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Bruce MK, Joseph WJ, Grunwaldt L, Nguyen VT, De La Cruz C. Transgender Mastectomy: Incidence of High-Risk Pathologic Findings and the Need for Postoperative Cancer Surveillance. Ann Plast Surg 2022; 88:S148-S151. [PMID: 35513312 DOI: 10.1097/sap.0000000000003175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and postsurgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery. METHODS Medical records were reviewed from all FtM patients undergoing gender-affirming chest reconstructive surgery from January 2010 to February 2021 by 3 plastic surgeons at the University of Pittsburgh Medical Center. Relative risk of malignant progression was used to stratify pathologic data. Subsequent management of atypical, in situ, and invasive pathology were recorded. RESULTS A total of 318 patients were included in this study; the average age at surgery was 24.6 ± 8.1 years. Eighty-six patients (27%) had a family history of breast and/or ovarian cancer. Overall, 21 patients (6.6%) had some increased risk of breast cancer: 17 (5.3%) had proliferative lesions, mean age 38.2 ± 12.4 years; 2 had atypical ductal hyperplasia, ages 33.4 and 38.3 years; and 2 had invasive ductal carcinoma, ages 35.4 and 40.6 years. CONCLUSIONS In this study, we found that 6.6% of FtM transgender patients undergoing top surgery had an elevated risk of breast cancer, with 1.2% of patients having a greater than 2 times risk of breast cancer. These results highlight the importance of appropriate preoperative screening as well as pathological analysis of surgical specimens to help guide clinical care. The authors advocate for a thorough breast cancer risk assessment before surgery for all patients, as well as using pathologic findings to guide postoperative cancer screening and follow-up.
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Affiliation(s)
- Madeleine K Bruce
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Walter J Joseph
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | | | - Vu T Nguyen
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Carolyn De La Cruz
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
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Lo Gullo R, Vincenti K, Rossi Saccarelli C, Gibbs P, Fox MJ, Daimiel I, Martinez DF, Jochelson MS, Morris EA, Reiner JS, Pinker K. Diagnostic value of radiomics and machine learning with dynamic contrast-enhanced magnetic resonance imaging for patients with atypical ductal hyperplasia in predicting malignant upgrade. Breast Cancer Res Treat 2021; 187:535-545. [PMID: 33471237 PMCID: PMC8190021 DOI: 10.1007/s10549-020-06074-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 02/03/2023]
Abstract
Purpose To investigate whether radiomics features extracted from magnetic resonance imaging (MRI) of patients with biopsy-proven atypical ductal hyperplasia (ADH) coupled with machine learning can differentiate high-risk lesions that will upgrade to malignancy at surgery from those that will not, and to determine if qualitatively and semi-quantitatively assessed imaging features, clinical factors, and image-guided biopsy technical factors are associated with upgrade rate. Methods This retrospective study included 127 patients with 139 breast lesions yielding ADH at biopsy who were assessed with multiparametric MRI prior to biopsy. Two radiologists assessed all lesions independently and with a third reader in consensus according to the BI-RADS lexicon. Univariate analysis and multivariate modeling were performed to identify significant radiomic features to be included in a machine learning model to discriminate between lesions that upgraded to malignancy on surgery from those that did not. Results Of 139 lesions, 28 were upgraded to malignancy at surgery, while 111 were not upgraded. Diagnostic accuracy was 53.6%, specificity 79.2%, and sensitivity 15.3% for the model developed from pre-contrast features, and 60.7%, 86%, and 22.8% for the model developed from delta radiomics datasets. No significant associations were found between any radiologist-assessed lesion parameters and upgrade status. There was a significant correlation between the number of specimens sampled during biopsy and upgrade status (p = 0.003). Conclusion Radiomics analysis coupled with machine learning did not predict upgrade status of ADH. The only significant result from this analysis is between the number of specimens sampled during biopsy procedure and upgrade status at surgery.
