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MacCallum C, Elder K, Nickson C, Ruecker K, Park A, Mann GB, Rose AK. Contrast-Enhanced Mammography in Local Staging of Screen-Detected Breast Cancer. Ann Surg Oncol 2024; 31:6820-6830. [PMID: 39048901 DOI: 10.1245/s10434-024-15848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND BreastScreen Australia, the population mammographic screening program for breast cancer, uses two-view digital screening mammography ± ultrasound followed by percutaneous biopsy to detect breast cancer. Secondary breast imaging for further local staging, not performed at BreastScreen, may identify additional clinically significant breast lesions. Staging options include further mammography, bilateral ultrasound, and/or contrast-based imaging (CBI) [magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM)]. CBI for local staging of screen-detected cancer was introduced at an academic hospital breast service in Melbourne, VIC, Australia. We report findings for otherwise occult disease and resulting treatment changes. MATERIAL AND METHODS Patients staged using CEM between November 2018 and April 2022 were identified from hospital records. Data were extracted from radiology, pathology, and breast unit databases. CEM-detected abnormalities were documented as true positive (TP) for invasive cancer or ductal carcinoma in situ (DCIS), or otherwise false positive (FP). The impact on surgical decisions was assessed. RESULTS Of 202 patients aged 44-84 years, 60 (30%) had 74 additional findings [34 (46%) TP, 40 (54%) FP]. These were malignant in 29/202 (14%) patients (79% invasive cancers, 21% DCIS). CEM resulted in surgical changes in 43/202 (21%) patients: wider resection (24/43), conversion to mastectomy (6/43), contralateral breast surgery (6/43), additional ipsilateral excision (5/43), and bracketing (2/43). Additional findings were more common for patients with larger index lesions and for invasive cancer, but there was no significant variation by age, breast density, or index lesion grade. CONCLUSIONS CEM for local staging of screen-detected breast cancers identified occult malignancy in 14% of patients. CEM improves local staging and may facilitate appropriate management of screen-detected breast cancers.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/pathology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/surgery
- Mammography/methods
- Middle Aged
- Aged
- Adult
- Neoplasm Staging
- Aged, 80 and over
- Early Detection of Cancer/methods
- Contrast Media
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Follow-Up Studies
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Magnetic Resonance Imaging/methods
- Prognosis
- Ultrasonography, Mammary/methods
- Retrospective Studies
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Affiliation(s)
| | - Kenneth Elder
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - Carolyn Nickson
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Kelly Ruecker
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - Allan Park
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
| | - G Bruce Mann
- The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia.
- The Royal Women's Hospital, Parkville, Melbourne, VIC, Australia.
- Department of Surgery, The University of Melbourne, Parkville, Melbourne, VIC, Australia.
| | - Allison K Rose
- The Royal Women's Hospital, Parkville, Melbourne, VIC, Australia
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Kubota K, Nakashima K, Nakashima K, Kataoka M, Inoue K, Goto M, Kanbayashi C, Hirokaga K, Yamaguchi K, Suzuki A. The Japanese breast cancer society clinical practice guidelines for breast cancer screening and diagnosis, 2022 edition. Breast Cancer 2024; 31:157-164. [PMID: 37973686 PMCID: PMC10901949 DOI: 10.1007/s12282-023-01521-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
This article provides updates to readers based on the newly published Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2022 Edition. These guidelines incorporate the latest evaluation of evidence from studies of diagnostic accuracy. For each clinical question, outcomes for benefits and harms were established, and qualitative or quantitative systematic reviews were conducted. Recommendations were determined through voting by a multidisciplinary group, and guidelines were documented to facilitate shared decision-making among patients and medical professionals. The guidelines address screening, surveillance, and pre- and postoperative diagnosis of breast cancer. In an environment that demands an integrated approach, decisions are needed on how to utilize modalities, such as mammography, ultrasound, MRI, and PET/CT. Additionally, it is vital to understand the appropriate use of new technologies, such as tomosynthesis, elastography, and contrast-enhanced ultrasound, and to consider how best to adapt these methods for individual patients.
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Affiliation(s)
- Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama, 343-8555, Japan.
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan.
| | - Kazutaka Nakashima
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Kazuaki Nakashima
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Division of Breast Imaging and Breast Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masako Kataoka
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenich Inoue
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Breast Cancer Center, Shonan Memorial Hospital, Kanagawa, Japan
| | - Mariko Goto
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chizuko Kanbayashi
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Akihiko Suzuki
- Division of Breast and Endocrine Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Mann GB, Skandarajah AR, Zdenkowski N, Hughes J, Park A, Petrie D, Saxby K, Grimmond SM, Murugasu A, Spillane AJ, Chua BH, Badger H, Braggett H, Gebski V, Mou A, Collins JP, Rose AK. Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study. Lancet 2024; 403:261-270. [PMID: 38065194 DOI: 10.1016/s0140-6736(23)02476-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Adjuvant breast radiotherapy as a standard component of breast-conserving treatment for early cancer can overtreat many women. Breast MRI is the most sensitive modality to assess local tumour burden. The aim of this study was to determine whether a combination of MRI and pathology findings can identify women with truly localised breast cancer who can safely avoid radiotherapy. METHODS PROSPECT is a prospective, multicentre, two-arm, non-randomised trial of radiotherapy omission in patients selected using preoperative MRI and postoperative tumour pathology. It is being conducted at four academic hospitals in Australia. Women aged 50 years or older with cT1N0 non-triple-negative breast cancer were eligible. Those with apparently unifocal cancer had breast-conserving surgery (BCS) and, if pT1N0 or N1mi, had radiotherapy omitted (group 1). Standard treatment including excision of MRI-detected additional cancers was offered to the others (group 2). All were recommended systemic therapy. The primary outcome was ipsilateral invasive recurrence rate (IIRR) at 5 years in group 1. Primary analysis occurred after the 100th group 1 patient reached 5 years follow-up. Quality-adjusted life-years (QALYs) and cost-effectiveness of the PROSPECT pathway were analysed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000810011). FINDINGS Between May 17, 2011, and May 6, 2019, 443 patients with breast cancer underwent MRI. Median age was 63·0 years. MRI detected 61 malignant occult lesions separate from the index cancer in 48 patients (11%). Of 201 group 1 patients who had BCS without radiotherapy, the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1, one local recurrence occurred at 4·5 years and a second at 7·5 years. In group 2, nine patients had mastectomy (2% of total cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%). The only distant metastasis in the entire cohort was genetically distinct from the index cancer. The PROSPECT pathway increased QALYs by 0·019 (95% CI 0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953 (672-1216) per patient. INTERPRETATION PROSPECT suggests that women with unifocal breast cancer on MRI and favourable pathology can safely omit radiotherapy. FUNDING Breast Cancer Trials, National Breast Cancer Foundation, Cancer Council Victoria, the Royal Melbourne Hospital Foundation, and the Breast Cancer Research Foundation.
