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Michel A, Ro V, McGuinness JE, Mutasa S, Terry MB, Tehranifar P, May B, Ha R, Crew KD. Breast cancer risk prediction combining a convolutional neural network-based mammographic evaluation with clinical factors. Breast Cancer Res Treat 2023:10.1007/s10549-023-06966-4. [PMID: 37209183 DOI: 10.1007/s10549-023-06966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Deep learning techniques, including convolutional neural networks (CNN), have the potential to improve breast cancer risk prediction compared to traditional risk models. We assessed whether combining a CNN-based mammographic evaluation with clinical factors in the Breast Cancer Surveillance Consortium (BCSC) model improved risk prediction. METHODS We conducted a retrospective cohort study among 23,467 women, age 35-74, undergoing screening mammography (2014-2018). We extracted electronic health record (EHR) data on risk factors. We identified 121 women who subsequently developed invasive breast cancer at least 1 year after the baseline mammogram. Mammograms were analyzed with a pixel-wise mammographic evaluation using CNN architecture. We used logistic regression models with breast cancer incidence as the outcome and predictors including clinical factors only (BCSC model) or combined with CNN risk score (hybrid model). We compared model prediction performance via area under the receiver operating characteristics curves (AUCs). RESULTS Mean age was 55.9 years (SD, 9.5) with 9.3% non-Hispanic Black and 36% Hispanic. Our hybrid model did not significantly improve risk prediction compared to the BCSC model (AUC of 0.654 vs 0.624, respectively, p = 0.063). In subgroup analyses, the hybrid model outperformed the BCSC model among non-Hispanic Blacks (AUC 0.845 vs. 0.589; p = 0.026) and Hispanics (AUC 0.650 vs 0.595; p = 0.049). CONCLUSION We aimed to develop an efficient breast cancer risk assessment method using CNN risk score and clinical factors from the EHR. With future validation in a larger cohort, our CNN model combined with clinical factors may help predict breast cancer risk in a cohort of racially/ethnically diverse women undergoing screening.
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Affiliation(s)
- Alissa Michel
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Hematology-Oncology, 177 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Vicky Ro
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Julia E McGuinness
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Simukayi Mutasa
- Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Parisa Tehranifar
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Benjamin May
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Richard Ha
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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2
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Masala G, Bendinelli B, Caini S, Duroni G, Ermini I, Pastore E, Fontana M, Facchini L, Querci A, Gilio MA, Mazzalupo V, Assedi M, Ambrogetti D, Palli D. Lifetime changes in body fatness and breast density in postmenopausal women: the FEDRA study. Breast Cancer Res 2023; 25:35. [PMID: 37004102 PMCID: PMC10067176 DOI: 10.1186/s13058-023-01624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND High mammographic breast density (MBD) is an established risk factor for breast cancer (BC). Body fatness conveys an increased BC risk in postmenopause but is associated with less dense breasts. Here, we studied the relationship between body fatness and breast composition within the FEDRA (Florence-EPIC Digital mammographic density and breast cancer Risk Assessment) longitudinal study. METHODS Repeated anthropometric data and MBD parameters (obtained through an automated software on BC screening digital mammograms) were available for all participants, as well as information on other BC risk factors. Multivariate linear regression and functional data analysis were used to longitudinally evaluate the association of body fatness, and changes thereof over time, with dense (DV) and non-dense (NDV) breast volumes and volumetric percent density (VPD). RESULTS A total of 5,262 women were included, with anthropometric data available at 20 and 40 years of age, at EPIC baseline (mean 49.0 years), and an average of 9.4 years thereafter. The mean number of mammograms per woman was 3.3 (SD 1.6). Body fatness (and increases thereof) at any age was positively associated with DV and NDV (the association being consistently stronger for the latter), and inversely associated with VPD. For instance, an increase by 1 kg/year between the age of 40 years and EPIC baseline was significantly associated with 1.97% higher DV, 8.85% higher NDV, and 5.82% lower VPD. CONCLUSION Body fatness and its increase from young adulthood until midlife are inversely associated with volumetric percent density, but positively associated with dense and non-dense breast volumes in postmenopausal women.
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Affiliation(s)
- Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Benedetta Bendinelli
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy.
| | - Giacomo Duroni
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ilaria Ermini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Miriam Fontana
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Luigi Facchini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Andrea Querci
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Maria Antonietta Gilio
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Vincenzo Mazzalupo
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Melania Assedi
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
| | - Daniela Ambrogetti
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo Il Veccio 2, 50139, Florence, Italy
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3
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Oiwa M, Suda N, Morita T, Takahashi Y, Sato Y, Hayashi T, Kato A, Nishimura R, Ichihara S, Endo T. Validity of computed mean compressed fibroglandular tissue thickness and breast composition for stratification of masking risk in Japanese women. Breast Cancer 2023:10.1007/s12282-023-01444-7. [PMID: 36920730 DOI: 10.1007/s12282-023-01444-7] [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: 09/25/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The volumetric measurement system for mammographic breast density is a high-precision objective method for evaluating the percentage of fibroglandular tissue volume (FG%). Nonetheless, FG% does not precisely correlate with subjective visual estimation (SVE) and shows poor evaluation performance regarding masking risk in patients with comparatively thin compressed breast thickness (CBT), commonly found in Japanese women. We considered that the mean compressed fibroglandular tissue thickness (mCGT), which incorporates the CBT element into the evaluation of breast density, may better predict masking risk. METHODS Volumetric measurements and SVEs were performed on mammograms of 108 breast cancer patients from our center. mCGT was calculated as the product of CBT and FG%. SVE was classified using the Breast Imaging-Reporting and Data System classification, 5th edition. Subsequently, the performance of mCGT, SVE, and FG% in predicting masking risk was estimated using the AUC. RESULTS The AUC values of mCGT and SVE were 0.84 (95% confidence interval, 0.71-0.92) and 0.78 (0.66-0.86), respectively (P = 0.16). The AUC of the FG% was 0.65 (0.52-0.77), which was significantly lower than that of mCGT (P < 0.001). The sensitivity and specificity of mCGT in predicting negative detection were 89% and 71%, respectively; of SVE 83% and 61% (versus 72% and 57% with FG%), suggesting that mCGT was superior to FG% in both sensitivity and specificity, and comparable with SVE. CONCLUSIONS Objective mCGT calculated from the volumetric measurement system will highly likely be useful in evaluating breast density and supporting visual assessment for masking risk stratification.
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Affiliation(s)
- Mikinao Oiwa
- Department of Radiology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
| | - Namiko Suda
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Takako Morita
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Yuko Takahashi
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Yasuyuki Sato
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Takako Hayashi
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Aya Kato
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Rieko Nishimura
- Department of Advanced Diagnosis, National Hospital Organization Division of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Shu Ichihara
- Department of Advanced Diagnosis, National Hospital Organization Division of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Tokiko Endo
- Department of Radiology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
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4
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Lloyd R, Pirikahu S, Walter J, Cadby G, Darcey E, Perera D, Hickey M, Saunders C, Karnowski K, Sampson DD, Shepherd J, Lilge L, Stone J. Alternative methods to measure breast density in younger women. Br J Cancer 2023; 128:1701-1709. [PMID: 36828870 PMCID: PMC10133329 DOI: 10.1038/s41416-023-02201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Breast density is a strong and potentially modifiable breast cancer risk factor. Almost everything we know about breast density has been derived from mammography, and therefore, very little is known about breast density in younger women aged <40. This study examines the acceptability and performance of two alternative breast density measures, Optical Breast Spectroscopy (OBS) and Dual X-ray Absorptiometry (DXA), in women aged 18-40. METHODS Breast tissue composition (percent water, collagen, and lipid content) was measured in 539 women aged 18-40 using OBS. For a subset of 169 women, breast density was also measured via DXA (percent fibroglandular dense volume (%FGV), absolute dense volume (FGV), and non-dense volume (NFGV)). Acceptability of the measurement procedures was assessed using an adapted validated questionnaire. Performance was assessed by examining the correlation and agreement between the measures and their associations with known determinants of mammographic breast density. RESULTS Over 93% of participants deemed OBS and DXA to be acceptable. The correlation between OBS-%water + collagen and %FGV was 0.48. Age and BMI were inversely associated with OBS-%water + collagen and %FGV and positively associated with OBS-%lipid and NFGV. CONCLUSIONS OBS and DXA provide acceptable and viable alternative methods to measure breast density in younger women aged 18-40 years.
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Affiliation(s)
- Rachel Lloyd
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Sarah Pirikahu
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Jane Walter
- University Health Network, Toronto, ON, Canada
| | - Gemma Cadby
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ellie Darcey
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dilukshi Perera
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
| | - Christobel Saunders
- Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Karol Karnowski
- Optical and Biomedical Engineering Laboratory School of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth, WA, Australia
| | - David D Sampson
- Surry Biophotonics, Advanced Technology Institute and School of Biosciences and Medicine, The University of Surrey, Guildford, Surrey, UK
| | - John Shepherd
- Epidemiology and Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Lothar Lilge
- University Health Network, Toronto, ON, Canada.,Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stone
- Genetic Epidemiology Group, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
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5
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Singh N, Joshi P, Singh DK, Narayan S, Gupta A. Volumetric breast density evaluation using fully automated Volpara software, its comparison with BIRADS density types and correlation with the risk of malignancy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00796-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mammography is currently the modality of choice for mass screening of breast cancer, although its sensitivity is low in dense breasts. Besides, higher breast density has been identified as independent risk factor so it has been conceptualized that women with dense breasts should be encouraged for supplemental screening. In this study, we aimed to estimate the distribution of volumetric breast density using fully automated Volpara software and to analyze the level of agreement between volumetric density grades and Breast Imaging Reporting and Data System (BI-RADS) density grades. We also aim to estimate the distribution of breast cancer in different VDG and to find a correlation between VDG and risk of malignancy.
