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Kalaba P, Sanchez de la Rosa C, Möller A, Alewood PF, Muttenthaler M. Targeting the Oxytocin Receptor for Breast Cancer Management: A Niche for Peptide Tracers. J Med Chem 2024; 67:1625-1640. [PMID: 38235665 PMCID: PMC10859963 DOI: 10.1021/acs.jmedchem.3c01089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
Breast cancer is a leading cause of death in women, and its management highly depends on early disease diagnosis and monitoring. This remains challenging due to breast cancer's heterogeneity and a scarcity of specific biomarkers that could predict responses to therapy and enable personalized treatment. This Perspective describes the diagnostic landscape for breast cancer management, molecular strategies targeting receptors overexpressed in tumors, the theranostic potential of the oxytocin receptor (OTR) as an emerging breast cancer target, and the development of OTR-specific optical and nuclear tracers to study, visualize, and treat tumors. A special focus is on the chemistry and pharmacology underpinning OTR tracer development, preclinical in vitro and in vivo studies, challenges, and future directions. The use of peptide-based tracers targeting upregulated receptors in cancer is a highly promising strategy complementing current diagnostics and therapies and providing new opportunities to improve cancer management and patient survival.
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Affiliation(s)
- Predrag Kalaba
- Institute
of Biological Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | | | - Andreas Möller
- QIMR
Berghofer Medical Research Institute, Brisbane, Queensland 4006, Australia
- The
Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Paul F. Alewood
- Institute
for Molecular Bioscience, The University
of Queensland, Brisbane, Queensland 4072, Australia
| | - Markus Muttenthaler
- Institute
of Biological Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
- Institute
for Molecular Bioscience, The University
of Queensland, Brisbane, Queensland 4072, Australia
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2
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Reig B, Kim E, Chhor CM, Moy L, Lewin AA, Heacock L. Problem-solving Breast MRI. Radiographics 2023; 43:e230026. [PMID: 37733618 DOI: 10.1148/rg.230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Breast MRI has high sensitivity and negative predictive value, making it well suited to problem solving when other imaging modalities or physical examinations yield results that are inconclusive for the presence of breast cancer. Indications for problem-solving MRI include equivocal or uncertain imaging findings at mammography and/or US; suspicious nipple discharge or skin changes suspected to represent an abnormality when conventional imaging results are negative for cancer; lesions categorized as Breast Imaging Reporting and Data System 4, which are not amenable to biopsy; and discordant radiologic-pathologic findings after biopsy. MRI should not precede or replace careful diagnostic workup with mammography and US and should not be used when a biopsy can be safely performed. The role of MRI in characterizing calcifications is controversial, and management of calcifications should depend on their mammographic appearance because ductal carcinoma in situ may not appear enhancing on MR images. In addition, ductal carcinoma in situ detected solely with MRI is not associated with a higher likelihood of an upgrade to invasive cancer compared with ductal carcinoma in situ detected with other modalities. MRI for triage of high-risk lesions is a subject of ongoing investigation, with a possible future role for MRI in decreasing excisional biopsies. The accuracy of MRI is likely to increase with the use of advanced techniques such as deep learning, which will likely expand the indications for problem-solving MRI. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Beatriu Reig
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Eric Kim
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Chloe M Chhor
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Alana A Lewin
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
| | - Laura Heacock
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016
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3
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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4
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Rahmat K, Mumin NA, Hamid MTR, Hamid SA, Ng WL. MRI Breast: Current Imaging Trends, Clinical Applications, and Future Research Directions. Curr Med Imaging 2022; 18:1347-1361. [PMID: 35430976 DOI: 10.2174/1573405618666220415130131] [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: 12/13/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 01/25/2023]
Abstract
Magnetic Resonance Imaging (MRI) is the most sensitive and advanced imaging technique in diagnosing breast cancer and is essential in improving cancer detection, lesion characterization, and determining therapy response. In addition to the dynamic contrast-enhanced (DCE) technique, functional techniques such as magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) further characterize and differentiate benign and malignant lesions thus, improving diagnostic accuracy. There is now an increasing clinical usage of MRI breast, including screening in high risk and supplementary screening tools in average-risk patients. MRI is becoming imperative in assisting breast surgeons in planning breast-conserving surgery for preoperative local staging and evaluation of neoadjuvant chemotherapy response. Other clinical applications for MRI breast include occult breast cancer detection, investigation of nipple discharge, and breast implant assessment. There is now an abundance of research publications on MRI Breast with several areas that still remain to be explored. This review gives a comprehensive overview of the clinical trends of MRI breast with emphasis on imaging features and interpretation using conventional and advanced techniques. In addition, future research areas in MRI breast include developing techniques to make MRI more accessible and costeffective for screening. The abbreviated MRI breast procedure and an area of focused research in the enhancement of radiologists' work with artificial intelligence have high impact for the future in MRI Breast.
