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Bernini M, Spolveri F, Tofani L, De Benedetto D, Bicchierai G, Bellini C, Morrone D, Nori Cucchiari J, Bianchi S, Livi L, Orzalesi L, Meattini I. B3 Breast Lesions: Positive Predictive Value and Follow-Up on a Large Single-Institution Series. J Surg Res 2024; 299:366-373. [PMID: 38815523 DOI: 10.1016/j.jss.2024.04.057] [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: 05/09/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Lesions of uncertain malignant potential (B3) represent 10% of core needle biopsies (CNBs) or vacuum-assisted breast biopsies (VABBs). Traditionally, B3 lesions are operated on. This study investigated the association between B3 subtypes and malignancy to determine the best management. METHODS Pre- and postoperative histological reports from 226 patients, who had undergone excisional surgery for B3 lesions, following CNB or VABB, were retrospectively analyzed. The correlation between the CNB/VABB diagnosis and the final pathology was investigated, along with the correlation between malignancy upgrade and the type of mammographic lesion. The positive predictive value (PPV) of malignancy of B3 lesions was calculated by simple logistic regression. Patients without cancer diagnosis underwent a 7-y follow-up. RESULTS Pathology showed 171 (75.6%) benign and 55 (24.3%) malignant lesions. The PPV was 24.3% (P = 0.043), including 31 (13.7%) ductal carcinomas in situ and 24 (10.6%) invasive carcinomas. The most frequently upgraded lesions were atypical ductal hyperplasia, 34.2% (P = 0.004), followed by lobular intraepithelial neoplasia, 27.5% (P = 0.025). The median diameter of mammographic lesions was 1.5 [0.9-2.5] cm, while for surgical specimens, it was 5 [4-7] cm (P < 0.0001). Mammographic findings and histology showed a significant correlation (P = 0.038). After a 7-y follow-up, 15 (8.9%) patients developed carcinoma, and 7 patients (4%) developed a new B3 lesion. CONCLUSIONS We can conclude that atypical ductal hyperplasia and lobular intraepithelial neoplasia still require surgery for a significant PPV. Other types that lacked significance or confidence intervals were too wide to draw any conclusion.
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Affiliation(s)
- Marco Bernini
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Federico Spolveri
- Breast Surgery Division, Breast Unit, San Jacopo Hospital, Pistoia, Italy.
| | - Lorenzo Tofani
- Department of Statistic, Computer Science, Applications, University of Florence, Florence, Italy
| | | | - Giulia Bicchierai
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Bellini
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Doralba Morrone
- Diagnostic Senology Unit, Villa Donatello Clinic, Florence, Italy
| | | | - Simonetta Bianchi
- Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Division, Breast Unit, Oncology Department, Careggi University Hospital, Florence, 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] [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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3
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Endrikat J, Khater H, Boreham ADP, Fritze S, Schwenke C, Bhatti A, Trnkova ZJ, Seidensticker P. Iopromide for Contrast-Enhanced Mammography: A Systemic Review and Meta-Analysis of Pertinent Literature. Breast Cancer (Auckl) 2023; 17:11782234231189467. [PMID: 37600467 PMCID: PMC10433886 DOI: 10.1177/11782234231189467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Background Contrast-enhanced mammography (CEM) is an emerging breast imaging modality. Clinical data is scarce. Objectives To summarize clinical evidence on the use of iopromide in CEM for the detection or by systematically analyzing the available literature on efficacy and safety. Design Systematic review and meta-analysis. Data sources and methods Iopromide-specific publications reporting its use in CEM were identified by a systematic search within Bayer's Product Literature Information (PLI) database and by levering a recent review publication. The literature search in PLI was performed up to January 2023. The confirmatory-supporting review publication was based on a MEDLINE/EMBASE + full text search for publications issued between September 2003 and January 2019. Relevant literature was selected based on pre-defined criteria by 2 reviewers. The comparison of CEM vs traditional mammography (XRM) was performed on published results of sensitivity and specificity. Differences in diagnostic parameters were assessed within a meta-analysis. Results Literature search: A total of 31 studies were identified reporting data on 5194 patients. Thereof, 19 studies on efficacy and 3 studies on safety. Efficacy: in 11 studies comparing iopromide CEM vs XRM, sensitivity was up to 43% higher (range 1%-43%) for CEM. Differences in specificity were found to be in a range of -4% to 46% for CEM compared with XRM. The overall gain in sensitivity for CEM vs XRM was 7% (95% CI [4%, 11%]) with no statistically significant loss in specificity in any study assessed. In most studies, accuracy, positive predictive value, and negative predictive value were found to be in favor of CEM. In 2 studies comparing CEM with breast magnetic resonance imaging (bMRI), both imaging modalities performed either equally well or CEM tended to show better results with respect to sensitivity and specificity. Safety: eight cases of iopromide-related adverse drug reactions were reported in 1022 patients (0.8%). Conclusions Pertinent literature provides evidence for clinical utility of iopromide in CEM for the detection or confirmation of breast cancer. The overall gain in sensitivity for iopromide CEM vs XRM was 7% with no statistically significant loss in specificity.
