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Boubnovski Martell M, Linton-Reid K, Hindocha S, Chen M, Moreno P, Álvarez-Benito M, Salvatierra Á, Lee R, Posma JM, Calzado MA, Aboagye EO. Deep representation learning of tissue metabolome and computed tomography annotates NSCLC classification and prognosis. NPJ Precis Oncol 2024; 8:28. [PMID: 38310164 PMCID: PMC10838282 DOI: 10.1038/s41698-024-00502-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
The rich chemical information from tissue metabolomics provides a powerful means to elaborate tissue physiology or tumor characteristics at cellular and tumor microenvironment levels. However, the process of obtaining such information requires invasive biopsies, is costly, and can delay clinical patient management. Conversely, computed tomography (CT) is a clinical standard of care but does not intuitively harbor histological or prognostic information. Furthermore, the ability to embed metabolome information into CT to subsequently use the learned representation for classification or prognosis has yet to be described. This study develops a deep learning-based framework -- tissue-metabolomic-radiomic-CT (TMR-CT) by combining 48 paired CT images and tumor/normal tissue metabolite intensities to generate ten image embeddings to infer metabolite-derived representation from CT alone. In clinical NSCLC settings, we ascertain whether TMR-CT results in an enhanced feature generation model solving histology classification/prognosis tasks in an unseen international CT dataset of 742 patients. TMR-CT non-invasively determines histological classes - adenocarcinoma/squamous cell carcinoma with an F1-score = 0.78 and further asserts patients' prognosis with a c-index = 0.72, surpassing the performance of radiomics models and deep learning on single modality CT feature extraction. Additionally, our work shows the potential to generate informative biology-inspired CT-led features to explore connections between hard-to-obtain tissue metabolic profiles and routine lesion-derived image data.
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Affiliation(s)
| | | | - Sumeet Hindocha
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, SW3 6JJ, UK
| | - Mitchell Chen
- Imperial College London Hammersmith Campus, London, SW7 2AZ, UK
| | - Paula Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, 14004, Spain
- Departamento de Cirugía Toráxica y Trasplante de Pulmón, Hospital Universitario Reina Sofía, Córdoba, 14014, Spain
| | - Marina Álvarez-Benito
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, 14004, Spain
- Unidad de Radiodiagnóstico y Cáncer de Mama, Hospital Universitario Reina Sofía, Córdoba, 14004, Spain
| | - Ángel Salvatierra
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, 14004, Spain
- Unidad de Radiodiagnóstico y Cáncer de Mama, Hospital Universitario Reina Sofía, Córdoba, 14004, Spain
| | - Richard Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, SW3 6JJ, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK
| | - Joram M Posma
- Imperial College London Hammersmith Campus, London, SW7 2AZ, UK
| | - Marco A Calzado
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, 14004, Spain.
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Córdoba, 14014, Spain.
| | - Eric O Aboagye
- Imperial College London Hammersmith Campus, London, SW7 2AZ, UK.
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Pulido-Carmona C, Romero-Martín S, Raya-Povedano JL, Cara-García M, Font-Ugalde P, Elías-Cabot E, Pedrosa-Garriguet M, Álvarez-Benito M. Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone. Eur Radiol 2024:10.1007/s00330-023-10546-x. [PMID: 38177619 DOI: 10.1007/s00330-023-10546-x] [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: 06/03/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone. METHODS The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann-Whitney U test were used to analyse quantitative features. RESULTS A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031). CONCLUSIONS The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts. CLINICAL RELEVANCE STATEMENT Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts. KEY POINTS • The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM).
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Affiliation(s)
- Cristina Pulido-Carmona
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
- University of Córdoba, Córdoba, Spain.
| | - Sara Romero-Martín
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - José Luis Raya-Povedano
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - María Cara-García
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Pilar Font-Ugalde
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- University of Córdoba, Córdoba, Spain
- Rheumatology Department, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Esperanza Elías-Cabot
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Margarita Pedrosa-Garriguet
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Marina Álvarez-Benito
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
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Elías-Cabot E, Romero-Martín S, Raya-Povedano JL, Brehl AK, Álvarez-Benito M. Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis. Eur Radiol 2023:10.1007/s00330-023-10426-4. [PMID: 37975920 DOI: 10.1007/s00330-023-10426-4] [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: 08/11/2023] [Revised: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT). MATERIAL AND METHODS We analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI. RESULTS A total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively. CONCLUSION AI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women. CLINICAL RELEVANCE STATEMENT Artificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis. KEY POINTS • AI systems based on deep learning technology offer potential for improving breast cancer screening programs. • Using artificial intelligence as support for reading improves radiologists' performance in breast cancer screening programs with mammography or tomosynthesis. • Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.
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Affiliation(s)
- Esperanza Elías-Cabot
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain.