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Affiliation(s)
- Kartini Rahmat
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Nazimah Ab Mumin
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Marlina Tanty Ramli Hamid
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Shamsiah Abdul Hamid
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Wei Lin Ng
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, Kuala Lumpur, Malaysia
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Diagnostic Approach to Developing Asymmetry in Opportunist Screening Mammography; Correlation of Ultrasound, Magnetic Resonance Imaging, and Histopathologic Findings with Developing Asymmetry: A Cross-sectional Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-122779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Developing asymmetries are uncommon mammographic findings with a chance of being associated with malignancy. Objectives: The current study aimed at correlating ultrasound, magnetic resonance imaging (MRI) findings, and histopathology of patients with developing focal asymmetry in opportunist screening mammograms setting, and presents a diagnostic approach to developing asymmetry. Methods: This was a cross-sectional study on a database of opportunist screening mammography at the Breast Clinic, Cancer Center, at Tehran University of Medical Sciences from January 2017 to December 2018. Mammogram screenings (n = 12,169) were evaluated for developing asymmetry. Findings of mammography, ultrasound, MRI findings, and histopathology of patients with developing asymmetry were collected and analyzed. Results: Fifty-four cases (0.44%) had developed asymmetry in screening mammograms. After excluding 18 patients with considering exclusion criteria, the data of 36 patients were analyzed. The summation artifact was the etiology of developing asymmetry in 11 (30.5%) patients. Ultrasound was performed in 28 patients, and 14 (38.8%) patients had no correlated findings. All 3 malignant cases had ultrasound correlates, and a significant association existed between sonography and the risk of malignancy in patients having developing asymmetry (P = 0.003). Three malignant cases of the study underwent MRI, 1 with segmental clumped non-mass enhancement, and 2 showed a mass with rim enhancement. A significant association was revealed between a family history of breast cancer (P = 0.04) and developing asymmetry. The positive predictive value of developing asymmetry for malignancy was 8.3%. Conclusions: Patients having developing asymmetry should be evaluated for malignancy, using supplementary techniques, such as additional mammographic views, ultrasound primarily, or MRI. A biopsy is required for indeterminate findings.
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McCowan CV, Salmon D, Hu J, Pudakalakatti S, Whiting N, Davis JS, Carson DD, Zacharias NM, Bhattacharya PK, Farach-Carson MC. Post-Acquisition Hyperpolarized 29Silicon Magnetic Resonance Image Processing for Visualization of Colorectal Lesions Using a User-Friendly Graphical Interface. Diagnostics (Basel) 2022; 12:diagnostics12030610. [PMID: 35328163 PMCID: PMC8947341 DOI: 10.3390/diagnostics12030610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Medical imaging devices often use automated processing that creates and displays a self-normalized image. When improperly executed, normalization can misrepresent information or result in an inaccurate analysis. In the case of diagnostic imaging, a false positive in the absence of disease, or a negative finding when disease is present, can produce a detrimental experience for the patient and diminish their health prospects and prognosis. In many clinical settings, a medical technical specialist is trained to operate an imaging device without sufficient background information or understanding of the fundamental theory and processes involved in image creation and signal processing. Here, we describe a user-friendly image processing algorithm that mitigates user bias and allows for true signal to be distinguished from background. For proof-of-principle, we used antibody-targeted molecular imaging of colorectal cancer (CRC) in a mouse model, expressing human MUC1 at tumor sites. Lesion detection was performed using targeted magnetic resonance imaging (MRI) of hyperpolarized silicon particles. Resulting images containing high background and artifacts were then subjected to individualized image post-processing and comparative analysis. Post-acquisition image processing allowed for co-registration of the targeted silicon signal with the anatomical proton magnetic resonance (MR) image. This new methodology allows users to calibrate a set of images, acquired with MRI, and reliably locate CRC tumors in the lower gastrointestinal tract of living mice. The method is expected to be generally useful for distinguishing true signal from background for other cancer types, improving the reliability of diagnostic MRI.
