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Sauer ST, Christner SA, Schlaiß T, Metz C, Schmid A, Kunz AS, Pabst T, Weiland E, Benkert T, Bley TA, Grunz JP. Diffusion-weighted Breast MRI at 3 Tesla: Improved Lesion Visibility and Image Quality with a Combination of Water-excitation and Spectral Fat Saturation. Acad Radiol 2023; 30:1773-1783. [PMID: 36764882 DOI: 10.1016/j.acra.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
RATIONALE AND OBJECTIVES In breast MRI with diffusion-weighted imaging (DWI), fat suppression is essential for eliminating the dominant lipid signal. This investigation evaluates a combined water-excitation-spectral-fatsat method (WEXfs) versus standard spectral attenuated inversion recovery (SPAIR) in high-resolution 3-Tesla breast MRI. MATERIALS AND METHODS Multiparametric breast MRI with 2 echo-planar DWI sequences was performed in 83 patients (50.1 ± 12.6 years) employing either WEXfs or SPAIR for fat signal suppression. Three radiologists assessed overall DWI quality and delineability of 88 focal lesions (28 malignant, 60 benign) on images with b values of 800 and 1600 s/mm2, as well as apparent diffusion coefficient (ADC) maps. For each fat suppression method and b value, the longest lesion diameter was determined in addition to measuring the signal intensity in DWI and ADC value in standardized regions of interest. RESULTS Regardless of b values, image quality (all p < 0.001) and lesion delineability (all p ≤ 0.003) with WEXfs-DWI were deemed superior compared to SPAIR-DWI in benign and malignant lesions. Irrespective of lesion characterization, WEXfs-DWI provided superior signal-to-noise, contrast-to-noise and signal-intensity ratios with 1600 s/mm2 (all p ≤ 0.05). The lesion size difference between contrast-enhanced T1 subtraction images and DWI was smaller for WEXfs compared to SPAIR fat suppression (all p ≤ 0.007). The mean ADC value in malignant lesions was lower for WEXfs-DWI (p < 0.001), while no significant ADC difference was ascertained between both techniques in benign lesions (p = 0.947). CONCLUSION WEXfs-DWI provides better subjective and objective image quality than standard SPAIR-DWI, resulting in a more accurate estimation of benign and malignant lesion size.
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Affiliation(s)
- Stephanie Tina Sauer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Sara Aniki Christner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Tanja Schlaiß
- Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Corona Metz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Radiology, Berlin, Germany
| | - Andrea Schmid
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Radiology, Berlin, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Thomas Pabst
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Elisabeth Weiland
- MRI Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thomas Benkert
- MRI Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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Ageeli W, Soha N, Zhang X, Szewcyk-Bieda M, Wilson J, Li C, Nabi G. Preoperative imaging accuracy in size determination of prostate cancer in men undergoing radical prostatectomy for clinically localised disease. Insights Imaging 2023; 14:105. [PMID: 37286770 DOI: 10.1186/s13244-023-01450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/06/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES To compare the accuracy of pre-surgical prostate size measurements using mpMRI and USWE with imaging-based 3D-printed patient-specific whole-mount moulds facilitated histopathology, and to assess whether size assessment varies between clinically significant and non-significant cancerous lesions including their locations in different zones of the prostate. METHODS The study population included 202 men with clinically localised prostate cancer opting for radical surgery derived from two prospective studies. Protocol-based imaging data was used for measurement of size of prostate cancer in clinically localised disease using MRI (N = 106; USWE (N = 96). Forty-eight men overlapped between two studies and formed the validation cohort. The primary outcome of this study was to assess the accuracy of pre-surgical prostate cancerous size measurements using mpMRI and USWE with imaging-based 3D-printed patient-specific whole-mount moulds facilitated histopathology as a reference standard. Independent-samples T-tests were used for the continuous variables and a nonparametric Mann-Whitney U test for independent samples was applied to examine the distribution and median differences between mpMRI and USWE groups. RESULTS A significant number of men had underestimation of prostate cancer using both mpMRI (82.1%; 87/106) and USWE (64.6%; 62/96). On average, tumour size was underestimated by a median size of 7 mm in mpMRI, and 1 mm in USWE. There were 327 cancerous lesions (153 with mpMRI and 174 for USWE). mpMRI and USWE underestimated the majority of cancerous lesions (108/153; 70.6%) and (88/174; 50.6%), respectively. Validation cohort data confirmed these findings MRI had a nearly 20% higher underestimation rate than USWE (χ2 (1, N = 327) = 13.580, p = 0.001); especially in the mid and apical level of the gland. Clinically non-significant cancers were underestimated in significantly higher numbers in comparison to clinically significant cancers. CONCLUSIONS Size measurement of prostate cancers on preoperative imaging utilising maximum linear extent technique, underestimated the extent of cancer. Further research is needed to confirm our observations using different sequences, methods and approaches for cancer size measurement.