Results
VDG-c was most common followed by VDG-b and BIRADS grade B was commonest followed by grade C. The density distribution was found inversely related to the age. Level of agreement between VDG and BIRADS grades was moderate (κ = 0.5890). Statistically significant correlation was noted between VDG-c and d for risk of malignancy (p < 0.001).
Conclusion
Difficulties associated with the use of BI-RADS density categories may be avoided if assessed using a fully automated volumetric method. High VDG can be considered as independent risk factor for malignancy. Thus, awareness of a woman’s breast density might be useful in determining the frequency and imaging modality for screening.
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6
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Bodewes F, van Asselt A, Dorrius M, Greuter M, de Bock G. Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis. Breast 2022; 66:62-68. [PMID: 36183671 PMCID: PMC9530665 DOI: 10.1016/j.breast.2022.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature. METHODS Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses. RESULTS Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous. CONCLUSIONS Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
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Affiliation(s)
- F.T.H. Bodewes
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - A.A. van Asselt
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - M.D. Dorrius
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - M.J.W. Greuter
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - G.H. de Bock
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands,Corresponding author.
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7
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Yamamuro M, Asai Y, Hashimoto N, Yasuda N, Kimura H, Yamada T, Nemoto M, Kimura Y, Handa H, Yoshida H, Abe K, Tada M, Habe H, Nagaoka T, Nin S, Ishii K, Kondo Y. Utility of U-Net for the objective segmentation of the fibroglandular tissue region on clinical digital mammograms. Biomed Phys Eng Express 2022; 8. [PMID: 35728581 DOI: 10.1088/2057-1976/ac7ada] [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: 02/15/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
This study investigates the equivalence or compatibility between U-Net and visual segmentations of fibroglandular tissue regions by mammography experts for calculating the breast density and mean glandular dose (MGD). A total of 703 mediolateral oblique-view mammograms were used for segmentation. Two region types were set as the ground truth (determined visually): (1) one type included only the region where fibroglandular tissue was identifiable (called the 'dense region'); (2) the other type included the region where the fibroglandular tissue may have existed in the past, provided that apparent adipose-only parts, such as the retromammary space, are excluded (the 'diffuse region'). U-Net was trained to segment the fibroglandular tissue region with an adaptive moment estimation optimiser, five-fold cross-validated with 400 training and 100 validation mammograms, and tested with 203 mammograms. The breast density and MGD were calculated using the van Engeland and Dance formulas, respectively, and compared between U-Net and the ground truth with the Dice similarity coefficient and Bland-Altman analysis. Dice similarity coefficients between U-Net and the ground truth were 0.895 and 0.939 for the dense and diffuse regions, respectively. In the Bland-Altman analysis, no proportional or fixed errors were discovered in either the dense or diffuse region for breast density, whereas a slight proportional error was discovered in both regions for the MGD (the slopes of the regression lines were -0.0299 and -0.0443 for the dense and diffuse regions, respectively). Consequently, the U-Net and ground truth were deemed equivalent (interchangeable) for breast density and compatible (interchangeable following four simple arithmetic operations) for MGD. U-Net-based segmentation of the fibroglandular tissue region was satisfactory for both regions, providing reliable segmentation for breast density and MGD calculations. U-Net will be useful in developing a reliable individualised screening-mammography programme, instead of relying on the visual judgement of mammography experts.
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Affiliation(s)
- Mika Yamamuro
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan.,Graduate School of Health Sciences, Niigata University, 2-746, Asahimachidori, Chuouku, Niigata 951-8518, Japan
| | - Yoshiyuki Asai
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Naomi Hashimoto
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Nao Yasuda
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiorto Kimura
- Radiology Center, Kindai University Hospital, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Takahiro Yamada
- Division of Positron Emission Tomography Institute of Advanced Clinical Medicine, Kindai University, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Mitsutaka Nemoto
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Yuichi Kimura
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Hisashi Handa
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Hisashi Yoshida
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Koji Abe
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Masahiro Tada
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Hitoshi Habe
- Department of Informatics, Kindai University Faculty of Science and Engineering, 3-4-1, Kowakae, Higashi-osaka, Osaka 577-8502, Japan
| | - Takashi Nagaoka
- Department of Computational Systems Biology, Kindai University Faculty of Biology-Oriented Science and Technology, 930, Nishimitani, Kinokawa, Wakayama 649-6433, Japan
| | - Seiun Nin
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ono-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Yohan Kondo
- Graduate School of Health Sciences, Niigata University, 2-746, Asahimachidori, Chuouku, Niigata 951-8518, Japan
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8
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Dontchos BN, Cavallo-Hom K, Lamb LR, Mercaldo SF, Eklund M, Dang P, Lehman CD. Impact of a Deep Learning Model for Predicting Mammographic Breast Density in Routine Clinical Practice. J Am Coll Radiol 2022; 19:1021-1030. [DOI: 10.1016/j.jacr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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9
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Bäcklund M, Eriksson M, Hammarström M, Thoren L, Bergqvist J, Margolin S, Hellgren R, Wengström Y, Gabrielson M, Czene K, Hall P. OUP accepted manuscript. Oncologist 2022; 27:e601-e603. [PMID: 35605013 PMCID: PMC9256030 DOI: 10.1093/oncolo/oyac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 10/25/2021] [Indexed: 11/14/2022] Open
Abstract
Mammographic density change has proven to be a reliable proxy for tamoxifen therapy response. The primary aim of this study was to identify time to tamoxifen-induced mammographic density change. We also analyzed side effects and adherence to therapy. In all, 42 women were randomized to 10 or 20 mg of daily oral tamoxifen. Mammograms were taken at baseline, 3, 6, and 9 months. Mammographic density change was measured using the automated STRATUS tool. Adverse events were monitored through a web-based questionnaire based on the FACT-ES tool. Nine out of the 42 (21%) participants discontinued therapy due to adverse events leaving 33 women in the study. A significant decrease in density was seen after 3 months of therapy. Dose did not seem to affect density change, side effects or adherence. Given the size of the study, additional studies are needed to confirm our data.
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Affiliation(s)
- Magnus Bäcklund
- Corresponding author: Magnus Bäcklund, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-171 77 Stockholm, Sweden. Tel: +46 8 524 823 39; Fax: +46-8 524 823 39;
| | | | - Mattias Hammarström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Linda Thoren
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Breast Centre, Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
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Munir A, Huws AM, Khawaja S, Khan S, Holt S, Sharaiha Y. Automated Breast Volume Assessment Derived From Digital Breast Tomosynthesis Images Compared to Mastectomy Specimen Weight and Its Applications in Cosmetic Optimisation. Cureus 2021; 13:e19642. [PMID: 34926087 PMCID: PMC8673690 DOI: 10.7759/cureus.19642] [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] [Accepted: 11/12/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Estimating the size and volume of the breast preoperatively is an important step in surgical planning for many breast procedures such as immediate implant-based breast reconstructions and reduction mammoplasties. Breast volume estimation helps in appropriate implant selection preoperatively. Objectives: The aim of this study was to objectively evaluate the estimation of breast weight by automatic volumetric breast assessment in digital breast tomosynthesis (DBT) using Quantra™ 2.2 Breast Density Assessment Software (Hologic Inc., Marlborough, Massachusetts, United States).
Methods: Breast specimen weight after mastectomy and volume estimated by Quantra software were recorded. Results: Volume assessment obtained from Quantra software showed a high correlation with actual mastectomy specimen weight, with Pearson’s correlation coefficients of 0.952. Conclusions: The automated DBT-derived breast volume using the Quantra software is a simple and practical method to assess breast size and weight preoperatively.
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Affiliation(s)
- Asma Munir
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Anita M Huws
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Saira Khawaja
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Sohail Khan
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Simon Holt
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
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Hernández A, Miranda DA, Pertuz S. Algorithms and methods for computerized analysis of mammography images in breast cancer risk assessment. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 212:106443. [PMID: 34656014 DOI: 10.1016/j.cmpb.2021.106443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The computerized analysis of mammograms for the development of quantitative biomarkers is a growing field with applications in breast cancer risk assessment. Computerized image analysis offers the possibility of using different methods and algorithms to extract additional information from screening and diagnosis images to aid in the assessment of breast cancer risk. In this work, we review the algorithms and methods for the automated, computerized analysis of mammography images for the task mentioned, and discuss the main challenges that the development and improvement of these methods face today. METHODS We review the recent progress in two main branches of mammography-based risk assessment: parenchymal analysis and breast density estimation, including performance indicators of most of the studies considered. Parenchymal analysis methods are divided into feature-based methods and deep learning-based methods; breast density methods are grouped into area-based, volume-based, and breast categorization methods. Additionally, we identify the challenges that these study fields currently face. RESULTS Parenchymal analysis using deep learning algorithms are on the rise, with some studies showing high-performance indicators, such as an area under the receiver operating characteristic curve of up to 90. Methods for risk assessment using breast density report a wider variety of performance indicators; however, we can also identify that the approaches using deep learning methods yield high performance in each of the subdivisions considered. CONCLUSIONS Both breast density estimation and parenchymal analysis are promising tools for the task of breast cancer risk assessment; deep learning methods have shown performance comparable or superior to the other considered methods. All methods considered face challenges such as the lack of objective comparison between them and the lack of access to datasets from different populations.
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Affiliation(s)
| | | | - Said Pertuz
- Universidad Industrial de Santander, Bucaramanga, Colombia.