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Affiliation(s)
- Jan Endrikat
- Radiology R&D, Bayer AG, Berlin, Germany
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | | | | | - Sabine Fritze
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Product Information, Bayer AG, Berlin, Germany
| | | | - Aasia Bhatti
- Benefit Risk Management Pharmacovigilance, Bayer US LLC, Whippany, NJ, USA
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4
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Pienaar WE, Taylor DB, Wylie E. Radial scar appearances on contrast-enhanced mammography. J Med Imaging Radiat Oncol 2023; 67:514-518. [PMID: 37401164 DOI: 10.1111/1754-9485.13554] [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: 01/15/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
With modern technological advances in imaging, radial scars are more frequently encountered in clinical practice. The management of radial scars remains challenging due to associated upgrade to malignancy at excision. Contrast-enhanced mammography (CEM) has a similar sensitivity compared to MRI in addition to lower cost, better availability and fewer contra-indications. CEM is reported to have an overall excellent negative predictive value for malignancy. In this study, imaging of 55 patients with a core biopsy diagnosis of radial scar since the introduction of CEM into local practice was reviewed. Nine patients underwent CEM as part of their diagnostic work-up and these appearances are presented as a pictorial essay to demonstrate enhancement patterns of radial scars on CEM in this cohort and consider how this knowledge may influence management.
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Affiliation(s)
- Wilmi Elizabeth Pienaar
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- BreastScreen WA, Perth, Western Australia, Australia
| | - Donna Blanche Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- BreastScreen WA, Perth, Western Australia, Australia
- Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Wylie
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
- BreastScreen WA, Perth, Western Australia, Australia
- Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
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5
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Tari DU, Pinto F. Mammography in Breast Disease Screening and Diagnosis. J Pers Med 2023; 13:jpm13020228. [PMID: 36836462 PMCID: PMC9958847 DOI: 10.3390/jpm13020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
Female breasts can suffer from a wide spectrum of pathologies, ranging from inflammatory diseases to benign and malignant tumors [...].
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Affiliation(s)
- Daniele Ugo Tari
- Department of Diagnostic Senology, District 12, Palazzo della Salute, Caserta LHA, 81100 Caserta, Italy
- Correspondence:
| | - Fabio Pinto
- Department of Radiology, “A. Guerriero” Hospital, Caserta LHA, 81025 Marcianise, Italy
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Girardi V, Guaragni M, Ruzzenenti N, Palmieri F, Fogazzi G, Cozzi A, Lucchini D, Buffoli A, Schiaffino S, Sardanelli F. B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies. Cancers (Basel) 2021; 13:5443. [PMID: 34771606 PMCID: PMC8582448 DOI: 10.3390/cancers13215443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8-4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1-2.1%) than B3b lesions (4.7%, 95% CI 2.9-7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1-232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.
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Affiliation(s)
- Veronica Girardi
- Breast Radiology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Monica Guaragni
- Breast Pathology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy; (M.G.); (N.R.)
| | - Nella Ruzzenenti
- Breast Pathology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy; (M.G.); (N.R.)
