PMID: 38556593 PMCID: PMC10982147 DOI: 10.1186/s41747-024-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is a promising technique. We evaluated the diagnostic potential of CEM performed immediately after contrast-enhanced computed tomography (CE-CT). METHODS Fifty patients with breast cancer underwent first CE-CT and then CEM without additional contrast material injection. Two independent radiologists evaluated CEM images. The sensitivity of CEM for detecting index and additional malignant lesions was compared with that of mammography/ultrasonography by the McNemar test, using histopathology as a reference standard. Interobserver agreement for detection of malignant lesions, for classifying index tumors, and for evaluating index tumor size and extent was assessed using Cohen κ. Pearson correlation was used for correlating index tumor size/extent at CEM or mammography/ultrasonography with histopathology. RESULTS Of the 50 patients, 30 (60%) had unifocal disease while 20 (40%) had multicentric or multifocal disease; 5 of 20 patients with multicentric disease (25%) had bilateral involvement, for a total of 78 malignant lesions, including 72 (92%) invasive ductal and 6 (8%) invasive lobular carcinomas. Sensitivity was 63/78 (81%, 95% confidence interval 70.27-88.82) for unenhanced breast imaging and 78/78 (100%, 95.38-100) for CEM (p < 0.001). The interobserver agreement for overall detection of malignant lesions, for classifying index tumor, and for evaluating index tumor size/extent were 0.94, 0.95, and 0.86 κ, respectively. For index tumor size/extent, correlation coefficients as compared with histological specimens were 0.50 for mammography/ultrasonography and 0.75 for CEM (p ≤ 0.010). CONCLUSIONS CEM acquired immediately after CE-CT without injection of additional contrast material showed a good performance for local staging of breast cancer. RELEVANCE STATEMENT When the CEM suite is near to the CE-CT acquisition room, CEM acquired immediately after, without injection of additional contrast material, could represent a way for local staging of breast cancer to be explored in larger prospective studies. KEY POINTS • CEM represents a new accurate tool in the field of breast imaging. • An intravenous injection of iodine-based contrast material is required for breast gland evaluation. • CEM after CE-CT could provide a one-stop tool for breast cancer staging.
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Affiliation(s)
- Antonietta Ancona
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Michele Telegrafo
- Breast Care Unit, University Hospital Consortium Policlinico of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Rita Roberta Fella
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Donato Iamele
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Sebastiano Cantore
- Section of Breast Imaging, Breast Care Unit, Santa Maria Hospital GVM-BA, Via Antonio De Ferrariis 22, Bari, 70124, Italy
| | - Marco Moschetta
- DIM, Interdisciplinary Department of Medicine, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, 70124, Italy.
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Nguyen DL, Greenwood HI, Rahbar H, Grimm LJ. Evolving Treatment Paradigms for Low-Risk Ductal Carcinoma In Situ: Imaging Needs. AJR Am J Roentgenol 2024; 222:e2330503. [PMID: 38090808 DOI: 10.2214/ajr.23.30503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
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Affiliation(s)
- Derek L Nguyen
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
| | - Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Lars J Grimm
- Department of Diagnostic Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27710
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Piccolo CL, Celli I, Bandini C, Tommasiello M, Sammarra M, Faggioni L, Cioni D, Beomonte Zobel B, Neri E. The Correlation between Morpho-Dynamic Contrast-Enhanced Mammography (CEM) Features and Prognostic Factors in Breast Cancer: A Single-Center Retrospective Analysis. Cancers (Basel) 2024; 16:870. [PMID: 38473232 DOI: 10.3390/cancers16050870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Breast cancer, a major contributor to female mortality globally, presents challenges in detection, prompting exploration beyond digital mammography. Contrast-Enhanced Mammography (CEM), integrating morphological and functional information, emerges as a promising alternative, offering advantages in cost-effectiveness and reduced anxiety compared to MRI. This study investigates CEM's correlation with breast cancer prognostic factors, encompassing histology, grade, and molecular markers. In a retrospective analysis involving 114 women, CEM revealed diverse lesion characteristics. Statistical analyses identified correlations between specific CEM features, such as spiculated margins and irregular shape, and prognostic factors like tumor grade and molecular markers. Notably, spiculated margins predicted lower grade and HER2 status, while irregular shape correlated with PgR and Ki-67 status. The study emphasizes CEM's potential in predicting breast cancer prognosis, shedding light on tumor behavior. Despite the limitations, including sample size and single-observer analysis, the findings advocate for CEM's role in stratifying breast cancers based on biological characteristics. CEM features, particularly spiculated margins, irregular shape, and enhancement dynamics, may serve as valuable indicators for personalized treatment decisions. Further research is crucial to validate these correlations and enhance CEM's clinical utility in breast cancer assessment.
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Affiliation(s)
- Claudia Lucia Piccolo
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Ilenia Celli
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Claudio Bandini
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Manuela Tommasiello
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Matteo Sammarra
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Dania Cioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Bruno Beomonte Zobel
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Operative Research Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
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Nicosia L, Battaglia O, Venturini M, Fontana F, Minenna M, Pesenti A, Budascu D, Pesapane F, Bozzini AC, Pizzamiglio M, Meneghetti L, Latronico A, Signorelli G, Mariano L, Cassano E. Contrast-enhanced mammography BI-RADS: a case-based approach to radiology reporting. Insights Imaging 2024; 15:37. [PMID: 38332410 PMCID: PMC10853105 DOI: 10.1186/s13244-024-01612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is a relatively recent diagnostic technique increasingly being utilized in clinical practice. Until recently, there was a lack of standardized reporting for CEM findings. However, this has changed with the publication of a supplement in the Breast Imaging Reporting and Data System (BI-RADS). A comprehensive understanding of CEM is essential for further enhancing its role in both screening and managing patients with breast malignancies. CEM can also be beneficial for problem-solving, improving the management of uncertain breast findings. Practitioners in this field should become more cognizant of how and when to employ this technique and interpret the various CEM findings. This paper aims to outline the key findings in the updated version of the BI-RADS specifically dedicated to CEM. Additionally, it will present some clinical cases commonly encountered in clinical practice.Critical relevance statement Standardized reporting and a thorough understanding of CEM findings are pivotal for advancing the role of CEM in screening and managing breast cancer patients. This standardization contributes significantly to integrating CEM as an essential component of daily clinical practice.Key points • A complete knowledge and understanding of the findings outlined in the new BI-RADS CEM are necessary for accurate reporting.• BI-RADS CEM supplement is intuitive and practical to use.• Standardization of the CEM findings enables more accurate patient management.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100, Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100, Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Manuela Minenna
- School of Medicine and Surgery, Insubria University, 21100, Varese, Italy
| | - Aurora Pesenti
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Diana Budascu
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Luciano Mariano
- Radiology Department, Università degli Studi di Torino, 10129, Turin, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
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10
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Zhang T, Mann RM. Contrast-enhanced mammography: better with AI? Eur Radiol 2024; 34:914-916. [PMID: 37667143 DOI: 10.1007/s00330-023-10190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Tianyu Zhang
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands.
- GROW School for Oncology and Development Biology, Maastricht University, Maastricht, The Netherlands.
| | - Ritse M Mann
- Department of Diagnostic Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands.
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Schiaffino S, Cozzi A, Clauser P, Giannotti E, Marino MA, van Nijnatten TJA, Baltzer PAT, Lobbes MBI, Mann RM, Pinker K, Fuchsjäger MH, Pijnappel RM. Current use and future perspectives of contrast-enhanced mammography (CEM): a survey by the European Society of Breast Imaging (EUSOBI). Eur Radiol 2024:10.1007/s00330-023-10574-7. [PMID: 38227202 DOI: 10.1007/s00330-023-10574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES To perform a survey among members of the European Society of Breast Imaging (EUSOBI) regarding the use of contrast-enhanced mammography (CEM). METHODS A panel of nine board-certified radiologists developed a 29-item online questionnaire, distributed to all EUSOBI members (inside and outside Europe) from January 25 to March 10, 2023. CEM implementation, examination protocols, reporting strategies, and current and future CEM indications were investigated. Replies were exploratively analyzed with descriptive and non-parametric statistics. RESULTS Among 434 respondents (74.9% from Europe), 50% (217/434) declared to use CEM, 155/217 (71.4%) seeing less than 200 CEMs per year. CEM use was associated with academic settings and high breast imaging workload (p < 0.001). The lack of CEM adoption was most commonly due to the perceived absence of a clinical need (65.0%) and the lack of resources to acquire CEM-capable systems (37.3%). CEM protocols varied widely, but most respondents (61.3%) had already adopted the 2022 ACR CEM BI-RADS® lexicon. CEM use in patients with contraindications to MRI was the most common current indication (80.6%), followed by preoperative staging (68.7%). Patients with MRI contraindications also represented the most commonly foreseen CEM indication (88.0%), followed by the work-up of inconclusive findings at non-contrast examinations (61.5%) and supplemental imaging in dense breasts (53.0%). Respondents declaring CEM use and higher CEM experience gave significantly more current (p = 0.004) and future indications (p < 0.001). CONCLUSIONS Despite a trend towards academic high-workload settings and its prevalent use in patients with MRI contraindications, CEM use and progressive experience were associated with increased confidence in the technique. CLINICAL RELEVANCE STATEMENT In this first survey on contrast-enhanced mammography (CEM) use and perspectives among the European Society of Breast Imaging (EUSOBI) members, the perceived absence of a clinical need chiefly drove the 50% CEM adoption rate. CEM adoption and progressive experience were associated with more extended current and future indications. KEY POINTS • Among the 434 members of the European Society of Breast Imaging who completed this survey, 50% declared to use contrast-enhanced mammography in clinical practice. • Due to the perceived absence of a clinical need, contrast-enhanced mammography (CEM) is still prevalently used as a replacement for MRI in patients with MRI contraindications. • The number of current and future CEM indications marked by respondents was associated with their degree of CEM experience.
