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Allajbeu I, Morris K, Nanaa M, Payne N, Charnley K, Moyle PL, Taylor K, Sharma N, Lim Y, Gilbert FJ. Introduction of automated breast ultrasound as an additional screening tool for dense breasts in the UK: a practical approach from the BRAID trial. Clin Radiol 2024; 79:e641-e650. [PMID: 38413353 DOI: 10.1016/j.crad.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 02/29/2024]
Affiliation(s)
- I Allajbeu
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge CB2 0QQ, UK; Western Balkans University, 1001, Tirana, Albania; Department of Radiology, University of Cambridge, School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - K Morris
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - M Nanaa
- Department of Radiology, University of Cambridge, School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - N Payne
- Department of Radiology, University of Cambridge, School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - K Charnley
- Department of Radiology, University of Cambridge, School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - P L Moyle
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K Taylor
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - N Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Y Lim
- University Hospital of South Manchester, NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - F J Gilbert
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge CB2 0QQ, UK; Department of Radiology, University of Cambridge, School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK.
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Upadhyay N, Wolska J. Imaging the dense breast. J Surg Oncol 2024. [PMID: 38685673 DOI: 10.1002/jso.27661] [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: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
The sensitivity of mammography reduces as breast density increases, which impacts breast screening and locoregional staging in breast cancer. Supplementary imaging with other modalities can offer improved cancer detection, but this often comes at the cost of more false positives. Magnetic resonance imaging and contrast-enhanced mammography, which assess tumour enhancement following contrast administration, are more sensitive than digital breast tomosynthesis and ultrasound, which predominantly rely on the assessment of tumour morphology.
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Affiliation(s)
- Neil Upadhyay
- Faculty of Medicine, Imperial College London, London, UK
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Joanna Wolska
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
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Wielema M, Sijens PE, Pijnappel RM, De Bock GH, Zorgdrager M, Kok MGJ, Rainer E, Varga R, Clauser P, Oudkerk M, Dorrius MD, Baltzer PAT. Image quality of DWI at breast MRI depends on the amount of fibroglandular tissue: implications for unenhanced screening. Eur Radiol 2023:10.1007/s00330-023-10321-y. [PMID: 38008743 DOI: 10.1007/s00330-023-10321-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES To compare image quality of diffusion-weighted imaging (DWI) and contrast-enhanced breast MRI (DCE-T1) stratified by the amount of fibroglandular tissue (FGT) as a measure of breast density. METHODS Retrospective, multi-reader, bicentric visual grading analysis study on breast density (A-D) and overall image and fat suppression quality of DWI and DCE-T1, scored on a standard 5-point Likert scale. Cross tabulations and visual grading characteristic (VGC) curves were calculated for fatty breasts (A/B) versus dense breasts (C/D). RESULTS Image quality of DWI was higher in the case of increased breast density, with good scores (score 3-5) in 85.9% (D) and 88.4% (C), compared to 61.6% (B) and 53.5% (A). Overall image quality of DWI was in favor of dense breasts (C/D), with an area under the VGC curve of 0.659 (p < 0.001). Quality of DWI and DCE-T1 fat suppression increased with higher breast density, with good scores (score 3-5) for 86.9% and 45.7% of density D, and 90.2% and 42.9% of density C cases, compared to 76.0% and 33.6% for density B and 54.7% and 29.6% for density A (DWI and DCE-T1 respectively). CONCLUSIONS Dense breasts show excellent fat suppression and substantially higher image quality in DWI images compared with non-dense breasts. These results support the setup of studies exploring DWI-based MR imaging without IV contrast for additional screening of women with dense breasts. CLINICAL RELEVANCE STATEMENT Our findings demonstrate that image quality of DWI is robust in women with an increased amount of fibroglandular tissue, technically supporting the feasibility of exploring applications such as screening of women with mammographically dense breasts. KEY POINTS • Image and fat suppression quality of diffusion-weighted imaging are dependent on the amount of fibroglandular tissue (FGT) which is closely connected to breast density. • Fat suppression quality in diffusion-weighted imaging of the breast is best in women with a high amount of fibroglandular tissue. • High image quality of diffusion-weighted imaging in women with a high amount of FGT in MRI supports that the technical feasibility of DWI can be explored in the additional screening of women with mammographically dense breasts.
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Affiliation(s)
- Mirjam Wielema
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul E Sijens
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel Zorgdrager
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marius G J Kok
- Department of Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Eva Rainer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raoul Varga
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Monique D Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Trapani D, Sandoval J, Aliaga PT, Ascione L, Maria Berton Giachetti PP, Curigliano G, Ginsburg O. Screening Programs for Breast Cancer: Toward Individualized, Risk-Adapted Strategies of Early Detection. Cancer Treat Res 2023; 188:63-88. [PMID: 38175342 DOI: 10.1007/978-3-031-33602-7_3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Early detection of breast cancer (BC) comprises two approaches: screening of asymptomatic women in a specified target population at risk (usually a target age range for women at average risk), and early diagnosis for women with BC signs and symptoms. Screening for BC is a key health intervention for early detection. While population-based screening programs have been implemented for age-selected women, the pivotal clinical trials have not addressed the global utility nor the improvement of screening performance by utilizing more refined parameters for patient eligibility, such as individualized risk stratification. In addition, with the exception of the subset of women known to carry germline pathogenetic mutations in (high- or moderately-penetrant) cancer predisposition genes, such as BRCA1 and BRCA2, there has been less success in outreach and service provision for the unaffected relatives of women found to carry a high-risk mutation (i.e., "cascade testing") as it is in these individuals for whom such actionable information can result in cancers (and/or cancer deaths) being averted. Moreover, even in the absence of clinical cancer genetics services, as is the case for the immediate and at least near-term in most countries globally, the capacity to stratify the risk of an individual to develop BC has existed for many years, is available for free online at various sites/platforms, and is increasingly being validated for non-Caucasian populations. Ultimately, a precision approach to BC screening is largely missing. In the present chapter, we aim to address the concept of risk-adapted screening of BC, in multiple facets, and understand if there is a value in the implementation of adapted screening strategies in selected women, outside the established screening prescriptions, in the terms of age-range, screening modality and schedules of imaging.
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Affiliation(s)
- Dario Trapani
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy.
| | - Josè Sandoval
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pamela Trillo Aliaga
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Liliana Ascione
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Pier Paolo Maria Berton Giachetti
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
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Shaw A, Sala E. Advances in cancer imaging. Clin Radiol 2021; 76:713-4. [PMID: 34215421 DOI: 10.1016/j.crad.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
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