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Affiliation(s)
- Caitlin V. McCowan
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA; (C.V.M.); (D.S.)
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center, Houston, TX 77054, USA
| | - Duncan Salmon
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA; (C.V.M.); (D.S.)
| | - Jingzhe Hu
- Department of Bioengineering, Rice University, Houston, TX 77005, USA;
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.P.); (N.W.); (P.K.B.)
| | - Shivanand Pudakalakatti
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.P.); (N.W.); (P.K.B.)
| | - Nicholas Whiting
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.P.); (N.W.); (P.K.B.)
| | - Jennifer S. Davis
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Daniel D. Carson
- Department of BioSciences, Rice University, Houston, TX 77005, USA;
| | - Niki M. Zacharias
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Pratip K. Bhattacharya
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.P.); (N.W.); (P.K.B.)
| | - Mary C. Farach-Carson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center, Houston, TX 77054, USA
- Department of Bioengineering, Rice University, Houston, TX 77005, USA;
- Department of BioSciences, Rice University, Houston, TX 77005, USA;
- Correspondence: ; Tel.: +1-713-486-4438
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7
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Gommers JJ, Voogd AC, Broeders MJ, van Breest Smallenburg V, Strobbe LJ, Donkers-van Rossum AB, van Beek HC, Mann RM, Duijm LE. Breast magnetic resonance imaging as a problem solving tool in women recalled at biennial screening mammography: A population-based study in the Netherlands. Breast 2021; 60:279-286. [PMID: 34823112 PMCID: PMC8628012 DOI: 10.1016/j.breast.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Problem solving magnetic resonance imaging (MRI) is used to exclude malignancy in women with equivocal findings on conventional imaging. However, recommendations on its use for women recalled after screening are lacking. This study evaluates the impact of problem solving MRI on diagnostic workup among women recalled from the Dutch screening program, as well as time trends and inter-hospital variation in its use. Methods Women who were recalled at screening mammography in the South of the Netherlands (2008–2017) were included. Two-year follow-up data were collected. Diagnostic-workup and accuracy of problem solving MRI were evaluated and time trends and inter-hospital variation in its use were examined. Results In the study period 16,175 women were recalled, of whom 906 underwent problem solving MRI. Almost half of the women (45.4%) who underwent problem solving MRI were referred back to the screening program without further workup. The sensitivity, specificity, and positive and negative predictive values of problem solving MRI were 98.2%, 70.0%, 31.1%, and 99.6%, respectively. The percentage of recalled women receiving problem solving MRI fluctuated over time (4.7%–7.2%) and significantly varied among hospitals (2.2%–7.0%). Conclusion The use of problem solving MRI may exclude malignancy in recalled women. The use of problem solving MRI varied over time and among hospitals, which indicates the need for guidelines on problem solving MRI. Problem solving MRI did correctly refer back women to the screening program. The sensitivity and specificity of problem solving MRI were 98.2% and 70.0%. Positive and negative predictive values of problem solving MRI were 31.1% and 99.6%. By excluding malignancy, problem solving MRI may reduce invasive diagnostic workup.