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Affiliation(s)
- Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Elisabetta Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael H Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Kinkar KK, Fields BKK, Yamashita MW, Varghese BA. Empowering breast cancer diagnosis and radiology practice: advances in artificial intelligence for contrast-enhanced mammography. Front Radiol 2024; 3:1326831. [PMID: 38249158 PMCID: PMC10796447 DOI: 10.3389/fradi.2023.1326831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
Artificial intelligence (AI) applications in breast imaging span a wide range of tasks including decision support, risk assessment, patient management, quality assessment, treatment response assessment and image enhancement. However, their integration into the clinical workflow has been slow due to the lack of a consensus on data quality, benchmarked robust implementation, and consensus-based guidelines to ensure standardization and generalization. Contrast-enhanced mammography (CEM) has improved sensitivity and specificity compared to current standards of breast cancer diagnostic imaging i.e., mammography (MG) and/or conventional ultrasound (US), with comparable accuracy to MRI (current diagnostic imaging benchmark), but at a much lower cost and higher throughput. This makes CEM an excellent tool for widespread breast lesion characterization for all women, including underserved and minority women. Underlining the critical need for early detection and accurate diagnosis of breast cancer, this review examines the limitations of conventional approaches and reveals how AI can help overcome them. The Methodical approaches, such as image processing, feature extraction, quantitative analysis, lesion classification, lesion segmentation, integration with clinical data, early detection, and screening support have been carefully analysed in recent studies addressing breast cancer detection and diagnosis. Recent guidelines described by Checklist for Artificial Intelligence in Medical Imaging (CLAIM) to establish a robust framework for rigorous evaluation and surveying has inspired the current review criteria.
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Affiliation(s)
- Ketki K. Kinkar
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Brandon K. K. Fields
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Mary W. Yamashita
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bino A. Varghese
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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13
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Nicosia L, Rotili A, Pesapane F, Bozzini AC, Battaglia O, Pellegrino G, Fusco N, Porta FM, Frassoni S, Bagnardi V, Corso G, Sangalli C, Cassano E. Contrast-Enhanced Mammography (CEM) compared to Breast Magnetic Resonance (MRI) in the evaluation of breast lobular neoplasia. Breast Cancer Res Treat 2024; 203:135-143. [PMID: 37787819 DOI: 10.1007/s10549-023-07096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To compare the diagnostic performance (detection, assessment of correct disease extent and multifocality/centricity) of Contrast-Enhanced Mammography (CEM) Versus Breast Magnetic Resonance (MRI) in the study of lobular neoplasms. METHODS We retrospectively selected all the patients who underwent surgery for a lobular breast neoplasm, either an in situ or an invasive tumor, and had undergone both breast CEM and MRI examinations during the pre-surgical planning. Wilcoxon Signed Rank test was performed to assess the differences between size measurements using the different methods and the post-surgical pathological measurements, considered the gold standard. The agreement in identifying multifocality/multicentricity among the different methods and the pathology was assessed using the Kappa statistics. RESULTS We selected 19 patients, of which one presented a bilateral neoplasm. Then, the images of these 19 patients were analyzed, for a total of 52 malignant breast lesions. We found no significant differences between the post-surgical pathological size of the lesions and the calculated size with CEM and MRI (p-value of the difference respectively 0.71 and 0.47). In all 20 cases, neoplasm detection was possible both with CEM and MRI. CEM and MRI showed an excellent ability to identify multifocal and multicentric cases (K statistic equal to 0.93 for both the procedures), while K statistic was 0.11 and 0.59 for FFDM and US, respectively. CONCLUSION The findings of this study suggest that CEM is a reliable imaging technique in the preoperative setting of patients with lobular neoplasm, with comparable results to breast MRI.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Anna Rotili
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Maria Porta
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
- School of Pathology, University of Milan, 20122, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126, Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- European Cancer Prevention Organization (ECP), 20122, Milan, Italy
| | - Claudia Sangalli
- European Cancer Prevention Organization (ECP), 20122, Milan, Italy
- Data Management, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
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14
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Lobbes MBI. Breast cancer screening in patients with intermediate risk using contrast-enhanced mammography. Eur Radiol 2023; 33:8407-8409. [PMID: 38041387 DOI: 10.1007/s00330-023-09889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Marc B I Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, P.O. Box 5500, 6130 MD, Sittard-Geleen, the Netherlands.
- GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
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15
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Pesapane F, Nicosia L, Tantrige P, Schiaffino S, Liguori A, Montesano M, Bozzini A, Rotili A, Cellina M, Orsi M, Penco S, Pizzamiglio M, Carrafiello G, Cassano E. Inter-reader agreement of breast magnetic resonance imaging and contrast-enhanced mammography in breast cancer diagnosis: a multi-reader retrospective study. Breast Cancer Res Treat 2023; 202:451-459. [PMID: 37747580 DOI: 10.1007/s10549-023-07093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Breast magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM) are nowadays used in breast imaging but studies about their inter-reader agreement are lacking. Therefore, we compared the inter-reader agreement of CEM and MRI in breast cancer diagnosis in the same patients. METHODS Breast MRI and CEM exams performed in a single center (09/2020-09/2021) for an IRB-approved study were retrospectively and independently evaluated by four radiologists of two different centers with different levels of experience who were blinded to the clinical and other imaging data. The reference standard was the histological diagnosis or at least 1-year negative imaging follow-up. Inter-reader agreement was examined using Cohen's and Fleiss' kappa (κ) statistics and compared with the Wald test. RESULTS Of the 750 patients, 395 met inclusion criteria (44.5 ± 14 years old), with 752 breasts available for CEM and MRI. Overall agreement was moderate (κ = 0.60) for MRI and substantial (κ = 0.74) for CEM. For expert readers, the agreement was substantial (κ = 0.77) for MRI and almost perfect (κ = 0.82) for CEM; for non-expert readers was fair (κ = 0.39); and for MRI and moderate (κ = 0.57) for CEM. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.50) for breast MRI and substantial (κ = 0.74) for CEM and it showed a statistically superior agreement of the expert over the non-expert readers only for MRI (p = 0.011) and not for CEM (p = 0.062). CONCLUSIONS The agreement of CEM was superior to that of MRI (p = 0.012), including for both expert (p = 0.031) and non-expert readers (p = 0.005).
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Priyan Tantrige
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Alessandro Liguori
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Marta Montesano
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Anna Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Michaela Cellina
- Department of Radiology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20131, Milan, Italy
| | - Marcello Orsi
- Department of Radiology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20131, Milan, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
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16
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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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17
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus SÖ, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Eur Radiol 2023:10.1007/s00330-023-10409-5. [PMID: 37999727 DOI: 10.1007/s00330-023-10409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Julia Camps Herrero
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain
- Ribera Salud Hospitals, Valencia, Spain
| | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
- Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit Aksoy Ozcan
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.R.L., La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Sila Ö Ulus
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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18
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Coffey K, Dixon LB, Sevilimedu V, Jochelson MS, Sung JS. Short-term follow-up of contrast-enhanced mammography lesions after negative breast MRI in women with elevated breast cancer risk. Eur J Radiol 2023; 168:111097. [PMID: 37738835 DOI: 10.1016/j.ejrad.2023.111097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To determine the outcome of enhancing lesions detected on contrast-enhanced mammography (CEM) that had no correlate on magnetic resonance imaging (MRI) and underwent short-term follow-up CEM. METHODS In this retrospective single-center study, we identified patients with elevated breast cancer risk who had a CEM between 2014 and 2021 showing indeterminate enhancement on recombined images (BI-RADS 0, 3, 4) that had no correlate on subsequent MRI (performed within one month), and therefore underwent short-term follow-up CEM (performed within eight months). Medical records and imaging studies were reviewed to collect data on patient and lesion characteristics, and outcomes. Cancer incidence with 95% confidence interval (CI) was calculated. RESULTS This study included 71 women (median age 49 years) with 81 enhancing CEM lesions who underwent short-term follow-up CEM (median 6.2 months) after MRI reported no correlate. Of 81 lesions (median size = 0.7 cm), 73 (90%) were non-mass enhancement and 8 (10%) were enhancing masses. No sonographic correlate was identified for 75 lesions that had a same-day targeted ultrasound. Two cancers (2.5%, 95% CI 0.3-8.6) were diagnosed during the short-term follow-up period, one at 6-months (invasive ductal carcinoma) and one at 12-months (ductal carcinoma in situ). The remaining 79 lesions were benign at 6-month follow-up CEM and at one-year mammographic follow-up. CONCLUSIONS Follow-up CEM of MRI-occult lesions is prudent and may be reasonable to perform at one-year given the low incidence of cancer detected at six-months (one of 81) in our small study sample.