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12
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Burnside ES, Warren LM, Myles J, Wilkinson LS, Wallis MG, Patel M, Smith RA, Young KC, Massat NJ, Duffy SW. Quantitative breast density analysis to predict interval and node-positive cancers in pursuit of improved screening protocols: a case-control study. Br J Cancer 2021; 125:884-892. [PMID: 34168297 PMCID: PMC8438060 DOI: 10.1038/s41416-021-01466-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/18/2021] [Accepted: 06/10/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study investigates whether quantitative breast density (BD) serves as an imaging biomarker for more intensive breast cancer screening by predicting interval, and node-positive cancers. METHODS This case-control study of 1204 women aged 47-73 includes 599 cancer cases (302 screen-detected, 297 interval; 239 node-positive, 360 node-negative) and 605 controls. Automated BD software calculated fibroglandular volume (FGV), volumetric breast density (VBD) and density grade (DG). A radiologist assessed BD using a visual analogue scale (VAS) from 0 to 100. Logistic regression and area under the receiver operating characteristic curves (AUC) determined whether BD could predict mode of detection (screen-detected or interval); node-negative cancers; node-positive cancers, and all cancers vs. controls. RESULTS FGV, VBD, VAS, and DG all discriminated interval cancers (all p < 0.01) from controls. Only FGV-quartile discriminated screen-detected cancers (p < 0.01). Based on AUC, FGV discriminated all cancer types better than VBD or VAS. FGV showed a significantly greater discrimination of interval cancers, AUC = 0.65, than of screen-detected cancers, AUC = 0.61 (p < 0.01) as did VBD (0.63 and 0.53, respectively, p < 0.001). CONCLUSION FGV, VBD, VAS and DG discriminate interval cancers from controls, reflecting some masking risk. Only FGV discriminates screen-detected cancers perhaps adding a unique component of breast cancer risk.
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Affiliation(s)
- Elizabeth S Burnside
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, E3/311 Clinical Science Center, Madison, WI, USA.
| | - Lucy M Warren
- National Co-ordinating Centre for the Physics of Mammography (NCCPM), Medical Physics Department, Royal Surrey County Hospital, Guildford, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | | | - Matthew G Wallis
- Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mishal Patel
- Scientific Computing, Medical Physics Department, Royal Surrey County Hospital, Guildford, UK
| | | | - Kenneth C Young
- National Co-ordinating Centre for the Physics of Mammography (NCCPM), Medical Physics Department, Royal Surrey County Hospital, Guildford, UK
| | - Nathalie J Massat
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
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13
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Han Y, Lee CT, Xu S, Mi X, Phillip CR, Salazar AS, Rakhmankulova M, Toriola AT. Medication use and mammographic breast density. Breast Cancer Res Treat 2021; 189:585-592. [PMID: 34196899 DOI: 10.1007/s10549-021-06321-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A dense breast on mammogram is a strong risk factor for breast cancer. Identifying factors that reduce mammographic breast density could thus provide insight into breast cancer prevention. Due to the limited number of studies and conflicting findings, we investigated the associations of medication use (specifically statins, aspirin, and ibuprofen) with mammographic breast density. METHODS We evaluated these associations in 775 women who were recruited during an annual screening mammogram at Washington University School of Medicine, St. Louis. We measured mammographic breast density using Volpara. We used multivariable-adjusted linear regressions to determine the associations of medication use (statins, aspirin, and ibuprofen) with mammographic breast density. Least squared means were generated and back-transformed for easier interpretation. RESULTS The mean age of study participants was 52.9 years. Statin use in the prior 12 months was not associated with volumetric percent density or dense volume, but was positively associated with non-dense volume. The mean volumetric percent density was 8.6% among statin non-users, 7.2% among women who used statins 1-3 days/week, and 7.3% among women who used statins ≥ 4 days/week (p trend = 0.07). The non-dense volume was 1297.1 cm3 among statin non-users, 1368.7 cm3 among women who used statins 1-3 days/week, and 1408.4 cm3 among those who used statins ≥ 4 days/week (p trend = 0.02). We did not observe statistically significant differences in mammographic breast density by aspirin or ibuprofen use. CONCLUSION Statin, aspirin, and ibuprofen use was not associated with volumetric percent density and dense volume, but statin use was positively associated with non-dense volume. Any potential associations of these medications with breast cancer risk are unlikely to be mediated through an effect on volumetric percent density.
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Affiliation(s)
- Yunan Han
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.,Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chee Teik Lee
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA.,School of Medicine, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
| | - Shuai Xu
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Xiaoyue Mi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Courtnie R Phillip
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Ana S Salazar
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Malika Rakhmankulova
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus, Box 8100, St. Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA.
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Huo L, Hu X, Xiao Q, Gu Y, Chu X, Jiang L. Segmentation of whole breast and fibroglandular tissue using nnU-Net in dynamic contrast enhanced MR images. Magn Reson Imaging 2021; 82:31-41. [PMID: 34147598 DOI: 10.1016/j.mri.2021.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Segmentation of the whole breast and fibroglandular tissue (FGT) is important for quantitatively analyzing the breast cancer risk in the dynamic contrast-enhanced magnetic resonance (DCE-MR) images. The purpose of this study is to improve the accuracy and efficiency of the segmentation of the whole breast and FGT in 3-D fat-suppressed DCE-MR images with a versatile deep learning (DL) framework. METHODS We randomly collected 100 breast DCE-MR scans from Shanghai Cancer Hospital of Fudan University. The MR scans in the dataset were different in both the spatial resolution and the MR scanners employed. Furthermore, four breast density categories were assessed by radiologists based on Breast Imaging Reporting and Data System (BI-RADS) of American College of Radiology. The dataset was separated into the training and the testing sets, while keeping a balanced distribution of scans with different imaging parameters and density categories. The nnU-Net has been recently proposed to automatically adapt preprocessing strategies and network architectures for a given medical image dataset, thus showing a great potential in the systematic adaptation of DL methods to different datasets. In this study, we applied the nnU-Net to segment the whole breast and FGT in 3-D fat-suppressed DCE-MR images. Five-fold cross validation was employed to train and validate the segmentation method. RESULTS The segmentation performance was evaluated with the volume and surface agreement metrics between the DL-based automatic and the manually delineated masks, as quantified with the following measures: the average Dice volume overlap (0.968 ± 0.017 and 0.877 ± 0.081), the average surface distances (0.201 ± 0.080 mm and 0.310 ± 0.043 mm), and the Pearson correlation coefficient of masks (0.995 and 0.972) between the automatic and the manually delineated masks, as calculated for the whole breast and the FGT segmentation, respectively. The correlation coefficient between the breast densities obtained with the DL-based segmentation and the manual delineation was 0.981. There was a positive bias of 0.8% (DL-based relative to manual) in breast density measurement with the Bland-Altman plot. The execution time of the DL-based segmentation was approximately 20 s for the whole breast segmentation and 15 s for the FGT segmentation. CONCLUSIONS Our DL-based segmentation framework using nnU-Net could robustly achieve high accuracy and efficiency across variable MR imaging settings without extra pre- or post-processing procedures. It would be useful for developing DCE-MR-based CAD systems to quantify breast cancer risk and to be integrated into the clinical workflow.
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Affiliation(s)
- Lu Huo
- Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, No.99 Haike Road, Shanghai 201200, China; University of Chinese Academy of Sciences, No.19 Yuquan Road, Beijing 100049, China; Shanghai United Imaging Healthcare Co., Ltd., No. 2258 Chengbei Road, Shanghai 201807, China
| | - Xiaoxin Hu
- Department of Radiology, Shanghai Cancer Hospital of Fudan University, No. 270 DongAn Road, Shanghai 200032, China
| | - Qin Xiao
- Department of Radiology, Shanghai Cancer Hospital of Fudan University, No. 270 DongAn Road, Shanghai 200032, China
| | - Yajia Gu
- Department of Radiology, Shanghai Cancer Hospital of Fudan University, No. 270 DongAn Road, Shanghai 200032, China
| | - Xu Chu
- Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, No.99 Haike Road, Shanghai 201200, China; Shanghai United Imaging Healthcare Co., Ltd., No. 2258 Chengbei Road, Shanghai 201807, China
| | - Luan Jiang
- Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, No.99 Haike Road, Shanghai 201200, China; Shanghai United Imaging Healthcare Co., Ltd., No. 2258 Chengbei Road, Shanghai 201807, China.
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15
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Dontchos BN, Yala A, Barzilay R, Xiang J, Lehman CD. External Validation of a Deep Learning Model for Predicting Mammographic Breast Density in Routine Clinical Practice. Acad Radiol 2021; 28:475-480. [PMID: 32089465 DOI: 10.1016/j.acra.2019.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Federal legislation requires patient notification of dense mammographic breast tissue because increased density is a marker of breast cancer risk and can limit the sensitivity of mammography. As previously described, we clinically implemented our deep learning model at the academic breast imaging practice where the model was developed with high clinical acceptance. Our objective was to externally validate our deep learning model on radiologist breast density assessments in a community breast imaging practice. MATERIALS AND METHODS Our deep learning model was implemented at a dedicated breast imaging practice staffed by both academic and community breast imaging radiologists in October 2018. Deep learning model assessment of mammographic breast density was presented to the radiologist during routine clinical practice at the time of mammogram interpretation. We identified 2174 consecutive screening mammograms after implementation of the deep learning model. Radiologist agreement with the model's assessment was measured and compared across radiologist groups. RESULTS Both academic and community radiologists had high clinical acceptance of the deep learning model's density prediction, with 94.9% (academic) and 90.7% (community) acceptance for dense versus nondense categories (p < 0.001). The proportion of mammograms assessed as dense by all radiologists decreased from 47.0% before deep learning model implementation to 41.0% after deep learning model implementation (p < 0.001). CONCLUSION Our deep learning model had a high clinical acceptance rate among both academic and community radiologists and reduced the proportion of mammograms assessed as dense. This is an important step to validating our deep learning model prior to potential widespread implementation.