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Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Kerri Vincenti
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Peter Gibbs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Michael J Fox
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, Mortimer B. Zuckerman Research Center, 417 E 68th Street, New York, NY, 10065, USA
| | - Isaac Daimiel
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Jeffrey S Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Abstract
BACKGROUND Reduction mammoplasty is indicated for symptomatic macromastia or breast asymmetry after contralateral cancer surgery. Previous studies compared the incidence of high-risk lesions in resection specimens between these 2 groups. However, no studies have compared incidental findings in breast reduction specimens based on relative risk of cancer. Our study stratifies lesions by relative risk of malignant progression and compares the frequency of these findings in bilateral versus unilateral reduction mammoplasties. METHODS Charts were reviewed from 422 patients undergoing breast reductions by a single surgeon over a 10-year period. Age, procedure, specimen weight, and histologic findings were recorded. Pathologic data were stratified by relative risk of malignant progression and compared between patients with and without cancer histories. RESULTS Three hundred five patients underwent bilateral reduction mammoplasty and 117 patients underwent unilateral reduction mammoplasty over the 10-year period. Bilateral patients had a higher incidence of benign lesions (P = 0.02). Both groups had similar incidences of proliferative lesions (P = 0.48). Unilateral patients had a higher incidence of atypia (P = 0.05) and carcinoma in situ (P < 0.01). One unilateral patient had an incidentally found invasive carcinoma. CONCLUSIONS Patients undergoing unilateral reduction after oncologic resection have a higher incidence of high-risk lesions compared with those undergoing bilateral reductions for macromastia. Although others have compared incidental findings between these cohorts, no group has compared these incidental findings stratified by risk. Our data underscore the importance of pathologic analysis of reduction specimens for early detection of high-risk lesions and will prove valuable for preoperative counseling before reduction mammoplasty for either of these indications.
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Falomo E, Adejumo C, Carson KA, Harvey S, Mullen L, Myers K. Variability in the Management Recommendations Given for High-risk Breast Lesions Detected on Image-guided Core Needle Biopsy at U.S. Academic Institutions. Curr Probl Diagn Radiol 2019; 48:462-466. [DOI: 10.1067/j.cpradiol.2018.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
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Kim EY, Youn I, Lee KH, Yun JS, Park YL, Park CH, Moon J, Choi SH, Choi YJ, Ham SY, Kook SH. Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer. J Breast Cancer 2018; 21:453-462. [PMID: 30607168 PMCID: PMC6310721 DOI: 10.4048/jbc.2018.21.e62] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer. Methods This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings. Results Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782). Conclusion CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Moon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon Hyeong Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Boateng S, Tirada N, Khorjekar G, Richards S, Ioffe O. Excision or Observation: The Dilemma of Managing High-Risk Breast Lesions. Curr Probl Diagn Radiol 2018; 49:124-132. [PMID: 30616911 DOI: 10.1067/j.cpradiol.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
Abstract
There is an enduring dilemma on the appropriate management of high-risk breast lesions; is surgical excision always warranted or can conservative management be utilized? We present cases of high-risk breast lesions diagnosed at core needle biopsy at our institution along with relevant factors to consider for appropriate management. We conclude that a nuanced approach is warranted over the broad stroke approach of surgical excision of all high-risk breast lesions.
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Affiliation(s)
- Sheila Boateng
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nikki Tirada
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Gauri Khorjekar
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Stephanie Richards
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Olga Ioffe
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
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Buist DSM, Abraham L, Lee CI, Lee JM, Lehman C, O'Meara ES, Stout NK, Henderson LM, Hill D, Wernli KJ, Haas JS, Tosteson ANA, Kerlikowske K, Onega T. Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer. JAMA Intern Med 2018; 178:458-468. [PMID: 29435556 PMCID: PMC5876894 DOI: 10.1001/jamainternmed.2017.8549] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC). OBJECTIVE To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013. EXPOSURES A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days). MAIN OUTCOMES AND MEASURES Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC. RESULTS We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk. CONCLUSIONS AND RELEVANCE Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.
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Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
| | | | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Deirdre Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jennifer S Haas
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice, Department of Medicine, and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Tracy Onega