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Affiliation(s)
- Kristen Coffey
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
| | - Linden B Dixon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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19
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Kaiyin M, Lingling T, Leilei T, Wenjia L, Bin J. Head-to-head comparison of contrast-enhanced mammography and contrast-enhanced MRI for assessing pathological complete response to neoadjuvant therapy in patients with breast cancer: a meta-analysis. Breast Cancer Res Treat 2023; 202:1-9. [PMID: 37615793 DOI: 10.1007/s10549-023-07034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Breast cancer patients receiving neoadjuvant therapy (NAT) are in need of a more patient-friendly imaging modality such as contrast-enhanced mammography (CEM) for monitoring therapy response. The purpose of this study was to conduct a meta-analysis to compare the diagnostic performances of CEM and contrast-enhanced magnetic resonance imaging (CE-MRI) for assessing pathological complete response (pCR) in these patients. METHODS The PubMed, Embase, and Cochrane Library databases were searched through March 2023 to identify studies reporting a head-to-head comparison of CEM and CE-MRI in detecting pCR in breast cancer patients receiving NAT. Pooled diagnostic performance was calculated using a bivariate random-effects model, and an AUC was derived for each test from hierarchic summary ROC analysis. RESULTS Six studies with 328 patients were included. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 93% (95% CI 84-97%), 68% (95% CI 60-76%), and 29.29 (95% CI 11.41-75.18) for CEM versus 84% (95% CI 62-95%), 80% (95% CI 71-87%), and 21.39 (95% CI 5.94-77.13) for CE-MRI. The AUC was 0.85 (95% CI 0.82-0.88) for CEM and 0.85 (95% CI 0.82-0.88) for CE-MRI. CONCLUSION This meta-analysis of head-to-head comparison studies showed that CEM provides an equivalent diagnostic accuracy to CE-MRI in identification of pCR in breast cancer patients receiving NAT. The results support the increasing use of CEM in this setting and would encourage future studies to validate CEM as a suitable replacement for MRI.
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Affiliation(s)
- Min Kaiyin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Tong Lingling
- Department of Gynecology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tang Leilei
- Department of Imaging, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Li Wenjia
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
| | - Ji Bin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
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20
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Grażyńska A, Niewiadomska A, Owczarek AJ, Winder M, Hołda J, Zwolińska O, Barczyk-Gutkowska A, Lorek A, Kuźbińska A, Steinhof-Radwańska K. BIRADS 4 - Is it possible to downgrade lesions that do not enhance on recombinant contrast-enhanced mammography images? Eur J Radiol 2023; 167:111062. [PMID: 37643559 DOI: 10.1016/j.ejrad.2023.111062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Analysis of the morphology of lesions classified into the BI-RADS 4 category and assessment of the possibility of downgrade the BI-RADS category in those that did not show enhancement on recombinant contrast-enhanced mammography (CEM) images. METHOD The retrospective, single-center study included 528 patients who underwent a core needle biopsy performed from January 2017 to November 2022 due to a breast lesion classified as BI-RADS 4 on CEM. Patients' electronic records and imaging examinations were reviewed. Individual lesions were classified into the morphological categories of mass, non-mass, and microcalcifications. Sensitivity, specificity, positive as well as negative predictive values were calculated for the whole group and individual morphological categories. The influence of the lesions' diameter on the results was analyzed. RESULTS CEM NPV for the whole group was 93.9% (±95% CI: 90.0-96.4), for mass lesions 100% (±95% CI: 94.5-100), for non-mass lesions 97.8% (±95% CI: 87.0-99.9) and 87.9% (±95% CI: 80.3-93.0) for microcalcifications. Given that 230 out of 383 benign lesions were not contrast-enhancing, 60.1% of unnecessary CNBs would have been correctly avoided. CEM sensitivity for lesions < 20 mm was lower than for lesions ≥ 20 mm and was respectively 86.6% (±95% CI: 76.8-92.8) vs 94.6% (±95% CI: 86.0-98.2), respectively. CONCLUSION CEM is characterized by high sensitivity in the detection of malignant lesions in the case of lesions with mass and non-mass morphology. The high NPV for recombinant images suggests that in the case of these lesions, the lack of enhancement supports the benign nature of the lesion and may lead to a downgrade of the BI-RADS category.
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Affiliation(s)
- Anna Grażyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland.
| | - Agnieszka Niewiadomska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Aleksander J Owczarek
- Department of Pathophysiology, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Jakub Hołda
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland; Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034 Cracow, Poland
| | - Olga Zwolińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Ceglana 35, 40-514 Katowice, Poland
| | - Aleksandra Kuźbińska
- Department of Pathomorfology, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland.
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21
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Nicosia L, Bozzini AC, Palma S, Pesapane F, Meneghetti L, Pizzamiglio M, Abbate F, Latronico A, Bagnardi V, Frassoni S, Sangalli C, Cassano E. Breast Imaging Reporting and Data System and Contrast Enhancement Mammography: Lesion Conspicuity Likelihood of Malignancy and Relationship With Breast Tumor Receptor Status. Acad Radiol 2023; 30:2243-2251. [PMID: 36898907 DOI: 10.1016/j.acra.2023.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 03/10/2023]
Abstract
RATIONALE AND OBJECTIVES The new version of the Contrast Enhanced Mammography (CEM) Breast imaging Reporting and Data System (BIRADs) encourages investigations of a new enhancement descriptor: "Lesion Conspicuity" (LC). The study aims to assess the diagnostic performance and the relationship with the receptor profile of this new enhancement descriptor. MATERIALS AND METHODS Three hundred twenty-five patients with 381 breast lesions who underwent CEM before histological assessmentwere selected. Four radiologists, blinded to each other, categorized LC into the following levels: absent, low, moderate, and high. Considering moderate and high evaluations as predictive of malignancy, the diagnostic performance of CEM was calculated using histological results of the biopsy as the gold standard. The association between LC values and the receptor profile of the neoplasms was also evaluated. RESULTS The median age at the CEM examination was 50 years (IQR: 45-59). Considering the value of LC of the most experienced radiologist with the interpretation of Low Energy images (LE), we obtained a sensitivity (SE) of 91.9% (95% CI: 88.6%-95.2%) and a specificity (SP) of 67.2% (95% CI: 58.9%-75.5%). An association between "high" lesion conspicuity with ER/PgR not expressed (p = 0.025), with Ki-67>20% (p = 0.033), and with Grading G3 (p = 0.020) was observed. CONCLUSION The new feature of enhancement, "Lesion Conspicuity", demonstrated satisfactory performance in predicting the malignancy of lesions and significant correlation with the receptor profile of malignant breast neoplasms.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy.
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Simone Palma
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Francesca Abbate
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Claudia Sangalli
- Data Management, European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, Via Riapamonti 435, Milan, 20141, Italy
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Lorente-Ramos RM, Azpeitia-Armán J, Oliva-Fonte C, Pérez-Bartolomé A, Azpeitia Hernández J. Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation. Radiographics 2023; 43:e230021. [PMID: 37792595 DOI: 10.1148/rg.230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Contrast-enhanced mammography (CEM) involves addition of intravenous iodinated contrast material at digital mammography, thus increasing the ability to detect breast cancer owing to tumor contrast enhancement. After image acquisition, interpretation includes careful assessment of the technique, artifacts, and pitfalls and reporting with a standard lexicon category and appropriate follow-up recommendations. Artifacts and pitfalls that may cause image misinterpretation should be detected and distinguished from pathologic conditions. Different artifacts apparent on CEM images are usually caused during image acquisition and include CEM-specific and contrast agent-related artifacts, apart from the typical digital mammography artifacts. The pitfalls are related to technical and diagnostic difficulties. One disadvantage of CEM that MRI does not have is a technical factor related to a mammography technique that consists of blind spots that may not be included in the imaging field of mammography views, including the axilla, medial region of the breast, or areas close to the breast wall. Normal breast tissue enhancement called background parenchymal enhancement is also present at CEM and may affect interpretation performance. Diagnostic pitfalls are caused by minimally enhancing lesions, such as invasive lobular carcinomas and mucinous carcinomas, which are difficult to detect with CEM, resulting in false-negative findings. Benign lesions can show enhancement at CEM and represent false-positive lesions that should also be recognized. The authors discuss image interpretation of CEM studies and focus on the artifacts and pitfalls that may be encountered. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Rosa M Lorente-Ramos
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia-Armán
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Carlos Oliva-Fonte
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Ana Pérez-Bartolomé
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia Hernández
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
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23
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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Park-Simon TW, Müller V, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Wuerstlein R, Janni W, Thill M. Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:289-305. [PMID: 37900552 PMCID: PMC10601667 DOI: 10.1159/000531578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
Background Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.