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Affiliation(s)
- Brian N Dontchos
- Massachusetts General Hospital, 55 Fruit Street, WAC-240, Boston, MA 02114.
| | - Adam Yala
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Regina Barzilay
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Justin Xiang
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Constance D Lehman
- Massachusetts General Hospital, 55 Fruit Street, WAC-240, Boston, MA 02114
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16
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Lizar JC, Volpato KC, Brandão FC, da Silva Guimarães F, Arruda GV, Pavoni JF. Tridimensional dose evaluation of the respiratory motion influence on breast radiotherapy treatments using conformal radiotherapy, forward IMRT, and inverse IMRT planning techniques. Phys Med 2021; 81:60-68. [DOI: 10.1016/j.ejmp.2020.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
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17
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Volumetric breast density estimation on MRI using explainable deep learning regression. Sci Rep 2020; 10:18095. [PMID: 33093572 PMCID: PMC7581772 DOI: 10.1038/s41598-020-75167-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/12/2020] [Indexed: 01/10/2023] Open
Abstract
To purpose of this paper was to assess the feasibility of volumetric breast density estimations on MRI without segmentations accompanied with an explainability step. A total of 615 patients with breast cancer were included for volumetric breast density estimation. A 3-dimensional regression convolutional neural network (CNN) was used to estimate the volumetric breast density. Patients were split in training (N = 400), validation (N = 50), and hold-out test set (N = 165). Hyperparameters were optimized using Neural Network Intelligence and augmentations consisted of translations and rotations. The estimated densities were evaluated to the ground truth using Spearman’s correlation and Bland–Altman plots. The output of the CNN was visually analyzed using SHapley Additive exPlanations (SHAP). Spearman’s correlation between estimated and ground truth density was ρ = 0.81 (N = 165, P < 0.001) in the hold-out test set. The estimated density had a median bias of 0.70% (95% limits of agreement = − 6.8% to 5.0%) to the ground truth. SHAP showed that in correct density estimations, the algorithm based its decision on fibroglandular and fatty tissue. In incorrect estimations, other structures such as the pectoral muscle or the heart were included. To conclude, it is feasible to automatically estimate volumetric breast density on MRI without segmentations, and to provide accompanying explanations.
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Lei B, Huang S, Li H, Li R, Bian C, Chou YH, Qin J, Zhou P, Gong X, Cheng JZ. Self-co-attention neural network for anatomy segmentation in whole breast ultrasound. Med Image Anal 2020; 64:101753. [DOI: 10.1016/j.media.2020.101753] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 11/25/2022]
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19
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Ghieh D, Saade C, Najem E, El Zeghondi R, Rawashdeh MA, Berjawi G. Staying abreast of imaging - Current status of breast cancer detection in high density breast. Radiography (Lond) 2020; 27:229-235. [PMID: 32611494 DOI: 10.1016/j.radi.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.
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Affiliation(s)
- D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - E Najem
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - R El Zeghondi
- Department of Medical Imaging Sciences, Faculty of Health Sciences, American University of Beirut, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - M A Rawashdeh
- Department of Allied Medical Sciences, Jordan University of Science and Technology, P.O.Box: 3030, Irbid 22110, Jordan.
| | - G Berjawi
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O.Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Mammographic density changes during neoadjuvant breast cancer treatment: NeoDense, a prospective study in Sweden. Breast 2020; 53:33-41. [PMID: 32563178 PMCID: PMC7375568 DOI: 10.1016/j.breast.2020.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess if mammographic density (MD) changes during neoadjuvant breast cancer treatment and is predictive of a pathological complete response (pCR). METHODS We prospectively included 200 breast cancer patients assigned to neoadjuvant chemotherapy (NACT) in the NeoDense study (2014-2019). Raw data mammograms were used to assess MD with a fully automated volumetric method and radiologists categorized MD using the Breast Imaging-Reporting and Data System (BI-RADS), 5th Edition. Logistic regression was used to calculate odds ratios (OR) for pCR comparing BI-RADS categories c vs. a, b, and d as well as with a 0.5% change in percent dense volume adjusting for baseline characteristics. RESULTS The overall median age was 53.1 years, and 48% of study participants were premenopausal pre-NACT. A total of 23% (N = 45) of the patients accomplished pCR following NACT. Patients with very dense breasts (BI-RADS d) were more likely to have a positive axillary lymph node status at diagnosis: 89% of the patients with very dense breasts compared to 72% in the entire cohort. A total of 74% of patients decreased their absolute dense volume during NACT. The likelihood of accomplishing pCR following NACT was independent of volumetric MD at diagnosis and change in volumetric MD during treatment. No trend was observed between decreasing density according to BI-RADS and the likelihood of accomplishing pCR following NACT. CONCLUSIONS The majority of patients decreased their MD during NACT. We found no evidence of MD as a predictive marker of pCR in the neoadjuvant setting.
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Vilmun BM, Vejborg I, Lynge E, Lillholm M, Nielsen M, Nielsen MB, Carlsen JF. Impact of adding breast density to breast cancer risk models: A systematic review. Eur J Radiol 2020; 127:109019. [DOI: 10.1016/j.ejrad.2020.109019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 01/19/2023]
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Alomaim W, O’Leary D, Ryan J, Rainford L, Evanoff M, Foley S. Subjective Versus Quantitative Methods of Assessing Breast Density. Diagnostics (Basel) 2020; 10:diagnostics10050331. [PMID: 32455552 PMCID: PMC7277954 DOI: 10.3390/diagnostics10050331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.
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Affiliation(s)
- Wijdan Alomaim
- Radiography & Medical Imaging, Fatima College of Health Sciences, Abu Dhabi, UAE
- Correspondence: ; Tel.: +9712-5078639
| | - Desiree O’Leary
- Radiography (Diagnostic Imaging), Keele University, Keele ST5 5BG, UK; D.s.o'
| | - John Ryan
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | - Louise Rainford
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
| | | | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, 4 Dublin, Ireland; (J.R.); (L.R.); (S.F.)
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Han Y, Berkey CS, Herman CR, Appleton CM, Alimujiang A, Colditz GA, Toriola AT. Adiposity Change Over the Life Course and Mammographic Breast Density in Postmenopausal Women. Cancer Prev Res (Phila) 2020; 13:475-482. [PMID: 32102947 PMCID: PMC8210631 DOI: 10.1158/1940-6207.capr-19-0549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022]
Abstract
Mammographic breast density is a strong risk factor for breast cancer. We comprehensively investigated the associations of body mass index (BMI) change from ages 10, 18, and 30 to age at mammogram with mammographic breast density in postmenopausal women. We used multivariable linear regression models, adjusted for confounders, to investigate the associations of BMI change with volumetric percent density, dense volume, and nondense volume, assessed using Volpara in 367 women. At the time of mammogram, the mean age was 57.9 years. Compared with women who had a BMI gain of 0.1-5 kg/m2 from age 10, women who had a BMI gain of 5.1-10 kg/m2 had a 24.4% decrease [95% confidence interval (CI), 6.0%-39.2%] in volumetric percent density; women who had a BMI gain of 10.1-15 kg/m2 had a 46.1% decrease (95% CI, 33.0%-56.7%) in volumetric percent density; and women who had a BMI gain of >15 kg/m2 had a 56.5% decrease (95% CI, 46.0%-65.0%) in volumetric percent density. Similar, but slightly attenuated associations were observed for BMI gain from ages 18 and 30 to age at mammogram and volumetric percent density. BMI gain over the life course was positively associated with nondense volume, but not dense volume. We observed strong associations between BMI change over the life course and mammographic breast density. The inverse associations between early-life adiposity change and volumetric percent density suggest that childhood adiposity may confer long-term protection against postmenopausal breast cancer via its effect of mammographic breast density.
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Affiliation(s)
- Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Catherine S Berkey
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cheryl R Herman
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
| | | | - Aliya Alimujiang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri
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Araújo ALC, Soares HB, Carvalho DF, Mendonça RM, Oliveira AG. Design and clinical validation of a software program for automated measurement of mammographic breast density. BMC Med Inform Decis Mak 2020; 20:45. [PMID: 32122371 PMCID: PMC7053043 DOI: 10.1186/s12911-020-1062-y] [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: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mammographic breast density is an important predictor of breast cancer, but its measurement has limitations related to subjectivity of visual evaluation or to difficult access for automatic volumetric measurement methods. Herein, we describe the design and clinical validation of Aguida, a software program for automated quantification of breast density from flat mammography images. Materials and methods The software program was developed in MatLab. After image segmentation separating the background from the breast image, the operator positions a cursor defining a region of interest on the pectoralis major muscle from the mediolateral oblique view. Then, in the craniocaudal view, the threshold for separation of the dense tissue is based on the optical density of the pectoral muscle, and the proportion of dense tissue is calculated by the program. Mammograms obtained from 2 different occasions in 291 women were used for clinical evaluation. Results The intraclass correlation coefficient (ICC) between breast density measurements by the software and by a radiologist was 0.96, with a bias of only 0.67 percentage points and a 95% limit of agreement of 13.5 percentage points; the ICC was 0.94 in the interobserver reliability assessment by two radiologists with different experience; and the ICC was 0.98 in the intraobserver reliability assessment. The distribution among the density classes was close to the values obtained with the volumetric software. Conclusions Measurement of breast density with the Aguida program from flat mammography images showed high agreement with the visual determination by radiologists, and high inter- and intra-observer reliability.