- University of Córdoba, Córdoba, Spain.
| | - Sara Romero-Martín
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - José Luis Raya-Povedano
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - A-K Brehl
- ScreenPoint Medical BV, Toernooiveld 300, 6525 EC, Nijmegen, The Netherlands
| | - Marina Álvarez-Benito
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
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Navarrete C, García-Martín A, Correa-Sáez A, Prados ME, Fernández F, Pineda R, Mazzone M, Álvarez-Benito M, Calzado MA, Muñoz E. A cannabidiol aminoquinone derivative activates the PP2A/B55α/HIF pathway and shows protective effects in a murine model of traumatic brain injury. J Neuroinflammation 2022; 19:177. [PMID: 35810304 PMCID: PMC9270745 DOI: 10.1186/s12974-022-02540-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is characterized by a primary mechanical injury and a secondary injury associated with neuroinflammation, blood-brain barrier (BBB) disruption and neurodegeneration. We have developed a novel cannabidiol aminoquinone derivative, VCE-004.8, which is a dual PPARγ/CB2 agonist that also activates the hypoxia inducible factor (HIF) pathway. VCE-004.8 shows potent antifibrotic, anti-inflammatory and neuroprotective activities and it is now in Phase II clinical trials for systemic sclerosis and multiple sclerosis. Herein, we investigated the mechanism of action of VCE-004.8 in the HIF pathway and explored its efficacy in a preclinical model of TBI. METHODS Using a phosphoproteomic approach, we investigated the effects of VCE-004.8 on prolyl hydroxylase domain-containing protein 2 (PHD2) posttranslational modifications. The potential role of PP2A/B55α in HIF activation was analyzed using siRNA for B55α. To evaluate the angiogenic response to the treatment with VCE-004.8 we performed a Matrigel plug in vivo assay. Transendothelial electrical resistance (TEER) as well as vascular cell adhesion molecule 1 (VCAM), and zonula occludens 1 (ZO-1) tight junction protein expression were studied in brain microvascular endothelial cells. The efficacy of VCE-004.8 in vivo was evaluated in a controlled cortical impact (CCI) murine model of TBI. RESULTS Herein we provide evidence that VCE-004.8 inhibits PHD2 Ser125 phosphorylation and activates HIF through a PP2A/B55α pathway. VCE-004.8 induces angiogenesis in vivo increasing the formation of functional vessel (CD31/α-SMA) and prevents in vitro blood-brain barrier (BBB) disruption ameliorating the loss of ZO-1 expression under proinflammatory conditions. In CCI model VCE-004.8 treatment ameliorates early motor deficits after TBI and attenuates cerebral edema preserving BBB integrity. Histopathological analysis revealed that VCE-004.8 treatment induces neovascularization in pericontusional area and prevented immune cell infiltration to the brain parenchyma. In addition, VCE-004.8 attenuates neuroinflammation and reduces neuronal death and apoptosis in the damaged area. CONCLUSIONS This study provides new insight about the mechanism of action of VCE-004.8 regulating the PP2A/B55α/PHD2/HIF pathway. Furthermore, we show the potential efficacy for TBI treatment by preventing BBB disruption, enhancing angiogenesis, and ameliorating neuroinflammation and neurodegeneration after brain injury.
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Affiliation(s)
| | | | - Alejandro Correa-Sáez
- Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.,Cellular Biology, Physiology and Immunology Department, University of Cordoba, Córdoba, Spain.,Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Francisco Fernández
- FEA Radiodiagnóstico, Sección de Neurorradiología Diagnóstica. Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Rafael Pineda
- Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.,Cellular Biology, Physiology and Immunology Department, University of Cordoba, Córdoba, Spain.,Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Massimiliano Mazzone
- Laboratory of Tumor Inflammation and Angiogenesis, Center for Cancer Biology, VIB-KULeuven, 3000, Louvain, Belgium
| | - Marina Álvarez-Benito
- Unidad de Radiodiagnóstico Y Cáncer de Mama, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Marco A Calzado
- Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain.,Cellular Biology, Physiology and Immunology Department, University of Cordoba, Córdoba, Spain.,Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Eduardo Muñoz
- Emerald Health Pharmaceuticals, San Diego, USA. .,Maimonides Biomedical Research Institute of Córdoba, University of Córdoba, Avda Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Cellular Biology, Physiology and Immunology Department, University of Cordoba, Córdoba, Spain. .,Hospital Universitario Reina Sofía, Córdoba, Spain.