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Affiliation(s)
- Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas D. Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Joerg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Lobbes MBI, Neeter LMFH, Raat F, Turk K, Wildberger JE, van Nijnatten TJA, Nelemans PJ. The performance of contrast-enhanced mammography and breast MRI in local preoperative staging of invasive lobular breast cancer. Eur J Radiol 2023; 164:110881. [PMID: 37201248 DOI: 10.1016/j.ejrad.2023.110881] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Breast MRI is considered the best modality for preoperative staging of invasive lobular carcinoma (ILC). However, contrast-enhanced mammography (CEM) shows comparable diagnostic performance to MRI, but evidence of CEM's accuracy in women diagnosed with ILC is scant. We aimed to retrospectively evaluate CEM and MRI accuracy in preoperative staging of ILC. METHODS ILC cases diagnosed between 2013 and 2021 were collected. For both modalities, tumour diameter was extracted from the reports. Bland-Altman plots were used to assess discrepancies between size measurements according to imaging and histopathological findings. CEM and MRI's ability to detect multifocal/contralateral cancer was expressed as sensitivity, specificity, and diagnostic odds ratios (DORs). Pairwise comparison of women undergoing both CEM and MRI was not performed. RESULTS 305 ILC-cases fulfilled preset inclusion criteria. Mean age was 63.7 years. Preoperative staging was performed using MRI or CEM in 266 (87.2%) and 77 (25.2%) cases, respectively. MRI and CEM overestimated tumour size by 1.5 and 2.1 mm, respectively. Sensitivity to detect multifocal disease was higher for MRI than for CEM (86% versus 78%), but specificity was lower for MRI (79% versus 92%). For detection of contralateral breast cancer, sensitivity for MRI was 96% versus 88% for CEM, and specificity was 92% and 99%, respectively. For both indications, DOR was higher for CEM, but differences were non-significant (p = 0.56 and p = 0.78). CONCLUSION CEM and MRI overestimate ILC size with comparable systematic and random errors. MRI's higher sensitivity for detection of multifocal/contralateral cancers is accompanied by lower specificity, but discriminative ability for both modalities was non-significant.
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Affiliation(s)
- Marc B I Lobbes
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Lidewij M F H Neeter
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Frank Raat
- Laurentius Hospital, Department of Radiology, P.O. Box 920, 6040AX Roermond, the Netherlands.
| | - Kim Turk
- Zuyderland Medical Center, Department of Medical Imaging, P.O. Box 5500, 6130MB Sittard-Geleen, the Netherlands.
| | - Joachim E Wildberger
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Thiemo J A van Nijnatten
- Maastricht University Medical Center, Department of Radiology and Nuclear Medicine, P.O. Box 5800, 6202AZ Maastricht, the Netherlands; GROW School for Oncology and Reproduction, P.O. Box 616, 6200MD Maastricht, the Netherlands.
| | - Patricia J Nelemans
- Maastricht University, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
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van Nijnatten TJA, Lobbes MBI, Cozzi A, Patel BK, Zuley ML, Jochelson MS. Barriers to Implementation of Contrast-Enhanced Mammography in Clinical Practice: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:3-6. [PMID: 36448912 PMCID: PMC11025563 DOI: 10.2214/ajr.22.28567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Accumulating evidence shows that contrast-enhanced mammography (CEM) has higher diagnostic performance than digital mammography and ultrasound and comparable diagnostic performance to MRI for various indications. CEM also offers certain practical advantages for patients. Nevertheless, the clinical implementation of CEM has been limited because of a range of factors. This AJR Expert Panel Narrative Review explores such factors hindering CEM implementation. These factors include the following: the risks of iodinated contrast media, increased radiation exposure, indications for which CEM is not the preferred test or for which further evidence is needed, workflow adjustments needed when performing CEM examinations, incomplete availability of CEM-guided biopsy systems, and reimbursement challenges. Considerations that currently mitigate or are expected to mitigate these factors are also highlighted.
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Affiliation(s)
- Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, Maastricht 6202 AZ, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
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27
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Zhang M, Mesurolle B, Theriault M, Meterissian S, Morris EA. Imaging of breast cancer-beyond the basics. Curr Probl Cancer 2023:100967. [PMID: 37316336 DOI: 10.1016/j.currproblcancer.2023.100967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 05/20/2023] [Indexed: 06/16/2023]
Abstract
Imaging of breast cancer is the backbone of breast cancer screening, diagnosis, preoperative/treatment assessment and follow-up. The main modalities are mammography, ultrasound and magnetic resonance imaging, each with its own advantages and disadvantages. New emerging technologies have also enabled each modality to improve on their weaknesses. Imaging-guided biopsies have allowed for accurate diagnosis of breast cancer, with low complication rates. The purpose of this article is to review the common modalities for breast cancer imaging in current practice with emphasis on the strengths and potential weaknesses, discuss the selection of the best imaging modality for the specific clinical question or patient population, and explore new technologies / future directions of breast cancer imaging.
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Affiliation(s)
- Michelle Zhang
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada.
| | - Benoit Mesurolle
- Department of Radiology, Elsan, Pôle Santé République, Clermont-Ferrand, France
| | - Melanie Theriault
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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28
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Nicosia L, Gnocchi G, Gorini I, Venturini M, Fontana F, Pesapane F, Abiuso I, Bozzini AC, Pizzamiglio M, Latronico A, Abbate F, Meneghetti L, Battaglia O, Pellegrino G, Cassano E. History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century. Healthcare (Basel) 2023; 11:healthcare11111596. [PMID: 37297735 DOI: 10.3390/healthcare11111596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Gnocchi
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Ilaria Gorini
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ida Abiuso
- Radiology Department, Università degli Studi di Torino, 10129 Turin, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesca Abbate
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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Nicosia L, Bozzini AC, Pesapane F, Rotili A, Marinucci I, Signorelli G, Frassoni S, Bagnardi V, Origgi D, De Marco P, Abiuso I, Sangalli C, Balestreri N, Corso G, Cassano E. Breast Digital Tomosynthesis versus Contrast-Enhanced Mammography: Comparison of Diagnostic Application and Radiation Dose in a Screening Setting. Cancers (Basel) 2023; 15:cancers15092413. [PMID: 37173880 PMCID: PMC10177523 DOI: 10.3390/cancers15092413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
This study aims to evaluate the Average Glandular Dose (AGD) and diagnostic performance of CEM versus Digital Mammography (DM) as well as versus DM plus one-view Digital Breast Tomosynthesis (DBT), which were performed in the same patients at short intervals of time. A preventive screening examination in high-risk asymptomatic patients between 2020 and 2022 was performed with two-view Digital Mammography (DM) projections (Cranio Caudal and Medio Lateral) plus one Digital Breast Tomosynthesis (DBT) projection (mediolateral oblique, MLO) in a single session examination. For all patients in whom we found a suspicious lesion by using DM + DBT, we performed (within two weeks) a CEM examination. AGD and compression force were compared between the diagnostic methods. All lesions identified by DM + DBT were biopsied; then, we assessed whether lesions found by DBT were also highlighted by DM alone and/or by CEM. We enrolled 49 patients with 49 lesions in the study. The median AGD was lower for DM alone than for CEM (3.41 mGy vs. 4.24 mGy, p = 0.015). The AGD for CEM was significantly lower than for the DM plus one single projection DBT protocol (4.24 mGy vs. 5.55 mGy, p < 0.001). We did not find a statistically significant difference in the median compression force between the CEM and DM + DBT. DM + DBT allows the identification of one more invasive neoplasm one in situ lesion and two high-risk lesions, compared to DM alone. The CEM, compared to DM + DBT, failed to identify only one of the high-risk lesions. According to these results, CEM could be used in the screening of asymptomatic high-risk patients.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Irene Marinucci
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Daniela Origgi
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Paolo De Marco
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ida Abiuso
- Radiology Department, Università Degli Studi di Torino, 10124 Turin, Italy
| | - Claudia Sangalli
- Data Management, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Nicola Balestreri
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- European Cancer Prevention Organization, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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30
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Weaver OO, Yang WT, Scoggins ME, Adrada BE, Arribas E, Moseley TW, Esquivel J, Melgar Y, Kornecki A. Challenging Contrast-Enhanced Mammography-Guided Biopsies: Practical Approach Using Real-Time Multimodality Imaging and a Proposed Procedural Algorithm. AJR Am J Roentgenol 2023; 220:512-523. [PMID: 36321982 DOI: 10.2214/ajr.22.28572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Contrast-enhanced mammography (CEM) is an emerging functional breast imaging technique that entails the acquisition of dual-energy digital mammographic images after IV administration of iodine-based contrast material. CEM-guided biopsy technology was introduced in 2019 and approved by the U.S. FDA in 2020. This technology's availability enables direct sampling of suspicious enhancement seen only on or predominantly on recombined CEM images and addresses a major obstacle to the clinical implementation of CEM technology. The literature describing clinical indications and procedural techniques of CEM-guided biopsy is scarce. This article describes our initial experience in performing challenging CEM-guided biopsies and proposes a step-by-step procedural algorithm designed to proactively address anticipated technical difficulties and thereby increase the likelihood of achieving successful targeting.