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Affiliation(s)
- Wael Ageeli
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
- Diagnostic Radiology Department, College of Applied Medical Sciences, Jazan University, Al Maarefah Rd, P.O. Box 114, Jazan, 45142, Saudi Arabia
| | - Nabi Soha
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Xinyu Zhang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
| | | | - Jennifer Wilson
- Department of Pathology, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Chunhui Li
- School of Science and Engineering, University of Dundee, Dundee, DD1 4HN, UK
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
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Impact of preoperative magnetic resonance imaging on surgery and eligibility for intraoperative radiotherapy in early breast cancer. PLoS One 2022; 17:e0274385. [PMID: 36256643 PMCID: PMC9578617 DOI: 10.1371/journal.pone.0274385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
We looked at the usefulness of magnetic resonance imaging (MRI) in decision-making and surgical management of patients selected for intraoperative radiotherapy (IORT). We also compared lesion size measurements in different modalities (ultrasound (US), mammogram (MMG), MRI) against pathological size as the gold standard. 63 patients eligible for IORT based on clinical and imaging criteria over a 34-month period were enrolled. All had MMG and US, while 42 had additional preoperative MRI for locoregional preoperative staging. Imaging findings and pathological size concordances were analysed across the three modalities. MRI changed the surgical management of 5 patients (11.9%) whereby breast-conserving surgery (BCS) and IORT was cancelled due to detection of satellite lesion, tumor size exceeding 30mm and detection of axillary nodal metastases. Ten of 42 patients (23.8%) who underwent preoperative MRI were subjected to additional external beam radiotherapy (EBRT); 7 due to lymphovascular invasion (LVI), 2 due to involved margins, and 1 due to axillary lymph node metastatic carcinoma detected in the surgical specimen. Five of 21 (23.8%) patients without prior MRI were subjected to additional EBRT post-surgery; 3 had LVI and 2 had involved margins. The rest underwent BCS and IORT as planned. MRI and MMG show better imaging-pathological size correlation. Significant increase in the mean 'waiting time' were seen in the MRI group (34.1 days) compared to the conventional imaging group (24.4 days). MRI is a useful adjunct to conventional imaging and impacts decision making in IORT. It is also the best imaging modality to determine the actual tumour size.
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Maimone S, Morozov AP, Li Z, Craver EC, Elder EA, McLaughlin SA. Additional Workups Recommended During Preoperative Breast MRI: Methods to Gain Efficiency and Limit Confusion. Ann Surg Oncol 2022; 29:3839-3848. [PMID: 35258769 DOI: 10.1245/s10434-022-11476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/28/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preoperative breast MRI is indicated for staging but can lead to complex imaging workups. This study reviewed imaging recommendations made on preoperative MRI exams, to simplify management approaches for patients with newly diagnosed breast cancer. METHODS This retrospective single-institution review was restricted to women with breast cancer who underwent staging MRI. Additional breast lesions, separate from index tumors, recommended for additional workup or surveillance were assessed to see which were detected and which characteristics predicted success in detection. Univariate mixed-effects logistic modeling predicted the likelihood of finding lesions using MRI-directed ultrasound (US), with odds ratios reported. Tests were two-sided, with a p value lower than 0.05 considered significant. RESULTS In this study, 534 (39.6%) patients had recommendations for additional workup after preoperative MRI. MRI detected additional malignancy in 178 patients (33.3%). Half of the 66 patients who refused an additional workup and opted for mastectomy had additional malignancies at mastectomy. MRI-directed US was 14 times more likely to detect masses than nonmass enhancement (NME) (p < 0.001). NME was detected on US in only 16% of cases, with one third of subsequent biopsy results considered discordant. Probably benign assessments were given to 35 patients, with 23% not returning for follow-up evaluation and 7% returning at least 6 months later than recommended. CONCLUSION Use of preoperative breast MRI has increased. Although it can add value, institutions should establish indications and expectations to prevent unnecessary workups. Limiting MRI-directed US to masses, avoiding probably benign assessments, and consulting with patients after MRI but prior to workups can prevent unnecessary exams and confusion.