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Romero-Martín S, Elías-Cabot E, Raya-Povedano JL, Gubern-Mérida A, Rodríguez-Ruiz A, Álvarez-Benito M. Stand-Alone Use of Artificial Intelligence for Digital Mammography and Digital Breast Tomosynthesis Screening: A Retrospective Evaluation. Radiology 2021; 302:535-542. [PMID: 34904872 DOI: 10.1148/radiol.211590] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Use of artificial intelligence (AI) as a stand-alone reader for digital mammography (DM) or digital breast tomosynthesis (DBT) breast screening could ease radiologists' workload while maintaining quality. Purpose To retrospectively evaluate the stand-alone performance of an AI system as an independent reader of DM and DBT screening examinations. Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired between January 2015 and December 2016 were retrospectively collected from the Tomosynthesis Cordoba Screening Trial. An AI system computed a cancer risk score (range, 1-100) for DM and DBT examinations independently. AI stand-alone performance was measured using the area under the receiver operating characteristic curve (AUC) and sensitivity and recall rate at different operating points selected to have noninferior sensitivity compared with the human readings (noninferiority margin, 5%). The recall rate of AI and the human readings were compared using a McNemar test. Results A total of 15 999 DM and DBT examinations (113 breast cancers, including 98 screen-detected and 15 interval cancers) from 15 998 women (mean age, 58 years ± 6 [standard deviation]) were evaluated. AI achieved an AUC of 0.93 (95% CI: 0.89, 0.96) for DM and 0.94 (95% CI: 0.91, 0.97) for DBT. For DM, AI achieved noninferior sensitivity as a single (58.4%; 66 of 113; 95% CI: 49.2, 67.1) or double (67.3%; 76 of 113; 95% CI: 58.2, 75.2) reader, with a reduction in recall rate (P < .001) of up to 2% (95% CI: -2.4, -1.6). For DBT, AI achieved noninferior sensitivity as a single (77%; 87 of 113; 95% CI: 68.4, 83.8) or double (81.4%; 92 of 113; 95% CI: 73.3, 87.5) reader, but with a higher recall rate (P < .001) of up to 12.3% (95% CI: 11.7, 12.9). Conclusion Artificial intelligence could replace radiologists' readings in breast screening, achieving a noninferior sensitivity, with a lower recall rate for digital mammography but a higher recall rate for digital breast tomosynthesis. © RSNA, 2021 See also the editorial by Fuchsjäger and Adelsmayr in this issue.
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Affiliation(s)
- Sara Romero-Martín
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Esperanza Elías-Cabot
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - José Luis Raya-Povedano
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Albert Gubern-Mérida
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Alejandro Rodríguez-Ruiz
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Marina Álvarez-Benito
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
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Raya-Povedano JL, Romero-Martín S, Elías-Cabot E, Gubern-Mérida A, Rodríguez-Ruiz A, Álvarez-Benito M. AI-based Strategies to Reduce Workload in Breast Cancer Screening with Mammography and Tomosynthesis: A Retrospective Evaluation. Radiology 2021; 300:57-65. [PMID: 33944627 DOI: 10.1148/radiol.2021203555] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The workflow of breast cancer screening programs could be improved given the high workload and the high number of false-positive and false-negative assessments. Purpose To evaluate if using an artificial intelligence (AI) system could reduce workload without reducing cancer detection in breast cancer screening with digital mammography (DM) or digital breast tomosynthesis (DBT). Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired from January 2015 to December 2016 were retrospectively collected from the Córdoba Tomosynthesis Screening Trial. The original reading settings were single or double reading of DM or DBT images. An AI system computed a cancer risk score for DM and DBT examinations independently. Each original setting was compared with a simulated autonomous AI triaging strategy (the least suspicious examinations for AI are not human-read; the rest are read in the same setting as the original, and examinations not recalled by radiologists but graded as very suspicious by AI are recalled) in terms of workload, sensitivity, and recall rate. The McNemar test with Bonferroni correction was used for statistical analysis. Results A total of 15 987 DM and DBT examinations (which included 98 screening-detected and 15 interval cancers) from 15 986 women (mean age ± standard deviation, 58 years ± 6) were evaluated. In comparison with double reading of DBT images (568 hours needed, 92 of 113 cancers detected, 706 recalls in 15 987 examinations), AI with DBT would result in 72.5% less workload (P < .001, 156 hours needed), noninferior sensitivity (95 of 113 cancers detected, P = .38), and 16.7% lower recall rate (P < .001, 588 recalls in 15 987 examinations). Similar results were obtained for AI with DM. In comparison with the original double reading of DM images (222 hours needed, 76 of 113 cancers detected, 807 recalls in 15 987 examinations), AI with DBT would result in 29.7% less workload (P < .001), 25.0% higher sensitivity (P < .001), and 27.1% lower recall rate (P < .001). Conclusion Digital mammography and digital breast tomosynthesis screening strategies based on artificial intelligence systems could reduce workload up to 70%. Published under a CC BY 4.0 license.
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Affiliation(s)
- José Luis Raya-Povedano
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
| | - Sara Romero-Martín
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
| | - Esperanza Elías-Cabot
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
| | - Albert Gubern-Mérida
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
| | - Alejandro Rodríguez-Ruiz
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
| | - Marina Álvarez-Benito
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.)
