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Xu Z, Lin Y, Huo J, Gao Y, Lu J, Liang Y, Li L, Jiang Z, Du L, Lang T, Wen G, Li Y. A bimodal nomogram as an adjunct tool to reduce unnecessary breast biopsy following discordant ultrasonic and mammographic BI-RADS assessment. Eur Radiol 2024; 34:2608-2618. [PMID: 37840099 DOI: 10.1007/s00330-023-10255-5] [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] [Received: 03/12/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To develop a bimodal nomogram to reduce unnecessary biopsies in breast lesions with discordant ultrasound (US) and mammography (MG) Breast Imaging Reporting and Data System (BI-RADS) assessments. METHODS This retrospective study enrolled 706 women following opportunistic screening or diagnosis with discordant US and MG BI-RADS assessments (where one assessed a lesion as BI-RADS 4 or 5, while the other assessed the same lesion as BI-RADS 0, 2, or 3) from two medical centres between June 2019 and June 2021. Univariable and multivariable logistic regression analyses were used to develop the nomogram. DeLong's and McNemar's tests were used to assess the model's performance. RESULTS Age, MG features (margin, shape, and density in masses, suspicious calcifications, and architectural distortion), and US features (margin and shape in masses as well as calcifications) were independent risk factors for breast cancer. The nomogram obtained an area under the curve of 0.87 (95% confidence interval (CI), 0.83-0.91), 0.91 (95% CI, 0.87 - 0.96), and 0.92 (95% CI, 0.86-0.98) in the training, internal validation, and external testing samples, respectively, and demonstrated consistency in calibration curves. Coupling the nomogram with US reduced unnecessary biopsies from 74 to 44% and the missed malignancies rate from 13 to 2%. Similarly, coupling with MG reduced missed malignancies from 20 to 6%, and 63% of patients avoided unnecessary biopsies. Interobserver agreement between US and MG increased from - 0.708 (poor agreement) to 0.700 (substantial agreement) with the nomogram. CONCLUSION When US and MG BI-RADS assessments are discordant, incorporating the nomogram may improve the diagnostic accuracy, avoid unnecessary breast biopsies, and minimise missed diagnoses. CLINICAL RELEVANCE STATEMENT The nomogram developed in this study could be used as a computer program to assist radiologists with detecting breast cancer and ensuring more precise management and improved treatment decisions for breast lesions with discordant assessments in clinical practice. KEY POINTS • Coupling the nomogram with US and mammography improves the detection of breast cancers without the risk of unnecessary biopsy or missed malignancies. • The nomogram increases mammography and US interobserver agreement and enhances the consistency of decision-making. • The nomogram has the potential to be a computer program to assist radiologists in identifying breast cancer and making optimal decisions.
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Affiliation(s)
- Ziting Xu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Yue Lin
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jiekun Huo
- Department of Imaging, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yang Gao
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jiayin Lu
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Yu Liang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Lian Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Zhouyue Jiang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Lingli Du
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Ting Lang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Ge Wen
- Department of Imaging, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
| | - Yingjia Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Sefidbakht S, Beizavi Z, Kanaani Nejad F, Pishdad P, Sadighi N, Ghoddusi Johari M, Bijan B, Tahmasebi S. Association of imaging and pathological findings of breast cancer in very young women: Report of a twenty-year retrospective study. Clin Imaging 2024; 110:110094. [PMID: 38599926 DOI: 10.1016/j.clinimag.2024.110094] [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: 09/03/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE In this study, we aimed to assess the new trends in characteristics, molecular subtypes, and imaging findings of breast cancer in very young women. METHODS We retrospectively reviewed the database of a primary breast cancer referral center in southern Iran in 342 cases of 30-year-old or younger women from 2001 to 2020. Pathologic data, including nuclear subtype and grade, tumor stage, presence of in situ cancer, imaging data including lesion type in mammogram and ultrasound, and treatment data were recorded. Descriptive statistics were applied. Differences between categorical values between groups were compared using Pearson's Chi-square test. RESULTS The mean age was 27.89 years. The tumor type was invasive ductal carcinoma in 82 % of cases. Fourteen patients (4.4 %) had only in situ cancer, and 170 patients had in situ components (49.7 %). Molecular subtypes were available in 278 patients, including 117 (42.1 %) Luminal A, 64 (23.0 %) Luminal B, 58 (20.9 %) triple negative, and 39 (14 %) HER2 Enriched. In those with mammograms available, 63 (30.1 %) had no findings, 53 (25.3 %) had mass, 27 (12.9 %) had asymmetry, whether focal or global, 21 (10 %) had microcalcifications solely, and 45 (21.5 %) had more than one finding. Microcalcifications were significantly more common in Luminal cancers than HER2 and triple-negative cancers (p = 0.041). CONCLUSION Our study shows the most common subtype to be Luminal A cancer, with 74 % of the tumors being larger than 2 cm at the time of diagnosis. Irregular masses with non-circumscribed margins were the most common imaging findings.
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Affiliation(s)
- Sepideh Sefidbakht
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Beizavi
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Fatemeh Kanaani Nejad
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Parisa Pishdad
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Sadighi
- Radiology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bijan Bijan
- Sutter Imaging (SMG) - Sacramento, Professor of Nuclear Medicine & Radiology (W.O.S.), University of California Davis Medical Center, Sacramento, CA, USA
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Leonov D, Venidiktova D, Costa-Júnior JFS, Nasibullina A, Tarasova O, Pashinceva K, Vetsheva N, Bulgakova J, Kulberg N, Borsukov A, Saikia MJ. Development of an anatomical breast phantom from polyvinyl chloride plastisol with lesions of various shape, elasticity and echogenicity for teaching ultrasound examination. Int J Comput Assist Radiol Surg 2024; 19:151-161. [PMID: 37099215 DOI: 10.1007/s11548-023-02911-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE The WHO reported an increasing trend in the number of new cases of breast cancer, making it the most prevalent cancer in the world. This fact necessitates the availability of highly qualified ultrasonographers, which can be achieved by the widespread implementation of training phantoms. The goal of the present work is to develop and test an inexpensive, accessible, and reproducible technology for creating an anatomical breast phantom for practicing ultrasound diagnostic skills in grayscale and elastography imaging, as well as ultrasound-guided biopsy sampling. METHODS We used FDM 3D printer and PLA plastic for printing an anatomical breast mold. We made a phantom using a mixture of polyvinyl chloride plastisol, graphite powder, and metallic glitter to simulate soft tissues and lesions. Various degrees of elasticity were imparted using plastisols of stiffness ranging from 3 to 17 on the Shore scale. The lesions were shaped by hand. The materials and methods used are easily accessible and reproducible. RESULTS Using the proposed technology, we have developed and tested a basic, differential, and elastographic versions of the breast phantom. The three versions of the phantom are anatomical and intended for use in medical education: the basic version is for practicing primary hand-eye coordination skills; the differential one is for practicing the differential diagnosis skills; the elastographic version helps developing the skills needed for assessing the stiffness of tissues. CONCLUSION The proposed technology allows the creation of breast phantoms for practicing hand-eye coordination and develop the critical skills for navigation and assessment of the shape, margins, and size of the lesion, as well as performing an ultrasound-guided biopsy. It is cost-effective, reproducible, and easily implementable, and could be instrumental in generating ultrasonographers with crucial skills for accurate diagnosis of breast cancer, especially in low-resource settings.