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Affiliation(s)
- Gregory Bruce Mann
- The Royal Melbourne Hospital, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.
| | - Anita Rohini Skandarajah
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | | | | | - Allan Park
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Karinna Saxby
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia; Melbourne Institute of Applied Economic and Social Research, Parkville, VIC, Australia
| | - Sean M Grimmond
- The University of Melbourne Centre for Cancer Research, Parkville, VIC, Australia
| | | | - Andrew J Spillane
- University of Sydney, Wollstonecraft, NSW, Australia; Mater Hospital, Wollstonecraft, NSW, Australia
| | - Boon H Chua
- UNSW Medicine & Health, The University of New South Wales, Sydney, NSW, Australia
| | | | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Arlene Mou
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - John P Collins
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Allison K Rose
- The Royal Melbourne Hospital, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
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Jones LI, Klimczak K, Geach R. Breast MRI: an illustration of benign findings. Br J Radiol 2023; 96:20220280. [PMID: 36488196 PMCID: PMC9975519 DOI: 10.1259/bjr.20220280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022] Open
Abstract
Despite its unparalleled sensitivity for aggressive breast cancer, breast MRI continually excites criticism for a specificity that lags behind that of modern mammographic techniques. Radiologists reporting breast MRI need to recognise the range of benign appearances on breast MRI to avoid unnecessary biopsy. This review summarises the reported diagnostic accuracy of breast MRI with particular attention to the technique's specificity, provides a referenced reporting strategy and discusses factors that compromise diagnostic confidence. We then present a pictorial review of benign findings on breast MRI. Enhancing radiological skills to discriminate malignant from benign findings will minimise false positive biopsies, enabling optimal use of multiparametric breast MRI for the benefit of screening clients and breast cancer patients.
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Affiliation(s)
- Lyn Isobel Jones
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Katherine Klimczak
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Rebecca Geach
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom
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5
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Gibson AL, Watkins JE, Agrawal A, Tyminski MM, DeBenedectis CM. Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes. JOURNAL OF BREAST IMAGING 2022; 4:430-440. [PMID: 38416977 DOI: 10.1093/jbi/wbac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 03/01/2024]
Abstract
While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.
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Affiliation(s)
- Averi L Gibson
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Jade E Watkins
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Anushree Agrawal
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Monique M Tyminski
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
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Onega T, Zhu W, Kerlikowske K, Miglioretti DL, Lee CI, Henderson LM, Tosteson ANA, Wernli KJ, diFlorio R, Weaver DL, Buist DSM. Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield. Breast Cancer Res Treat 2022; 191:177-190. [PMID: 34686934 PMCID: PMC9881728 DOI: 10.1007/s10549-021-06418-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/11/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well-documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density. METHODS We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005 to 2017. We quantified breast biopsies and cancers detected within 6 months of diagnosis by preoperative breast MRI receipt, overall and by breast density, accounting for MRI selection bias using inverse probability weighted logistic regression. RESULTS Among 19,324 women with newly diagnosed breast cancer, 28% had preoperative MRI, 11% additional biopsy, and 5% additional cancer detected. Four times as many women with preoperative MRI underwent additional biopsy compared to women without MRI (22.6% v. 5.1%). Additional biopsy rates with preoperative MRI increased with increasing breast density (27.4% for extremely dense compared to 16.2% for almost entirely fatty breasts). Rates of additional cancer detection were almost four times higher for women with v. without MRI (9.9% v. 2.6%). Conditional on additional biopsy, age-adjusted rates of additional cancer detection were lowest among women with extremely dense breasts, regardless of imaging modality (with MRI: 35.0%; 95% CI 27.0-43.0%; without MRI: 45.1%; 95% CI 32.6-57.5%). CONCLUSION For women with dense breasts, preoperative MRI was associated with much higher biopsy rates, without concomitant higher cancer detection. Preoperative MRI may be considered for some women, but selecting women based on breast density is not supported by evidence. TRIAL REGISTRATION ClinicalTrials.gov: NCT02980848; registered 2017.
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Affiliation(s)
- Tracy Onega
- Department of Population Health Sciences, and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, RS 4725, 2000 Circle of Hope Dr., Salt Lake City, UT, 84018, USA.
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Roberta diFlorio
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Donald L Weaver
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Dialani V, Tseng I, Slanetz PJ, Fein-Zachary V, Phillips J, Karimova E, Brook A, Mehta TS. Potential role of abbreviated MRI for breast cancer screening in an academic medical center. Breast J 2019; 25:604-611. [PMID: 31206889 DOI: 10.1111/tbj.13297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/29/2022]
Abstract
The purpose is to determine whether an abbreviated MRI protocol (ABMR) is ready to be used for breast cancer screening in an academic practice setting. Two hundred and fifty nine breast MRIs from 1/1/2012 to 6/30/2012 were retrospectively reviewed using ABMR (MIP, Pre-contrastT1, single dynamic post-contrastT1, and subtraction). Five breast radiologists (4-28 year-expr) participated in this reader study performed in two phases: Phase1 - radiologist's privy to clinical history but not to comparison imaging. Phase2 - radiologists provided comparison imaging. For phase1, studies were reviewed using three steps: (a) MIP only (positive/negative/intermediate); (b) ABMR (recall/no recall) and (c) With T2 (for changes in recommendations). Radiologist also recorded total time for interpretation. In Phase2 the MRIs coded as "recall" were re-reviewed with available comparison studies, noting changes in final recommendation. The abnormal interpretation rates (AIRs) were calculated for phase1 and phase2 results with comparison to the original full protocol. Of the 259 patients (avg. age-52 years; range 26-78), there were seven cancers (three invasive, three DCIS and one breast lymphoma). Acquisition time for ABMR was 3 minutes, ABMR + T2-8 minutes, and original full protocol 16 minutes. Average MIP was positive or indeterminate in 86% (6/7) and negative in 14% (1/7) cancers. The average AIR for MIP only was 20.8% (sens-77.1%; spec-80.8%. The AIR w/o comparisons was 25.6% (sens-91.4%; spec- 76.2%); however the average AIR decreased in phase 2 with comparisons to 13.7% (sens-91.4%; spec-88.5%). The AIR of the original full protocol read was 16.2% (sens-100%; spec-85.7%). Addition of T2 changed assessment in only 3% (1.2%-6.5%). Avg. read time for ABMR including T2 was 2.5 minutes (1.6-4.0 minutes). ABMR is reliable for breast cancer screening, with acceptable interpretation time and acceptable AIR.