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Bousquet J, Illario M, Farrell J, Batey N, Carriazo AM, Malva J, Hajjam J, Colgan E, Guldemond N, Perälä-Heape M, Onorato GL, Bedbrook A, Leonardini L, Stroetman V, Birov S, Abreu C, Abrunhosa A, Agrimi A, Alalääkkölä T, Allegretti N, Alonso-Trujillo F, Álvarez-Benito M, Angioli S, Apóstolo J, Armitage G, Arnavielhe S, Baena-ParejoI M, Bamidis PD, Balenović A, Barbolini M, Baroni I, Blain H, Bernard PL, Bersani M, Berti E, Bogatyrchuk L, Bourret R, Brehm J, Brussino L, Buhr D, Bultje D, Cabeza E, Cano A, De Capitani C, Carantoña E, Cardoso A, Coll Clavero JI, Combe B, Conforti D, Coppola L, Corti F, Coscioni E, Costa E, Crooks G, Cunha A, Daien C, Dantas, Darpón Sierra J, Davoli M, Dedeu Baraldes A, De Luca V, De Nardi L, Di Ciano M, Dozet A, Ekinci B, Erve S, Espinoza Almendro JM, Fait A, Fensli R, Fernandez Nocelo S, Gálvez-Daza P, Gámez-Payá J, García Sáez M, Garcia Sanchez I, Gemicioğlu B, Goetzke W, Goossens E, Geurdens M, Gütter Z, Hansen H, Hartman S, Hegendörfer G, Heikka H, Henderson D, Héran D, Hirvonen S, Iaccarino G, Jansson N, Kallasvaara H, Kalyoncu F, Kirchmayer U, Kokko JA, Korpelainen J, Kostka T, Kuna P, Lajarín Ortega T, Lama CM, Laune D, Lauri D, Ledroit V, Levato G, Lewis L, Liotta G, Lundgren L, Lupiañez-Villanueva F, Mc Garry P, Maggio M, Manuel de Keenoy E, Martinez C, Martínez-Domene M, Martínez-Lozano Aranaga B, Massimilliano M, Maurizio A, Mayora O, Melle C, Mendez-Zorilla A, Mengon H, Mercier G, Mercier J, Meyer I, Millet Pi-Figueras A, Mitsias P, Molloy DW, Monti R, Moro ML, Muranko H, Nalin M, Nobili A, Noguès M, O’Caoimh R, Pais S, Papini D, Parkkila P, Pattichis C, Pavlickova A, Peiponen A, Pereira S, Pépin JL, Piera Jiménez J, Portheine P, Potel L, Pozzi AC, Quiñonez P, Ramirez Lauritsen X, Ramos MJ, Rännäli-Kontturi A, Risino A, Robalo-Cordeiro C, Rolla G, Roller R, Romano M, Romano V, Ruiz-Fernández J, Saccavini C, Sachinopoulou A, Sánchez Rubio MJ, Santos L, Scalvini S, Scopetani E, Smedberg D, Solana-Lara R, Sołtysik B, Sorlini M, Stericker S, Stramba Badiale M, Taillieu I, Tervahauta M, Teixeira A, Tikanmäki H, Todo-Bom A, Tooley A, Tuulonen A, Tziraki C, Ussai S, Van der Veen S, Venchiarutti A, Verdoy-Berastegi D, Verissimo M, Visconti L, Vollenbroek-Hutten M, Weinzerl K, Wozniak L, Yorgancıoğlu A, Zavagli V, Zurkuhlen AJ. The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing. Transl Med UniSa 2019; 19:66-81. [PMID: 31360670 PMCID: PMC6581486] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.
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Affiliation(s)
- J Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France,VIMA, INSERM U 1168, VIMA : Ageing and chronic diseases. Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - M Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples, Italy
| | - J Farrell
- LANUA International Healthcare Consultancy, Down, UK
| | - N Batey
- EIPonAHA Reference Site Collaborative network, Head of EU & International Funding, Health and Social Services Group, Welsh Government, Cardiff, UK
| | - AM Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra; Coimbra, and Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - J Hajjam
- CENTICH Mutualité Française Anjou Mayenne, Angers, France
| | - E Colgan
- Department of Health, Social Services and Public Safety, Northern Ireland Belfast, UK
| | - N Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | | | - GL Onorato
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - A Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - L Leonardini
- Veneto Region, Mattone Internazionale Program, Italy
| | - V Stroetman
- Empirica Communication and Technology Research, Bonn, Germany
| | - S Birov
- Empirica Communication and Technology Research, Bonn, Germany
| | - C Abreu
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - A Abrunhosa
- Comissão de Coordenação e Desenvolvimento Regional do Centro (CCDRC), Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - A Agrimi
- Aprulia Region - Research, Innovation and Capacity Building department, Bari – Italy
| | | | | | - F Alonso-Trujillo
- Agency for Social Services and Dependency of Andalusia, Seville, Spain
| | | | - S Angioli
- Campania Councillor for European Funds, Euromediterranean Basin and Youth Policies, Naples, Italy
| | - J Apóstolo
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - G Armitage
- Newcastle University, Operations Director, National Innovation Centre for Ageing, New Castle, UK
| | | | | | - PD Bamidis
- Medical Education Informatics; Lab of Medical Physics; Medical School; Aristotle University of Thessaloniki, Greece
| | - A Balenović
- Health Care Center Zagreb, City of Zagreb, AHA Reference site, Zagreb, Croatia
| | - M Barbolini
- Regione Emilia Romagna - Agenzia Sanitaria e Sociale, Regional Health and Social Agency Emilia-Romagna, Reference Site of the European Innovation Partnership on Healthy and Active Ageing, Bologna, Italy, and EU Commission Senior Public Health Expert
| | | | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France,EUROMOV. EA 2991, Euromov, University of Montpellier, France
| | - PL Bernard
- Sport Faculty, University of Montpellier, France
| | - M Bersani
- Head Unit Plans and Projects; DG Welfare – Region of Lombardy, Milano (Italy)
| | - E Berti
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - L Bogatyrchuk
- The medical improving center “Elbrus”, Zhytomir, Ukraine
| | - R Bourret
- Centre Hospitalier Valenciennes, France
| | - J Brehm
- Health region CologneBonn, Köln, Germany
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - D Buhr
- University of Tuebingen / Steinbeis Transfercenter for Social and Technological Innovation, Tuebingen, Germany
| | - D Bultje
- Healthy Ageing Network Northern Netherlands, Groningen, The Netherlands