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Affiliation(s)
- Denis Leonov
- Moscow Center for Diagnostics and Telemedicine, Moscow, Russia.
- Moscow Power Engineering Institute, Moscow, Russia.
| | | | | | - Anastasia Nasibullina
- Moscow Center for Diagnostics and Telemedicine, Moscow, Russia
- Moscow Power Engineering Institute, Moscow, Russia
| | - Olga Tarasova
- Plekhanov Russian University of Economics, Moscow, Russia
| | | | - Natalia Vetsheva
- Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federatio, Moscow, Russia
| | - Julia Bulgakova
- Moscow Center for Diagnostics and Telemedicine, Moscow, Russia
- Moscow Power Engineering Institute, Moscow, Russia
| | - Nicholas Kulberg
- Federal Research Center "Computer Science and Control" of the Russian Academy of Sciences, Moscow, Russia
| | | | - Manob Jyoti Saikia
- Department of Electrical Engineering, University of North Florida, Jacksonville, FL, 32224, USA
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Ma Q, Lu X, Qin X, Xu X, Fan M, Duan Y, Tu Z, Zhu J, Wang J, Zhang C. A sonogram radiomics model for differentiating granulomatous lobular mastitis from invasive breast cancer: a multicenter study. Radiol Med 2023; 128:1206-1216. [PMID: 37597127 DOI: 10.1007/s11547-023-01694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To construct a nomogram based on sonogram features and radiomics features to differentiate granulomatous lobular mastitis (GLM) from invasive breast cancer (IBC). MATERIALS AND METHODS A retrospective collection of 213 GLMs and 472 IBCs from three centers was divided into a training set, an internal validation set, and an external validation set. A radiomics model was built based on radiomics features, and the RAD score of the lesion was calculated. The sonogram radiomics model was constructed using ultrasound features and RAD scores. Finally, the diagnostic efficacy of the three sonographers with different levels of experience before and after combining the RAD score was assessed in the external validation set. RESULTS The RAD score, lesion diameter, orientation, echogenicity, and tubular extension showed significant differences in GLM and IBC (p < 0.05). The sonogram radiomics model based on these factors achieved optimal performance, and its area under the curve (AUC) was 0.907, 0.872, and 0.888 in the training, internal, and external validation sets, respectively. The AUCs before and after combining the RAD scores were 0.714, 0.750, and 0.830 and 0.834, 0.853, and 0.878, respectively, for sonographers with different levels of experience. The diagnostic efficacy was comparable for all sonographers when combined with the RAD score (p > 0.05). CONCLUSION Radiomics features effectively enhance the ability of sonographers to discriminate between GLM and IBC and reduce interobserver variation. The nomogram combining ultrasound features and radiomics features show promising diagnostic efficacy and can be used to identify GLM and IBC in a noninvasive approach.
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Affiliation(s)
- Qianqing Ma
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiaofeng Lu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Xiachuan Qin
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
- Department of Ultrasound, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University Nan Chong), Sichuan, China
| | - Xiangyi Xu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Min Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yayang Duan
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China
| | - Zhengzheng Tu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Jianhui Zhu
- Anhui Provincial Key Laboratory of Multimodal Cognitive Computation, School of Computer Science and Technology, Anhui University, Hefei, China
| | - Junli Wang
- Department of Ultrasound, The Second People's Hospital of Wuhu, No.259 Jiuhuashan Road, Jinghu District, Wuhu, 241001, Anhui, China.
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei, 230022, Anhui, China.
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Temel E, Elverici E, Sarı E, Özsoy A, Akbaş Doğan M, Kulaçoğlu S. Relationship of The Characteristic Imaging Findings of Breast Cancer with Molecular Subtypes in Young Women. Curr Med Imaging 2023:CMIR-EPUB-133070. [PMID: 37489787 DOI: 10.2174/1573405620666230721124048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The characteristic imaging findings of breast cancer in young women are not yet fully understood. It causes a delay in diagnosis by mixing with benign findings. OBJECTIVE To evaluate the relationship between the imaging and histopathological features of breast cancer in women aged under 40 years. METHODS In our center, 537 suspicious lesions were detected in a total of 15,223 adult female patients under 40 years who were evaluated by breast ultrasonography (US). As a result of the mammographic, histopathological, and immunohistochemical analysis, 101 lesions meeting the study criteria were included in the sample. RESULTS The luminal subtypes of breast cancer mostly visualized as irregularly shaped spiculated lesions with calcification and architectural distortion mammography and presented as masses that were sometimes accompanied by increased echogenicity in the surrounding tissue on US. The human epidermal growth factor receptor 2 (HER2) enriched subtypes mostly had microlobulated or indistinct margins with heterogeneous echoes accompanied by high calcification on mammography. The triple-negative (TN) subtypes generally appeared as microlobulated lesions with angular or indistinct margins, hypo echogenicity, posterior enhancement or shadowing, and vascularization. CONCLUSION Some radiological features of breast cancer in young women were found to be associated with molecular subtypes similar to other age groups in the literature. However, unlike other age groups, the incidences of the HER2-enriched subtype presenting with only calcification, TN subtypes presenting with circumscribed masses, and calcification were found to be low among the young women in our study.