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Affiliation(s)
- Jessie Jj Gommers
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Universiteitssingel 60, 6229, ER, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands
| | - Mireille Jm Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Dutch Expert Center for Screening, Wijchenseweg 101, 6538, SW, Nijmegen, the Netherlands
| | | | - Luc Ja Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands
| | | | - Hermen C van Beek
- Department of Radiology, Maxima Medical Center, De Run 4600, 5504, MB, Veldhoven, the Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Lucien Em Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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8
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Hernández L, Díaz GM, Posada C, Llano-Sierra A. Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population. Insights Imaging 2021; 12:149. [PMID: 34674056 PMCID: PMC8531154 DOI: 10.1186/s13244-021-01098-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Currently, mammography and ultrasonography are the most used imaging techniques for breast cancer screening. However, these examinations report many indeterminate studies with a low probability of being malignant, i.e., BIRADS 3 and 4A. This prospective study aims to evaluate the value of breast magnetic resonance imaging (MRI) to clarify the BIRADS categorization of indeterminate mammography or ultrasonography studies. METHODS MRI studies acquired prospectively from 105 patients previously classified as BIRADS 3 or 4A were analyzed independently by four radiologists with different experience levels. Interobserver agreement was determined by the first-order agreement coefficient (AC1), and divergent results were re-analyzed for consensus. The possible correlation between the MRI and the mammography/ultrasound findings was evaluated, and each study was independently classified in one of the five BIRADS categories (BIRADS 1 to 5). In lesions categorized as BIRADS 4 or 5 at MRI, histopathological diagnosis was established by image-guided biopsy; while short-term follow-up was performed in lesions rated as BIRADS 3. RESULTS Breast MRI was useful in diagnosing three invasive ductal carcinomas, upgraded from BIRADS 4A to BIRADS 5. It also allowed excluding malignancy in 86 patients (81.9%), avoiding 22 unnecessary biopsies and 64 short-term follow-ups. The MRI showed good diagnostic performance with the area under roc curve, sensitivity, specificity, PPV, and NPV of 0.995, 100%, 83.5%, 10.5%, and 100%, respectively. CONCLUSIONS MRI showed to be useful as a problem-solving tool to clarify indeterminate findings in breast cancer screening and avoiding unnecessary short-follow-ups and percutaneous biopsies.
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Affiliation(s)
- Liliana Hernández
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Gloria M Díaz
- MIRP Lab-Parque i, Instituto Tecnológico Metropolitano, Medellín, Colombia.
| | - Catalina Posada
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia.,Universidad CES, Medellín, Colombia
| | - Alejandro Llano-Sierra
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia.,Universidad CES, Medellín, Colombia
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9
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Abstract
Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.
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Affiliation(s)
- Anabel M Scaranelo
- Medical Imaging Department, 12366University of Toronto, Ontario, Canada.,Breast Imaging Division, Joint Department of Medical Imaging, University of Health Network, Sinai Health and Women's College Hospital, Toronto, Ontario, Canada
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10
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Murchison S, Truong P. Locoregional therapy in breast cancer patients treated with neoadjuvant chemotherapy. Expert Rev Anticancer Ther 2021; 21:865-875. [PMID: 33719866 DOI: 10.1080/14737140.2021.1903876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Neoadjuvant chemotherapy (NAC) is increasingly used preoperatively in breast cancer patients to achieve disease downstaging, reduce distant dissemination, and assess chemosensitivity. While NAC indications are expanding, knowledge of its impact on subsequent locoregional treatment with surgery and radiation therapy (RT) decisions is evolving. Radiation oncologists are often called upon to estimate locoregional recurrence (LRR) risks and provide recommendations for adjuvant RT to the breast/chest wall and regional lymph nodes postoperatively. In the non-NAC setting, adjuvant RT decisions are guided by the pathology findings after definitive surgery. In the NAC setting, decisions for or against adjuvant RT are complex, particularly in patients who achieve complete pathologic response (pCR).Areas covered: This review will examine contemporary data on NAC in patients with breast cancer and discuss its impact on surgical and RT decisions. We will also evaluate controversies in the role of LRRT for these patients, focussing on prognostic factors that include biological subtypes and pCR after NAC.Expert opinion: Advances in personalized medicine and diagnostic techniques have shifted paradigms and increased complexities in locoregional treatment decisions, particularly in the setting of NAC. Despite the challenges, our goals while we await prospective data remain focused on improving survival, minimizing toxicity, and optimizing function and cosmesis.