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Affiliation(s)
- Olena O Weaver
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Wei T Yang
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Marion E Scoggins
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Beatriz E Adrada
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Elsa Arribas
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Tanya W Moseley
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joanna Esquivel
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Yamile Melgar
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Anat Kornecki
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Hogan MP, Horvat JV, Ross DS, Sevilimedu V, Jochelson MS, Kirstein LJ, Goldfarb SB, Comstock CE, Sung JS. Contrast-enhanced mammography in the assessment of residual disease after neoadjuvant treatment. Breast Cancer Res Treat 2023; 198:349-359. [PMID: 36754936 PMCID: PMC10375516 DOI: 10.1007/s10549-023-06865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE To investigate the utility of contrast-enhanced mammography (CEM) as an alternative to breast MRI for the evaluation of residual disease after neoadjuvant treatment (NAT). METHODS This prospective study enrolled consecutive women undergoing NAT for breast cancer from July 2017-July 2019. Breast MRI and CEM exams performed after completion of NAT were read independently by two breast radiologists. Residual disease and lesion size on MRI and CEM recombined (RI) and low-energy images (LEI) were compared. Histopathology was considered the reference standard. Statistical analysis was performed using McNemar's and Leisenring's tests. Multiple comparison adjustment was made using Bonferroni procedure. Lesion sizes were correlated using Kendall's tau coefficient. RESULTS There were 110 participants with 115 breast cancers. Residual disease (invasive cancer or ductal carcinoma in situ) was detected in 83/115 (72%) lesions on pathology, 71/115 (62%) on MRI, 55/115 (48%) on CEM RI, and 75/115 (65%) on CEM LEI. When using multiple comparison adjustment, no significant differences were detected between MRI combined with CEM LEI and CEM RI combined with CEM LEI, in terms of accuracy (MRI: 77%, CEM: 72%; p ≥ 0.99), sensitivity (MRI: 88%, CEM: 81%; p ≥ 0.99), specificity (MRI: 47%, CEM: 50%; p ≥ 0.99), PPV (MRI: 81%, CEM: 81%; p ≥ 0.99), or NPV (MRI: 60%, CEM: 50%; p ≥ 0.99). Size correlation between pathology and both MRI combined with CEM LEI and CEM RI combined with CEM LEI was moderate: τ = 0. 36 vs 0.33 (p ≥ 0.99). CONCLUSION Contrast-enhanced mammography is an acceptable alternative to breast MRI for the detection of residual disease after neoadjuvant treatment.
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Affiliation(s)
- Molly P Hogan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Dara S Ross
- Department of Pathology, 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
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Laurie J Kirstein
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Shari B Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christopher E Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Miller MM, Rubaiyat AHM, Rohde GK. Predicting Malignancy of Breast Imaging Findings Using Quantitative Analysis of Contrast-Enhanced Mammography (CEM). Diagnostics (Basel) 2023; 13:diagnostics13061129. [PMID: 36980437 PMCID: PMC10047016 DOI: 10.3390/diagnostics13061129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
We sought to develop new quantitative approaches to characterize the spatial distribution of mammographic density and contrast enhancement of suspicious contrast-enhanced mammography (CEM) findings to improve malignant vs. benign classifications of breast lesions. We retrospectively analyzed all breast lesions that underwent CEM imaging and tissue sampling at our institution from 2014–2020 in this IRB-approved study. A penalized linear discriminant analysis was used to classify lesions based on the averaged histograms of radial distributions of mammographic density and contrast enhancement. T-tests were used to compare the classification accuracies of density, contrast, and concatenated density and contrast histograms. Logistic regression and AUC-ROC analyses were used to assess if adding demographic and clinical data improved the model accuracy. A total of 159 suspicious findings were evaluated. Density histograms were more accurate in classifying lesions as malignant or benign than a random classifier (62.37% vs. 48%; p < 0.001), but the concatenated density and contrast histograms demonstrated a higher accuracy (71.25%; p < 0.001) than the density histograms alone. Including the demographic and clinical data in our models led to a higher AUC-ROC than concatenated density and contrast images (0.81 vs. 0.70; p < 0.001). In the classification of invasive vs. non-invasive malignancy, the concatenated density and contrast histograms demonstrated no significant improvement in accuracy over the density histograms alone (77.63% vs. 78.59%; p = 0.504). Our findings suggest that quantitative differences in the radial distribution of mammographic density could be used to discriminate malignant from benign breast findings; however, classification accuracy was significantly improved with the addition of contrast-enhanced imaging data from CEM. Adding patient demographic and clinical information further improved the classification accuracy.
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Affiliation(s)
- Matthew M. Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22903, USA
- Correspondence:
| | - Abu Hasnat Mohammad Rubaiyat
- Department of Electrical and Computer Engineering, University of Virginia, 415 Lane Rd., Charlottesville, VA 22903, USA
| | - Gustavo K. Rohde
- Department of Biomedical Engineering, University of Virginia, 415 Lane Rd., Charlottesville, VA 22903, USA
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Liu H, Liu M, Jiang X, Luo J, Song Y, Chu X, Zan G. Multimodal Image Fusion for X-ray Grating Interferometry. Sensors (Basel) 2023; 23:3115. [PMID: 36991826 PMCID: PMC10053574 DOI: 10.3390/s23063115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
X-ray grating interferometry (XGI) can provide multiple image modalities. It does so by utilizing three different contrast mechanisms-attenuation, refraction (differential phase-shift), and scattering (dark-field)-in a single dataset. Combining all three imaging modalities could create new opportunities for the characterization of material structure features that conventional attenuation-based methods are unable probe. In this study, we proposed an image fusion scheme based on the non-subsampled contourlet transform and spiking cortical model (NSCT-SCM) to combine the tri-contrast images retrieved from XGI. It incorporated three main steps: (i) image denoising based on Wiener filtering, (ii) the NSCT-SCM tri-contrast fusion algorithm, and (iii) image enhancement using contrast-limited adaptive histogram equalization, adaptive sharpening, and gamma correction. The tri-contrast images of the frog toes were used to validate the proposed approach. Moreover, the proposed method was compared with three other image fusion methods by several figures of merit. The experimental evaluation results highlighted the efficiency and robustness of the proposed scheme, with less noise, higher contrast, more information, and better details.