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Affiliation(s)
- Vandana Dialani
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Irene Tseng
- Department of Radiology, Winchester Hospital, Lahey Health, Winchester, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Valerie Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Jordana Phillips
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Evguenia Karimova
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
| | - Tejas S Mehta
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts
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Faermann R, Weidenfeld J, Chepelev L, Kendal W, Verma R, Scott-Moncrieff A, Peddle S, Doherty G, Lau J, Ramsay T, Arnaout A, Lamb L, Watters JM, Seely JM. Outcomes after Surgery for Early Stage Breast Cancer in Women Staged With Preoperative Breast Magnetic Resonance Imaging According to Breast Tissue Density. JOURNAL OF BREAST IMAGING 2019; 1:115-121. [PMID: 38424925 DOI: 10.1093/jbi/wbz018] [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: 01/11/2019] [Indexed: 03/02/2024]
Abstract
PURPOSE To determine surgical outcomes and breast cancer disease-free survival outcomes of women with early stage breast cancer with and without use of preoperative breast MRI according to breast tissue density. METHODS Women with early stage breast cancer diagnosed from 2004 to 2009 were classified into 2 groups: 1) those with dense and heterogeneously dense breasts (DB); 2) those with nondense breasts (NDB) (scattered fibroglandular and fatty replaced tissue). The 2 groups were reviewed to determine who underwent preoperative MRI. Breast tissue density was determined with mammography according to ACR BI-RADS. Patients were compared according to tumor size, grade, stage, and treatment. Survival analysis was performed using Kaplan-Meier estimates. RESULTS In total, 261 patients with mean follow-up of 85 months (25-133) were included: 156 DB and 105 NDB. Disease-free survival outcomes were better in the DB group in patients with MRI than in those without MRI: patients with MRI had significantly fewer local recurrences (P < 0.016) and metachronous contralateral breast cancers (P < 0.001), but this was not the case in the NDB group. Mastectomies were higher in the DB group with preoperative MRI than in those without MRI (P < 0.01), as it was in the NDB group (P > 0.05). CONCLUSIONS Preoperative breast MRI was associated with reduced local recurrence and metachronous contralateral cancers in the DB group, but not in the NDB group; however, the DB patients with MRI had higher mastectomy rates.
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Affiliation(s)
- Renata Faermann
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Weidenfeld
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Leonid Chepelev
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Wayne Kendal
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital, Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Raman Verma
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Scott-Moncrieff
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Susan Peddle
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Geoff Doherty
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Jackie Lau
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Epidemiology, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Angel Arnaout
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital, Department of Surgery, Ottawa, ON, Canada
| | - Leslie Lamb
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | | | - Jean M Seely
- Ottawa Hospital, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
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9
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MRI predictors of tumor-positive margins after breast-conserving surgery. Clin Imaging 2019; 57:45-49. [PMID: 31128385 DOI: 10.1016/j.clinimag.2019.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 05/14/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study is to identify predictors of tumor-positive surgical margins after breast-conserving surgery on dynamic contrast-enhanced (DCE) MRI. MATERIALS AND METHODS We conducted a retrospective study of consecutive women who underwent DCE MRI before breast-conserving surgery from 2005 to 2014. Patient demographics, indication for surgery, MRI findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t-test and chi-square test were used to compare the positive and negative margins groups. RESULTS 554 women (mean age, 56; range, 26-90) underwent DCE MRI before 575 breast-conserving surgeries for invasive carcinoma (n = 473) or ductal carcinoma in situ (DCIS) (n = 102). Positive margins requiring re-excision occurred in 19.7% (93/473) of surgeries for invasive carcinoma and 31.4% (32/102) of surgeries for DCIS. For invasive carcinoma surgeries, positive margins were more common when MRI demonstrated the finding of non-mass enhancement (NME) rather than the finding of enhancing mass (33.8% [22/65] versus 16.9% [61/360], p < 0.01). Tumor size on MRI was significantly larger in the positive margins group (2.5 cm versus 1.9 cm, p < 0.001). Positive margins were more common with invasive lobular rather than invasive ductal histology at core biopsy (38.3% [18/47] versus 16.0% [56/350], p < 0.001). For DCIS surgeries, there were no significant differences in positive margin rates related to MRI features. CONCLUSION For invasive carcinoma surgeries, positive margins are associated with NME on MRI, larger tumor size on MRI, and lobular histology at core biopsy. These findings may be used to predict which patients are at risk for positive margins after breast-conserving surgery.
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Karlsson A, Gonzalez V, Jaraj SJ, Bottai M, Sandelin K, Arver B, Eriksson S. The accuracy of incremental pre-operative breast MRI findings – Concordance with histopathology in the Swedish randomized multicenter POMB trial. Eur J Radiol 2019; 114:185-191. [DOI: 10.1016/j.ejrad.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/12/2019] [Accepted: 03/11/2019] [Indexed: 11/28/2022]
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Clinical findings and outcomes of MRI staging of breast cancer in a diverse population. Breast Cancer Res Treat 2018; 174:315-324. [PMID: 30542816 DOI: 10.1007/s10549-018-05084-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The performance of magnetic resonance imaging (MRI), the effect of patient factors, and resulting surgical management in underserved and ethnically diverse breast cancer (BC) patient populations have been understudied. METHODS We retrospectively analyzed the data of 1116 consecutive patients who were newly diagnosed with in situ or invasive BC with preoperative staging MRI. Non-index lesions (NILs) were defined as abnormal MRI findings with BI-RADS score of 4 or 5 in breast or axillary nodes not previously detected by conventional imaging. Occult cancers (OCs) were NILs found to be malignant by biopsy or surgery. Logistic regression was used to examine associations between probabilities of NILs or OCs and patient characteristics. RESULTS Staging MRI detected NILs and OCs in 24% and 7.5% of patients, respectively. Of 1116 patients, 271 (24%) had 327 NILs, and 84 (7.5%) had 87 OCs. Follow-up information was available for 306 NILs. Ipsilateral breast NILs (n = 124) were seen in 115 patients (10.3%), with OCs (n = 51) seen in 48 patients (4.4%). Contralateral breast NILs (n = 134) were seen in 118 (10.6%) patients, with OCs (n = 20) seen in 20 patients (1.8%). Laterality (p < 0.001) and disease stage (p = 0.018) were associated with probability of OC. Patients without BRCA mutations had a significantly higher probability of having NILs (p = 0.003) but not OCs. CONCLUSIONS Our study provides useful estimates of the rates of NILs and OCs anticipated in a younger, uninsured, ethnically diverse population. Prospective trials and larger pooled retrospective analyses are needed to define the long-term impacts of MRI staging after a BC diagnosis.