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Affiliation(s)
- Emirhan Temel
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
| | - Eda Elverici
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
| | - Engin Sarı
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
| | - Arzu Özsoy
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
| | - Mutlu Akbaş Doğan
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
| | - Sezer Kulaçoğlu
- Ankara City Hospital Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya/Ankara
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Enomoto K, Hara Y, Dobashi K, Masuda S, Tada K. A patient with breast fibroadenoma accompanied by carcinoma: early detection by screening. J Med Ultrason (2001) 2023; 50:111-112. [PMID: 36181579 DOI: 10.1007/s10396-022-01264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Katsuhisa Enomoto
- Division of Breast and Endocrine Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yukiko Hara
- Division of Breast and Endocrine Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | | | - Shinobu Masuda
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Keiichiro Tada
- Division of Breast and Endocrine Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Zhang J, Cai L, Pan X, Chen L, Chen M, Yan D, Liu J, Luo L. Comparison and risk factors analysis of multiple breast cancer screening methods in the evaluation of breast non-mass-like lesions. BMC Med Imaging 2022; 22:202. [PMID: 36404330 PMCID: PMC9677910 DOI: 10.1186/s12880-022-00921-3] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare multiple breast cancer screening methods for evaluating breast non-mass-like lesions (NMLs), and investigate new best screening method for breast non-mass-like lesions and the value of the lexicon of ACR BI-RADS in NML evaluation. METHODS This retrospective study examined 253 patients aged 24-68 years who were diagnosed with breast NMLs and described the lexicon of ACR BI-RADS from April 2017 to December 2019. All lesions were evaluated by HHUS, MG, and ABUS to determine BI-RADS category, and underwent pathological examination within six months or at least 2 years of follow-up. The sensitivity, specificity, accuracy, positive predictive values (PPV), and negative predictive values (NPV) of MG, HHUS and ABUS in the prediction of malignancy were compared. Independent risk factors for malignancy were assessed using non-conditional logistic regression. RESULTS HHUS, MG and ABUS findings significantly differed between benign and malignant breast NML, including internal echo, hyperechoic spot, peripheral blood flow, internal blood flow, catheter change, peripheral change, coronal features of ABUS, and structural distortion, asymmetry, and calcification in MG. ABUS is superior to MG and HHUS in sensitivity, specificity, PPV, NPV, as well as in evaluating the necessity of biopsy and accuracy in identifying malignancy. MG was superior to HHUS in specificity, PPV, and accuracy in evaluating the need for biopsy. CONCLUSIONS ABUS was superior to HHUS and MG in evaluating the need for biopsy in breast NMLs. Compared to each other, HHUS and MG had their own relative advantages. Internal blood flow, calcification, and coronal plane feature was independent risk factors in NMLs Management, and different screening methods had their own advantages in NML management. The lexicon of ACR BI-RADS could be used not only in the evaluation of mass lesions, but also in the evaluation of NML.
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Affiliation(s)
- Jianxing Zhang
- grid.258164.c0000 0004 1790 3548Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630 Guangdong Province China ,grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Lishan Cai
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou, 510403 Guangdong Province China
| | - Xiyang Pan
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Ling Chen
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Miao Chen
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Dan Yan
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Jia Liu
- grid.411866.c0000 0000 8848 7685Department of Ultrasound, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou, 510120 Guangdong Province China
| | - Liangping Luo
- grid.258164.c0000 0004 1790 3548Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630 Guangdong Province China
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Park SY, Park JY, Park JW, Kim WH, Park JY, Kim HJ. Unexpected hyperechoic lesions of the breast and their correlations with pathology: a pictorial essay. Ultrasonography 2022; 41:597-609. [PMID: 35462528 PMCID: PMC9262659 DOI: 10.14366/usg.21243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/18/2021] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
Hyperechoic lesions of the breast encompass a wide range of conditions that are occasionally encountered during breast ultrasonography. Although typical hyperechoic lesions with a distinct fat component on imaging are well known, some hyperechoic lesions are diagnosed as unexpected pathology, making the radiology-pathology correlation difficult. Therefore, understanding the pathology of these lesions and how it correlates with imaging findings can help radiologists accurately diagnose and properly manage a range of related conditions. This article presents a pictorial review of unexpected hyperechoic benign and malignant breast lesions, with a focus on the pathological conditions that give rise to the hyperechoic pattern.
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Affiliation(s)
- Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Radiology, Fatima Hospital, Daegu, Korea
| | - Jee Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Won Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.,Department of Radiology, Chamteunteun Hospital, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Zheng L, Zheng F, Xing Z, Zhang Y, Li Y, Xu H, Lai Y, Li J, Wang W. Breast lesions excised via vacuum-assisted system: could we get any clues for B3 lesions before excision biopsy? BMC Cancer 2021; 21:633. [PMID: 34049527 DOI: 10.1186/s12885-021-08382-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this study was to determine the validity of the ultrasound features as well as patient characteristics assigned to B3 (uncertain malignant potential) breast lesions before vacuum-assisted excision biopsy (VAEB). Methods This study population consisted of 2245 women with breast-nodular abnormalities, which were conducted ultrasound-guided VAEB (US-VAEB). Patient’s clinical and anamnestic data and lesion-related ultrasonic feature variables of B3 captured before US-VAEB were compared with those of benign or malignant cases, using histopathological results as a benchmark. Results The proportions of benign, B3 and malignant breast lesions diagnosed post-US-VAEB were 88.5, 8.2 and 3.4% respectively. B3 high frequent occurred in BI-RADS-US grade 3 (7.7%), grade 4a (11.0%) and grade 4b (9.1%). The overall malignancy underestimation rate of B3 was 4.4% (8/183). Malignant lesions were found mostly in the range of BI-RADS grade 4b (27.3%), grade 4c (33.3%) and grade 5 (100%). Multivariate binary logistic regression analyses (B3 vs benign) showed that non-menopausal patients (95% CI 1.628–8.616, P = 0.002), single (95% CI 1.370–2.650, P = 0.000) or vascularity (95% CI 1.745–4.150, P = 0.000) nodules in ultrasonic features were significant risk factors for B3 occurrences. In addition, patients elder than 50 years (95% CI 3.178–19.816, P = 0.000), unclear margin (95% CI 3.571–14.119, P = 0.000) or suspicious calcification (95% CI 4.010–30.733, P = 0.000) lesions were significantly associated with higher risks of malignant potentials for B3 cases (malignant vs B3). Conclusion The results of this study indicate that ultrasound findings and patients’ characteristics might provide valuable information for distinguishing B3 lesions from benign breast abnormalities before VAEB, and help to reduce malignancy underestimation of B3.