- Department of Biomedical Data Science, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Kuhl CK, Keulers A, Strobel K, Schneider H, Gaisa N, Schrading S. Not all false positive diagnoses are equal: On the prognostic implications of false-positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening. Breast Cancer Res 2018; 20:13. [PMID: 29426360 PMCID: PMC5807753 DOI: 10.1186/s13058-018-0937-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/17/2018] [Indexed: 12/23/2022] Open
Abstract
Background Breast magnetic resonance imaging (MRI) has been reported to frequently result in false-positive diagnoses, limiting its positive predictive value (PPV). However, for PPV calculation, all nonmalignant tissue changes are equally considered false-positive, although the respective prognostic importance, and thus patient management implications, of different pathologies may well differ. We investigated the pathology of false-positive diagnoses made by MRI compared with radiographic (digital mammography/tomosynthesis [DM/DBT]) screening. Methods We conducted an institutional review board-approved prospective analysis of 710 consecutive asymptomatic women at average risk for breast cancer who underwent vacuum biopsy with or without surgical biopsy for screen-detected DM/DBT (n = 344) or MRI (n = 366) findings. We compared the frequency of false-positive biopsies (given by PPV3), as well as the types of nonmalignant tissue changes that caused the respective false-positive biopsies. In an order of increasing relative risk of subsequent breast cancer, pathologies of false-positive biopsies were categorized as nonproliferative, simple proliferative, complex proliferative, or atypical proliferative (including lobular carcinoma in situ/lobular intraepithelial neoplasia). The Mann-Whitney U test was used to compare distributions. Results Histology yielded nonmalignant tissue in 202 of 366 biopsies done for positive MRI studies and 195 of 344 biopsies for positive DM/DBT studies, respectively, yielding a similar PPV3 percentages of 44.8% (164 of 202) and 43.3% (149 of 202) for both methods. However, the distribution of tissue types that caused false-positive diagnoses differed significantly (p < 0.0001). On the basis of MRI, high-risk atypical proliferative changes (40.1%; 81 of 202) were most common, followed by complex proliferative changes (23.8%; 48 of 202). In DM/DBT, low-risk, nonproliferative changes were the dominant reason for false-positive diagnoses (49.7%; 97 of 195), followed by simple proliferative changes (25.2%; 51 of 195). Low-risk nonproliferative changes resulted in false-positive diagnoses based on MRI as infrequently as did high-risk atypical proliferative changes based on DM/DBT (18.8% [38 of 202] vs. 18.0% [35 of 195]). The likelihood of a false-positive diagnosis including atypias was twice as high in women undergoing biopsy for MRI findings (81 of 202; 40%) as for those with DM/DBT findings (35 of 195; 18%). Conclusions The prognostic importance, and thus the clinical implications, of false-positive diagnoses made on the basis of breast MRI vs. radiographic screening differed significantly, with a reversed prevalence of high- and low-risk lesions. This should be taken into account when discussing the rate of false-positive diagnoses (i.e., PPV levels of MRI vs. radiographic screening). Current benchmarks that rate the utility of breast cancer screening programs (i.e., cancer detection rates and PPVs) do not reflect these substantial biological differences and the different prognostic implications.
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Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Annika Keulers
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Hannah Schneider
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadine Gaisa
- Department of Pathology, Hospital of the University of Aachen, RWTH, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
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Cheeney S, Rahbar H, Dontchos BN, Javid SH, Rendi MH, Partridge SC. Apparent diffusion coefficient values may help predict which MRI-detected high-risk breast lesions will upgrade at surgical excision. J Magn Reson Imaging 2017; 46:1028-1036. [PMID: 28181343 DOI: 10.1002/jmri.25656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate whether diffusion-weighted imaging (DWI) features could assist in determining which high-risk lesions identified on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and diagnosed on core needle biopsy (CNB) will upgrade to malignancy on surgical excision. MATERIALS AND METHODS This Institutional Review Board (IRB)-approved prospective study included participants with MRI-detected Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions with high-risk pathology on CNB who underwent surgical excision. Twenty-three high-risk lesions detected on 3T breast MRI in 20 women (average age = 54 ± 9 years) were evaluated, of which six lesions (26%) upgraded to malignancy at surgery. DCE, DWI characteristics, and clinical factors were compared between high-risk lesions that upgraded to malignancy on surgical excision and those that did not. Logistic regression modeling was performed to identify features that optimally predicted upgrade to malignancy, with performance described using area under the receiver operating characteristic curve (AUC). RESULTS High-risk lesions that upgraded on excision demonstrated lower apparent diffusion coefficient (ADC) than those that did not (median, 1.08 × 10-3 mm2 /s vs.1.39 × 10-3 mm2 /s, P = 0.046), and a trend of greater maximum lesion size (median, 24 mm vs. 8 mm, P = 0.053). There were no significant differences in lesion type (mass vs. nonmass enhancement, P = 1.0) or kinetic features (P = 0.78 for peak initial enhancement; P = 1.0 for worst curve type) among the high-risk cohorts. A model incorporating maximum lesion size and ADC provided optimal performance to predict upgrade to malignancy (AUC = 0.89). CONCLUSION ADC and maximum lesion size on MRI show promise for predicting which MRI-detected high-risk lesions will upgrade to malignancy at surgical excision. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1028-1036.