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Affiliation(s)
- Sonja Murchison
- Department of Radiation Oncology, University of British Columbia, Vancouver, Canada.,Department of Radiation Oncology, BC Cancer, Victoria, Canada
| | - Pauline Truong
- Department of Radiation Oncology, University of British Columbia, Vancouver, Canada.,Department of Radiation Oncology, BC Cancer, Victoria, Canada
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11
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Lee JW, Lee K, Ahn SH, Son BH, Ko BS, Kim HJ, Chung IY, Kim J, Lee W, Ko MS, Choi S, Chang S, Ko CK, Lee SB, Kim DC. Potential of MALDI-TOF-based serum N-glycan analysis for the diagnosis and surveillance of breast cancer. Sci Rep 2020; 10:19136. [PMID: 33154535 PMCID: PMC7644762 DOI: 10.1038/s41598-020-76195-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/26/2020] [Indexed: 11/08/2022] Open
Abstract
Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based serum N-glycan analysis has gained acknowledgment for the diagnosis of breast cancer in recent years. In this study, the possibilities of expanding its application for breast cancer management and surveillance were discovered and evaluated. First, a novel MALDI-TOF platform, IDsys RT, was confirmed to be effective for breast cancer analysis, showing a maximum area under the curve of 0.91. Multiple N-glycan markers were identified and validated using this process, and they were found to be applicable for differentiating recurring breast cancer samples from healthy control or ordinary breast cancer samples. Recurrence samples were especially distinct from non-recurrence samples when N-glycan signatures were sampled in multiple time points and monitored via MALDI-TOF, throughout the therapy. These results suggested the feasibility of MALDI-TOF-based N-glycan analysis for tracking the molecular signatures of breast cancer and predicting recurrence.
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Affiliation(s)
- Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kyungsoo Lee
- R&D Center, NOSQUEST Inc., 660, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea
| | - Sei Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woochang Lee
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Su Ko
- Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Soojeong Choi
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Suhwan Chang
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chung Kon Ko
- R&D Center, NOSQUEST Inc., 660, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Dong-Chan Kim
- R&D Center, NOSQUEST Inc., 660, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea.
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12
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Avendano D, Marino MA, Onishi N, Leithner D, Martinez DF, Gibbs P, Jochelson M, Pinker K, Morris EA, Sutton EJ. Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI? Eur Radiol 2020; 31:975-982. [PMID: 32870394 DOI: 10.1007/s00330-020-07216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess whether no enhancement on pre-treatment MRI can rule out malignancy of additional US mass(es) initially assessed as BI-RADS 3 or 4 in women with newly diagnosed breast cancer. METHODS This retrospective study included consecutive women from 2010-2018 with newly diagnosed breast cancer; at least one additional breast mass (distinct from index cancer) assigned a BI-RADS 3 or 4 on US; and a bilateral contrast-enhanced breast MRI performed within 90 days of US. All malignant masses were pathologically proven; benign masses were pathologically proven or defined as showing at least 2 years of imaging stability. Incidence of malignant masses and NPV were calculated on a per-patient level using proportions and exact 95% CIs. RESULTS In 230 patients with 309 additional masses, 140/309 (45%) masses did not enhance while 169/309 (55%) enhanced on MRI. Of the 140 masses seen in 105 women (mean age, 54 years; range 28-82) with no enhancement on MRI, all had adequate follow-up and 140/140 (100%) were benign, of which 89/140 (63.6%) were pathologically proven and 51/140 (36.4%) demonstrated at least 2 years of imaging stability. Pre-treatment MRI demonstrating no enhancement of US mass correlate(s) had an NPV of 100% (95% CI 96.7-100.0). CONCLUSIONS All BI-RADS 3 and 4 US masses with a non-enhancing correlate on pre-treatment MRI were benign. The incorporation of MRI, when ordered by the referring physician, may decrease unnecessary follow-up imaging and/or biopsy if the initial US BI-RADS assessment and management recommendation were to be retrospectively updated. KEY POINTS • Of 309 BI-RADS 3 or 4 US masses with a corresponding mass on MRI, 140/309 (45%) demonstrated no enhancement whereas 169/309 (55%) demonstrated enhancement • All masses classified as BI-RADS 3 or 4 on US without enhancement on MRI were benign • MRI can rule out malignancy in non-enhancing US masses with an NPV of 100.