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Ou WC, Polat D, Dogan BE. Deep learning in breast radiology: current progress and future directions. Eur Radiol 2021; 31:4872-4885. [PMID: 33449174 DOI: 10.1007/s00330-020-07640-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 08/06/2020] [Revised: 10/30/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast radiology continue to improve, giving rise to the prospect that these methods may be integrated not only into detection and classification of breast lesions, but also into areas such as risk estimation and prediction of tumor responses to therapy. Remaining challenges include limited availability of high-quality data with expert annotations and ground truth determinations, the need for further validation of initial results, and unresolved medicolegal considerations. KEY POINTS: • Deep learning (DL) continues to push the boundaries of what can be accomplished by artificial intelligence (AI) in breast imaging with distinct advantages over conventional computer-aided detection. • DL-based AI has the potential to augment the capabilities of breast radiologists by improving diagnostic accuracy, increasing efficiency, and supporting clinical decision-making through prediction of prognosis and therapeutic response. • Remaining challenges to DL implementation include a paucity of prospective data on DL utilization and yet unresolved medicolegal questions regarding increasing AI utilization.
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Affiliation(s)
- William C Ou
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA.
| | - Dogan Polat
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA
| | - Basak E Dogan
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA
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Sim Y, Lee SE, Kim EK, Kim S. A Radiomics Approach for the Classification of Fibroepithelial Lesions on Breast Ultrasonography. Ultrasound Med Biol 2020; 46:1133-1141. [PMID: 32102739 DOI: 10.1016/j.ultrasmedbio.2020.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
A radiomics-based classifier to distinguish phyllodes tumor and fibroadenoma on gray-scale breast ultrasonography was developed and validated. A total of 93 radiomics features were extracted from representative transverse plane ultrasound images of 182 fibroepithelial lesions initially diagnosed by core needle biopsy. High-throughput radiomics features were selected using the intra-class correlation coefficient between two radiologist readers and the Least Absolute Shrinkage and Selection Operator regression through 10-fold cross-validation. When applied to the validation set, the radiomics classifier for the differentiation of phyllodes tumors and benign/fibroadenomas achieved an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0.597-0.888) with an accuracy of 0.703 (sensitivity: 0.857; specificity: 0.5). Our radiomics signature-based classifier may help predict phyllodes tumors among fibroepithelial lesions on breast ultrasonography.
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Affiliation(s)
- Yongsik Sim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si Eun Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Tutar B, Esen Icten G, Guldogan N, Kara H, Arıkan AE, Tutar O, Uras C. Comparison of automated versus hand-held breast US in supplemental screening in asymptomatic women with dense breasts: is there a difference regarding woman preference, lesion detection and lesion characterization? Arch Gynecol Obstet 2020; 301:1257-1265. [PMID: 32215718 DOI: 10.1007/s00404-020-05501-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/05/2019] [Accepted: 03/06/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare automated breast volumetric scanning (ABVS) with hand-held bilateral whole breast ultrasound (HHUS) prospectively in regards to patient workflow, woman preference, efficacy in lesion detection, and characterization. MATERIALS AND METHODS Supplemental screening was performed with both ABVS and HHUS to 345 women with dense breasts and negative mammograms. Acquisition and evaluation times were recorded. Lesions were classified according to BIRADS US criteria and compared one to one. Women were recalled for a secondary HHUS examination if ABVS showed any additional lesions. Findings were compared based on biopsy results and/or 36-48 months of follow-up. RESULTS Findings could be compared for 340 women. There were two carcinomas which were detected by both methods, with no interval cancers in the follow-up period. Recall rate was 46/340 (13.05%) for ABVS and 4/340 (1.18%) for HHUS. ABVS recalls decreased with experience. HHUS had more true negative (BIRADS 1-2) results, while ABVS had more false positive ones (p < 0.001). Positive predictive value was 4.17% for ABVS and 50% for HHUS. ABVS overdiagnosed shadowings (p < 0.01), distortions (p < 0.034), and irregular nodules (p < 0.001) in comparison to HHUS. At ABVS, 10.6% of women experienced severe pain. 59.7% stated that they would choose HHUS if they had the chance. CONCLUSION ABVS is as good as HHUS in lesion detection. However, the recall rate is higher and positive predictive value is lower with ABVS, which could result in more follow-ups, and more anxiety for the women. More than 50% women stated they would prefer HHUS if they were given the chance.
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Affiliation(s)
- Burçin Tutar
- Department of Radiology, Acıbadem Maslak Hospital, Büyükdere St. 40, Maslak, 34457, Istanbul, Turkey.
| | - Gül Esen Icten
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nilgün Guldogan
- Department of Radiology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Halil Kara
- Department of Breast Surgery, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Akif Enes Arıkan
- Department of Breast Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Onur Tutar
- Department of Radiology, University of İstanbul, Cerrahpaşa Medical College, Istanbul, Turkey
| | - Cihan Uras
- Department of Breast Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Bertani V, Urbani M, La Grassa M, Balestreri L, Berger N, Frauenfelder T, Boss A, Marcon M. Atypical ductal hyperplasia: breast DCE-MRI can be used to reduce unnecessary open surgical excision. Eur Radiol 2020; 30:4069-4081. [PMID: 32144463 DOI: 10.1007/s00330-020-06701-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/29/2019] [Revised: 01/11/2020] [Accepted: 01/31/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of dynamic contrast-enhanced (DCE)-MRI in predicting malignancy after percutaneous biopsy diagnosis of atypical ductal hyperplasia (ADH). METHODS AND MATERIALS In this retrospective study, 68 lesions (66 women) with percutaneous biopsy diagnosis of ADH and pre-operative breast DCE-MRI performed between January 2016 and December 2017 were included. Two radiologists reviewed in consensus mammography, ultrasound, and MR images. The final diagnosis after surgical excision was used as standard of reference. Clinical and imaging features were compared in patients with and without upgrade to malignancy after surgery. The diagnostic performance of DCE-MRI in predicting malignant upgrade was evaluated. RESULTS A 9-gauge vacuum-assisted biopsy was performed in 40 (58.8%) cases and a 14-gauge core needle biopsy in 28 (41.2%) cases. Upgrade to malignancy was observed in 17/68 (25%) lesions, including 4/17 (23.5%) cases of invasive cancer and 13/17 (76.5%) cases of ductal carcinoma in situ (DCIS). In 16/17 (94.1%) malignant and 20/51 (39.2%) benign lesions, a suspicious enhancement could be recognized in DCE-MRI. The malignant lesion without suspicious enhancement was a low-grade DCIS (4 mm size). Sensitivity, specificity, positive predictive value, and negative predictive value of DCE-MRI on predicting malignancy were respectively 94.1%, 60.7%, 44.4%, and 96.8%. No other clinical or imaging features were significantly different in patients with and without upgrade to malignancy. CONCLUSION After a percutaneous biopsy diagnosis of ADH, malignancy can be ruled out in most of the cases, if no suspicious enhancement is present in the biopsy area at DCE-MRI. Breast DCE-MRI may be used to avoid surgery in more than half of the patients with final benign diagnosis. KEY POINTS • Breast DCE-MRI can safely rule out malignancy if no suspicious enhancement is present in the biopsy area after a percutaneous biopsy diagnosis of ADH. • All cases of upgrade to high-grade DCIS and invasive cancers can be identified at breast DCE-MRI after a percutaneous biopsy diagnosis of ADH. • Breast DCE-MRI may be used to avoid surgery in more than half of the patients with final benign diagnosis.