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Affiliation(s)
- Safia Cheeney
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Brian N Dontchos
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sara H Javid
- Department of Surgical Oncology, University of Washington, Seattle, Washington, USA
| | - Mara H Rendi
- Department of Pathology, University of Washington, Seattle, Washington, USA
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Weigert JM. The Connecticut Experiment; The Third Installment: 4 Years of Screening Women with Dense Breasts with Bilateral Ultrasound. Breast J 2016; 23:34-39. [PMID: 27647744 DOI: 10.1111/tbj.12678] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To determine if the addition of breast ultrasound in women with dense breasts finds cancers that otherwise would have been obscured. Retrospective chart review from five sites from October 2009 through December 2013. Data included: number of screening mammograms; number of screening ultrasounds; Breast Imaging Reporting Data System code results; biopsy results including type of lesion, size, nuclear grade, receptor and node status, and patient demographic data. Year 1, 2,706 ultrasound with 151 biopsies yielded 11 cancers, positive predictive value (PPV) 7.3%. Detection rate of 4.0/1,000. Year 2, 3,351 ultrasounds with 180 biopsies yielded 11 cancers and high risk lesions (HRL), PPV 6.1%. Detection rate 3.3/1,000. Year 3, 4,128 ultrasounds with 148 biopsies yielded 13 cancers and HRL, PPV 8.8%. Detection rate 3.1/1,000. Year 4, 3,331 ultrasounds with 53 biopsies yielded 11 cancers and HRL, PPV of 20.1%. Detection rate of 3.3/1,000. Lesion size ranged 0.3-8.0 cm. Patient age 45-77 years. Three tumors nuclear grade 3 and 1 nuclear grade 2 had positive sentinel nodes. 8 patents had risk factors other than dense breasts. Cancers in patients with prior negative screening ultrasound measured 0.4-1.2 cm and were node negative. Breast ultrasound in women with dense breasts detects mammographically occult malignancy. Over 4 years, the PPV doubled indicating increased accuracy of lesions biopsied while rate of detection remained stable. Lesions were of all cancer types, grade and hormonal status. Only high grade cancers were sentinel node positive and women returning for yearly ultrasound had small lesions with no positive sentinel nodes.
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Affiliation(s)
- Jean M. Weigert
- Radiology; The Hospitals of Central Connecticut; New Britain Connecticut
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11
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Weigert J, Steenbergen S. The connecticut experiments second year: ultrasound in the screening of women with dense breasts. Breast J 2015; 21:175-80. [PMID: 25683369 DOI: 10.1111/tbj.12386] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine if the addition of screening breast ultrasound in women with mammographically normal but dense breasts improves breast cancer detection. The study utilized a retrospective chart review. Data collected included: (a) total number of screening mammograms; (b) total number of dense breast screening ultrasounds; (c) screening ultrasound Breast Imaging Reporting Data System (BI-RADS) code results; (d) biopsy results; and (e) demographic data on women with malignant biopsies. Data were obtained from sites throughout Connecticut from November 1, 2010 to October 31, 2011. Data from 5 Connecticut radiology practices covering 10 sites were collected. Sites conducted a total of 57,417 screening mammograms and 10,282 dense breast screening ultrasounds. Of the screening ultrasounds, 87% (8,972/10,282) were BI-RADS 1 or 2, 9% (875/10,282) were BI-RADS 3, 4% (435/10,282) were BI-RADS 4 or 5, and 39 were found to have a cancer or high-risk lesion on biopsy. This correlates to 3.8 cancers or high-risk lesions per 1,000 women screened. If high-risk lesions are excluded, there are 24 cases of biopsy proven malignancy corresponding to 2.3 cancers per 1,000 women screened. In this study, screening breast ultrasound in women with mammographically normal but dense breasts demonstrated a positive predictive value of 9% (39/435) and specificity of 96% (8,972/9,368). Based on the data collected from sites throughout Connecticut, screening breast ultrasound in women with dense breast parenchyma detects mammographically occult malignancy and high-risk lesions. The results are especially significant given recent studies suggesting that breast density is an independent risk factor for breast cancer and that mammography is less effective in detecting cancer in dense breasts. The improved specificity and sensitivity between the 1st and 2nd years' suggests there is a learning curve that may continue to improve the results.
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Affiliation(s)
- Jean Weigert
- Mandell and Blau MD's PC; New Britain Connecticut
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Diagnosis and management of high-risk breast lesions: Aristotle's dilemma. AJR Am J Roentgenol 2012; 198:246-8. [PMID: 22268164 DOI: 10.2214/ajr.11.7269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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What information do public organizations provide to Belgian women on primary prevention of breast cancer? Eur J Cancer Prev 2009; 19:68-70. [PMID: 19955905 DOI: 10.1097/cej.0b013e32830c8dba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Women need to be adequately informed about risk factors and risk reduction strategies for breast cancer to seek optimal primary prevention care. The aim of this study was to determine the amount and content of written information published by Belgian health services and related to primary prevention of breast cancer. We collected all available French language brochures and leaflets related to breast cancer primary prevention and analyzed which risk factors and risk reduction strategies were mentioned. Risk factors and prevention strategies were seldom mentioned. Among the 21 selected leaflets, pertinent to the patient, alcohol was mentioned in eight leaflets; age and genetic predisposition in five; overweight/obesity, personal history of breast cancer, and exercise in four; hormonal treatment in three; family history in two; earlier high-risk benign lesions in one, and ethnicity, breast density, and earlier chest radiation therapy in none. Lifestyle modifications were described in nine, but not one mentioned chemoprevention and risk reduction surgeries. As breast cancer risk reduction now represents an achievable medical objective for women, available written information to women must be improved to help them make an informed choice regarding risk reduction strategies.
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