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Lameijer JR, Coolen AM, Nederend J, Voogd AC, Tjan-Heijnen VC, Duijm LE. Frequency and characteristics of additionally detected ipsilateral breast lesions following recall at screening mammography. Breast 2018; 42:94-101. [PMID: 30216838 DOI: 10.1016/j.breast.2018.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the frequency and outcome of additionally detected ipsilateral breast abnormalities following recall at screening mammography. METHODS AND MATERIALS We included a consecutive series of 130,338 screening mammograms obtained between January 1, 2014 and January 1, 2016. During 2-year follow-up, clinical data were collected of all recalls. Women with a bilateral recall (115) and women recalled for multiple lesions in one breast (165) were excluded from the analyses. Screening outcome parameters were determined for recalled women with or without evaluation of additional ipsilateral breast abnormalities following recall. RESULTS A total of 3995 women were recalled (recall rate, 3.1%). In 258 (6.4%) of these women, another lesion was detected in the ipsilateral breast than the one for which she had been recalled. Biopsy was more frequently performed of additionally detected ipsilateral lesions than of recalled lesions (55.8% (144/258)) versus 39.7% (1375/3457), (p < 0.001)). The proportion of malignancy in recalled lesions and additionally detected lesions was comparable (21.5% (743/3457) versus 19.0% (49/258), p = 0.34). Of all 144 biopsies of additionally detected ipsilateral lesions, 9 revealed a synchronous tumour in addition to a malignant recalled lesion, and 33 biopsies revealed multicentric or multifocal tumours. In 5 women, the recalled lesion turned out to be benign, whereas the additional lesion in a different quadrant was malignant at biopsy. A total of 97 biopsies showed benign findings. CONCLUSION A substantial proportion of women are analyzed for additional ipsilateral breast lesions following recall. These lesions are more frequently biopsied than recalled lesions, but have a comparable probability of being malignant. The majority of additionally detected cancerous lesions are part of multifocal or multicentric malignancies.
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Affiliation(s)
- Joost Rc Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Angela Mp Coolen
- Department of Radiology, Elisabeth-Tweesteden Hospital (ETZ), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Vivianne Cg Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Lucien Em Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
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Christopherson KM, Smith BD. How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Radiation Oncologist. Magn Reson Imaging Clin N Am 2018; 26:295-302. [PMID: 29622135 DOI: 10.1016/j.mric.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Radiation therapy is used in many cases of both early and late breast cancer. The authors examine the role of MR imaging as it pertains to radiotherapy planning and treatment approaches for patients with breast cancer. MR imaging can assist the radiation oncologist in determining the best radiation approach and in creating treatment planning volumes. MR imaging may be useful in the setting of accelerated partial breast irradiation. Radiation oncologists should attend to MR breast images, when obtained, to ensure that these imaging findings are taken into consideration when developing a radiation therapy plan.
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Affiliation(s)
- Kaitlin M Christopherson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Boone Pickens Academic Tower (FCT6.5075), 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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14
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Impact of breast MRI in women eligible for breast conservation surgery and intra-operative radiation therapy. Surg Oncol 2018; 27:95-99. [DOI: 10.1016/j.suronc.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/20/2017] [Accepted: 01/07/2018] [Indexed: 11/20/2022]
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15
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Henderson LM, Hubbard RA, Zhu W, Weiss J, Wernli KJ, Goodrich ME, Kerlikowske K, DeMartini W, Ozanne EM, Onega T. Preoperative Breast Magnetic Resonance Imaging Use by Breast Density and Family History of Breast Cancer. J Womens Health (Larchmt) 2018; 27:987-993. [PMID: 29334616 DOI: 10.1089/jwh.2017.6428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Use of preoperative breast magnetic resonance imaging (MRI) among women with a new breast cancer has increased over the past decade. MRI use is more frequent in younger women and those with lobular carcinoma, but associations with breast density and family history of breast cancer are unknown. MATERIALS AND METHODS Data for 3075 women ages >65 years with stage 0-III breast cancer who underwent breast conserving surgery or mastectomy from 2005 to 2010 in the Breast Cancer Surveillance Consortium were linked to administrative claims data to assess associations of preoperative MRI use with mammographic breast density and first-degree family history of breast cancer. Multivariable logistic regression estimated adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association of MRI use with breast density and family history, adjusting for woman and tumor characteristics. RESULTS Overall, preoperative MRI use was 16.4%. The proportion of women receiving breast MRI was similar by breast density (17.6% dense, 16.9% nondense) and family history (17.1% with family history, 16.5% without family history). After adjusting for potential confounders, we found no difference in preoperative MRI use by breast density (OR = 0.95 for dense vs. nondense, 95% CI: 0.73-1.22) or family history (OR = 0.99 for family history vs. none, 95% CI: 0.73-1.32). CONCLUSIONS Among women aged >65 years with breast cancer, having dense breasts or a first-degree relative with breast cancer was not associated with greater preoperative MRI use. This utilization is in keeping with lack of evidence that MRI has higher yield of malignancy in these subgroups.