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Affiliation(s)
- Valeria Bertani
- Department of Oncologic Radiation Therapy and Diagnostic Imaging, Centro di Riferimento Oncologico, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - Martina Urbani
- Department of Oncologic Radiation Therapy and Diagnostic Imaging, Centro di Riferimento Oncologico, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - Manuela La Grassa
- Department of Oncologic Radiation Therapy and Diagnostic Imaging, Centro di Riferimento Oncologico, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - Luca Balestreri
- Department of Oncologic Radiation Therapy and Diagnostic Imaging, Centro di Riferimento Oncologico, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - Nicole Berger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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de Jong L, Welleweerd MK, van Zelst JCM, Siepel FJ, Stramigioli S, Mann RM, de Korte CL, Fütterer JJ. Production and clinical evaluation of breast lesion skin markers for automated three-dimensional ultrasonography of the breast: a pilot study. Eur Radiol 2020; 30:3356-3362. [PMID: 32060713 PMCID: PMC7248012 DOI: 10.1007/s00330-020-06695-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022]
Abstract
Objectives Automated ultrasound of the breast has the advantage to have the whole breast scanned by technicians. Consequently, feedback to the radiologist about concurrent focal abnormalities (e.g., palpable lesions) is lost. To enable marking of patient- or physician-reported focal abnormalities, we aimed to develop skin markers that can be used without disturbing the interpretability of the image. Methods Disk-shaped markers were casted out of silicone. In this IRB-approved prospective study, 16 patients were included with a mean age of 57 (39–85). In all patients, the same volume was imaged twice using an automated breast ultrasound system, once with and once without a marker in place. Nine radiologists from two medical centers filled scoring forms regarding image quality, image interpretation, and confidence in providing a diagnosis based on the images. Results Marker adhesion was sufficient for automated scanning. Observer scores showed a significant shift in scores from excellent to good regarding diagnostic yield/image quality (χ2, 15.99, p < 0.01), and image noise (χ2, 21.20, p < 0.01) due to marker presence. In 93% of cases, the median score of observers “agree” with the statement that marker-induced noise did not influence image interpretability. Marker presence did not interfere with confidence in diagnosis (χ2, 6.00, p = 0.20). Conclusion Inexpensive, easy producible skin markers can be used for accurate lesion marking in automated ultrasound examinations of the breast while image interpretability is preserved. Any marker-induced noise and decreased image quality did not affect confidence in providing a diagnosis. Key Points • The use of a skin marker enables the reporting radiologist to identify a location which a patient is concerned about. • The developed skin marker can be used for accurate breast lesion marking in ultrasound examinations.
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Affiliation(s)
- Leon de Jong
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands.
| | - Marcel K Welleweerd
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Jan C M van Zelst
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Francoise J Siepel
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Stefano Stramigioli
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Chris L de Korte
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
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Yang Y, Li S, Liu G, Shao Z. Is core needle biopsy effective at diagnosing male breast lesions? Breast Cancer Res Treat 2019; 177:507-11. [PMID: 31168757 DOI: 10.1007/s10549-019-05312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this study was to examine the diagnostic accuracy of sonographically guided core needle biopsy (CNB) of breast lesions in men. METHODS This was a retrospective study where we analyzed consecutive sonographically guided 14-gauge CNB results on 234 male breast lesions. The CNB accuracy is determined by the comparison between the CNB and its corresponding excisional biopsy or to long-term follow-up imaging. RESULTS Sonographically guided CNB was effective to collect satisfactory samples from all 234 lesions. Out of those, 58.55% (137/234) were benign, 38.0% (89/234) were malignant, 1.71% (4/234) were papilloma with atypia and 1.71% (4/234) were atypical ductal hyperplasia lesions. Underestimation occurred in 3.4% (8/234) of the lesions. As for the detection of breast malignancy, the sensitivity of the CNB is 98.9%, specificity is 100%, negative predictive value is 99.3%, positive predictive value is 100%, false positive is 0% and false negative is 1.1%. The overall accuracy of sonographically guided CNB as a diagnostic tool is 99.6%. CONCLUSION Sonographically guided 14-gauge CNB is an accurate, reliable and low invasive procedure for assessing breast lesions in men. Triple tests and follow-up checks of benign cases are essential for a successful breast biopsy program in men.
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Dobruch-Sobczak K, Piotrzkowska-Wróblewska H, Klimonda Z, Roszkowska-Purska K, Litniewski J. Ultrasound echogenicity reveals the response of breast cancer to chemotherapy. Clin Imaging 2019; 55:41-46. [PMID: 30739033 DOI: 10.1016/j.clinimag.2019.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/16/2018] [Revised: 12/16/2018] [Accepted: 01/25/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the ultrasound (US) response in patients with breast cancer (BC) during neoadjuvant chemotherapy (NAC). METHODS Prospective US analysis was performed on 19 malignant tumors prior to NAC treatment and 7 days after each first four courses of NAC in 13 patients (median age = 57 years). Echogenicity, size, vascularity, and sonoelastography were measured and compared with posttreatment scores of residual cancers burden. RESULTS Changes in the echogenicity of tumors after 3 courses of NAC had the most statistically strong correlation with the percentage of residual malignant cells used in histopathology to assess the response to treatment (odds ratio = 60, p < 0.05). Changes in lesion size and elasticity were also significant (p < 0.05). CONCLUSIONS There is a statistically significant relationship between breast tumors' echogenicity in US, neoplasm size, and stiffness and the response to NAC. In particular, our results show that the change in tumor echogenicity could predict a pathological response with satisfactory accuracy and may be considered in NAC monitoring.