| | - E Cabeza
- Cap de Servei de Promoció de la Salut, Direcció General de Salut Pública i Participació, Palma de Mallorca, Spain
| | - A Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain,INCLIVA, Valencia, Spain
| | - C De Capitani
- Lombardy Cluster Technologies for Living Environments, Lecco (LC), Italy
| | - E Carantoña
- Consejería de Presidencia y Participación Ciudadana, Oviedo, Spain
| | - A Cardoso
- Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal
| | - JI Coll Clavero
- Innovation and new technologies, Hospital de Barbastro Servicio Aragones de Salud Aragon, Spain
| | - B Combe
- Department of Rheumotology, University Hospital, Montpellier, France
| | - D Conforti
- Autonomous Province of Trento, Health and Social Solidarity Department & TrentinoSalute4.0, Trento, Italy
| | - L Coppola
- Head Unit Health Promotion and Screening; DG Welfare – Region of Lombardy, Milan, Italy
| | - F Corti
- FIMMG, Federazione Italiana Medici di Medicina Generale, Milan, Italy
| | - E Coscioni
- Department of Heart Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy
| | - E Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy of University of Porto, Porto4ageing Reference Site, University of Porto, PORTO, Portugal
| | - G Crooks
- Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - A Cunha
- Instituto Pedro Nunes, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - C Daien
- Department of Rheumotology, University Hospital, Montpellier, France
| | - Dantas
- Cáritas Diocesana de Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | | | - M Davoli
- Department of Epidemiology, ASL Roma 1, Lazio Regional Health Service, Roma, Italy
| | - A Dedeu Baraldes
- Agency for Health Quality & Assessment of Catalonia of the Ministry of Health of Catalonia – AquAs, Barcelona, Spain
| | - V De Luca
- R&D Unit, Federico II University Hospital, Naples, Italy
| | - L De Nardi
- Health Information System International Projects, Lombardia Informatica SpA, Milano, Italy
| | - M Di Ciano
- InnovaPuglia - Inhouse ICT company of Regione Puglia and Reference Site Puglia WI-FI Management, Bari, Italy
| | - A Dozet
- Health economist, Region Skåne, Sweden
| | - B Ekinci
- Head Chronic Disease Department, Ministry of Health, Ankara, Turkey
| | - S Erve
- CENTICH Mutualité Française Anjou Mayenne, Angers, France
| | | | - A Fait
- Health and Social Care Directorate, ATS Città Metropolitana (Health and Social Care Agency), Milano, Italy
| | - R Fensli
- Centre of eHealth and Health Care Technology, University of Agder, Faculty of Engineering and Science, Grimstad, Norway
| | - S Fernandez Nocelo
- Galician Health Knowledge Agency (ACIS), Regional Ministry of Public Health of Galicia
| | - P Gálvez-Daza
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - M García Sáez
- Agency for Social Services and Dependency of Andalusia, Seville, Spain
| | | | - B Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W Goetzke
- Health region CologneBonn, Köln, Germany
| | - E Goossens
- Center for Gastrology, School of Gastrologic Sciences and Primary Food Care, Leuven, Belgium
| | - M Geurdens
- Center of Expertise in Primary Food Care, Center for Research and Innovation in Care (CRIC), Antwerp, Belgium
| | - Z Gütter
- University Hospital Olomouc - NTMC, National eHealth Centre, Olomouc, Czech Republic
| | - H Hansen
- EU Consultant & Project Manager, South Denmark European Office, Brussels, Belgium
| | - S Hartman
- Department of Social Services and Health Care, Business Development, HELSINGIN KAUPUNKI, City of Helsinki, Finland
| | | | | | - D Henderson
- Head of European Engagement, NHS 24, Glasgow, UK
| | | | | | - G Iaccarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - N Jansson
- Network Ecosystem, BusinessOulu, Oulu, Finland
| | - H Kallasvaara
- Helsinki-Uusimaa Regional Council, Helsinki, Finland
| | - F Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - U Kirchmayer
- Department of Epidemiology, ASL Roma 1, Lazio Regional Health Service, Roma, Italy
| | - JA Kokko
- Department of Healthcare and Social Welfare, Technology Specialist, Oulu, Finland
| | - J Korpelainen
- Oulu University Hospital OYS, Hospital District, Oulu, Finland
| | - T Kostka
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - T Lajarín Ortega
- Committee of Representatives of People with disabilities and their Families, Region de Murcia, Spain
| | - CM Lama
- Regional Ministry of Health of Andalusia, Seville, Spain
| | | | | | - V Ledroit
- Alsace Lorraine Champagne Ardenne, Bureau Europe Grand Est, Bruxelles, Belgique
| | - G Levato
- SIFMED, Scuola Italiana Di Formazione E Ricerca In Medicina Di Famiglia, Milan, Italy
| | - L Lewis
- Head of Research and Development, International Foundation for Integrated Care and EIP on AHA B3 Action Group Chair, Wolfson College, Oxford, UK
| | - G Liotta
- Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy
| | - L Lundgren
- Development Department, Region Norrbotten, Sweden
| | | | - P Mc Garry
- Greater Manchester Ageing Hub, Greater Manchester Combined Authority, Manchester, UK
| | - M Maggio
- Department of Medicine and Surgery - Geriatric Clinic Unit Department of Medicine Geriatric Rehabilitation, University Hospital of Parma, Italy
| | - E Manuel de Keenoy
- Kronikgune, International Centre of Excellence in Chronicity Research, Barakaldo, Bizkaia, Spain
| | - C Martinez
- Costa Cálida Cares-Senior Tourism and Services, Region de Murcia, Spain
| | - M Martínez-Domene
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - M Massimilliano
- Financial Range for Innovation, Research, International care and health sector; Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy
| | - A Maurizio
- Plans and Projects Unit, DG Welfare – Region of Lombardy, Italy