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Affiliation(s)
- Santo Maimone
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Andrey P Morozov
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Zhuo Li
- Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Emily C Craver
- Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Erin A Elder
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.,Department of Surgery, Ochsner Medical Center, New Orleans, LA, USA
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Evaluation of Breast Cancer Size Measurement by Computer-Aided Diagnosis (CAD) and a Radiologist on Breast MRI. J Clin Med 2022; 11:jcm11051172. [PMID: 35268263 PMCID: PMC8911102 DOI: 10.3390/jcm11051172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: This study aimed to evaluate cancer size measurement by computer-aided diagnosis (CAD) and radiologist on breast magnetic resonance imaging (MRI) relative to histopathology and to determine clinicopathologic and MRI factors that may affect measurements. Methods: Preoperative MRI of 208 breast cancers taken between January 2017 and March 2021 were included. We evaluated correlation between CAD-generated size and pathologic size as well as that between radiologist-measured size and pathologic size. We classified size discrepancies into accurate and inaccurate groups. For both CAD and radiologist, clinicopathologic and imaging factors were compared between accurate and inaccurate groups. Results: The mean sizes as predicted by CAD, radiologist and pathology were 2.66 ± 1.68 cm, 2.54 ± 1.68 cm, and 2.30 ± 1.61 cm, with significant difference (p < 0.001). Correlation coefficients of cancer size measurement by radiologist and CAD in reference to pathology were 0.898 and 0.823. Radiologist’s measurement was more accurate than CAD, with statistical significance (p < 0.001). CAD-generated measurement was significantly more inaccurate for cancers of larger pathologic size (>2 cm), in the presence of an extensive intraductal component (EIC), with positive progesterone receptor (PR), and of non-mass enhancement (p = 0.045, 0.045, 0.03 and 0.002). Radiologist-measured size was significantly more inaccurate for cancers in presence of an in situ component, EIC, positive human epidermal growth factor receptor 2 (HER2), and non-mass enhancement (p = 0.017, 0.008, 0.003 and <0.001). Conclusion: Breast cancer size measurement showed a very strong correlation between CAD and pathology and radiologist and pathology. Radiologist-measured size was significantly more accurate than CAD size. Cancer size measurement by CAD and radiologist can both be inaccurate for cancers with EIC or non-mass enhancement.
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Does preoperative MRI accurately stratify early-stage HER2 + breast cancer patients to upfront surgery vs neoadjuvant chemotherapy? Breast Cancer Res Treat 2021; 189:307-315. [PMID: 34263366 DOI: 10.1007/s10549-021-06331-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE HER2 +- amplified breast cancer patients derive benefit from treatment with anti-HER2-targeted therapy. Though adjuvant treatment is based on final pathology, decisions regarding neoadjuvant chemotherapy are made in the preoperative setting with imaging playing a key role in staging. We examined the accuracy of pre-operative imaging in determining pathological tumor size (pT) in patients undergoing upfront surgery. METHODS Early (cT1-T2N0) HER2 + breast cancer patients who underwent upfront surgery between 2015 and 2016 were identified from a prospective institutional database. We compared data for both clinical and final pathologic stage. Only those who underwent magnetic resonance imaging (MRI), mammography, and ultrasound in the preoperative setting were included in the analysis. Adjuvant treatment regimens were reviewed. RESULTS We identified 87 cT1-2N0 patients with invasive HER2 + breast cancer who underwent upfront surgery. Median age was 52 years (IQR 43, 58) and median tumor size was 1.1 cm (IQR 0.5, 1.6). Fifteen patients (17%) were upstaged to stage II/III based on final pathology. Thirty-seven patients were T1cN0 on final pathology; 8 were cT1a-bN0 preop and 12 had pT overestimated by MRI by an average of 1.5 cm (> 0.5-1.5 cm). Compared to both mammography and MRI, the imaging modality most predictive of pT was ultrasound (p = 0.000072 ultrasound vs mammography and 0.000042 ultrasound vs MRI). CONCLUSION For small HER2 + cN0 tumors undergoing upfront surgery, ultrasound was the imaging modality most predictive of pT. MRI overestimated tumor size in approximately 40% of patients. MRI may not accurately discriminate low-volume tumor burden in the breast and carries the potential of overtreatment in the upfront setting.