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Affiliation(s)
- Katarzyna Dobruch-Sobczak
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland; Department of Ultrasound, Cancer Center and Institute of Oncology, M. Skłodowska-Curie Memorial, Wawelska 15, 02-034 Warsaw, Poland.
| | - Hanna Piotrzkowska-Wróblewska
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
| | - Ziemowit Klimonda
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
| | - Katarzyna Roszkowska-Purska
- Department of Pathology, Cancer Center and Institute of Oncology, M. Skłodowska-Curie Memorial, Warsaw, Poland
| | - Jerzy Litniewski
- Ultrasound Department, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Pawińskiego 5B, 02-106, Poland
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De Matheo LL, Geremia J, Calas MJG, Costa-Júnior JFS, da Silva FFF, von Krüger MA, Pereira WCDA. PVCP-based anthropomorphic breast phantoms containing structures similar to lactiferous ducts for ultrasound imaging: A comparison with human breasts. Ultrasonics 2018; 90:144-152. [PMID: 29966842 DOI: 10.1016/j.ultras.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 05/11/2023]
Abstract
The purpose of this work was to obtain an anthropomorphic phantom with acoustic properties similar to those of breast tissue, possessing lactiferous duct-like structures, which would be a first for this type of phantom. Breast lesions usually grow in glandular tissues or lactiferous ducts. Shape variations in these structures are detectable by using ultrasound imaging. To increase early diagnosis, it is important to develop computer-aided diagnosis (CAD) systems and improve medical training. Using tissue-like materials that mimic known internal structures can help achieve both of these goals. However, most breast ultrasound phantoms described in the literature emulate only fat tissues and lesion-like masses. In addition, commercially available phantoms claim to be realistic, but do not contain lactiferous duct structures. In this work, we collected reference images from both breasts of ten healthy female volunteers aged between 20 and 30 years using a 10 MHz linear transducer of a B-mode medical ultrasound system. Histograms of the grey scale distribution of each tissue component of interest, the grey level means, and standard deviations of the regions of interest were obtained. Phantoms were produced using polyvinyl chloride plastisol (PVCP) suspensions. The lactiferous duct-like structures were prepared using pure PVCP. Solid scatterers, such as alumina (mesh #100) and graphite powders (mesh #140) were added to the phantom matrix to mimic glandular and fat tissue, respectively. The phantom duct-like structure diameters observed on B-mode images (1.92 mm ± 0.44) were similar to real measures obtained with a micrometer (2.08 mm ± 0.23). The phantom ducts are easy to produce and are largely stable for at least one year. This phantom allows the researchers to elaborate the structure at their will and may be used in training and as a reference for development of CAD systems.
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Affiliation(s)
- Lucas Lobianco De Matheo
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Juliana Geremia
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Júlia Gregorio Calas
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Francisco Silva Costa-Júnior
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flavia Fernandes Ferreira da Silva
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco Antônio von Krüger
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wagner Coelho de Albuquerque Pereira
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, RJ, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Ustbas B, Kilic D, Bozkurt A, Aribal ME, Akbulut O. Silicone-based composite materials simulate breast tissue to be used as ultrasonography training phantoms. Ultrasonics 2018. [PMID: 29525227 DOI: 10.1016/j.ultras.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A silicone-based composite breast phantom is fabricated to be used as an education model in ultrasonography training. A matrix of silicone formulations is tracked to mimic the ultrasonography and tactile response of human breast tissue. The performance of two different additives: (i) silicone oil and (ii) vinyl-terminated poly (dimethylsiloxane) (PDMS) are monitored by a home-made acoustic setup. Through the use of 75 wt% vinyl-terminated PDMS in two-component silicone elastomer mixture, a sound velocity of 1.29 ± 0.09 × 103 m/s and an attenuation coefficient of 12.99 ± 0.08 dB/cm-values those match closely to the human breast tissue-are measured with 5 MHz probe. This model can also be used for needle biopsy as well as for self-exam trainings. Herein, we highlight the fabrication of a realistic, durable, accessible, and cost-effective training platform that contains skin layer, inner breast tissue, and tumor masses.
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Affiliation(s)
- Burcin Ustbas
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Deniz Kilic
- Surgitate Medikal Arge Sanayi ve Ticaret A.Ş., Kocaeli, Turkey
| | - Ayhan Bozkurt
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Mustafa Erkin Aribal
- Marmara University Pendik Research and Application Hospital, Radiology Department, Istanbul, Turkey
| | - Ozge Akbulut
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey.
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Abstract
Background According to the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS), background echotexture in breast ultrasound (US) can be categorized as homogeneous or heterogeneous. Purpose To prospectively evaluate the inter-observer agreement of a four-category classification in background echotexture assessments of breast US and to determine whether background echotexture is related to breast cancer risk factors, including mammography density. Material and Methods Thirty-eight healthy women (age range, 25-72) were recruited. Eleven radiologists performed breast US on all participants and classified each background echotexture into four categories (homogeneous, mild, moderate, and marked heterogeneous). The inter-observer agreement in the assessments was measured using kappa statistics (к). The association between background echotexture and breast cancer risk factors, including mammographic density, menopausal status, and parity, were evaluated using Spearman's correlation coefficient (ρ) and multiple linear regression analysis. Results There was moderate inter-observer agreement between the radiologists for the four categories of background echotexture (average к = 0.45). Heterogeneity of the background echotexture was positively correlated with mammographic density in both pre- and postmenopausal women (premenopausal, ρ = 0.42, P < 0.0001; postmenopausal, ρ = 0.56, P < 0.0001). Multiple linear regression analysis revealed that mammographic density and parity were significantly associated with background echotexture. Conclusion Background echotexture assessment of breast US using a four-category classification showed moderate inter-observer agreement, and more heterogeneous background echotexture was associated with denser breasts and lower parity.
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Affiliation(s)
- Won Hwa Kim
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Su Hyun Lee
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
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Vourtsis A, Kachulis A. The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women. Eur Radiol 2017; 28:592-601. [PMID: 28828640 DOI: 10.1007/s00330-017-5011-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [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: 04/28/2017] [Revised: 07/10/2017] [Accepted: 07/31/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aimed to evaluate automated breast ultrasound (ABUS) compared to hand-held traditional ultrasound (HHUS) in the visualisation and BIRADS characterisation of breast lesions. MATERIALS AND METHODS From January 2016 to January 2017, 1,886 women with breast density category C or D (aged 48.6±10.8 years) were recruited. All participants underwent ABUS and HHUS examination; a subcohort of 1,665 women also underwent a mammography. RESULTS The overall agreement between HHUS and ABUS was 99.8 %; kappa=0.994, p<0.0001. Two cases were graded as BI-RADS 1 in HHUS, but were graded as BIRADS 4 in ABUS; biopsy revealed a radial scar. Three carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 4 in ABUS; two additional carcinomas were graded as BI-RADS 2 in mammography but BI-RADS 5 in ABUS. Two carcinomas, appearing as a well-circumscribed mass or developing asymmetry in mammography, were graded as BI-RADS 4 in mammography but BI-RADS 5 in ABUS. CONCLUSIONS ABUS could be successfully used in the visualisation and characterisation of breast lesions. ABUS seemed to outperform HHUS in the detection of architectural distortion on the coronal plane and can supplement mammography in the detection of non-calcified carcinomas in women with dense breasts. KEY POINTS • The new generation of ABUS yields comparable results to HHUS. • ABUS seems superior to HHUS in detecting architectural distortions. • In dense breasts, supplemental ABUS to mammography detects additional cancers.