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Affiliation(s)
- Adriano L C Araújo
- Department of Radiology, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha 620, Petrópolis, Natal, RN, 59012-300, Brazil. .,Instituto de Radiologia de Natal, Av. Afonso Pena 744 - Tirol, Natal, RN, 59020-100, Brazil.
| | - Heliana B Soares
- Department of Biomedical Engineering, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Av. Senador Salgado Filho 300, Lagoa Nova, Natal, RN, 59078-970, Brazil
| | - Daniel F Carvalho
- Department of Biomedical Engineering, Centro de Tecnologia, Universidade Federal do Rio Grande do Norte, Campus Universitário, Av. Senador Salgado Filho 300, Lagoa Nova, Natal, RN, 59078-970, Brazil
| | - Roberto M Mendonça
- Department of Radiology, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha 620, Petrópolis, Natal, RN, 59012-300, Brazil
| | - Antonio G Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Rua General Gustavo Cordeiro de Farias s/n, Petrópolis, Natal, RN, 29012-570, Brazil
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Waade GG, Holen Å, Sebuødegård S, Aase H, Pedersen K, Hanestad B, Hofvind S. Breast compression parameters among women screened with standard digital mammography and digital breast tomosynthesis in a randomized controlled trial. Acta Radiol 2020; 61:321-330. [PMID: 31342757 DOI: 10.1177/0284185119863989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background No evidence-based guidelines regarding optimal breast compression in mammography exist, neither for standard digital mammography nor for digital breast tomosynthesis. Purpose To compare breast compression parameters and mean glandular dose in a randomized controlled trial with digital mammography versus digital breast tomosynthesis. Material and Methods We used information from 21,729 women aged 50–69 years, who participated in the To-Be trial, as part of BreastScreen Norway, 2016–2017. Information was obtained from the DICOM header and by assessing the images in an automated software for density estimation (VolparaDensity). Using linear regression, we investigated the effect of screening technique on breast compression parameters; compression force (N), compression pressure (kPa), and compressed breast thickness (mm), and mean glandular dose (mGy), by view (craniocaudal [CC] and mediolateral oblique [MLO]). We adjusted for age, breast volume and fibroglandular volume. Results A total of 11,056 (50.9%) women were screened with digital mammography and 10,673 (49.1%) with digital breast tomosynthesis. Adjusted regression analysis showed that women undergoing digital mammography received higher compression forces than women undergoing digital breast tomosynthesis (CC: –4.7 N; MLO: –1.1 N, P < 0.001 for both), higher compression pressure (CC: –1.0 k Pa; MLO: –0.1 kPa, P < 0.001 for both), and higher values of compressed breast thickness in the MLO view (–0.3 mm, P = 0.02). The women undergoing digital mammography received a lower mean glandular dose than women undergoing digital breast tomosynthesis ([+]0.06 mGy, P < 0.001). Conclusion Women undergoing digital breast tomosynthesis received lower compression force, compression pressure, and compressed breast thickness in MLO view, compared to women undergoing digital mammography. Further studies should investigate the impact of breast compression on image quality, screening outcome, and radiation dose for digital mammography and digital breast tomosynthesis in order to establish evidence-based guidelines for breast compression.
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Affiliation(s)
| | | | | | - Hildegunn Aase
- Breast Center, Haukeland University Hospital, Bergen, Norway
| | | | - Berit Hanestad
- Breast Center, Haukeland University Hospital, Bergen, Norway
| | - Solveig Hofvind
- OsloMet -- Oslo Metropolitan University, Oslo, Norway
- Cancer Registry of Norway, Oslo, Norway
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Wavelia Breast Imaging: The Optical Breast Contour Detection Subsystem. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10041234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Wavelia is a low-power electromagnetic wave breast imaging device for breast cancer diagnosis, which consists of two subsystems, both performing non-invasive examinations: the Microwave Breast Imaging (MBI) subsystem and the Optical Breast Contour Detection (OBCD) subsystem. The Wavelia OBCD subsystem is a 3D scanning device using an infrared 3D stereoscopic camera, which performs an azimuthal scan to acquire 3D point clouds of the external surface of the breast. The OBCD subsystem aims at reconstructing fully the external envelope of the breast, with high precision, to provide the total volume of the breast and morphological data as a priori information to the MBI subsystem. This paper presents a new shape-based calibration procedure for turntable-based 3D scanning devices, a new 3D breast surface reconstruction method based on a linear stretching function, as well as the breast volume computation method that have been developed and integrated with the Wavelia OBCD subsystem, before its installation at the Clinical Research Facility of Galway (CRFG), in Ireland, for first-in-human clinical testing. Indicative results of the Wavelia OBCD subsystem both from scans of experimental breast phantoms and from patient scans are thoroughly presented and discussed in the paper.
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Natesan R, Wiskin J, Lee S, Malik BH. Quantitative Assessment of Breast Density: Transmission Ultrasound is Comparable to Mammography with Tomosynthesis. Cancer Prev Res (Phila) 2019; 12:871-876. [DOI: 10.1158/1940-6207.capr-19-0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/19/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
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Hassinger TE, Mehaffey JH, Knisely AT, Contrella BN, Brenin DR, Schroen AT, Schirmer BD, Hallowell PT, Harvey JA, Showalter SL. The impact of bariatric surgery on qualitative and quantitative breast density. Breast J 2019; 25:1198-1205. [PMID: 31310402 DOI: 10.1111/tbj.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity and breast density are associated with breast cancer in postmenopausal women. Bariatric surgery effectively treats morbid obesity, with sustainable weight loss and reductions in cancer incidence. We evaluated changes in qualitative and quantitative density; hypothesizing breast density would increase following bariatric surgery. METHODS Women undergoing bariatric surgery from 1990 to 2015 were identified, excluding patients without a mammogram performed both before and after surgery. Changes in body mass index (BMI), time between mammograms and surgery, and American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) scores were assessed. VolparaDensity™ automated software calculated volumetric breast density (VBD), fibroglandular volume (FGV), and total breast volume for the 82 women with digital data available. Differences between pre- and postsurgery values were assessed. RESULTS One hundred eighty women were included. Median age at surgery was 50.0 years, with 8.8 months between presurgery mammogram and surgery and 62.3 months between surgery and postsurgery mammogram. Median BMI significantly decreased over the study period (46.0 vs 35.4 kg/m2 ; P < 0.001). No change in BI-RADS scores was seen between the pre- and postsurgery mammograms. Eighty-two women had VolparaDensity™ data available. While VBD increased in these patients, FGV and total breast volume both decreased following bariatric surgery. CONCLUSIONS Increased VBD, decreased FGV, and decreased total breast volume were seen following bariatric surgery-induced weight loss. There was no difference in qualitative breast density, highlighting the discrepancy between BI-RADS and VolparaDensity™ measurements. Further investigation will be required to determine how differential changes in components of breast density may affect breast cancer risk.
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Affiliation(s)
- Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Anne T Knisely
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Benjamin N Contrella
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David R Brenin
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter T Hallowell
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jennifer A Harvey
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Fieselmann A, Förnvik D, Förnvik H, Lång K, Sartor H, Zackrisson S, Kappler S, Ritschl L, Mertelmeier T. Volumetric breast density measurement for personalized screening: accuracy, reproducibility, consistency, and agreement with visual assessment. J Med Imaging (Bellingham) 2019; 6:031406. [PMID: 30746394 PMCID: PMC6362711 DOI: 10.1117/1.jmi.6.3.031406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/27/2018] [Indexed: 01/22/2023] Open
Abstract
Assessment of breast density at the point of mammographic examination could lead to optimized breast cancer screening pathways. The onsite breast density information may offer guidance of when to recommend supplemental imaging for women in a screening program. A software application (Insight BD, Siemens Healthcare GmbH) for fast onsite quantification of volumetric breast density is evaluated. The accuracy of the method is assessed using breast tissue equivalent phantom experiments resulting in a mean absolute error of 3.84%. Reproducibility of measurement results is analyzed using 8427 exams in total, comparing for each exam (if available) the densities determined from left and right views, from cranio-caudal and medio-lateral oblique views, from full-field digital mammograms (FFDM) and digital breast tomosynthesis (DBT) data and from two subsequent exams of the same breast. Pearson correlation coefficients of 0.937, 0.926, 0.950, and 0.995 are obtained. Consistency of the results is demonstrated by evaluating the dependency of the breast density on women's age. Furthermore, the agreement between breast density categories computed by the software with those determined visually by 32 radiologists is shown by an overall percentage agreement of 69.5% for FFDM and by 64.6% for DBT data. These results demonstrate that the software delivers accurate, reproducible, and consistent measurements that agree well with the visual assessment of breast density by radiologists.
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Affiliation(s)
| | - Daniel Förnvik
- Lund University and Skåne University Hospital, Department of Translational Medicine, Malmö, Sweden
| | - Hannie Förnvik
- Lund University and Skåne University Hospital, Department of Translational Medicine, Malmö, Sweden
| | - Kristina Lång
- Lund University and Skåne University Hospital, Department of Translational Medicine, Malmö, Sweden
- Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland
| | - Hanna Sartor
- Lund University and Skåne University Hospital, Department of Translational Medicine, Malmö, Sweden
| | - Sophia Zackrisson
- Lund University and Skåne University Hospital, Department of Translational Medicine, Malmö, Sweden
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Brentnall AR, Cohn WF, Knaus WA, Yaffe MJ, Cuzick J, Harvey JA. A Case-Control Study to Add Volumetric or Clinical Mammographic Density into the Tyrer-Cuzick Breast Cancer Risk Model. JOURNAL OF BREAST IMAGING 2019; 1:99-106. [PMID: 31423486 PMCID: PMC6690422 DOI: 10.1093/jbi/wbz006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 01/21/2023]
Abstract
Background Accurate breast cancer risk assessment for women attending routine screening is needed to guide screening and preventive interventions. We evaluated the accuracy of risk predictions from both visual and volumetric mammographic density combined with the Tyrer-Cuzick breast cancer risk model. Methods A case-control study (474 patient participants and 2243 healthy control participants) of women aged 40–79 years was performed using self-reported classical risk factors. Breast density was measured by using automated volumetric software and Breast Imaging and Reporting Data System (BI-RADS) density categories. Odds ratios (95% CI) were estimated by using logistic regression, adjusted for age, demographic factors, and 10-year risk from the Tyrer-Cuzick model, for a change from the 25th to 75th percentile of the adjusted percent density distribution in control participants (IQ-OR). Results After adjustment for classical risk factors in the Tyrer-Cuzick model, age, and body mass index (BMI), BI-RADS density had an IQ-OR of 1.55 (95% CI = 1.33 to 1.80) compared with 1.40 (95% CI = 1.21 to 1.60) for volumetric percent density. Fibroglandular volume (IQ-OR = 1.28, 95% CI = 1.12 to 1.47) was a weaker predictor than was BI-RADS density (Pdiff = 0.014) or volumetric percent density (Pdiff = 0.065). In this setting, 4.8% of women were at high risk (8% + 10-year risk), using the Tyrer-Cuzick model without density, and 7.1% (BI-RADS) compared with 6.8% (volumetric) when combined with density. Conclusion The addition of volumetric and visual mammographic density measures to classical risk factors improves risk stratification. A combined risk could be used to guide precision medicine, through risk-adapted screening and prevention strategies.