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Cozzi A, Buragina G, Spinelli D, Schiaffino S, Zanardo M, Di Leo G, Carbonaro LA, Sardanelli F. Accuracy and inter-reader agreement of breast MRI for cancer staging using 0.08 mmol/kg of gadobutrol. Clin Imaging 2020; 72:154-161. [PMID: 33249403 DOI: 10.1016/j.clinimag.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence on gadolinium brain accumulation after contrast-enhanced MRI prompted research in dose reduction. PURPOSE To estimate accuracy and inter-reader reproducibility of tumor size measurement in breast MRI using 0.08 mmol/kg of gadobutrol. METHODS We retrospectively analyzed all women who underwent 1.5-T breast MRI for cancer staging at our department with 0.08 mmol/kg of gadobutrol. Two readers (R1 and R2, 12 and 3 years-experience) measured the largest lesion diameter. Accuracy was estimated both as correlation with pathology and rate of absolute (>5 mm) overestimation and underestimation, inter-reader reproducibility using the Bland-Altman method. Data are given as median and interquartile range. RESULTS Thirty-six patients were analyzed (median age 56 years, 49-66) for a total of 38 lesions, 24 (63%) mass enhancement, 14 (37%) non-mass enhancement. Histopathological median size (mm) of all lesions was 15 (9-25): 13 (9-19) for mass lesions, 19 (11-39) for non-mass lesions. On MRI, R1 measured (mm) 14 (10-22) for all lesions, 13 (10-19) for mass lesions, 19 (11-49) for non-mass lesions. MRI-pathology correlation was very high for all lesion categories (ρ ≥ 0.766). On MRI, R1 overestimated lesion size in 6 cases (16%), and underestimated in 3 (8%); R2, overestimated 7 cases (18%) and underestimated 3 cases (8%). At inter-reader reproducibility analysis (mm): bias 0.9, coefficient of reproducibility 13 for all lesions; -0.1 and 6 for mass lesions; 2.5 and 20 for non-mass lesions. CONCLUSIONS Breast MRI may be performed using 0.08 mmol/kg of gadobutrol with high accuracy and acceptable inter-reader agreement.
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Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Giuseppe Buragina
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Diana Spinelli
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
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Ko KH, Jung HK, Park AY, Koh JE, Jang H, Kim Y. Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer. Medicine (Baltimore) 2020; 99:e23023. [PMID: 33126387 PMCID: PMC7598781 DOI: 10.1097/md.0000000000023023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ± 6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ± 6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.
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Geng Z, Zhang Y, Wang S, Li H, Zhang C, Yin S, Xie C, Dai Y. Radiomics Analysis of Susceptibility Weighted Imaging for Hepatocellular Carcinoma: Exploring the Correlation between Histopathology and Radiomics Features. Magn Reson Med Sci 2020; 20:253-263. [PMID: 32788505 PMCID: PMC8424030 DOI: 10.2463/mrms.mp.2020-0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: No previous researches have extracted radiomics features from susceptibility weighted imaging (SWI) for biomedical applications. This research aimed to explore the correlation between histopathology of hepatocellular carcinoma (HCC) and radiomics features extracted from SWI. Methods: A total of 53 patients were ultimately enrolled into this retrospective study with MR examinations undertaken at a 3T scanner. About 107 radiomics features were extracted from SWI images of each patient. Then, the Spearman correlation test was performed to evaluate the correlation between the SWI-derived radiomics features and histopathologic indexes including histopathologic grade, microvascular invasion (MVI) as well as the expression status of cytokeratin 7 (CK-7), cytokeratin 19 (CK-19) and Glypican-3 (GPC-3). With SWI-derived radiomics features utilized as independent variables, four logistic regression-based diagnostic models were established for diagnosing patients with positive CK-7, CK-19, GPC-3 and high histopathologic grade, respectively. Then, receiver operating characteristic analysis was performed to evaluate the diagnostic performance. Results: A total of 11, 32, 18 and one SWI-derived radiomics features were significantly correlated with histopathologic grade, the expression of CK-7, the expression of CK-19 and the expression of GPC-3 (P < 0.05), respectively. None of the SWI-derived radiomics features was correlated with MVI status. The areas under the curve were 0.905, 0.837, 0.800 and 0.760 for diagnosing patients with positive CK-19, positive CK-7, high histopathologic grade and positive GPC-3. Conclusion: Extracting the radiomics features from SWI images was feasible to evaluate multiple histopathologic indexes of HCC.