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Affiliation(s)
- Athina Vourtsis
- 'Diagnostic Mammography' Medical Diagnostic Imaging Unit, Kifisias Ave 362, Chalandri, 15233, Athens, Greece.
| | - Aspasia Kachulis
- 'Diagnostic Mammography' Medical Diagnostic Imaging Unit, Kifisias Ave 362, Chalandri, 15233, Athens, Greece
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21
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Park AY, Seo BK, Han H, Cho KR, Woo OH, Cha SH, Cha J. Clinical Value of Real-Time Ultrasonography-MRI Fusion Imaging for Second-Look Examination in Preoperative Breast Cancer Patients: Additional Lesion Detection and Treatment Planning. Clin Breast Cancer 2017; 18:261-269. [PMID: 28774783 DOI: 10.1016/j.clbc.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/16/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate the clinical effect of real-time magnetic resonance imaging (MRI)-navigated ultrasonography (US) for preoperative second-look examination in patients with breast cancer. PATIENTS AND METHODS Between October 2013 and February 2015, 232 patients with breast cancer underwent MRI for staging; second-look US was performed in 70 patients to evaluate additional lesions suspected to be disease detected using MRI. We retrospectively included 67 lesions in 55 patients. Lesions were classified as detected on conventional US (group 1), and not visible on conventional US, but detected on MRI-navigated US (group 2). The imaging features between groups 1 and 2 were compared using Student t, χ2, or Fisher exact tests. We compared the detection rate and histopathology of additional lesions using a McNemar test. RESULTS Heterogeneous background echotexture (69.6% [16 of 23] vs. 34.1% [14 of 41]) and lesion isoechogenicity (65.2% [15 of 23] vs. 7.3% [3 of 41]) on US and middle or posterior lesion depth on MRI (78.3% [18 of 23] vs. 46.3% [19 of 41]) were more common in group 2 (P < .05). More lesions were detected using MRI-navigated US (64 of 67; 95.5%) than conventional US (41 of 67; 61.2%; P < .01). Using MRI-navigated US we found more high-risk or malignant lesions than conventional US (21 vs. 11; P < .01). The optimal treatment plan was determined for 9 of 16 (56.3%) patients by virtue of MRI-navigated US. CONCLUSION Real-time MRI-navigated US significantly improved the detection of additional high-risk or malignant lesions during second-look US in preoperative evaluation of patients with breast cancer and ultimately determined the optimal treatment plan.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea; Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon-si, Republic of Korea; Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea.
| | - Heon Han
- Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon-si, Republic of Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
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22
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Comer JD, Cui X, Eisen CS, Abbey G, Arleo EK. Myofibroblastoma of the male breast: a rare entity with radiologic-pathologic correlation. Clin Imaging 2016; 42:109-112. [PMID: 27936420 DOI: 10.1016/j.clinimag.2016.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/29/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 12/15/2022]
Abstract
A 73-year old man with a history of multiple genitourinary malignancies was found to have a left retroareolar soft tissue mass on CT assessment of disease, and dedicated breast imaging was recommended. Diagnostic mammography and ultrasonography confirmed a solid mass, for which biopsy was recommended. Pathologic analysis demonstrated a spindle cell neoplasm with an immunoreactivity pattern consistent with myofibroblastoma. While this entity is benign, nonspecific imaging features necessitate tissue sampling for pathologic diagnosis, and, given pathologic rarity, open communication between the radiologist and pathologist is important to establish the correct diagnosis and to recommend appropriate management.
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Affiliation(s)
- John D Comer
- New York-Presbyterian/Weill Cornell Imaging, 425 East 61st Street, 9th floor, New York, NY 10065, United States.
| | - Xiaoyan Cui
- New York-Presbyterian/Weill Cornell Medical Center, Department of Pathology and Laboratory Medicine, 525 E. 68th Street, Room C302, New York, NY 10065, United States
| | - Carolyn Sharyn Eisen
- New York-Presbyterian/Weill Cornell Imaging, 425 East 61st Street, 9th floor, New York, NY 10065, United States
| | - Genevieve Abbey
- New York-Presbyterian/Weill Cornell Imaging, 425 East 61st Street, 9th floor, New York, NY 10065, United States
| | - Elizabeth Kagan Arleo
- New York-Presbyterian/Weill Cornell Imaging, 425 East 61st Street, 9th floor, New York, NY 10065, United States
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23
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de Carvalho IM, De Matheo LL, Costa Júnior JFS, Borba CDM, von Krüger MA, Infantosi AFC, Pereira WCDA. Polyvinyl chloride plastisol breast phantoms for ultrasound imaging. Ultrasonics 2016; 70:98-106. [PMID: 27153374 DOI: 10.1016/j.ultras.2016.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 05/11/2023]
Abstract
Ultrasonic phantoms are objects that mimic some features of biological tissues, allowing the study of their interactions with ultrasound (US). In the diagnostic-imaging field, breast phantoms are an important tool for testing performance and optimizing US systems, as well as for training medical professionals. This paper describes the design and manufacture of breast lesions by using polyvinyl chloride plastisol (PVCP) as the base material. Among the materials available for this study, PVCP was shown to be stable, durable, and easy to handle. Furthermore, it is a nontoxic, nonpolluting, and low-cost material. The breast's glandular tissue (image background) was simulated by adding graphite powder with a concentration of 1% to the base material. Mixing PVCP and graphite powder in differing concentrations allows one to simulate lesions with different echogenicity patterns (anechoic, hypoechoic, and hyperechoic). From this mixture, phantom materials were obtained with speed of sound varying from 1379.3 to 1397.9ms(-1) and an attenuation coefficient having values between 0.29 and 0.94dBcm(-1) for a frequency of 1MHz at 24°C. A single layer of carnauba wax was added to the lesion surface in order to evaluate its applicability for imaging. The images of the phantoms were acquired using commercial ultrasound equipment; a specialist rated the images, elaborating diagnoses representative of both benign and malignant lesions. The results indicated that it was possible to easily create a phantom by using low-cost materials, readily available in the market and stable at room temperature, as the basis of ultrasonic phantoms that reproduce the image characteristics of fatty breast tissue and typical lesions of the breast.