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Affiliation(s)
- Adam R Brentnall
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Wendy F Cohn
- University of Virginia, Public Health Sciences, University of Virginia Health Sciences Center, Charlottesville, VA
| | - William A Knaus
- NantHealth, Inc., Culver City, CA, and University of Virginia, Public Health Sciences, University of Virginia Health Sciences Center, Charlottesville, VA
| | - Martin J Yaffe
- Sunnybrook Health Sciences Center, Medical Biophysics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Jennifer A Harvey
- University of Virginia, Department of Radiology and Medical Imaging, University of Virginia Health Sciences Center, Charlottesville, VA
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31
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Breast MRI and X-ray mammography registration using gradient values. Med Image Anal 2019; 54:76-87. [DOI: 10.1016/j.media.2019.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/21/2022]
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Comparison of a personalized breast dosimetry method with standard dosimetry protocols. Sci Rep 2019; 9:5866. [PMID: 30971741 PMCID: PMC6458177 DOI: 10.1038/s41598-019-42144-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/20/2019] [Indexed: 11/24/2022] Open
Abstract
Average glandular dose (AGD) in digital mammography crucially depends on the estimation of breast glandularity. In this study we compared three different methods of estimating glandularities according to Wu, Dance and Volpara with respect to resulting AGDs. Exposure data from 3050 patient images, acquired with a GE Senographe Essential constituted the study population of this work. We compared AGD (1) according to Dance et al. applying custom g, c, and s factors using HVL, breast thickness, patient age and incident air kerma (IAK) from the DICOM headers; (2) according to Wu et al. as determined by the GE system; and (3) AGD derived with the Dance model with personalized c factors using glandularity determined with the Volpara (Volpara Solutions, Wellington, New Zealand) software (Volpare AGD). The ratios of the resulting AGDs were analysed versus parameters influencing dose. The highest deviation between the resulting AGDs was found in the ratio of GE AGD to Volpara AGD for breast thicknesses between 20 and 40 mm (ratio: 0.80). For thicker breasts this ratio is close to one (1 ± 0.02 for breast thicknesses >60 mm). The Dance to Volpara ratio was between 0.86 (breast thickness 20–40 mm) and 0.99 (>80 mm), and Dance/GE AGD was between 1.07 (breast thickness 20–40 mm) and 0.98 (41–60, and >80 mm). Glandularities by Volpara were generally smaller than the one calculated with the Dance method. This effect is most pronounced for small breast thickness and older ages. Taking the considerable divergences between the AGDs from different methods into account, the selection of the method should by done carefully. As the Volpara method provides an analysis of the individual breast tissue, while the Wu and the Dance methods use look up tables and custom parameter sets, the Volpara method might be more appropriate if individual ADG values are sought. For regulatory purposes and comparison with diagnostic reference values, the method to be used needs to be defined exactly and clearly be stated. However, it should be accepted that dose values calculated with standardized models, like AGD and also effective dose, are afflicted with a considerable uncertainty budgets that need to be accounted for in the interpretation of these values.
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Vourtsis A, Berg WA. Breast density implications and supplemental screening. Eur Radiol 2019; 29:1762-1777. [PMID: 30255244 PMCID: PMC6420861 DOI: 10.1007/s00330-018-5668-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/21/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast ultrasound detects additional early-stage, invasive breast cancers when combined with mammography; however, its relevant limitations, including the shortage of trained operators, operator dependence and small field of view, have limited its widespread implementation. Automated breast sonography (ABS) is a promising technique but the time to interpret and false-positive rates need to be improved. Supplemental screening with contrast-enhanced magnetic resonance imaging (MRI) in high-risk women reduces late-stage disease; abbreviated MRI protocols may reduce cost and increase accessibility to women of average risk with dense breasts. Contrast-enhanced digital mammography (CEDM) and molecular breast imaging improve cancer detection but require further validation for screening and direct biopsy guidance should be implemented for any screening modality. This article reviews the status of screening women with dense breasts. KEY POINTS: • The sensitivity of mammography is reduced in women with dense breasts. Supplemental screening with US detects early-stage, invasive breast cancers. • Tomosynthesis reduces recall rate and increases cancer detection rate but is less effective in women with extremely dense breasts. • Screening MRI improves early diagnosis of breast cancer more than ultrasound and is currently recommended for women at high risk. Risk assessment is needed, to include breast density, to ascertain who should start early annual MRI screening.
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Affiliation(s)
- Athina Vourtsis
- "Diagnostic Mammography", Medical Diagnostic Imaging Unit, Founding President of the Hellenic Breast Imaging Society, Kifisias Ave 362, Chalandri, 15233, Athens, Greece.
| | - Wendie A Berg
- Department of Radiology, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Alomaim W, O'Leary D, Ryan J, Rainford L, Evanoff M, Foley S. Variability of Breast Density Classification Between US and UK Radiologists. J Med Imaging Radiat Sci 2019; 50:53-61. [DOI: 10.1016/j.jmir.2018.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/09/2018] [Accepted: 11/27/2018] [Indexed: 12/22/2022]
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Napolitano G, Lynge E, Lillholm M, Vejborg I, van Gils CH, Nielsen M, Karssemeijer N. Change in mammographic density across birth cohorts of Dutch breast cancer screening participants. Int J Cancer 2019; 145:2954-2962. [PMID: 30762225 PMCID: PMC6850337 DOI: 10.1002/ijc.32210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 12/02/2022]
Abstract
High mammographic density is a well‐known risk factor for breast cancer. This study aimed to search for a possible birth cohort effect on mammographic density, which might contribute to explain the increasing breast cancer incidence. We separately analyzed left and right breast density of Dutch women from a 13‐year period (2003–2016) in the breast cancer screening programme. First, we analyzed age‐specific changes in average percent dense volume (PDV) across birth cohorts. A linear regression analysis (PDV vs. year of birth) indicated a small but statistically significant increase in women of: 1) age 50 and born from 1952 to 1966 (left, slope = 0.04, p = 0.003; right, slope = 0.09, p < 0.0001); 2) age 55 and born from 1948 to 1961 (right, slope = 0.04, p = 0.01); and 3) age 70 and born from 1933 to 1946 (right, slope = 0.05, p = 0.002). A decrease of total breast volume seemed to explain the increase in PDV. Second, we compared proportion of women with dense breast in women born in 1946–1953 and 1959–1966, and observed a statistical significant increase of proportion of highly dense breast in later born women, in the 51 to 55 age‐groups for the left breast (around a 20% increase in each age‐group), and in the 50 to 56 age‐groups for the right breast (increase ranging from 27% to 48%). The study indicated a slight increase in mammography density across birth cohorts, most pronounced for women in their early 50s, and more marked for the right than for the left breast. What's new? Women with dense breast tissue are at increased risk of breast cancer. Here, changes in mammographic density were investigated across birth cohorts in women enrolled in a breast cancer screening program in the Netherlands. The findings reveal an increase in the average fraction of dense tissue in the breast across cohorts. In particular, greater breast density was observed in a higher proportion of women in later‐born than earlier‐born birth cohorts. The increase was most significant among women in their early 50s and may be linked to a reported shift toward older age at menopause among women in Europe.
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Affiliation(s)
- George Napolitano
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lillholm
- Department of Computer Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, University Hospital Copenhagen, Copenhagen, Denmark
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health, Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mads Nielsen
- Department of Computer Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University, Medical Center, Nijmegen, The Netherlands
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Wengert GJ, Helbich TH, Leithner D, Morris EA, Baltzer PAT, Pinker K. Multimodality Imaging of Breast Parenchymal Density and Correlation with Risk Assessment. CURRENT BREAST CANCER REPORTS 2019; 11:23-33. [PMID: 35496471 PMCID: PMC9044508 DOI: 10.1007/s12609-019-0302-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose of Review Breast density, or the amount of fibroglandular tissue in the breast, has become a recognized and independent marker for breast cancer risk. Public awareness of breast density as a possible risk factor for breast cancer has resulted in legislation for risk stratification purposes in many US states. This review will provide a comprehensive overview of the currently available imaging modalities for qualitative and quantitative breast density assessment and the current evidence on breast density and breast cancer risk assessment. Recent Findings To date, breast density assessment is mainly performed with mammography and to some extent with magnetic resonance imaging. Data indicate that computerized, quantitative techniques in comparison with subjective visual estimations are characterized by higher reproducibility and robustness. Summary Breast density reduces the sensitivity of mammography due to a masking effect and is also a recognized independent risk factor for breast cancer. Standardized breast density assessment using automated volumetric quantitative methods has the potential to be used for risk prediction and stratification and in determining the best screening plan for each woman.
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Can quantitative evaluation of mammographic breast density, "volumetric measurement", predict the masking risk with dense breast tissue? Investigation by comparison with subjective visual estimation by Japanese radiologists. Breast Cancer 2018; 26:349-358. [PMID: 30387023 DOI: 10.1007/s12282-018-0930-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sensitivity to detect breast cancer (BC) is not high in a dense breast due to masking in mammography. To evaluate the breast density, a volumetric measurement system has been recently developed that measures the percent fibroglandular tissue volume (percent FGV, hereafter termed as "FG%") to the breast volume (BV). This study was designed to investigate whether evaluation using FG% can accurately predict the masking risk by comparing with the current standard method of subjective visual estimation (SVE). METHODS Using pre-biopsy mammograms of 114 cases histopathologically diagnosed with BC in our facility, SVE based on BI-RADS (5th edition) and volumetric measurements of FG% were conducted. Performance to predict the masking risk was evaluated using the area under the receiver operating characteristic curve (AUC). Relationship between these parameters and the masking risk was evaluated by the adjusted multivariate linear regression analysis. RESULTS The AUC of SVE values was 0.742 (95% CI 0.641-0.822), while that of FG% was as significantly low as 0.560 (95% CI 0.427-0.685) (P = 0.0014). The SVE values correlated with the detection of BC in mammography (P = 0.0035), but there was no significant relationship with FG% (P = 0.74). The median BV and FGV were 313 cm3 (IQR 191-440) and 63 cm3 (IQR 44-102), respectively. The FGV was comparable to the data for Caucasian women reported in previous studies, but the BV was one-half of the previous data. CONCLUSION The current volumetric measurement system to evaluate FG% to BV was found to be insufficient in the performance to predict the masking risk in Japanese women with relatively small-sized breasts.