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Affiliation(s)
- Haoran Liu
- School of Data Science and Artificial Intelligence, Wenzhou University of Technology, Wenzhou 325000, China
- State Key Laboratory of Geohazard Prevention and Geoenvironment Protection, Chengdu University of Technology, Chengdu 610059, China
| | - Mingzhe Liu
- School of Data Science and Artificial Intelligence, Wenzhou University of Technology, Wenzhou 325000, China
- State Key Laboratory of Geohazard Prevention and Geoenvironment Protection, Chengdu University of Technology, Chengdu 610059, China
| | - Xin Jiang
- School of Data Science and Artificial Intelligence, Wenzhou University of Technology, Wenzhou 325000, China
| | - Jinglei Luo
- The Engineering & Technical College of Chengdu University of Technology, Leshan 614000, China
| | - Yuming Song
- The Engineering & Technical College of Chengdu University of Technology, Leshan 614000, China
| | - Xingyue Chu
- The Engineering & Technical College of Chengdu University of Technology, Leshan 614000, China
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Migliaro G, Bicchierai G, Valente P, Di Naro F, De Benedetto D, Amato F, Boeri C, Vanzi E, Miele V, Nori J. Contrast Enhanced Mammography (CEM) Enhancing Asymmetry: Single-Center First Case Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061011. [PMID: 36980319 PMCID: PMC10047777 DOI: 10.3390/diagnostics13061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
(1) Purpose: The latest Breast Imaging Reporting and Data System (BI-RADS) lexicon for CEM introduced a new descriptor, enhancing asymmetries (EAs). The purpose of this study was to determine which types of lesions were correlated with EAs. (2) Methods: A total of 3359 CEM exams, executed at AOUC Careggi in Florence, Italy between 2019 and 2021 were retrospectively assessed by two radiologists. For each of the EAs found, the size, the enhancing conspicuity (degree of enhancement relative to background described as low, moderate, or high), whether there was a corresponding finding in the traditional radiology images (US or mammography), the biopsy results when performed including any follow-up exams, and the presence of background parenchymal enhancement (BPE) of the normal breast tissue (minimal, mild, moderate, marked) were described. (3) Results: A total of 64 women were included, 36 of them underwent CEM for a preoperative staging assessment, and 28 for a problem-solving examination. Among the 64 EAs, 19/64 (29.69%) resulted in being category B5 (B5) lesions, 5/64 (7.81%) as category B3 (B3) lesions, and 40/64(62.50%) were negative or benign either after biopsy or second-look exams or follow-up. We assessed that EAs with higher enhancing conspicuity correlated significantly with a higher risk of B5 lesions (p: 0.0071), especially bigger ones (p: 0.0274). Conclusions: EAs can relate both with benign and tumoral lesions, and they need to be assessed as the other CEM descriptors, with re-evaluation of low-energy images and second-look exams, particularly larger EAs with higher enhancing conspicuity.
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Affiliation(s)
- Giuliano Migliaro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Bicchierai
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
- Correspondence:
| | - Pietro Valente
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Federica Di Naro
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Diego De Benedetto
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Francesco Amato
- Breast Imaging Diagnostic Unit, Radiology Department, Ospedale San Giovanni di Dio, 92100 Agrigento, Italy
| | - Cecilia Boeri
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Ermanno Vanzi
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Jacopo Nori
- Breast Imaging Diagnostic Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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Marzogi A, Baltzer PAT, Kapetas P, Milos RI, Bernathova M, Helbich TH, Clauser P. Is the Level of Contrast Enhancement on Contrast-Enhanced Mammography (CEM) Associated with the Presence and Biological Aggressiveness of Breast Cancer? Diagnostics (Basel) 2023; 13. [PMID: 36832242 DOI: 10.3390/diagnostics13040754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
There is limited information about whether the level of enhancement on contrast-enhanced mammography (CEM) can be used to predict malignancy. The purpose of this study was to correlate the level of enhancement with the presence of malignancy and breast cancer (BC) aggressiveness on CEM. This IRB-approved, cross-sectional, retrospective study included consecutive patients examined with CEM for unclear or suspicious findings on mammography or ultrasound. Excluded were examinations performed after biopsy or during neoadjuvant treatment for BC. Three breast radiologists who were blinded to patient data evaluated the images. The enhancement intensity was rated from 0 (no enhancement) to 3 (distinct enhancement). ROC analysis was performed. Sensitivity and negative likelihood ratio (LR-) were calculated after dichotomizing enhancement intensity as negative (0) versus positive (1-3). A total of 156 lesions (93 malignant, 63 benign) in 145 patients (mean age 59 ± 11.6 years) were included. The mean ROC curve was 0.827. Mean sensitivity was 95.4%. Mean LR- was 0.12%. Invasive cancer presented predominantly (61.8%) with distinct enhancement. A lack of enhancement was mainly observed for ductal carcinoma in situ. Stronger enhancement intensity was positively correlated with cancer aggressiveness, but the absence of enhancement should not be used to downgrade suspicious calcifications.
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Nicosia L, Bozzini AC, Signorelli G, Palma S, Pesapane F, Frassoni S, Bagnardi V, Pizzamiglio M, Farina M, Trentin C, Penco S, Meneghetti L, Sangalli C, Cassano E. Contrast-Enhanced Spectral Mammography in the Evaluation of Breast Microcalcifications: Controversies and Diagnostic Management. Healthcare (Basel) 2023; 11. [PMID: 36833045 DOI: 10.3390/healthcare11040511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that underwent CESM and histological assessment were included. All the lesions were scored using a 4-point qualitative scale according to the degree of contrast enhancement at the CESM examination. The histological results were considered the gold standard. In the first analysis, enhancement degree scores of 2 and 3 were considered predictive of malignity. The sensitivity (SE) and positive predictive value (PPV) were significative lower for patients with lesions with microcalcifications without other radiological findings (SE = 53.3% vs. 82.2%, p-value < 0.001 and PPV = 84.2% vs. 95.2%, p-value = 0.049, respectively). On the contrary, the specificity (SP) and negative predictive value (NPV) were significative higher among lesions with microcalcifications without other radiological findings (SP = 95.8% vs. 84.2%, p-value = 0.026 and NPV = 82.9% vs. 55.2%, p-value < 0.001, respectively). In a second analysis, degree scores of 1, 2, and 3 were considered predictive of malignity. The SE (80.0% vs. 96.8%, p-value < 0.001) and PPV (70.6% vs. 88.3%, p-value: 0.005) were significantly lower among lesions with microcalcifications without other radiological findings, while the SP (85.9% vs. 50.9%, p-value < 0.001) was higher. The enhancement of microcalcifications has low sensitivity in predicting malignancy. However, in certain controversial cases, the absence of CESM enhancement due to its high negative predictive value can help to reduce the number of biopsies for benign lesions.
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Nida BA, Rooney TB, Miller MM. Utility of MRI-Directed Contrast-Enhanced Mammography for Biopsy Planning for Suspicious MRI-Detected Breast Lesions. AJR Am J Roentgenol 2023; 220:202-11. [PMID: 36000664 DOI: 10.2214/AJR.22.28055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND. Suspicious lesions detected on contrast-enhanced breast MRI often undergo targeted ultrasound evaluation to determine whether they are amenable to ultrasound-guided biopsy. OBJECTIVE. The purpose of this study is to assess the utility of MRI-directed contrast-enhanced mammography (CEM) performed for biopsy planning for suspicious MRI-detected breast lesions and to compare its use with that of MRI-directed ultrasound. METHODS. This retrospective study included 120 patients (median age, 50.3 years) who underwent MRI-directed CEM from September 2014 to July 2020 for biopsy planning for a total of 140 suspicious breast MRI lesions; 109 lesions were also evaluated by MRI-directed ultrasound at the same visit. The reference standard was histopathology or at least 2 years of imaging follow-up for benign lesions. Rates of detecting a correlate for the MRI lesion, among all lesions and among malignant lesions, were compared between MRI-directed CEM, MRI-directed ultrasound, and combined MRI-directed CEM and ultrasound (i.e., with the correlate detected on either modality), by use of the McNemar test. The frequencies with which imaging modalities were used for biopsy guidance after MRI-directed imaging were determined. RESULTS. Twenty-three of 109 lesions were malignant. The lesion detection rate was higher for MRI-directed CEM than for MRI-directed ultrasound (69.7% [76/109] vs 45.9% [50/109]; p < .001) and higher for combined MRI-directed CEM and ultrasound (77.1% [84/109]) than for either MRI-directed CEM (p = .008) or MRI-directed ultrasound (p < .001). The rate of detection of malignant lesions was not significantly different between MRI-directed CEM and MRI-directed ultrasound (95.7% [22/23] vs 78.3% [18/23]; p = .13). A total of 31.2% (34/109) of lesions were seen on MRI-directed CEM only, and 7.3% (8/109) were seen on MRI-directed ultrasound only. A total of 17.4% (4/23) of malignant lesions were seen on MRI-directed CEM only, and none were seen on MRI-directed ultrasound only. Among lesions recommended for biopsy, stereotactic- or tomosynthesis-guided biopsy was recommended for 25.2% (26/103), ultrasound-guided biopsy for 35.9% (37/103), and MRI-guided biopsy for 38.8% (40/103). CONCLUSION. MRI-directed CEM detects a higher fraction of suspicious MRI lesions than does MRI-directed ultrasound. Combined MRI-directed CEM and ultrasound detects a higher fraction than either method does individually. CLINICAL IMPACT. MRI-directed CEM may be a useful alternate or complementary tool to MRI-directed ultrasound in biopsy planning for suspicious MRI lesions, facilitating the use of biopsy guidance methods other than MRI guidance.