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Affiliation(s)
- Zhijun Geng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare
| | - Shutong Wang
- Department of Hepatic Surgery, First Affiliated Hospital of Sun Yat-sen University
| | - Hui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Cheng Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Shaohan Yin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiology, Sun Yat-sen University Cancer Center
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare
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Sezgın G, Apaydın M, Etıt D, Atahan MK. Tumor size estimation of the breast cancer molecular subtypes using imaging techniques. Med Pharm Rep 2020; 93:253-259. [PMID: 32832890 PMCID: PMC7418834 DOI: 10.15386/mpr-1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/01/2020] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aim In medical practice the classification of breast cancer is most commonly based on the molecular subtypes, in order to predict the disease prognosis, avoid over-treatment, and provide individualized cancer management. Tumor size is a major determiner of treatment planning, acting on the decision-making process, whether to perform breast surgery or administer neoadjuvant chemotherapy. Imaging methods play a key role in determining the tumor size in breast cancers at the time of the diagnosis. We aimed to compare the radiologically determined tumor sizes with the corresponding pathologically determined tumor sizes of breast cancer at the time of the diagnosis, in correlation with the molecular subtypes. Methods Ninety-one patients with primary invasive breast cancer were evaluated. The main molecular subtypes were luminal A, luminal B, HER-2 positive, and triple-negative. The Bland-Altman plot was used for presenting the limits of agreement between the radiologically and the pathologically determined tumor sizes by the molecular subtypes. Results A significantly proportional underestimation was found for the luminal A subtype, especially for large tumors. The p-values for the magnetic resonance imaging, mammography, and ultrasonography were 0.020, 0.030, and <0.001, respectively. No statistically significant differences were observed among the radiologic modalities in determining the tumor size in the remaining molecular subtypes (p>0.05). Conclusion The radiologically determined tumor size was significantly smaller than the pathologically determined tumor size in the luminal A subtype of breast cancers when measured with all three imaging modalities. The differences were more prominent with ultrasonography and mammography. The underestimation rate increases as the tumor gets larger.
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Affiliation(s)
- Gulten Sezgın
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Melda Apaydın
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Demet Etıt
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
| | - Murat Kemal Atahan
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey
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Sanderink WBG, Caballo M, Strobbe LJA, Bult P, Vreuls W, Venderink DJ, Sechopoulos I, Karssemeijer N, Mann RM. Reliability of MRI tumor size measurements for minimal invasive treatment selection in small breast cancers. Eur J Surg Oncol 2020; 46:1463-1470. [PMID: 32536526 DOI: 10.1016/j.ejso.2020.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/06/2020] [Accepted: 04/19/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Due to the shift towards minimal invasive treatment, accurate tumor size estimation is essential for small breast cancers. The purpose of this study was to determine the reliability of MRI-based tumor size measurements with respect to clinical, histological and radiomics characteristics in small invasive or in situ carcinomas of the breast to select patients for minimal invasive therapy. MATERIALS AND METHODS All consecutive cases of cT1 invasive breast carcinomas that underwent pre-operative MRI, treated in two hospitals between 2005 and 2016, were identified retrospectively from the Dutch cancer registry and cross-correlated with local databases. Concordance between MRI-based measurements and final pathological size was analyzed. The influence of clinical, histological and radiomics characteristics on the accuracy of MRI size measurements were analyzed. RESULTS Analysis included 343 cT1 breast carcinomas in 336 patients (mean age, 55 years; range, 25-81 years). Overall correlation of MRI measurements with pathology was moderately strong (ρ = 0.530, P < 0.001), in 42 cases (12.2%) MRI underestimated the size with more than 5 mm. Underestimation occurs more often in grade 2 and grade 3 disease than in low grade invasive cancers. In DCIS the frequency of underestimation is higher than in invasive breast cancer. Unfortunately, none of the patient, imaging or biopsy characteristics appeared predictive for underestimation. CONCLUSION Size measurements of small breast cancers on breast MRI are within 5 mm of pathological size in 88% of patients. Nevertheless, underestimation cannot be adequately predicted, particularly for grade 2 and grade 3 tumors, which may hinder patient selection for minimal invasive therapy.