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Affiliation(s)
- Louise M Henderson
- 1 Department of Radiology, The University of North Carolina , Chapel Hill, North Carolina
| | - Rebecca A Hubbard
- 2 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Weiwei Zhu
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Julie Weiss
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karen J Wernli
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Martha E Goodrich
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karla Kerlikowske
- 5 Departments of Medicine and Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
| | - Wendy DeMartini
- 6 Department of Radiology, Stanford University , Stanford, California
| | - Elissa M Ozanne
- 7 Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah
| | - Tracy Onega
- 8 The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center , Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire
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Hlubocky J, Bhavnagri S, Swinford A, Mitri C, Rebner M, Pai V. Does the use of pretreatment MRI change the management of patients with newly diagnosed breast cancer? Breast J 2017; 24:309-313. [PMID: 29105963 DOI: 10.1111/tbj.12946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022]
Abstract
Breast MRI plays a critical role in the diagnosis and management of breast cancer. The purpose of this study is to evaluate the effect of preoperative breast MRI on the management of a large cohort of breast cancer patients at our institution. This study is a retrospective chart review of all newly diagnosed breast cancer patients who underwent preoperative breast MRI at our institution between January 1, 2004 and December 31, 2009. 1352 patients comprised the study population. 241 (17.8%) patients underwent a change in surgical management as a result of preoperative MRI. Patients with tumors in the lower inner quadrant and the central breast and those with pathology of invasive lobular carcinoma were significantly more likely to have their management changed by preoperative MRI. There was also a significant trend for larger tumors to be associated with a change in surgical management. No statistically significant association was found between breast density and change in management. This study supports the recommendation for the use of preoperative breast MRI in the majority of newly diagnosed breast cancer patients, especially those with larger tumors, pathology of invasive lobular carcinoma, and tumors in the lower inner quadrant. Preoperative breast MRI is a useful tool for the evaluation of additional disease that led to a change in the surgical management of 17.8% of patients.
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17
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Elder EA, Ferlin A, Vallow LA, Li Z, Gibson TC, Bagaria SP, McLaughlin SA. The Influence of Breast Density on Preoperative MRI Findings and Outcome in Patients with a Known Diagnosis of Breast Cancer. Ann Surg Oncol 2017; 24:2898-2906. [DOI: 10.1245/s10434-017-5981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 11/18/2022]
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18
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Newburg AR, Chhor CM, Young Lin LL, Heller SL, Gillman J, Toth HK, Moy L. Magnetic Resonance Imaging-Directed Ultrasound Imaging of Non-Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:493-504. [PMID: 28108994 DOI: 10.7863/ultra.16.03001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non-mass enhancement. METHODS From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non-mass enhancing lesions for which follow-up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non-mass enhancement. Patient demographics, pathologic results, and the presence of an adjacent landmark were recorded. Targeted US examinations were recommended for 331 of 879 cases (38%), and 284 of 331 women (86%) underwent US evaluations. RESULTS The US correlate rate for non-mass enhancement was 23% (64 of 284). An adjacent landmark was significantly associated with a US correlate (P < .001). Biopsy was recommended for 43 of 64 correlates (67%). Ultrasound-guided biopsy was performed on 39 of 43 (91%); 7 of 39 (18%) were malignant. No correlate was seen for 220 of 284 lesions (77%). At magnetic resonance imaging-guided biopsy, 14 of 117 (12%) were malignancies. For all biopsied non-mass enhancements, the malignancy rate was 18% (55 of 308) and was significantly more prevalent in the setting of a known index cancer (P < .001), older age (P < .001), the presence of a landmark (P = .002), and larger lesion size (P = .019). CONCLUSIONS Non-mass enhancement with an adjacent landmark is more likely to have a US correlate compared to non-mass enhancement without an adjacent landmark. Non-mass enhancement in the setting of a known index cancer, older age, a landmark, and larger lesion size is more likely to be malignant. However, no statistical difference was detected in the rate of malignancy between non-mass enhancement with (18%) or without (12%) a correlate. Absence of a correlate does not obviate the need to biopsy suspicious non-mass enhancement.
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Affiliation(s)
- Adrienne R Newburg
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chloe M Chhor
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Leng Leng Young Lin
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Samantha L Heller
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Jennifer Gillman
- Department of Internal Medicine, Lenox Hill Hospital, New York, New York, USA
| | - Hildegard K Toth
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, New York, New York, USA
- Department of Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, New York, USA
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He H, Plaxco JS, Wei W, Huo L, Candelaria RP, Kuerer HM, Yang WT. Incremental cancer detection using breast ultrasonography versus breast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients. Br J Radiol 2016; 89:20160401. [PMID: 27384241 DOI: 10.1259/bjr.20160401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. METHODS A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. RESULTS A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p = 0.01), while BWBUS was significantly more accurate and specific than MRI (p < 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptor-positive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. CONCLUSION MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRI-detected additional malignant lesions did not change surgical planning in almost half of these patients. ADVANCES IN KNOWLEDGE BWBUS may be a cost-effective and practical tool in breast cancer staging.
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Affiliation(s)
- Hongying He
- 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,2 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jeri S Plaxco
- 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Wei
- 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- 4 Department of Surgical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind P Candelaria
- 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- 5 Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei T Yang
- 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zhang H, Tan H, Gao J, Wei Y, Yu Z, Zhou Y. The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery. Exp Ther Med 2016; 12:1275-1278. [PMID: 27588049 PMCID: PMC4998097 DOI: 10.3892/etm.2016.3449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.
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Affiliation(s)
- Huiyu Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Hongna Tan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Wei
- Department of Urology, Henan Province Zhigong Hospital, Zhengzhou, Henan 450002, P.R. China
| | - Zhan Yu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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21
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Influence of preoperative magnetic resonance imaging on the surgical management of breast cancer patients. Am J Surg 2016; 211:1089-94. [DOI: 10.1016/j.amjsurg.2015.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/15/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022]
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22
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Lourenco AP, Mainiero MB. Incorporating Imaging Into the Locoregional Management of Breast Cancer. Semin Radiat Oncol 2015; 26:17-24. [PMID: 26617206 DOI: 10.1016/j.semradonc.2015.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although some breast cancers present as palpable masses or with other clinical findings, many are detected at screening. Most screening is currently done with digital mammography, but high-risk patients or those with dense breast tissue may undergo additional screening examinations with magnetic resonance imaging or ultrasound. Additionally, digital breast tomosynthesis, contrast-enhanced mammography, and molecular breast imaging are newer technologies available at some sites. Optimal usage of breast imaging technologies remains controversial, both in screening and diagnostic settings following a new diagnosis of breast cancer. This article will review well established and newer, alternative breast imaging technologies as well as recent data regarding their role in optimizing patient care.