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Trimboli RM, Vatteroni G, Bernardi D. Reply to "Contrast-Enhanced Mammography, a Diagnostic and Follow-Up Method With Potential Research Opportunities". AJR Am J Roentgenol 2023; 220:306-7. [PMID: 36383048 DOI: 10.2214/AJR.22.28314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Magni V, Cozzi A, Schiaffino S, Colarieti A, Sardanelli F. Artificial intelligence for digital breast tomosynthesis: Impact on diagnostic performance, reading times, and workload in the era of personalized screening. Eur J Radiol 2023; 158:110631. [PMID: 36481480 DOI: 10.1016/j.ejrad.2022.110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
The ultimate goals of the application of artificial intelligence (AI) to digital breast tomosynthesis (DBT) are the reduction of reading times, the increase of diagnostic performance, and the reduction of interval cancer rates. In this review, after outlining the journey from computer-aided detection/diagnosis systems to AI applied to digital mammography (DM), we summarize the results of studies where AI was applied to DBT, noting that long-term advantages of DBT screening and its crucial ability to decrease the interval cancer rate are still under scrutiny. AI has shown the capability to overcome some shortcomings of DBT in the screening setting by improving diagnostic performance and by reducing recall rates (from -2 % to -27 %) and reading times (up to -53 %, with an average 20 % reduction), but the ability of AI to reduce interval cancer rates has not yet been clearly investigated. Prospective validation is needed to assess the cost-effectiveness and real-world impact of AI models assisting DBT interpretation, especially in large-scale studies with low breast cancer prevalence. Finally, we focus on the incoming era of personalized and risk-stratified screening that will first see the application of contrast-enhanced breast imaging to screen women with extremely dense breasts. As the diagnostic advantage of DBT over DM was concentrated in this category, we try to understand if the application of AI to DM in the remaining cohorts of women with heterogeneously dense or non-dense breast could close the gap in diagnostic performance between DM and DBT, thus neutralizing the usefulness of AI application to DBT.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Anna Colarieti
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy.
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Nicosia L, Bozzini AC, Ballerini D, Palma S, Pesapane F, Raimondi S, Gaeta A, Bellerba F, Origgi D, De Marco P, Castiglione Minischetti G, Sangalli C, Meneghetti L, Curigliano G, Cassano E. Radiomic Features Applied to Contrast Enhancement Spectral Mammography: Possibility to Predict Breast Cancer Molecular Subtypes in a Non-Invasive Manner. Int J Mol Sci 2022; 23:ijms232315322. [PMID: 36499648 PMCID: PMC9740943 DOI: 10.3390/ijms232315322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
We aimed to investigate the association between the radiomic features of contrast-enhanced spectral mammography (CESM) images and a specific receptor pattern of breast neoplasms. In this single-center retrospective study, we selected patients with neoplastic breast lesions who underwent CESM before a biopsy and surgical assessment between January 2013 and February 2022. Radiomic analysis was performed on regions of interest selected from recombined CESM images. The association between the features and each evaluated endpoint (ER, PR, Ki-67, HER2+, triple negative, G2-G3 expressions) was investigated through univariate logistic regression. Among the significant and highly correlated radiomic features, we selected only the one most associated with the endpoint. From a group of 321 patients, we enrolled 205 malignant breast lesions. The median age at the exam was 50 years (interquartile range (IQR) 45-58). NGLDM_Contrast was the only feature that was positively associated with both ER and PR expression (p-values = 0.01). NGLDM_Coarseness was negatively associated with Ki-67 expression (p-value = 0.02). Five features SHAPE Volume(mL), SHAPE_Volume(vx), GLRLM_RLNU, NGLDM_Busyness and GLZLM_GLNU were all positively and significantly associated with HER2+; however, all of them were highly correlated. Radiomic features of CESM images could be helpful to predict particular molecular subtypes before a biopsy.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Correspondence:
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Daniela Ballerini
- Breast Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy
| | - Simone Palma
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO IRCCS, 20139 Milan, Italy
| | - Aurora Gaeta
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO IRCCS, 20139 Milan, Italy
| | - Federica Bellerba
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO IRCCS, 20139 Milan, Italy
| | - Daniela Origgi
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Paolo De Marco
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Castiglione Minischetti
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- School of Medical Physics, University of Milan, Via Celoria 16, 20133 Milan, Italy
| | - Claudia Sangalli
- Data Management, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, 20122 Milano, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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Bernardi D, Vatteroni G, Acquaviva A, Valentini M, Sabatino V, Bolengo I, Pellegrini M, Fantò C, Trimboli RM. Contrast-Enhanced Mammography Versus MRI in the Evaluation of Neoadjuvant Therapy Response in Patients With Breast Cancer: A Prospective Study. AJR Am J Roentgenol 2022; 219:884-94. [PMID: 35731101 DOI: 10.2214/AJR.22.27756] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Contrast-enhanced mammography (CEM) is rapidly expanding as a credible alternative to MRI in various clinical settings. OBJECTIVE. The purpose of this study was to compare CEM and MRI for neoadjuvant therapy (NAT) response assessment in patients with breast cancer. METHODS. This prospective study included 51 patients (mean age, 46 ± 11 [SD] years) with biopsy-proven breast cancer who were candidates for NAT from May 2015 to April 2018. Patients underwent both CEM and MRI before, during, and after NAT (pre-NAT, mid-NAT, and post-NAT, respectively). Post-NAT CEM included a 6-minute delayed acquisition. One breast radiologist with experience in CEM reviewed CEM examinations; one breast radiologist with experience in MRI reviewed MRI examinations. The radiologists assessed for the presence of an enhancing lesion; if an enhancing lesion was detected, its size was measured. RECIST version 1.1 response assessment categories were derived. Pathologic complete response (pCR) was defined as absence of both invasive cancer and ductal carcinoma in situ (DCIS). RESULTS. Of 51 patients, 16 achieved pCR. CEM yielded systematically lower size measurements compared with MRI (mean difference, -0.2 mm for pre-NAT, -0.7 mm for mid-NAT, and -0.3 mm for post-NAT). All post-NAT imaging tests yielded systematically larger size measurements compared with pathology (mean difference, 0.8 mm for CEM, 1.2 mm for MRI, and 1.9 mm for delayed CEM). Of 12 patients with residual DCIS, an enhancing lesion was detected in seven on post-NAT CEM, eight on post-NAT MRI, and nine on post-NAT delayed CEM. Agreement of RECIST response categories between CEM and MRI, expressed as kappa coefficient, was 0.791 at mid-NAT and 0.871 at post-NAT. For detecting pCR by post-NAT imaging, sensitivity and specificity were 81% and 83% for CEM, 100% and 86% for MRI, and 81% and 89% for delayed CEM. Sensitivity was significantly higher for MRI than CEM (p = .001) and delayed CEM (p = .002); remaining comparisons were not significant (p > .05). CONCLUSION. After NAT for breast cancer, CEM and MRI yielded comparable assessments of lesion size (both slightly overestimated vs pathology) and RECIST categories and showed no significant difference in specificity for pCR. MRI had higher sensitivity for pCR. Delayed CEM acquisition may help detect residual DCIS. CLINICAL IMPACT. Although MRI remains the preferred test for NAT response monitoring, the findings support CEM as a useful alternative when MRI is contraindicated or not tolerated.
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Siminiak N, Pasiuk-Czepczyńska A, Godlewska A, Wojtyś P, Olejnik M, Michalak J, Nowaczyk P, Gajdzis P, Godlewski D, Ruchała M, Czepczyński R. Are contrast enhanced mammography and digital breast tomosynthesis equally effective in diagnosing patients recalled from breast cancer screening? Front Oncol 2022; 12:941312. [PMID: 36505843 PMCID: PMC9730826 DOI: 10.3389/fonc.2022.941312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/04/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Full-field digital mammography (FFDM) is widely used in breast cancer screening. However, to improve cancer detection rates, new diagnostic tools have been introduced. Contrast enhanced mammography (CEM) and digital breast tomosynthesis (DBT) are used in the diagnostic setting, however their accuracies need to be compared.The aim of the study was to evaluate the diagnostic performance of CEM and DBT in women recalled from breast cancer screening program. Methods The study included 402 consecutive patients recalled from breast cancer screening program, who were randomized into two groups, to undergo either CEM (202 patients) or DBT (200 patients). All visible lesions were evaluated and each suspicious lesion was histopathologically verified. Results CEM detected 230 lesions; 119 were classified as benign and 111 as suspicious or malignant, whereas DBT identified 209 lesions; 105 were classified as benign and 104 as suspicious or malignant. In comparison to histopathology, CEM correctly detected cancer in 43 out of 44 cases, and DBT in all 33 cases, while FFDM identified 15 and 18 neoplastic lesions in two groups, respectively. CEM presented with 97% sensitivity, 63% specificity, 70% accuracy, 38% PPV and 99% NPV, while DBT showed 100% sensitivity, 60% specificity, 32%, PPV, 100% NPV and 66% accuracy. The CEM's AUC was 0.97 and DBT's 0.99. The ROC curve analysis proved a significant (p<0.000001) advantage of both CEM and DBT over FFDM, however, there was no significant difference between CEM and DBT diagnostic accuracies (p=0.23). Conclusions In this randomized, prospective study CEM and DBT show similar diagnostic accuracy.