| | - O Mayora
- Bruno Kessler Foundation, eHealth Unit and TrentinoSalute4.0, Trento, Italy
| | - C Melle
- Care Management Unit, Hausach, Gesundes Kinzigtal GmbH, Kizingtal, Germany
| | | | - H Mengon
- Autonomous Province of Trento, Health and Social Solidarity Department & TrentinoSalute4.0, Trento, Italy
| | - G Mercier
- Unité Médico-Economie, Département de l’Information Médicale, University Hospital, Montpellier, France
| | - J Mercier
- Department of Physiology, CHRU, University Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, France
| | - I Meyer
- Care Management Unit, Hausach, Gesundes Kinzigtal GmbH, Kizingtal, Germany
| | | | - P Mitsias
- Department of Neurology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - DW Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, UCC @ St Finbarr’s Hospital, Cork, Ireland
| | - R Monti
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - ML Moro
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - H Muranko
- GEWI Institute, Regional Innovation Partnership on Active and Healthy Ageing, Köln, Germany
| | | | - A Nobili
- Mario Negri Institute for Pharmacological Research, IRCCS; Clinical Pharmacology, Geriatrics, Internal Medicine, Milano, Italy
| | | | - R O’Caoimh
- Centre for Gerontology and Rehabilitation, School of Medicine, UCC @ St Finbarr’s Hospital, Cork, Ireland,Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - S Pais
- Center for Biomedical Research-CBMR, Department of Biomedical Sciences and Medicine, International Center on Ageing-CENIE, University of Algarve, Portugal
| | - D Papini
- Regional Health and Social Agency Emilia-Romagna, Bologna, Italy
| | - P Parkkila
- Oulu University Hospital OYS, Hospital District, Oulu, Finland
| | - C Pattichis
- Dept of Computer Science, University of Cyprus, Cyprus, Greece
| | - A Pavlickova
- European Service Development Manager, NHS 24, Glasgow, UK
| | - A Peiponen
- Social services and health care division, Hospital, rehabilitation and care services, Southern service district, City of Helsinki, FINLAND
| | - S Pereira
- University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | - JL Pépin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, France
| | - J Piera Jiménez
- Information and R&D Officer, Badalona Serveis Assistencials, Badalona, Spain
| | - P Portheine
- Coöperatie Slimmer Leven, Eindhoven, The Netherlands
| | - L Potel
- International Affairs & Public Procurement of Innovation, Hospital Procurement Network, Paris, France
| | - AC Pozzi
- IML, Lombardy Medical Initiative, Bergamo, Italy
| | - P Quiñonez
- Agency for Social Services and Dependency of Andalusia, Seville, Spain,Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | | | - MJ Ramos
- UCIBIO, REQUIMTE, Faculty of Sciences of University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | | | - A Risino
- Health Innovation Manchester, Manchester, UK
| | - C Robalo-Cordeiro
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - G Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - R Roller
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | - V Romano
- IRES - Institute for Economic and Social Research - Piedmont, Torino, Italy
| | | | - C Saccavini
- Arsenàl.IT, Veneto’s Research Centre for eHealth Innovation, Venice, Italy
| | - A Sachinopoulou
- Oulu University, Center of Health and Technology, Oulu, Finland
| | - MJ Sánchez Rubio
- Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain
| | - L Santos
- Odem dos Farmacêuticos, Secção Regional do Centro, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - S Scalvini
- Cardiology Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane, Brescia, Italy
| | - E Scopetani
- Tuscany Region, Directorate Citizenship rights and social cohesion, Firenze, Italy
| | - D Smedberg
- RISE Research Institutes of Sweden, Division Safety and Transport - Measurement Science and Technology, Lund, Sweden
| | - R Solana-Lara
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - B Sołtysik
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | - M Sorlini
- International Affairs & Public Procurement of Innovation, Hospital Procurement Network, Paris, France
| | - S Stericker
- Head of Programmes, Yorkshire & Humber Academic Health Science Network, Wakefield, UK
| | - M Stramba Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - I Taillieu
- Coördinator Zorgeconomie, Fabrieken voor de Toekomst, Brugge, Belgium
| | | | - A Teixeira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Portugal
| | - H Tikanmäki
- Life Science Industries and Company Networks, BusinessOulu, Oulu, Finland
| | - A Todo-Bom
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - A Tooley
- University of Porto and Porto4Ageing Reference Site, Porto, Portugal
| | - A Tuulonen
- Tays Eye Centre, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - C Tziraki
- Research and Evaluation Department, Municipality of Jérusalem, Israël,Medicine and Health Care Science, Allilegi Community Based Organization for AD and Active Healthy Aging, Heraklion, Crete, Heraklion-Crete Reference Site Region, Greece
| | - S Ussai
- DG Welfare, Lombardy Region, Italy
| | - S Van der Veen
- Department of Med Hum, Amsterdam University Medical Centers, VU University, NL
| | - A Venchiarutti
- Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy
| | - D Verdoy-Berastegi
- Kronikgune, International Centre of Excellence in Chronicity Research, Barakaldo, Bizkaia, Spain
| | - M Verissimo
- Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site
| | - L Visconti
- LifeTechValley, Life Sciences Incubator BioVille, Diepenbeek, Belgium
| | - M Vollenbroek-Hutten
- University of Twente, Biomedical systems and signal group/telemedicine, Twente, The Netherlands
| | - K Weinzerl
- Human.technology Styria GmbH, Graz, Austria