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Affiliation(s)
- Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
| | - Martha B Mainiero
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
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23
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The Yield of Pre-operative Breast MRI in Patients According to Breast Tissue Density. Eur Radiol 2015; 26:3280-9. [DOI: 10.1007/s00330-015-4118-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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24
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Khoury T, Li Z, Sanati S, Desouki MM, Chen X, Wang D, Liu S, Karabakhtsian R, Kumar P, Reig B. The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions. Histopathology 2015; 68:713-21. [PMID: 26291517 DOI: 10.1111/his.12811] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/14/2015] [Indexed: 01/15/2023]
Abstract
AIMS To identify variables that can predict upgrade for magnetic resonance imaging (MRI)-detected atypical ductal hyperplasia (ADH). METHODS AND RESULTS We reviewed 1655 MRI-guided core biopsies between 2005 and 2013, yielding 100 (6%) cases with ADH. The pathological features of ADH and MRI findings were recorded. An upgrade was considered when the subsequent surgical excision yielded invasive carcinoma (IC) or ductal carcinoma in situ (DCIS). The rate of ADH between institutions was 3.3-7.1%, with an average of 6%. A total of 15 (15%) cases had upgrade, 12 DCIS and three IC. When all cases were included, only increased number of involved cores was statistically significant (P = 0.02). When cases with concurrent lobular neoplasia (LN) were excluded (n = 14), increased number of ADH foci and increased number of involved cores were statistically significant (P = 0.002, P = 0.009). We analysed the data separately from a single institution (n = 61). Increased number of foci, increased number of total cores and involved cores and larger ADH size predicted upgrade with statistical significance. CONCLUSIONS The incidence of ADH in MRI-guided core biopsy is rare. The rate of upgrade is comparable to mammographically detected ADH, warranting surgical excision. Similar to mammographically detected lesions, the volume of the ADH predicts the upgrade.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Zaibo Li
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Souzan Sanati
- Department of Pathology, Washington University, St Louis, MO, USA
| | | | - Xiwei Chen
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Dan Wang
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Song Liu
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Rouzan Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Prasanna Kumar
- Department of Radiology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Beatriu Reig
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Debald M, Abramian A, Nemes L, Döbler M, Kaiser C, Keyver-Paik MD, Leutner C, Höller T, Braun M, Kuhl C, Kuhn W, Schild HH. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Res Treat 2015; 153:531-7. [PMID: 26323190 DOI: 10.1007/s10549-015-3556-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/22/2015] [Indexed: 02/03/2023]
Abstract
Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.
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Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Alina Abramian
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Lisa Nemes
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Döbler
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christina Kaiser
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Mignon-Denise Keyver-Paik
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Claudia Leutner
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Tobias Höller
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Michael Braun
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department of Gynecology, Red Cross Women's Clinic Munich, Munich, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen RWTH, Aachen, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
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Breast magnetic resonance imaging performance: safety, techniques, and updates on diffusion-weighted imaging and magnetic resonance spectroscopy. Top Magn Reson Imaging 2015; 23:373-84. [PMID: 25463410 DOI: 10.1097/rmr.0000000000000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance imaging (MRI) is a well-established, highly sensitive technique for the detection and evaluation of breast cancer. Optimal performance of breast MRI continues to evolve. This article addresses breast MRI applications, covers emerging breast MRI safety concerns; outlines the technical aspects of breast MRI, including equipment and protocols at 3 T and 1.5 T; and describes current promising areas of research including diffusion-weighted imaging and magnetic resonance spectroscopy.
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Preoperative MRI in patients with locoregional recurrent breast cancer: influence on treatment modalities. Acad Radiol 2014; 21:1276-85. [PMID: 25091598 DOI: 10.1016/j.acra.2014.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this analysis was to evaluate the impact of preoperative magnetic resonance imaging (MRI) on management in patients with locoregional recurrent breast cancer. MATERIALS AND METHODS Forty-three patients who underwent treatment for locoregional relapse of breast cancer from 2008 through 2012 were analyzed. All patients underwent both conventional surveillance by mammography, ultrasound, and clinical examination and subsequent bilateral breast MRI. RESULTS Preoperative MRI detected additional tumor foci in 15 of 43 patients (34.9%). In two cases (4.7%), the diagnosis of occult sites had no influence on the subsequent treatment. Two patients (4.7%) had an unfavorable change of surgical management with unnecessary additional resection of benign foci. Eleven patients benefited from the MRI scan detecting malignant occult lesions (25.6%) resulting in either additional surgical resection or radiotherapy. Patient and tumor characteristics in primary disease did not differ significantly between patients with a favorable impact on surgical management and patients who experienced either no benefit or even disadvantage from MRI scan. CONCLUSIONS Preoperative breast MRI has a strong impact on the management of locoregional recurrent breast cancer. This study demonstrates that breast MRI is a powerful supplement to conventional diagnostic work-up, both during follow-up or preoperative treatment planning in recurrent disease.
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Destounis SV, Arieno AL, Morgan RC. Importance of presurgical breast MRI in patients 60 years of age and older. J Clin Imaging Sci 2014; 4:46. [PMID: 25250195 PMCID: PMC4168544 DOI: 10.4103/2156-7514.139736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/07/2014] [Indexed: 11/29/2022] Open
Abstract
Objective: To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI) in women 60 years of age and older. Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results. Results: Of 1268 exams performed in this population, 272 (21.5%) patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%), benign findings in 127 (47%), and atypia in 31 (11%). Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy. Conclusions: Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268) and atypia in 2.4% (n = 31/1268). A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268). These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.