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Lehman CD, Yala A, Schuster T, Dontchos B, Bahl M, Swanson K, Barzilay R. Mammographic Breast Density Assessment Using Deep Learning: Clinical Implementation. Radiology 2018; 290:52-58. [PMID: 30325282 DOI: 10.1148/radiol.2018180694] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To develop a deep learning (DL) algorithm to assess mammographic breast density. Materials and Methods In this retrospective study, a deep convolutional neural network was trained to assess Breast Imaging Reporting and Data System (BI-RADS) breast density based on the original interpretation by an experienced radiologist of 41 479 digital screening mammograms obtained in 27 684 women from January 2009 to May 2011. The resulting algorithm was tested on a held-out test set of 8677 mammograms in 5741 women. In addition, five radiologists performed a reader study on 500 mammograms randomly selected from the test set. Finally, the algorithm was implemented in routine clinical practice, where eight radiologists reviewed 10 763 consecutive mammograms assessed with the model. Agreement on BI-RADS category for the DL model and for three sets of readings-(a) radiologists in the test set, (b) radiologists working in consensus in the reader study set, and (c) radiologists in the clinical implementation set-were estimated with linear-weighted κ statistics and were compared across 5000 bootstrap samples to assess significance. Results The DL model showed good agreement with radiologists in the test set (κ = 0.67; 95% confidence interval [CI]: 0.66, 0.68) and with radiologists in consensus in the reader study set (κ = 0.78; 95% CI: 0.73, 0.82). There was very good agreement (κ = 0.85; 95% CI: 0.84, 0.86) with radiologists in the clinical implementation set; for binary categorization of dense or nondense breasts, 10 149 of 10 763 (94%; 95% CI: 94%, 95%) DL assessments were accepted by the interpreting radiologist. Conclusion This DL model can be used to assess mammographic breast density at the level of an experienced mammographer. © RSNA, 2018 Online supplemental material is available for this article . See also the editorial by Chan and Helvie in this issue.
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Affiliation(s)
- Constance D Lehman
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Adam Yala
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Tal Schuster
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Brian Dontchos
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Manisha Bahl
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Kyle Swanson
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
| | - Regina Barzilay
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Avon Comprehensive Breast Evaluation Center, 55 Fruit St, WAC 240, Boston, MA 02114-2698 (C.D.L., B.D., M.B.); and Massachusetts Institute of Technology, Cambridge, Mass (A.Y., T.S., K.S., R.B.)
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Smilg JS. Are you dense? The implications and imaging of the dense breast. SA J Radiol 2018; 22:1356. [PMID: 31754514 PMCID: PMC6837771 DOI: 10.4102/sajr.v22i2.1356] [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: 04/19/2018] [Accepted: 06/18/2018] [Indexed: 11/21/2022] Open
Abstract
Mammography relies on a visual interpretation of imaging results that is often confounded by dense breast tissue. Dense tissue affects the ability and accuracy with which the radiologist is able to detect cancer. Dense tissue may mask the presence of a breast cancer, and breast density is well recognised as an independent risk factor for the development of breast cancer. In the dense breast, detected cancers tend to be larger, more often lymph node positive and of a higher stage than those diagnosed in fatty tissue. The incidence of tumour multifocality and multicentricity is higher, decreasing the chances for breast conserving treatment. The literature convincingly supports the use of supplemental imaging modalities in women who present with increased breast density. There are clear advantages and disadvantages to each set of diagnostic imaging tests. However, there is no simple, cost-effective solution for women with dense breasts to obtain a definitive detection status through imaging. Suggestions are put forward as to what supplemental imaging choices should be included for the imaging of the dense breast with reference to the current South African setting. Use of supplemental screening modalities should be tailored to individual risk assessment. In a resource-constrained environment, international recommendations may need to be adjusted.
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Affiliation(s)
- Jacqueline S Smilg
- Evolutionary Studies Institute, University of the Witwatersrand, South Africa.,Department of Radiation Sciences, University of the Witwatersrand, South Africa.,Department of Diagnostic Radiology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Shanley E, Johnston A, Hillick D, Ng KC, Sugrue M. Digital breast volume estimation (DBVE)-A new technique. Br J Radiol 2018; 91:20180406. [PMID: 30028189 DOI: 10.1259/bjr.20180406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: There are several limitations with current methods of breast volume measurement; principally relating to assumption of fixed shape forms. This study, utilizing computer aided volume estimates, developed a new method using the digital mapping of breast area and compares results to existing techniques of breast volume measurement and actual breast volume. METHODS: 50 consecutive breast cancer patients had breast volume calculated from mammograms [craniocaudal (CC) and mediolateral oblique views]; using breast height, width, radius, area and compression thickness. Area was recorded using cursor measurement tool for AGFA® Impax™6 software. The new volumetric estimation is based on the basic formula for the volume of a solid. The technique was compared with three known breast volume estimation techniques. Subsequently, 15 patients undergoing mastectomy had pre-op breast volume calculated using this new method and 3 existing techniques; values were compared to fresh mastectomy weights/volumes. RESULTS: 50 patients, mean age 63.2 ± 14.4 (range 38-88) had breast volume estimation. The CC view appears to provide the best correlation with existing techniques. Scatterplots show a significant correlation of all the methods with the digital breast volume estimation method. Mastectomy volume compared with four breast volume techniques in n = 15, confined to the CC, shows good correlation between the digital technique and real volume. Scatterplots show significant correlation between digital breast volume estimation and mastectomy weight. CONCLUSION: This study provided a novel simple tool to estimate breast volume in patients. ADVANCES IN KNOWLEDGE: This may aid in planning cosmetic outcome and oncoplastic approaches in breast cancer and breast reduction surgery.
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Affiliation(s)
- Eoghan Shanley
- 1 Breast Centre North West, Letterkenny University Hospital , Letterkenny, Donegal , Ireland.,2 National University of Ireland , Galway , Ireland
| | - Alison Johnston
- 1 Breast Centre North West, Letterkenny University Hospital , Letterkenny, Donegal , Ireland.,3 Donegal Clinical Research Academy, Letterkenny University Hospital , Letterkenny , Ireland
| | - Dearbhla Hillick
- 1 Breast Centre North West, Letterkenny University Hospital , Letterkenny, Donegal , Ireland.,2 National University of Ireland , Galway , Ireland
| | - Kin Cheung Ng
- 1 Breast Centre North West, Letterkenny University Hospital , Letterkenny, Donegal , Ireland
| | - Michael Sugrue
- 1 Breast Centre North West, Letterkenny University Hospital , Letterkenny, Donegal , Ireland.,3 Donegal Clinical Research Academy, Letterkenny University Hospital , Letterkenny , Ireland
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Förnvik D, Förnvik H, Fieselmann A, Lång K, Sartor H. Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort. Eur Radiol 2018; 29:330-336. [PMID: 29943180 PMCID: PMC6291428 DOI: 10.1007/s00330-018-5582-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare software estimates of volumetric breast density (VBD) based on breast tomosynthesis (BT) projections to those based on digital mammography (DM) images in a large screening cohort, the Malmö Breast Tomosynthesis Screening Trial (MBTST). METHODS DM and BT images of 9909 women (enrolled 2010-2015) were retrospectively analysed with prototype software to estimate VBD. Software calculation is based on a physics model of the image acquisition process and incorporates the effect of masking in DM based on accumulated dense tissue areas. VBD (continuously and categorically) was compared between BT [central projection (mediolateral oblique view (MLO)] and two-view DM, and with radiologists' BI-RADS density 4th ed. scores. Agreement and correlation were investigated with weighted kappa (κ), Spearman's correlation coefficient (r), and Bland-Altman analysis. RESULTS There was a high correlation (r = 0.83) between VBD in DM and BT and substantial agreement between the software breast density categories [observed agreement, 61.3% and 84.8%; κ = 0.61 and ĸ = 0.69 for four (a/b/c/d) and two (fat involuted vs. dense) density categories, respectively]. There was moderate agreement between radiologists' BI-RADS scores and software density categories in DM (ĸ = 0.55) and BT (ĸ = 0.47). CONCLUSIONS In a large public screening setting, we report a substantial agreement between VBD in DM and BT using software with special focus on masking effect. This automated and objective mode of measuring VBD may be of value to radiologists and women when BT is used as the primary breast cancer screening modality. KEY POINTS • There was a high correlation between continuous volumetric breast density in DM and BT. • There was substantial agreement between software breast density categories (four groups) in DM and BT; with clinically warranted binary software breast density categories, the agreement increased markedly. • There was moderate agreement between radiologists' BI-RADS scores and software breast density categories in DM and BT.
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Affiliation(s)
- Daniel Förnvik
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | - Hannie Förnvik
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | | | - Kristina Lång
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden
| | - Hanna Sartor
- Department of Medical Imaging and Physiology, Skåne University Hospital, Medical Radiology Unit, Department of Translational Medicine, Lund University, Inga Marie Nilssons gata 49, 205 02, Malmö, Sweden.