| | - L Wozniak
- Research and International Relations, Department of Structural Biology, Medical University of Lodz, Lodz, Poland
| | - A Yorgancıoğlu
- Celal Bayar University, School of Medicine, Department of Pulmonology, Manisa, Turkey
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8
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Luque RM, López-Sánchez LM, Villa-Osaba A, Luque IM, Santos-Romero AL, Yubero-Serrano EM, Cara-García M, Álvarez-Benito M, López-Mirand A J, Gahete MD, Castaño JP. Breast cancer is associated to impaired glucose/insulin homeostasis in premenopausal obese/overweight patients. Oncotarget 2017; 8:81462-81474. [PMID: 29113405 PMCID: PMC5655300 DOI: 10.18632/oncotarget.20399] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/25/2017] [Indexed: 01/04/2023] Open
Abstract
The association between breast cancer (BCa) presence and altered glucose/insulin metabolism is controversial likely due to an inaccurate insulin resistance (IR) assessment and inappropriate stratification of patients by body-mass index (BMI) and menopausal state. 148 women with suspect of sporadic BCa were stratified by BMI and menopause. Fasting levels of glucose, insulin, glycohemoglobin and selected IR-related and tumor-derived markers were measured. Glucose/insulin levels during OGTT were used to calculate insulin resistance/sensitivity indexes. Analysis of 77 BCa-bearing patients and 71 controls showed an association between BCa and IR as demonstrated by impaired glucose/insulin homeostasis (increased fasting- and OGTT-induced glucose levels) and deteriorated IR indexes, which was especially patent in premenopausal women. The association between BCa presence and IR was markedly influenced by BMI, being obese BCa patients significantly more insulin resistant than controls. BCa presence was associated to elevated levels of IR (glucose, triglycerides) and tumor-derived (VEGF) markers, especially in overweight/obese patients. BCa presence is associated to IR in overweight/obese premenopausal but not in premenopausal normal weight or postmenopausal women. Our data support a bidirectional relationship between dysregulated/imbalanced glucose/insulin metabolism and BCa, as tumor- and IR-markers are correlated with the impairment of glucose/insulin metabolism in overweight/obese premenopausal BCa patients.
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Affiliation(s)
- Raúl M Luque
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain.,CIBERobn, Córdoba, Spain.,ceiA3, Córdoba, Spain
| | - Laura M López-Sánchez
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain.,CIBERobn, Córdoba, Spain.,ceiA3, Córdoba, Spain
| | - Alicia Villa-Osaba
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain.,CIBERobn, Córdoba, Spain.,ceiA3, Córdoba, Spain
| | - Isabel M Luque
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ana L Santos-Romero
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,CIBERobn, Córdoba, Spain.,Mammary Gland Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena M Yubero-Serrano
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,CIBERobn, Córdoba, Spain.,Lipids and Atherosclerosis Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - María Cara-García
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,CIBERobn, Córdoba, Spain.,Mammary Gland Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Marina Álvarez-Benito
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,CIBERobn, Córdoba, Spain.,Mammary Gland Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - José López-Mirand A
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,CIBERobn, Córdoba, Spain.,Lipids and Atherosclerosis Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuel D Gahete
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain.,CIBERobn, Córdoba, Spain.,ceiA3, Córdoba, Spain
| | - Justo P Castaño
- Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain.,Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofia, Córdoba, Spain.,CIBERobn, Córdoba, Spain.,ceiA3, Córdoba, Spain
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9
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Navarro-Rodríguez E, Díaz-Jiménez N, Ruiz-Rabelo J, Gómez-Luque I, Bascuñana-Estudillo G, Rioja-Torres P, Torres-Lorite M, Ciria-Bru R, Álvarez-Benito M, Briceño-Delgado J. Factors Associated With Disease Recurrence in Breast Cancer Patients With Negative Sentinel Lymph Node Biopsy. Clin Breast Cancer 2016; 16:e181-e186. [PMID: 27498119 DOI: 10.1016/j.clbc.2016.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/27/2016] [Revised: 05/21/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of our study was to assess recurrence after negative sentinel lymph node biopsy (SLNB) and to determine the risk factors related to local and distant recurrence in this group of patients. MATERIALS AND METHODS We conducted a prospective observational study from 2006 to 2011. It included 607 patients with early-stage breast cancer and negative SLNB with a 5-year follow-up period. RESULTS The disease-free survival rate was 98.5% and 96.5% at 2 and 5 years, respectively. Multivariate analysis identified the following prognostic factors for disease recurrence: tumor necrosis (hazard ratio [HR], 4.89; 95% confidence interval [CI], 1.61-14.89; P = .005), lymphovascular invasion (HR, 3.46; 95% CI, 1.14-10.55; P = .029), T2 tumor size (HR, 4.35; 95% CI, 1.40-13.52; P = .011), and moderate to severe lymphoplasmacytic stromal infiltration (HR, 3.06; 95% CI, 1.18-7.96; P = .022). CONCLUSION Recurrence in patients with negative SLNB was satisfactorily low. Nevertheless, determining the prognostic factors related to a greater recurrence rate could help identify high-risk patients and influence systemic adjuvant therapy.