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Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol 2014; 32:2304-10. [PMID: 24958821 DOI: 10.1200/jco.2013.52.5386] [Citation(s) in RCA: 459] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We investigated whether an abbreviated protocol (AP), consisting of only one pre- and one postcontrast acquisition and their derived images (first postcontrast subtracted [FAST] and maximum-intensity projection [MIP] images), was suitable for breast magnetic resonance imaging (MRI) screening. METHODS We conducted a prospective observational reader study in 443 women at mildly to moderately increased risk who underwent 606 screening MRIs. Eligible women had normal or benign digital mammograms and, for those with heterogeneously dense or extremely dense breasts (n = 427), normal or benign ultrasounds. Expert radiologists reviewed the MIP image first to search for significant enhancement and then reviewed the complete AP (consisting of MIP and FAST images and optionally their nonsubtracted source images) to characterize enhancement and establish a diagnosis. Only thereafter was the regular full diagnostic protocol (FDP) analyzed. RESULTS MRI acquisition time for FDP was 17 minutes, versus 3 minutes for the AP. Average time to read the single MIP and complete AP was 2.8 and 28 seconds, respectively. Eleven breast cancers (four ductal carcinomas in situ and seven invasive cancers; all T1N0 intermediate or high grade) were diagnosed, for an additional cancer yield of 18.2 per 1,000. MIP readings were positive in 10 (90.9%) of 11 cancers and allowed establishment of the absence of breast cancer, with a negative predictive value (NPV) of 99.8% (418 of 419). Interpretation of the complete AP, as with the FDP, allowed diagnosis of all cancers (11 [100%] of 11). Specificity and positive predictive value (PPV) of AP versus FDP were equivalent (94.3% v 93.9% and 24.4% v 23.4%, respectively). CONCLUSION An MRI acquisition time of 3 minutes and an expert radiologist MIP image reading time of 3 seconds are sufficient to establish the absence of breast cancer, with an NPV of 99.8%. With a reading time < 30 seconds for the complete AP, diagnostic accuracy was equivalent to that of the FDP and resulted in an additional cancer yield of 18.2 per 1,000.
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Affiliation(s)
- Christiane K Kuhl
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany.
| | - Simone Schrading
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany
| | - Kevin Strobel
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany
| | - Ralf-Dieter Hilgers
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany
| | - Heribert B Bieling
- Christiane K. Kuhl, Simone Schrading, Kevin Strobel, Ralf-Dieter Hilgers, and Heribert B. Bieling, University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Aachen; and Hans H. Schild, University of Bonn, Bonn, Germany
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Parsyan A, Alqahtani A, Mesurolle B, Meterissian S. Impact of preoperative breast MRI on surgical decision making and clinical outcomes: a systematic review. World J Surg 2014; 37:2134-9. [PMID: 23661259 DOI: 10.1007/s00268-013-2077-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative magnetic resonance imaging (MRI) is increasingly used in the workup of breast cancer patients and could lead to changes in surgical management. It is unclear how the information gained from MRI studies affects surgical decision making and influences clinical outcomes. These issues are addressed in this review. METHODS PubMed database searches were performed to retrieve and analyze respective original research and review articles on preoperative MRI in the evaluation of breast cancer patients. RESULTS Preoperative MRI is a highly sensitive but nonspecific method that leads to changes in surgical management with increased numbers of more extended surgical interventions. It appears that a relatively large proportion of MRI-driven changes in surgical management result in overtreatment without conclusively proven beneficial effects on such clinical outcomes as decrease in reoperation rates or improved patient survival. CONCLUSIONS Thus, routine use of supplementary preoperative breast MRI should be discouraged until compelling evidence of its effectiveness is available.
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Affiliation(s)
- Armen Parsyan
- Department of Surgery, McGill University and McGill University Health Centre, Montreal, QC H3A 1A1, Canada.
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Behrendt CE, Tumyan L, Gonser L, Shaw SL, Vora L, Paz IB, Ellenhorn JDI, Yim JH. Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer. Breast 2014; 23:341-5. [PMID: 24530008 DOI: 10.1016/j.breast.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/11/2013] [Accepted: 01/09/2014] [Indexed: 01/15/2023] Open
Abstract
Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.
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MESH Headings
- Adult
- Aged
- Breast/pathology
- Breast/surgery
- Breast Density
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/surgery
- Cohort Studies
- Female
- Genetic Predisposition to Disease
- Humans
- Magnetic Resonance Imaging/methods
- Mammary Glands, Human/abnormalities
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/surgery
- Patient Selection
- Practice Guidelines as Topic/standards
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Assessment
- Young Adult
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Affiliation(s)
- Carolyn E Behrendt
- Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Lusine Tumyan
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Laura Gonser
- General Surgery, University of California San Francisco, Fresno Campus/Community Regional Medical Center, 2823 Fresno St., Fresno, CA 93721, USA
| | - Sara L Shaw
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Lalit Vora
- Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - I Benjamin Paz
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - Joshua D I Ellenhorn
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA
| | - John H Yim
- Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
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Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy.
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Kim TY, Kim SH, Kang BJ, Kim HS, Cha ES, Kim JY, Song BJ. Characterization of the enhancing lesions on dynamic contrast enhanced magnetic resonance imaging in patients with interstitial mammoplasty. Eur J Radiol 2013; 82:2205-11. [DOI: 10.1016/j.ejrad.2013.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/31/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
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Patient Age and Tumor Size Determine the Cancer Yield of Preoperative Bilateral Breast MRI in Women With Ductal Carcinoma In Situ. AJR Am J Roentgenol 2013; 201:684-91. [DOI: 10.2214/ajr.12.10167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Butler RS, Chen C, Vashi R, Hooley RJ, Philpotts LE. 3.0 Tesla vs 1.5 Tesla breast magnetic resonance imaging in newly diagnosed breast cancer patients. World J Radiol 2013; 5:285-294. [PMID: 24003354 PMCID: PMC3758496 DOI: 10.4329/wjr.v5.i8.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/27/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare 3.0 Tesla (T) vs 1.5T magnetic resonance (MR) imaging systems in newly diagnosed breast cancer patients.
METHODS: Upon Institutional Review Board approval, a Health Insurance Portability and Accountability Act-compliant retrospective review of 147 consecutive 3.0T MR examinations and 98 consecutive 1.5T MR examinations in patients with newly diagnosed breast cancer between 7/2009 and 5/2010 was performed. Eleven patients who underwent neoadjuvant chemotherapy in the 3.0T group were excluded. Mammographically occult suspicious lesions (BIRADS Code 4 and 5) additional to the index cancer in the ipsilateral and contralateral breast were identified. Lesion characteristics and pathologic diagnoses were recorded, and results achieved with both systems compared. Statistical significance was analyzed using Fisher’s exact test.
RESULTS: In the 3.0T group, 206 suspicious lesions were identified in 55% (75/136) of patients and 96% (198/206) of these lesions were biopsied. In the 1.5T group, 98 suspicious lesions were identified in 53% (52/98) of patients and 90% (88/98) of these lesions were biopsied. Biopsy results yielded additional malignancies in 24% of patients in the 3.0T group vs 14% of patients in the 1.5T group (33/136 vs 14/98, P = 0.07). Average size and histology of the additional cancers was comparable. Of patients who had a suspicious MR imaging study, additional cancers were found in 44% of patients in the 3.0T group vs 27% in the 1.5T group (33/75 vs 14/52, P = 0.06), yielding a higher positive predictive value (PPV) for biopsies performed with the 3.0T system.