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Hjerkind KV, Ellingjord-Dale M, Johansson AL, Aase HS, Hoff SR, Hofvind S, Fagerheim S, dos-Santos-Silva I, Ursin G. Volumetric Mammographic Density, Age-Related Decline, and Breast Cancer Risk Factors in a National Breast Cancer Screening Program. Cancer Epidemiol Biomarkers Prev 2018; 27:1065-1074. [DOI: 10.1158/1055-9965.epi-18-0151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/25/2018] [Accepted: 06/15/2018] [Indexed: 11/16/2022] Open
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van Rijssel MJ, Pluim JPW, Luijten PR, Gilhuijs KGA, Raaijmakers AJE, Klomp DWJ. Estimating B 1+ in the breast at 7 T using a generic template. NMR IN BIOMEDICINE 2018; 31:e3911. [PMID: 29570887 PMCID: PMC5947628 DOI: 10.1002/nbm.3911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
Dynamic contrast-enhanced MRI is the workhorse of breast MRI, where the diagnosis of lesions is largely based on the enhancement curve shape. However, this curve shape is biased by RF transmit (B1+ ) field inhomogeneities. B1+ field information is required in order to correct these. The use of a generic, coil-specific B1+ template is proposed and tested. Finite-difference time-domain simulations for B1+ were performed for healthy female volunteers with a wide range of breast anatomies. A generic B1+ template was constructed by averaging simulations based on four volunteers. Three-dimensional B1+ maps were acquired in 15 other volunteers. Root mean square error (RMSE) metrics were calculated between individual simulations and the template, and between individual measurements and the template. The agreement between the proposed template approach and a B1+ mapping method was compared against the agreement between acquisition and reacquisition using the same mapping protocol. RMSE values (% of nominal flip angle) comparing individual simulations with the template were in the range 2.00-4.01%, with mean 2.68%. RMSE values comparing individual measurements with the template were in the range8.1-16%, with mean 11.7%. The agreement between the proposed template approach and a B1+ mapping method was only slightly worse than the agreement between two consecutive acquisitions using the same mapping protocol in one volunteer: the range of agreement increased from ±16% of the nominal angle for repeated measurement to ±22% for the B1+ template. With local RF transmit coils, intersubject differences in B1+ fields of the breast are comparable to the accuracy of B1+ mapping methods, even at 7 T. Consequently, a single generic B1+ template suits subjects over a wide range of breast anatomies, eliminating the need for a time-consuming B1+ mapping protocol.
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Brand JS, Humphreys K, Li J, Karlsson R, Hall P, Czene K. Common genetic variation and novel loci associated with volumetric mammographic density. Breast Cancer Res 2018; 20:30. [PMID: 29665850 PMCID: PMC5904990 DOI: 10.1186/s13058-018-0954-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/09/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Mammographic density (MD) is a strong and heritable intermediate phenotype of breast cancer, but much of its genetic variation remains unexplained. METHODS We conducted a genetic association study of volumetric MD in a Swedish mammography screening cohort (n = 9498) to identify novel MD loci. Associations with volumetric MD phenotypes (percent dense volume, absolute dense volume, and absolute nondense volume) were estimated using linear regression adjusting for age, body mass index, menopausal status, and six principal components. We also estimated the proportion of MD variance explained by additive contributions from single-nucleotide polymorphisms (SNP-based heritability [h2SNP]) in 4948 participants of the cohort. RESULTS In total, three novel MD loci were identified (at P < 5 × 10- 8): one for percent dense volume (HABP2) and two for the absolute dense volume (INHBB, LINC01483). INHBB is an established locus for ER-negative breast cancer, and HABP2 and LINC01483 represent putative new breast cancer susceptibility loci, because both loci were associated with breast cancer in available meta-analysis data including 122,977 breast cancer cases and 105,974 control subjects (P < 0.05). h2SNP (SE) estimates for percent dense, absolute dense, and nondense volume were 0.29 (0.07), 0.31 (0.07), and 0.25 (0.07), respectively. Corresponding ratios of h2SNP to previously observed narrow-sense h2 estimates in the same cohort were 0.46, 0.72, and 0.41, respectively. CONCLUSIONS These findings provide new insights into the genetic basis of MD and biological mechanisms linking MD to breast cancer risk. Apart from identifying three novel loci, we demonstrate that at least 25% of the MD variance is explained by common genetic variation with h2SNP/h2 ratios varying between dense and nondense MD components.
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Affiliation(s)
- Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden.
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden.,Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden
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Han M, Kim B, Baek J. Human and model observer performance for lesion detection in breast cone beam CT images with the FDK reconstruction. PLoS One 2018; 13:e0194408. [PMID: 29543868 PMCID: PMC5854363 DOI: 10.1371/journal.pone.0194408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 02/19/2018] [Indexed: 12/12/2022] Open
Abstract
We investigate the detectability of breast cone beam computed tomography images using human and model observers and the variations of exponent, β, of the inverse power-law spectrum for various reconstruction filters and interpolation methods in the Feldkamp-Davis-Kress (FDK) reconstruction. Using computer simulation, a breast volume with a 50% volume glandular fraction and a 2mm diameter lesion are generated and projection data are acquired. In the FDK reconstruction, projection data are apodized using one of three reconstruction filters; Hanning, Shepp-Logan, or Ram-Lak, and back-projection is performed with and without Fourier interpolation. We conduct signal-known-exactly and background-known-statistically detection tasks. Detectability is evaluated by human observers and their performance is compared with anthropomorphic model observers (a non-prewhitening observer with eye filter (NPWE) and a channelized Hotelling observer with either Gabor channels or dense difference-of-Gaussian channels). Our results show that the NPWE observer with a peak frequency of 7cyc/degree attains the best correlation with human observers for the various reconstruction filters and interpolation methods. We also discover that breast images with smaller β do not yield higher detectability in the presence of quantum noise.
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Affiliation(s)
- Minah Han
- School of Integrated Technology and Yonsei Institute of Convergence Technology, Yonsei University, Incheon, South Korea
| | - Byeongjoon Kim
- School of Integrated Technology and Yonsei Institute of Convergence Technology, Yonsei University, Incheon, South Korea
| | - Jongduk Baek
- School of Integrated Technology and Yonsei Institute of Convergence Technology, Yonsei University, Incheon, South Korea
- * E-mail:
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Garcia E, Diez Y, Diaz O, Llado X, Gubern-Merida A, Marti R, Marti J, Oliver A. Multimodal Breast Parenchymal Patterns Correlation Using a Patient-Specific Biomechanical Model. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:712-723. [PMID: 28885152 DOI: 10.1109/tmi.2017.2749685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we aim to produce a realistic 2-D projection of the breast parenchymal distribution from a 3-D breast magnetic resonance image (MRI). To evaluate the accuracy of our simulation, we compare our results with the local breast density (i.e., density map) obtained from the complementary full-field digital mammogram. To achieve this goal, we have developed a fully automatic framework, which registers MRI volumes to X-ray mammograms using a subject-specific biomechanical model of the breast. The optimization step modifies the position, orientation, and elastic parameters of the breast model to perform the alignment between the images. When the model reaches an optimal solution, the MRI glandular tissue is projected and compared with the one obtained from the corresponding mammograms. To reduce the loss of information during the ray-casting, we introduce a new approach that avoids resampling the MRI volume. In the results, we focus our efforts on evaluating the agreement of the distributions of glandular tissue, the degree of structural similarity, and the correlation between the real and synthetic density maps. Our approach obtained a high-structural agreement regardless the glandularity of the breast, whilst the similarity of the glandular tissue distributions and correlation between both images increase in denser breasts. Furthermore, the synthetic images show continuity with respect to large structures in the density maps.
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Moshina N, Roman M, Sebuødegård S, Waade GG, Ursin G, Hofvind S. Comparison of subjective and fully automated methods for measuring mammographic density. Acta Radiol 2018; 59:154-160. [PMID: 28565960 DOI: 10.1177/0284185117712540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (kw). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend < 0.001 for both subjective classifications). The agreement between BI-RADS and volumetric breast density categories was kw = 0.5 (95% CI = 0.47-0.53; P < 0.001). Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.
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Affiliation(s)
| | | | | | - Gunvor G Waade
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, CA, USA
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway
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A step-by-step review on patient-specific biomechanical finite element models for breast MRI to x-ray mammography registration. Med Phys 2017; 45:e6-e31. [DOI: 10.1002/mp.12673] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/27/2017] [Accepted: 11/03/2017] [Indexed: 01/08/2023] Open
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49
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Vinnicombe SJ. Breast density: why all the fuss? Clin Radiol 2017; 73:334-357. [PMID: 29273225 DOI: 10.1016/j.crad.2017.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/17/2017] [Indexed: 01/06/2023]
Abstract
The term "breast density" or mammographic density (MD) denotes those components of breast parenchyma visualised at mammography that are denser than adipose tissue. MD is composed of a mixture of epithelial and stromal components, notably collagen, in variable proportions. MD is most commonly assessed in clinical practice with the time-honoured method of visual estimation of area-based percent density (PMD) on a mammogram, with categorisation into quartiles. The computerised semi-automated thresholding method, Cumulus, also yielding area-based percent density, is widely used for research purposes; however, the advent of fully automated volumetric methods developed as a consequence of the widespread use of digital mammography (DM) and yielding both absolute and percent dense volumes, has resulted in an explosion of interest in MD recently. Broadly, the importance of MD is twofold: firstly, the presence of marked MD significantly reduces mammographic sensitivity for breast cancer, even with state-of-the-art DM. Recognition of this led to the formation of a powerful lobby group ('Are You Dense') in the US, as a consequence of which 32 states have legislated for mandatory disclosure of MD to women undergoing mammography. Secondly, it is now widely accepted that MD is in itself a risk factor for breast cancer, with a four-to sixfold increased relative risk in women with PMD in the highest quintile compared to those with PMD in the lowest quintile. Consequently, major research efforts are underway to assess whether use of MD could provide a major step forward towards risk-adapted, personalised breast cancer prevention, imaging, and treatment.
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Affiliation(s)
- S J Vinnicombe
- Cancer Research, School of Medicine, Level 7, Mailbox 4, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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Farshid G. Routine reporting of mammographic density from screening mammograms. ANZ J Surg 2017; 87:965-967. [DOI: 10.1111/ans.14179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Gelareh Farshid
- BreastScreen SA; Adelaide South Australia Australia
- Discipline of Medicine; Adelaide University; Adelaide South Australia Australia
- Directorate of Surgical Pathology; SA Pathology; Adelaide South Australia Australia
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