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Affiliation(s)
| | | | - Juan Ruiz-Rabelo
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Irene Gómez-Luque
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | | | - Rubén Ciria-Bru
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
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10
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Villa-Osaba A, Gahete MD, Córdoba-Chacón J, de Lecea L, Pozo-Salas AI, Delgado-Lista FJ, Álvarez-Benito M, López-Miranda J, Luque RM, Castaño JP. Obesity alters gene expression for GH/IGF-I axis in mouse mammary fat pads: differential role of cortistatin and somatostatin. PLoS One 2015; 10:e0120955. [PMID: 25806796 PMCID: PMC4373840 DOI: 10.1371/journal.pone.0120955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 02/10/2015] [Indexed: 12/03/2022] Open
Abstract
Locally produced growth hormone (GH) and IGF-I are key factors in the regulation of mammary gland (MG) development and may be important in breast cancer development/progression. Somatostatin (SST) and cortistatin (CORT) regulate GH/IGF-I axis at various levels, but their role in regulating GH/IGF-I in MGs remains unknown. Since obesity alters the expression of these systems in different tissues and is associated to MG (patho) physiology, we sought to investigate the role of SST/CORT in regulating GH/IGF-I system in the MGs of lean and obese mice. Therefore, we analyzed GH/IGF-I as well as SST/CORT and ghrelin systems expression in the mammary fat pads (MFPs) of SST- or CORT-knockout (KO) mice and their respective littermate-controls fed a low-fat (LF) or a high-fat (HF) diet for 16 wks. Our results demonstrate that the majority of the components of GH/IGF-I, SST/CORT and ghrelin systems are locally expressed in mouse MFP. Expression of elements of the GH/IGF-I axis was significantly increased in MFPs of HF-fed control mice while lack of endogenous SST partially suppressed, and lack of CORT completely blunted, the up-regulation observed in obese WT-controls. Since SST/CORT are known to exert an inhibitory role on the GH/IGFI axis, the increase in SST/CORT-receptor sst2 expression in MFPs of HF-fed CORT- and SST-KOs together with an elevation on circulating SST in CORT-KOs could explain the differences observed. These results offer new information on the factors (GH/IGF-I axis) involved in the endocrine/metabolic dysregulation of MFPs in obesity, and suggest that CORT is not a mere SST sibling in regulating MG physiology.
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Affiliation(s)
- Alicia Villa-Osaba
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Manuel D. Gahete
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - José Córdoba-Chacón
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
- Department of Medicine, University of Illinois at Chicago and Jesse Brown Veteran Affairs Medical Center, Research and Development Division, Chicago, Illinois, United States of America
| | - Luis de Lecea
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ana I. Pozo-Salas
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Francisco Javier Delgado-Lista
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Medicine, Reina Sofía University Hospital, Córdoba, Spain
| | - Marina Álvarez-Benito
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- Mammary Gland Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - José López-Miranda
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
- Lipids and Atherosclerosis Unit, Department of Medicine, Reina Sofía University Hospital, Córdoba, Spain
| | - Raúl M. Luque
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
| | - Justo P. Castaño
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
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Navarro-Rodríguez E, Gómez-Luque I, Díaz-Jiménez N, Rioja-Torres P, Bascuñana-Estudillo G, Ruiz-Rabelo JF, Ciria-Bru R, Álvarez-Benito M, Rufián-Peña S, Briceño-Delgado J. Effectiveness of an absorbable fibrin sealant patch to reduce lymphoceles formation after axillary lymphadenectomy for breast cancer: a matched-pair analysis. Am J Surg 2014; 208:824-830. [DOI: 10.1016/j.amjsurg.2013.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/29/2013] [Accepted: 12/23/2013] [Indexed: 11/15/2022]
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