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Affiliation(s)
- W B G Sanderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M Caballo
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - P Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - D J Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - I Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
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Jiang Z, Yin J. Performance evaluation of texture analysis based on kinetic parametric maps from breast DCE-MRI in classifying benign from malignant lesions. J Surg Oncol 2020; 121:1181-1190. [PMID: 32167588 DOI: 10.1002/jso.25901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the performance of texture analysis based on enhancement kinetic parametric maps derived from breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in discriminating benign from malignant tumors. METHODS A total of 192 cases confirmed by histopathology were retrospectively selected from our Picture Archiving and Communication System, including 93 benign and 99 malignant tumors. Lesion areas were delineated semi-automatically, and six kinetic parametric maps reflecting the perfusion information were generated, namely the maximum slope of increase (MSI), slope of signal intensity (SIslope ), initial percentage of peak enhancement (Einitial ), percentage of peak enhancement (Epeak ), early signal enhancement ratio (ESER), and second enhancement percentage (SEP) maps. A total of 286 texture features were extracted from those quantitative parametric maps. The Student t test or Mann-Whitney U test was used to select features that were statistically significantly different between the benign and malignant groups. A support vector machine was employed with a leave-one-out cross-validation method to establish the classification model. Classification performance was evaluated according to the receiver operating characteristic (ROC) theory. RESULTS The areas under ROC curves (AUCs) indicating the diagnostic performance were 0.925 for MSI, 0.854 for SIslope , 0.756 for Einitial , 0.923 for Epeak , 0.871 for ESER and 0.881 for SEP. Significant differences in AUCs were found between Einitial vs MSI, Einitial vs Epeak and Einitial vs SEP (P < .05). There were no significant differences in other pairwise comparisons. CONCLUSION Texture analysis of the kinetic parametric maps derived from breast DCE-MRI can contribute to the discrimination between malignant and benign lesions. It can be considered as a supplementary tool for breast diagnosis.
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Affiliation(s)
- Zejun Jiang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiandong Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Romeo V, Picariello V, Pignata A, Mancusi V, Stanzione A, Cuocolo R, Di Crescenzo R, Accurso A, Staibano S, Imbriaco M. Influence of different post-contrast time points on dynamic contrast-enhanced (DCE) MRI T staging in breast cancer. Eur J Radiol 2020; 124:108819. [PMID: 31958631 DOI: 10.1016/j.ejrad.2020.108819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE to assess whether MRI T stage of breast cancer lesions (BCLs) is affected by maximum diameter (MD) measured at different post-contrast time points (TPs) on different acquisition planes on dynamic contrast-enhanced (DCE) MRI sequence. METHODS 53 DCE-MRI examinations of patients with BCLs were retrospectively selected. MD of BCLs was measured on axial, coronal and sagittal planes on DCE images at five different post-contrast TPs. Friedman test followed by Bonferroni-adjusted Wilcoxon-signed rank test for post-hoc analysis was performed to evaluate differences among the five measurements. Reliability of the measurements was evaluated with the intraclass correlation coefficient analysis. Differences between pathological and MRI T stage assessed at each TP on each acquisition plane were assessed using the Wilcoxon-sign rank test; p values <0.05 were considered statistically significant. RESULTS on axial, coronal and sagittal planes, MD measured at TP1 was significantly different (p < 0.0001) compared to those obtained at the subsequent TPs. No significant differences were found between MD measured at TPs 3, 4 and 5. Intra and inter-observer reliability resulted as very good, with ICC ranging between 0.915-0.992 and 0.845-0.911, respectively. MRI T stage assessed at TP1 on axial and sagittal plane as well as at all TPs on coronal plane was significantly different from pathological T stage. CONCLUSION MRI T stage definition of BCLs is significantly affected by the TP used for lesions' MD measurement. TPs 3, 4 and 5 are the preferred TPs for the assessment of MRI T stage of BCLs on both axial and sagittal planes.
