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Depretto C, D'Ascoli E, Della Pepa G, Irmici G, De Berardinis C, Ballerini D, Bonanomi A, Ancona E, Ferranti C, Scaperrotta GP. Assessing the malignancy of suspicious breast microcalcifications: the role of contrast enhanced mammography. Radiol Med 2024:10.1007/s11547-024-01813-y. [PMID: 38607514 DOI: 10.1007/s11547-024-01813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To assess the role of contrast-enhanced mammography (CEM) in predicting the malignancy of breast calcifications. MATERIAL AND METHODS We retrospectively evaluated patients with suspicious calcifications (BIRADS 4) who underwent CEM and stereotactic vacuum-assisted biopsy (VAB) at our institution. We assessed the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of CEM in predicting malignancy of microcalcifications with a 95% confidence interval; we performed an overall analysis and a subgroup analysis stratified into group A-low risk (BIRADS 4a) and group B-medium/high risk (BIRADS 4b-4c). We then evaluated the correlation between enhancement and tumour proliferation index (Ki-67) for all malignant lesions. RESULTS Data from 182 patients with 184 lesions were collected. Overall the SE of CEM in predicting the malignancy of microcalcifications was 0.70, SP was 0.85, the PPV was 0.82, the NPV was 0.76 and AUC was 0.78. SE in group A was 0.89, SP was 0.89, PPV was 0.57, NPV was 0.98 and AUC was 0.75. SE in group B was 0.68, SP was 0.80, PPV was 0.87, NPV was 0.57 and AUC was 0.75. Among malignant microcalcifications that showed enhancement (N = 52), 61.5% had Ki-67 ≥ 20% and 38.5% had low Ki-67 values. Among the lesions that did not show enhancement (N = 22), 90.9% had Ki-67 < 20% and 9.1% showed high Ki-67 values 20%. CONCLUSIONS The absence of enhancement can be used as an indicative parameter for the absence of disease in cases of low-suspicious microcalcifications, but not in intermediate-high suspicious ones for which biopsy remains mandatory and can be used to distinguish indolent lesions from more aggressive neoplasms, with consequent reduction of overdiagnosis and overtreatment.
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Affiliation(s)
- Catherine Depretto
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Elisa D'Ascoli
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy.
| | - Gianmarco Della Pepa
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Giovanni Irmici
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Claudia De Berardinis
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Daniela Ballerini
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Alice Bonanomi
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Eleonora Ancona
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Claudio Ferranti
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
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O’Keefe T, Yau C, Iaconetti E, Jeong E, Brabham C, Kim P, McGuire J, Griffin A, Wallace A, Esserman L, Harismendy O, Hirst G. Duration of Endocrine Treatment for DCIS impacts second events: Insights from a large cohort of cases at two academic medical centers. Res Sq 2024:rs.3.rs-3403438. [PMID: 38260526 PMCID: PMC10802747 DOI: 10.21203/rs.3.rs-3403438/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Ductal carcinoma in situ (DCIS) incidence has risen rapidly with the introduction of screening mammography, yet it is unclear who benefits from both the amount and type of adjuvant treatment (radiation therapy, (RT), endocrine therapy (ET)) versus what constitutes over-treatment. Our goal was to identify the effects of adjuvant RT, or ET+/- RT versus breast conservation surgery (BCS) alone in a large multi-center registry of retrospective DCIS cases (N = 1,916) with median follow up of 8.2 years. We show that patients with DCIS who took less than 2 years of adjuvant ET alone have a similar second event rate as BCS. However, patients who took more than 2 years of ET show a significantly reduced second event rate, similar to those who received either RT or combined ET+RT, which was independent of age, tumor size, grade, or period of diagnosis. This highlights the importance of ET duration for risk reduction.