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Affiliation(s)
- Natalia Siminiak
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland,*Correspondence: Natalia Siminiak,
| | | | - Antonina Godlewska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Wojtyś
- Cancer Prevention and Epidemiology Center, Poznań, Poland
| | | | | | - Piotr Nowaczyk
- Breast Surgical Oncology Department, Greater Poland Cancer Center, Poznań, Poland
| | - Paweł Gajdzis
- Cancer Prevention and Epidemiology Center, Poznań, Poland
| | | | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
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Lobbes MBI, Jochelson MS, Neeter LMFH, Nelemans PJ. Contrast-enhanced Mammography and Breast MRI: Friends or Foes? Radiology 2022; 307:e221558. [PMID: 36413132 DOI: 10.1148/radiol.221558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Marc B. I. Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, PO Box 5500, 6130 MB Sittard-Geleen, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Maxine S. Jochelson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lidewij M. F. H. Neeter
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Patricia J. Nelemans
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Skaane P. Contrast-enhanced mammography for screening recalls: a problem-solving assessment tool ready for use? Eur Radiol 2022; 32:7386-7387. [PMID: 36100775 DOI: 10.1007/s00330-022-09094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/07/2022] [Accepted: 07/07/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Per Skaane
- Department of Radiology, Oslo University Hospital, University of Oslo, Ullernchausseen 64-66, NO-0379, Oslo, Norway.
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Kang Y, Li Z, Yang G, Xue J, Zhang L, Rong X. Diagnostic performance of the Kaiser score in the evaluation of breast lesions on contrast-enhanced mammography. Eur J Radiol 2022; 156:110524. [PMID: 36126352 DOI: 10.1016/j.ejrad.2022.110524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/14/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate whether the Kaiser score (KS) could improve the diagnostic performance of breast imaging reporting and data system (BI-RADS) in evaluating breast enhancing lesions on contrast-enhanced mammography (CEM). METHODS Three hundred fifty-nine patients with 375 lesions (231 malignant and 144 benign) were included in this retrospective study from April 2019 to December 2021.Two readers with different levels of experience in breast imaging were asked to give a BI-RADS assessment category according to the CEM BI-RADS and final score based on the KS. The diagnostic performance of all lesions, mass and non-mass enhancement (NME) were assessed by receiver operating characteristic (ROC) analysis, and the areas under the ROC curve (AUCs) were measured. The weighted kappa coefficients were calculated to investigate the interreader agreement. RESULTS The AUCs of the KS for all lesions were 0.915 (95 %CI: 0.884-0.947) and 0.876 (95 %CI: 0.838-0.914) for two readers. When mass and NME were evaluated separately, the AUCs of the KS for mass were higher than those for NME (p < 0.001). The AUCs of BI-RADS for all lesion diagnoses ranged between 0.821 (95 %CI: 0.778-0.864) and 0.842(95 %CI: 0.801-0.883) for two readers. The AUCs of the KS were higher than those of BI-RADS (p < 0.001, p = 0.016). There were no significant differences in the sensitivity between the KS (97.4 %) and BI-RADS (99.6 %) for all lesions (p = 0.130). The specificity of the KS was significantly higher than that of BI-RADS (p < 0.001). Compared with BI-RADS, the application of the KS could have potentially obviated 41.7 % to 47.9 % unnecessary biopsies in 144 benign lesions. Interreader agreement between the two readers of the KS was almost perfect (k = 0.883 [95 % CI: 0.842-0.924]). CONCLUSION The use of the KS provided a high diagnostic performance in distinguishing malignant and benign breast lesions on CEM and outperformed BI-RADS. The application of the KS can downgrade up to 47.9% of unnecessary biopsies of benign breast lesions.
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Affiliation(s)
- Yihe Kang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Zhigang Li
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Guang Yang
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Jing Xue
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Lingling Zhang
- Department of Pathology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Xiaocui Rong
- Department of Radiology. The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
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Abstract
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street New York, NY 10065, United States.
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Schiaffino S, Cozzi A. Contrast-enhanced mammography-guided biopsy: why, when, and where we need it. Eur Radiol 2022; 33:414-416. [DOI: 10.1007/s00330-022-09196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022]
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Gennaro G, Cozzi A, Schiaffino S, Sardanelli F, Caumo F. Radiation Dose of Contrast-Enhanced Mammography: A Two-Center Prospective Comparison. Cancers (Basel) 2022; 14. [PMID: 35406546 DOI: 10.3390/cancers14071774] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only by single-center studies. In this retrospective study, we aimed to compare the radiation dose between two centers performing CEM within two prospective studies, using the same type of equipment. The CEM mean glandular dose (MGD) was computed for low energy (LE) and high energy (HE) images and their sum was calculated for each view. MGD and related parameters (entrance dose, breast thickness, compression, and density) were compared between the two centers using the Mann−Whitney test. Finally, per-patient MGD was calculated by pooling the two datasets and determining the contribution of LE and HE images. A total of 348 CEM examinations were analyzed (228 from Center 1 and 120 from Center 2). The median total MGD per view was 2.33 mGy (interquartile range 2.19−2.51 mGy) at Center 1 and 2.46 mGy (interquartile range 2.32−2.70 mGy) at Center 2, with a 0.15 mGy median difference (p < 0.001) equal to 6.2%. LE-images contributed between 64% and 77% to the total patient dose in CEM, with the remaining 23−36% being associated with HE images. The mean radiation dose for a two-view bilateral CEM exam was 4.90 mGy, about 30% higher than for digital mammography.
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Cozzi A, Schiaffino S, Fanizza M, Magni V, Menicagli L, Monaco CG, Benedek A, Spinelli D, Di Leo G, Di Giulio G, Sardanelli F. Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study. Eur Radiol 2022; 32:7388-7399. [PMID: 35648209 PMCID: PMC9668944 DOI: 10.1007/s00330-022-08868-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the potential of contrast-enhanced mammography (CEM) for reducing the biopsy rate of screening recalls. METHODS Recalled women were prospectively enrolled to undergo CEM alongside standard assessment (SA) through additional views, tomosynthesis, and/or ultrasound. Exclusion criteria were symptoms, implants, allergy to contrast agents, renal failure, and pregnancy. SA and CEM were independently evaluated by one of six radiologists, who recommended biopsy or 2-year follow-up. Biopsy rates according to SA or recombined CEM (rCEM) were compared with the McNemar's test. Diagnostic performance was calculated considering lesions with available final histopathology. RESULTS Between January 2019 and July 2021, 220 women were enrolled, 207 of them (median age 56.6 years) with 225 suspicious findings analysed. Three of 207 patients (1.4%) developed mild self-limiting adverse reactions to iodinated contrast agent. Overall, 135/225 findings were referred for biopsy, 90/225 by both SA and rCEM, 41/225 by SA alone and 4/225 by rCEM alone (2/4 being one DCIS and one invasive carcinoma). The rCEM biopsy rate (94/225, 41.8%, 95% CI 35.5-48.3%) was 16.4% lower (p < 0.001) than the SA biopsy rate (131/225, 58.2%, 95% CI 51.7-64.5%). Considering the 124/135 biopsies with final histopathology (44 benign, 80 malignant), rCEM showed a 93.8% sensitivity (95% CI 86.2-97.3%) and a 65.9% specificity (95% CI 51.1-78.1%), all 5 false negatives being ductal carcinoma in situ detectable as suspicious calcifications on low-energy images. CONCLUSIONS Compared to SA, the rCEM-based work-up would have avoided biopsy for 37/225 (16.4%) suspicious findings. Including low-energy images in interpretation provided optimal overall CEM sensitivity. KEY POINTS • The work-up of suspicious findings detected at mammographic breast cancer screening still leads to a high rate of unnecessary biopsies, involving between 2 and 6% of screened women. • In 207 recalled women with 225 suspicious findings, recombined images of contrast-enhanced mammography (CEM) showed a 93.8% sensitivity and a 65.9% specificity, all 5 false negatives being ductal carcinoma in situ detectable on low-energy images as suspicious calcifications. • CEM could represent an easily available one-stop shop option for the morphofunctional assessment of screening recalls, potentially reducing the biopsy rate by 16.4%.
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Affiliation(s)
- Andrea Cozzi
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Simone Schiaffino
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Marianna Fanizza
- grid.419425.f0000 0004 1760 3027Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Veronica Magni
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Laura Menicagli
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Cristian Giuseppe Monaco
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Adrienn Benedek
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Diana Spinelli
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Giovanni Di Leo
- grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Giuseppe Di Giulio
- grid.419425.f0000 0004 1760 3027Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Francesco Sardanelli
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy ,grid.419557.b0000 0004 1766 7370Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
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