CONCLUSION: 3.0T MR imaging detected more additional malignancies in patients with newly diagnosed breast cancer and yielded a higher PPV for biopsies performed with the 3.0T system.
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Moser EC, Vrieling C. Accelerated partial breast irradiation: the need for well-defined patient selection criteria, improved volume definitions, close follow-up and discussion of salvage treatment. Breast 2012; 21:707-15. [PMID: 23127279 DOI: 10.1016/j.breast.2012.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/17/2012] [Accepted: 09/23/2012] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving therapy, including whole breast irradiation, has become a well-established alternative to mastectomy in early-stage breast cancer patients, with similar survival rates and better cosmetic outcome. However, many women are still treated with mastectomy, due to logistical issues related to the long course of radiotherapy (RT). To reduce mastectomy rates and/or omission of RT after breast-conserving surgery, shorter, hypofractionated RT treatments have been introduced. More recently, the necessity of routinely treating the entire breast in all patients has been questioned, leading to the development of partial breast radiotherapy. With accelerated partial breast irradiation (APBI) these two approaches have been combined: the tumor bed with a 1-2 cm margin is irradiated either intra-operatively (single fraction) or postoperatively over 5-15 days. Different techniques have been developed, including interstitial brachytherapy, intra-cavity brachytherapy, intra-operative radiotherapy and external beam radiotherapy. These techniques are being evaluated in several ongoing phase III studies. Since its introduction, APBI has been the subject of continuous debate. ASTRO and GEC-ESTRO have published guidelines for patient selection for APBI, and strongly recommend that APBI be carried out within ongoing clinical trials. Recently, the patient selection criteria for APBI have also been up for debate, following the publication of results from different groups that do/do not confirm a difference in recurrence risk among the ASTRO defined risk groups. This paper reviews the different APBI techniques, current recommendations for patient selection, available clinical data and ongoing clinical trials. A case report is included to illustrate the need for careful follow-up of patients treated with APBI.
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Affiliation(s)
- Elizabeth C Moser
- Breast Unit/Department of Radiotherapy, Champalimaud Cancer Centre, Lisbon, Portugal.
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Santen RJ, Yue W, Heitjan DF. Modeling of the growth kinetics of occult breast tumors: role in interpretation of studies of prevention and menopausal hormone therapy. Cancer Epidemiol Biomarkers Prev 2012; 21:1038-48. [PMID: 22586072 PMCID: PMC4589189 DOI: 10.1158/1055-9965.epi-12-0043] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autopsy studies report a reservoir of small, occult, undiagnosed breast cancers in up to 15.6% of women dying from unrelated causes. The effective doubling times (EDT) of these occult neoplasms range from 70 to 350 days and mammographic detection threshold diameters from 0.88 to 1.66 cm. Modeling of the biologic behavior of these occult tumors facilitates interpretation of tamoxifen breast cancer prevention and menopausal hormone therapy studies. METHODS We used iterative and mathematical techniques to develop a model of occult tumor growth (OTG) whose parameters included prevalence, EDT, and detection threshold. The model was validated by comparing predicted with observed incidence of breast cancer in several populations. RESULTS Iterative analysis identified a 200-day EDT, 7% prevalence and 1.16 cm detection threshold as optimal parameters for an OTG model as judged by comparison with Surveillance Epidemiology and End Results (SEER) population incidence rates in the United States. We validated the model by comparing predicted incidence rates with those observed in five separate population databases, in three long-term contralateral breast cancer detection studies, and with data from a computer-simulated tumor growth (CSTG) model. Our model strongly suggests that breast cancer prevention with anti-estrogens or aromatase inhibitors represents early treatment not prevention. In addition, menopausal hormone therapy does not primarily induce de novo tumors but promotes the growth of occult lesions. CONCLUSIONS Our OGTG model suggests that occult, undiagnosed tumors are prevalent, grow slowly, and are the biologic targets of anti-estrogen therapy for prevention and hormone therapy for menopausal women.
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Affiliation(s)
- Richard J Santen
- Department of Internal Medicine, Division of Endocrinology, University of Virginia, Charlottesville, VA 22908, USA.
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Menes TS, Zissman S, Golan O, Sperber F, Klausner J, Schneebaum S. Yield of Selective Magnetic Resonance Imaging in Preoperative Workup of Newly Diagnosed Breast Cancer Patients Planned for Breast Conserving Surgery. Am Surg 2012. [DOI: 10.1177/000313481207800437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent pre-operative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI.
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Affiliation(s)
| | | | - Orit Golan
- Breast Imaging Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - Fani Sperber
- Breast Imaging Unit, Sourasky Medical Center, Tel Aviv, Israel
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Vanderwalde LH, Dang CM, Bresee C, Phillips EH. Discordance Between Pathologic and Radiologic Tumor Size on Breast MRI May Contribute to Increased Re-excision Rates. Am Surg 2011. [DOI: 10.1177/000313481107701020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative breast MRI does not decrease re-excision rates in patients who undergo lumpectomy. We evaluated concordance of tumor size on MRI and pathologic size in patients who underwent re-excision of margins after lumpectomy. A retrospective review of patients at the Cedars-Sinai Breast Center who received breast MRI was performed. We found that MRI was performed before lumpectomy in 136 patients. Mean age was 55.2 years (standard deviation ± 12.6). Re-excision occurred in 34 per cent (n = 46). Of those undergoing re-excision, 35 per cent (16/46) were re-excised for ductal carcinoma in situ (DCIS) at the lumpectomy margin. There was no significant difference between radiologic and pathologic size of the tumor (1.94 vs 2.12 cm; P = 0.159). In those who underwent re-excision, the radiologic size was underestimated compared with the pathologic size (2.01 vs 2.66 cm; P = 0.032). Patients with pure DCIS lesions (n = 9) also had smaller radiologic tumor size compared with pathologic (0.64 vs 2.88 cm; P = 0.039), and this difference trended toward significance in those who underwent re-excision (0.55 vs 3.50 cm; P = 0.059). Discordance between tumor size on MRI and pathologic size may contribute to re-excisions in patients who undergo lumpectomy. The limitations of breast MRI to evaluate the extent of DCIS surrounding many breast cancers, and the impact on re-excision rates, should be further evaluated.
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Affiliation(s)
| | - Catherine M. Dang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H. Phillips
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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