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Affiliation(s)
- Thomas O’Keefe
- Department of Surgery, University of California, San Diego
| | - Christina Yau
- Department of Surgery, University of California, San Francisco, CA
| | - Emma Iaconetti
- Department of Surgery, University of California, San Francisco, CA
| | - Eliza Jeong
- Moores Cancer Center, Division of Biomedical Informatics, UCSD School of
Medicine University of California, San Diego, La Jolla, CA
| | - Case Brabham
- Department of Surgery, University of California, San Francisco, CA
| | - Paul Kim
- Department of Surgery, University of California, San Francisco, CA
| | | | - Ann Griffin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Anne Wallace
- Department of Surgery, University of California, San Diego
| | - Laura Esserman
- Department of Surgery, University of California, San Francisco, CA
| | - Olivier Harismendy
- Moores Cancer Center, Division of Biomedical Informatics, UCSD School of
Medicine University of California, San Diego, La Jolla, CA
| | - Gillian Hirst
- Department of Surgery, University of California, San Francisco, CA
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Nguyen DL, Shelley Hwang E, Ryser MD, Grimm LJ. Imaging Changes and Outcomes of Patients Undergoing Active Monitoring for Ductal Carcinoma In Situ: Seven-Year Follow-up Study. Acad Radiol 2024:S1076-6332(23)00699-2. [PMID: 38184419 DOI: 10.1016/j.acra.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
RATIONALE AND OBJECTIVES To determine the imaging changes and their associated positive predictive value (PPV) for invasive breast cancer in women undergoing active monitoring for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS In this seven-year follow-up retrospective IRB-exempted cohort study, we reviewed patients diagnosed with DCIS who elected active monitoring between 2003 and 2022 at a single academic institution. Imaging characteristics, histopathology at initial diagnosis, and subsequent follow-up were recorded. Low-risk DCIS was defined as low or intermediate grade and hormone receptor (HR) positive (estrogen and/or progesterone receptor positive) disease diagnosed in women at least 40 years of age. Progression was defined as subsequent ipsilateral invasive breast cancer diagnosis. RESULTS There were 39 patients with a median age of 58.4 years (IQR: 51.1-69.6 years) and a median follow-up of 4.3 years (range: 0.6-16.4 years). Nearly two thirds of patients (64%, 25/39) had stable imaging (range: 0.6-16.4 years) and remained progression-free during active monitoring. Among the remaining 14 patients (36%), there were 24 imaging findings which prompted 22 subsequent core needle biopsies (range: 1-3 biopsies per patient) and two surgical biopsies. The PPV of invasive cancer was 29% (7/24) overall and 38% (3/8) for masses, 33% (3/9) for calcifications, 17% (1/6) for non-mass enhancement, and 0% (0/1) for architectural distortion. CONCLUSION Of the radiographic changes prompting an additional biopsy, development of a new mass (38%) and new calcifications (33%) had the highest PPV for invasive progression. Close imaging follow-up should be a critical component for patients undergoing monitoring for DCIS.
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Affiliation(s)
- Derek L Nguyen
- Department of Radiology, Duke University School of Medicine, 20 Duke Medicine Cir Durham, Durham, North Carolina, 27710, USA (D.L.N., L.J.G.).
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, 20 Duke Medicine Cir Durham, Durham, North Carolina, 27710, USA (E.S.H.)
| | - Marc D Ryser
- Department of Population Health Sciences, Duke University Medical Center, Duke University, 20 Duke Medicine Cir Durham, Durham, North Carolina, 27710, USA (M.D.R.)
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, 20 Duke Medicine Cir Durham, Durham, North Carolina, 27710, USA (D.L.N., L.J.G.)
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Gram EG, Manso TFR, Heleno B, Siersma V, Á Rogvi J, Brodersen JB. The long-term psychosocial consequences of screen-detected ductal carcinoma in situ and invasive breast cancer. Breast 2023; 70:41-48. [PMID: 37307773 DOI: 10.1016/j.breast.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer (IBC). The prognosis of DCIS is considerably better than for IBC, yet women do not distinguish between the threat. We aimed to compare the psychosocial consequences of screen-detected DCIS and IBC, and to examine this comparison over time. METHODS We surveyed a Danish mammography-screening cohort from 2004 to 2018. We assessed outcomes at six-time points: baseline, 1, 6, 18, 36 months, and 14 years after the screening. We measured psychosocial consequences with the Consequences Of Screening - Breast Cancer (COS-BC): a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions. We used weighted linear models with generalized estimating equations to compare responses between groups. We used a 1% level of significance. RESULTS 170 out of 1309 women were diagnosed with breast cancer (13.0%). 23 were diagnosed with DCIS (13.5%) and 147 with IBC (86.5%). From baseline to six months after diagnosis, there were no significant differences between women with DCIS and IBC. However, mean scores indicated that IBC generally was more affected than DCIS. After six months, we observed that women with DCIS and IBC might be affected differently in the long term; mean scores and mean differences showed that IBC were more affected on some scales, while DCIS were on others. CONCLUSION Overall, the DCIS and IBC experienced similar levels of psychosocial consequences. Women might benefit from renaming DCIS to exclude cancer nomenclature.
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Affiliation(s)
- Emma Grundtvig Gram
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark.
| | - Túlia Filipa Roberto Manso
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Bruno Heleno
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Volkert Siersma
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Á Rogvi
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Region Zealand, Denmark; Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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