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Affiliation(s)
- Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Natsuko Onishi
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Peter Gibbs
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth Jane Sutton
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
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13
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Sun K, Qu L, Lian C, Pan Y, Hu D, Xia B, Li X, Chai W, Yan F, Shen D. High-Resolution Breast MRI Reconstruction Using a Deep Convolutional Generative Adversarial Network. J Magn Reson Imaging 2020; 52:1852-1858. [PMID: 32656955 DOI: 10.1002/jmri.27256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A generative adversarial network could be used for high-resolution (HR) medical image synthesis with reduced scan time. PURPOSE To evaluate the potential of using a deep convolutional generative adversarial network (DCGAN) for generating HRpre and HRpost images based on their corresponding low-resolution (LR) images (LRpre and LRpost ). STUDY TYPE This was a retrospective analysis of a prospectively acquired cohort. POPULATION In all, 224 subjects were randomly divided into 200 training subjects and an independent 24 subjects testing set. FIELD STRENGTH/SEQUENCE Dynamic contrast-enhanced (DCE) MRI with a 1.5T scanner. ASSESSMENT Three breast radiologists independently ranked the image datasets, using the DCE images as the ground truth, and reviewed the image quality of both the original LR images and the generated HR images. The BI-RADS category and conspicuity of lesions were also ranked. The inter/intracorrelation coefficients (ICCs) of mean image quality scores, lesion conspicuity scores, and Breast Imaging Reporting and Data System (BI-RADS) categories were calculated between the three readers. STATISTICAL TEST Wilcoxon signed-rank tests evaluated differences among the multireader ranking scores. RESULTS The mean overall image quality scores of the generated HRpre and HRpost were significantly higher than those of the original LRpre and LRpost (4.77 ± 0.41 vs. 3.27 ± 0.43 and 4.72 ± 0.44 vs. 3.23 ± 0.43, P < 0.0001, respectively, in the multireader study). The mean lesion conspicuity scores of the generated HRpre and HRpost were significantly higher than those of the original LRpre and LRpost (4.18 ± 0.70 vs. 3.49 ± 0.58 and 4.35 ± 0.59 vs. 3.48 ± 0.61, P < 0.001, respectively, in the multireader study). The ICCs of the image quality scores, lesion conspicuity scores, and BI-RADS categories had good agreements among the three readers (all ICCs >0.75). DATA CONCLUSION DCGAN was capable of generating HR of the breast from fast pre- and postcontrast LR and achieved superior quantitative and qualitative performance in a multireader study. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1852-1858.