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Affiliation(s)
- Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Valentina Picariello
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Alma Pignata
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Valeria Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Rosa Di Crescenzo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Antonello Accurso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
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Agreement between dynamic contrast-enhanced magnetic resonance imaging and pathologic tumour size of breast cancer and analysis of the correlation with BI-RADS descriptors. Pol J Radiol 2019; 84:e616-e624. [PMID: 32082460 PMCID: PMC7016361 DOI: 10.5114/pjr.2019.92285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to evaluate magnetic resonance imaging (MRI)-pathology concordance of tumour size in patients with invasive breast carcinoma, with an emphasis on Breast Imaging Reporting and Data System (BI-RADS) descriptors of dynamic contrast-enhanced MRI (DCE-MRI). Material and methods Of patients who had preoperative DCE-MRI, 94 were enrolled. Concordance between MRI and the pathological findings was defined as a difference in tumour size of 5 mm or less. The greatest dimension was measured by two radiologists, and BI-RADS descriptives were described in accordance. The gold standard was chosen as the pathologic assessment. Results Tumour measurements determined by MRI and the pathological reports were not statistically different (2.64 ± 1.16 cm, Wilcaxon Z = –1.853, p = 0.064). Tumour sizes were concordant in 72/94 patients (76.6%). The mean difference between the pathological and MRI tumour sizes was –0.1 cm. MRI overestimated the size of 17/94 tumours (18.1%) and underestimated the size of 5/94 tumours (5.3%). Discordance was associated with larger tumour size. Histologic and molecular type of tumours, patient age, histologic grade, lymphovascular invasion or perineural invasion positivity, fibroglandular volume, background parenchymal enhancement, and being mass or non-mass were not associated with concordance. Irregular margin and heterogenous enhancement in DCE-MRI were associated with discordance in logistic regression analysis (p = 0.035, OR: 4.24; p = 0.021, OR: 4.96). Conclusions Two BI-RADS descriptors of irregular contour and heterogeneous contrast uptake were found to be associated with tumour size discrepancy. This might be attributed to the dynamic and morphologic specialities of tumours primarily rather than tumour biology.
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Bae SJ, Ahn SG, Yoon CI, Yang BS, Lee HW, Son EJ, Jeong J. Measuring Tumor Extent Based on Subtypes Using Magnetic Resonance Imaging: Radiologic-Pathologic Discordance and High Positive Margin Rates in Breast Cancer. J Breast Cancer 2019; 22:453-463. [PMID: 31598344 PMCID: PMC6769395 DOI: 10.4048/jbc.2019.22.e36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/10/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose We evaluated the clinical value of breast magnetic resonance imaging (MRI) in patients who underwent breast-conserving surgery (BCS). The degree of correlation between pathology size and MRI or ultrasonography (US) size was compared based on breast cancer subtypes. In addition, we investigated the positive margin rates. Methods Patients with invasive breast cancer who underwent preoperative breast MRI and US between 2011 and 2016 were included in the study. Lin's concordance correlation coefficient was used to measure the correlation between MRI or US andpathologic tumor extent. Tumor extent was defined as pathologic tumor size, including in situ carcinoma. Margin positivity was assessed based on frozen-section examination. Results A total of 516 patients with a single tumor who underwent BCS were included in the study. The correlation between pathologic size and MRI was significantly higher than that of US (r = 0.6975 vs. 0.6211, p = 0.001). The superiority of MRI over US in measuring the pathologic extent was only observed in triple-negative breast cancer (TNBC; r = 0.8089 vs. 0.6014, p < 0.001). The agreement between MRI or US and tumor extent was low for the human epidermal growth factor receptor 2 (HER2)-positive subtype (MRI: 0.5243, US: 0.4898). Moreover, the positive margin rate was higher in the HER2-positive subtype than in the others (luminal/HER2-negative: 11.6%, HER2-positive: 23.2%, TNBC: 17.8%, p = 0.019). The post hoc analysis showed that the HER2-positive subtype was more likely to show positive margins than the luminal/HER2-negative subtype (p = 0.007). Conclusion Breast MRI was superior to US in the preoperative assessment of the pathologic extent of tumor size; this was most evident in TNBC. For HER2-positive tumors, imaging-pathologic discordance resulted in higher positive margin rates than that with other subtypes.
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Affiliation(s)
- Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ik Yoon
- Department of Surgery, St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Ban Seok Yang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Hamza A, Khawar S, Sakhi R, Alrajjal A, Miller S, Ibrar W, Edens J, Salehi S, Ockner D. Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 27:45-54. [PMID: 30774698 DOI: 10.1177/1742271x18804278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022]
Abstract
Background Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is. Materials and methods The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm. Results The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired t-test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, p = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) (p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) (p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors (p = 0.02). Conclusion Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.
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Affiliation(s)
- Ameer Hamza
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Sidrah Khawar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Ramen Sakhi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | | | - Shelby Miller
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Warda Ibrar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Jacob Edens
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Sajad Salehi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Daniel Ockner
- St. John Hospital and Medical Center, Detroit, MI, USA
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