| | - Fabrizio Palmieri
- Breast Surgery, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Gianluca Fogazzi
- Breast Medical Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy;
| | - Diana Lucchini
- Breast Psycho-Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Alberto Buffoli
- Radiation Oncology, EUSOMA-Certified Breast Unit, Istituto Clinico Sant’Anna, Via del Franzone 31, 25127 Brescia, Italy;
| | - Simone Schiaffino
- 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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7
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Bicchierai G, Amato F, Vanzi B, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cirone D, Cozzi D, Miele V, Nori J. Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)? Breast 2020; 54:15-24. [PMID: 32889303 PMCID: PMC7479440 DOI: 10.1016/j.breast.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm. The variables associated with an increased risk of no enhancement were unifocal disease extension, non-classifiable molecular subtype, DCIS histotype, lesion dimensions <10 mm, index lesion represented by microcalcifications. A greater probability of showing enhancement entailed the presence of an invasive ductal component, index lesion represented by ultrasound mass, Luminal B HER2 negative molecular subtype, lesion dimensions ≥10 mm, multifocal disease extension.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Bianca Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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8
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Bicchierai G, Tonelli P, Piacenti A, De Benedetto D, Boeri C, Vanzi E, Bianchi S, Cirone D, Kaur Gill M, Miele V, Nori J. Evaluation of contrast‐enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: Large‐scale single‐center experience. Breast J 2020; 26:1276-1283. [DOI: 10.1111/tbj.13766] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/04/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Paolina Tonelli
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Alba Piacenti
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy University of Florence Florence Italy
| | - Donatello Cirone
- General Management Staff Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Maninderpal Kaur Gill
- Department of Biomedical Imaging Kuala Lumpur General Hospital Kuala Lumpur Malaysia
| | - Vittorio Miele
- Emergency Radiology Department Azienda Ospedaliero‐Universitaria Careggi Florence Florence Italy
| | - Jacopo Nori
- Diagnostic Senology Unit Azienda Ospedaliero‐Universitaria Careggi Florence Italy
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9
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Amato F, Bicchierai G, Cirone D, Depretto C, Di Naro F, Vanzi E, Scaperrotta G, Bartolotta TV, Miele V, Nori J. Preoperative loco-regional staging of invasive lobular carcinoma with contrast-enhanced digital mammography (CEDM). Radiol Med 2019; 124:1229-1237. [PMID: 31773458 DOI: 10.1007/s11547-019-01116-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
The aim of our study was to assess the performance of contrast-enhanced digital mammography (CEDM) in the preoperative loco-regional staging of invasive lobular carcinoma (ILC) patients, about the valuation of the extension of disease and in measurement of lesions. Then, we selected retrospectively, among the 1500 patients underwent to CEDM at the Breast Diagnostics Department of the Careggi University Hospital of Florence and the National Cancer Institute of Milan from September 2016 to November 2018, 31 women (mean age 57.1 aa; range 41-78 aa) with a definitive histological diagnosis of ILC. CEDM has proved to be a promising imaging technique, being characterized by a sensitivity of 100% in the detection of the index lesion, and of 84.2% in identifying any adjunctive lesions: It was the presence of a non-mass enhancement (NME) to lower the sensitivity of the technique (25% vs. 100% for mass-like enhancements or a mass closely associated with a NME). Specificity in the characterization of additional lesions was 66.7%, and the diagnosis of the extension of disease was correct in 77.4% of cases: NME also led to a decrease in diagnostic accuracy in the evaluation of disease extension up to 40% versus 85% for masses and 80% for masses associated with NME (M/NME). Moreover, in 12/31 (38.7%), CEDM allowed to correctly identify lesions not shown by mammography + ultrasonography + tomosynthesis: In the half of these (6/12), there was a multicentricity, thus allowing an adequate surgical planning change. CEDM was also very accurate in analyzing the maximum diameter of the masses, while it was much less reliable in the case of the M/NME and pure NME. In conclusion, CEDM is a new promising imaging technique in the loco-regional preoperative staging and in the evaluation of disease extension for ILC, especially in case of mass enhancement lesions.
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Affiliation(s)
- Francesco Amato
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Catherine Depretto
- Breast Imaging Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | | | | | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
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10
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Schiaffino S, Calabrese M, Melani EF, Trimboli RM, Cozzi A, Carbonaro LA, Di Leo G, Sardanelli F. Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia: Systematic Review and Meta-Analysis of 6458 Lesions. Radiology 2019; 294:76-86. [PMID: 31660803 DOI: 10.1148/radiol.2019190748] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised lesions and 5% (95% CI: 4%, 8%) for lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete lesion removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete lesion removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.
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Affiliation(s)
- Simone Schiaffino
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Massimo Calabrese
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Enrico Francesco Melani
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Rubina Manuela Trimboli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Andrea Cozzi
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Luca Alessandro Carbonaro
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Giovanni Di Leo
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
| | - Francesco Sardanelli
- From the Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., L.A.C., G.D.L., F.S.); Unit of Radiology, IRCCS Policlinico San Martino, Genoa, Italy (M.C.); Unit of Radiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.F.M.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy (R.M.T., A.C., F.S.)
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Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
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Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- 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, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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