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Affiliation(s)
- Kun Sun
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Liangqiong Qu
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chunfeng Lian
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yongsheng Pan
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dan Hu
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bingqing Xia
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinyue Li
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weimin Chai
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dinggang Shen
- Department of Research and Development, Shanghai United Imaging Intelligence Co.,Ltd., Shanghai, China.,Department of Brain and Cognitive Engineering, Korea University, Seoul 02841, Republic of Korea
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14
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Lamb LR, Mohallem Fonseca M, Verma R, Seely JM. Missed Breast Cancer: Effects of Subconscious Bias and Lesion Characteristics. Radiographics 2020; 40:941-960. [PMID: 32530745 DOI: 10.1148/rg.2020190090] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical errors are a substantial cause of morbidity and mortality and the third leading cause of death in the United States. Errors resulting in missed breast cancer are the most common reason for medical malpractice lawsuits against all physicians. Missed breast cancers are breast malignancies that are detectable at retrospective review of a previously obtained mammogram that was prospectively reported as showing negative, benign, or probably benign findings. Investigators in prior studies have found that up to 35% of both interval cancers and screen-detected cancers could be classified as missed. As such, in conjunction with having awareness of the most common misleading appearances of breast cancer, it is important to understand the cognitive processes and unconscious biases that can impact image interpretation, thereby helping to decrease the number of missed breast cancers. The various cognitive processes that lead to unconscious bias in breast imaging, such as satisfaction of search, inattention blindness, hindsight, anchoring, premature closing, and satisfaction of reporting, are outlined in this pictorial review of missed breast cancers. In addition, strategies for reducing the rates of these missed cancers are highlighted. The most commonly missed and misinterpreted lesions, including stable lesions, benign-appearing masses, one-view findings, developing asymmetries, subtle calcifications, and architectural distortion, also are reviewed. This information will help illustrate why and how breast cancers are missed and aid in the development of appropriate minimization strategies in breast imaging. ©RSNA, 2020.
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Affiliation(s)
- Leslie R Lamb
- From the Department of Radiology, Division of Breast Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marina Mohallem Fonseca
- From the Department of Radiology, Division of Breast Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Raman Verma
- From the Department of Radiology, Division of Breast Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean M Seely
- From the Department of Radiology, Division of Breast Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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15
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Lee SB, Bose S, Ahn SH, Son BH, Ko BS, Kim HJ, Chung IY, Kim J, Lee W, Ko MS, Lee K, Chang S, Park HS, Lee JW, Kim DC. Breast cancer diagnosis by analysis of serum N-glycans using MALDI-TOF mass spectroscopy. PLoS One 2020; 15:e0231004. [PMID: 32271809 PMCID: PMC7144955 DOI: 10.1371/journal.pone.0231004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/13/2020] [Indexed: 12/12/2022] Open
Abstract
Blood and serum N-glycans can be used as markers for cancer diagnosis, as alterations in protein glycosylation are associated with cancer pathogenesis and progression. We aimed to develop a platform for breast cancer (BrC) diagnosis based on serum N-glycan profiles using MALDI-TOF mass spectroscopy. Serum N-glycans from BrC patients and healthy volunteers were evaluated using NosQuest’s software “NosIDsys.” BrC-associated “NosID” N-glycan biomarkers were selected based on abundance and NosIDsys analysis, and their diagnostic potential was determined using NosIDsys and receiver operating characteristic curves. Results showed an efficient pattern recognition of invasive ductal carcinoma patients, with very high diagnostic performance [area under the curve (AUC): 0.93 and 95% confidence interval (CI): 0.917–0.947]. We achieved effective stage-specific differentiation of BrC patients from healthy controls with 82.3% specificity, 84.1% sensitivity, and 82.8% accuracy for stage 1 BrC and recognized hormone receptor-2 and lymph node invasion subtypes based on N-glycan profiles. Our novel technique supplements conventional diagnostic strategies for BrC detection and can be developed as an independent platform for BrC screening.
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Affiliation(s)
- Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shambhunath Bose
- R&D Center, NOSQUEST Inc., Seongnam, Gyeonggi, Republic of Korea
| | - Sei Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woochang Lee
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Su Ko
- Health Screening and Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Kyungsoo Lee
- R&D Center, NOSQUEST Inc., Seongnam, Gyeonggi, Republic of Korea
| | - Suhwan Chang
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (JWL); (DCK)
| | - Dong-Chan Kim
- R&D Center, NOSQUEST Inc., Seongnam, Gyeonggi, Republic of Korea
- * E-mail: (JWL); (DCK)
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