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Affiliation(s)
| | - Lucas Lobianco De Matheo
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Cecília de Melo Borba
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco Antonio von Krüger
- Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Uematsu T. The need for supplemental breast cancer screening modalities: a perspective of population-based breast cancer screening programs in Japan. Breast Cancer 2016; 24:26-31. [PMID: 27259342 DOI: 10.1007/s12282-016-0707-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 04/21/2016] [Accepted: 05/22/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This article discusses possible supplemental breast cancer screening modalities for younger women with dense breasts from a perspective of population-based breast cancer screening program in Japan. CONCLUSION Supplemental breast cancer screening modalities have been proposed to increase the sensitivity and detection rates of early stage breast cancer in women with dense breasts; however, there are no global guidelines that recommend the use of supplemental breast cancer screening modalities in such women. Also, no criterion standard exists for breast density assessment. Based on the current situation of breast imaging in Japan, the possible supplemental breast cancer screening modalities are ultrasonography, digital breast tomosynthesis, and breast magnetic resonance imaging. An appropriate population-based breast cancer screening program based on the balance between cost and benefit should be a high priority. Further research based on evidence-based medicine is encouraged. It is very important that the ethnicity, workforce, workflow, and resources for breast cancer screening in each country should be considered when considering supplemental breast cancer screening modalities for women with dense breasts.
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Affiliation(s)
- Takayoshi Uematsu
- Breast Imaging and Breast Intervention Section, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan.
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25
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Shibusawa M, Nakayama R, Okanami Y, Kashikura Y, Imai N, Nakamura T, Kimura H, Yamashita M, Hanamura N, Ogawa T. The usefulness of a computer-aided diagnosis scheme for improving the performance of clinicians to diagnose non-mass lesions on breast ultrasonographic images. J Med Ultrason (2001) 2016; 43:387-94. [PMID: 27230095 DOI: 10.1007/s10396-016-0718-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 01/12/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of a computer-aided diagnosis (CAD) scheme for improving the performance of clinicians to diagnose non-mass lesions appearing as hypoechoic areas on breast ultrasonographic images. METHODS The database included 97 ultrasonographic images with hypoechoic areas: 48 benign cases [benign lesion with benign mammary tissue or fibrocystic disease (n = 20), fibroadenoma (n = 11), and intraductal papilloma (n = 17)] and 49 malignant cases [ductal carcinoma in situ (n = 17) and invasive ductal carcinoma (n = 32)]. Seven clinicians, three expert breast surgeons, and four general surgeons participated in the observer study. They were asked their confidence level concerning the possibility of malignancy in all 97 cases with and without the use of the CAD scheme. Receiver operating characteristic (ROC) analysis was performed to evaluate the usefulness of the CAD scheme. RESULTS The areas under the ROC curve (AUC) improved for all observers when they used the CAD scheme and increased from 0.649 to 0.783 (P = 0.0167). Notably, the AUC for the general surgeon group increased from 0.625 to 0.793 (P = 0.045). CONCLUSIONS This study showed that the performance of clinicians to diagnose non-mass lesions appearing as hypoechoic areas on breast ultrasonographic images was improved by the use of a CAD scheme.
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Affiliation(s)
- Mai Shibusawa
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Ryohei Nakayama
- Department of Electronic and Computer Engineering, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu City, Shiga, 525-8577, Japan
| | - Yuko Okanami
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Yumi Kashikura
- Department of Senology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba City, Ibaraki, 305-8558, Japan
| | - Nao Imai
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takashi Nakamura
- Department of Breast Surgery, Nabari City Hospital, 1-178 Yurigaokanishi, Nabari City, Mie, 518-0481, Japan
| | - Hiroko Kimura
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Masako Yamashita
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Noriko Hanamura
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Hadjiminas DJ, Zacharioudakis KE, Tasoulis MK, Hu JCC, Lanitis S, Bright-Thomas R, Dimopoulos NG, Hornzee G, Cunningham DA, Cleator SJ, Al Mufti R. Adequacy of diagnostic tests and surgical management of symptomatic invasive lobular carcinoma of the breast. Ann R Coll Surg Engl 2016; 97:578-83. [PMID: 26492903 DOI: 10.1308/rcsann.2015.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Invasive lobular carcinoma (ILC) presents diagnostic and therapeutic challenges as it produces subtle radiological changes. It has been suggested that it is not suitable for breast conserving surgery (BCS). The aim of this study was to ascertain the diagnostic adequacy of modern mammography and ultrasonography in the context of a fast track symptomatic diagnostic clinic in the UK. It also sought to compare the mastectomy, re-excision and BCS rates for ILC with those for invasive ductal carcinoma (IDC). METHODS A retrospective analysis of prospectively collected data was carried out on all new symptomatic cancers presenting to the one-stop diagnostic clinic of a single breast unit between 1998 and 2007. RESULTS Compared with IDC, ILC was significantly larger at presentation (46mm vs 25mm), needed re-excision after BCS more often (38.8% vs 22.3%) and required mastectomy more frequently (58.8% vs 40.8%). Although mammography performs poorly in diagnosing ILC compared with IDC, when combined with ultrasonography, sensitivity of the combined imaging was not significantly different between these two histological types. CONCLUSIONS Provided ultrasonography is performed, standard radiological imaging is adequate for initial diagnosis of symptomatically presenting ILC but some additional preoperative workup should clearly be employed to reduce the higher number of reoperations for this histological type.
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Affiliation(s)
| | | | | | - J C C Hu
- Imperial College Healthcare NHS Trust , UK
| | - S Lanitis
- Imperial College Healthcare NHS Trust , UK
| | | | | | - G Hornzee
- Imperial College Healthcare NHS Trust , UK
| | | | | | - R Al Mufti
- Imperial College Healthcare NHS Trust , UK
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27
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Konno S, Takada E, Ejiri N, Kawamata M, Takase N, Nakazato Y, Suzuki K, Takekawa H. Stereoscopic images of breast tumors using 3D real-time tissue elastography. J Med Ultrason (2001) 2015; 42:365-71. [PMID: 26576788 DOI: 10.1007/s10396-015-0618-4] [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: 02/02/2014] [Accepted: 02/03/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed at evaluating the usefulness of 3D real-time tissue elastography (RTE) images for diagnosing breast tumors. METHODS A total of 166 breast tumor patients who underwent conventional ultrasound and 2D and 3D RTE examinations were retrospectively analyzed. The 3D RTE images were divided into three types according to the occupancy of blue contrast images. Elastic scores (ES) were obtained by 2D RTE examination. The diagnostic accuracy of 3D and 2D RTE images in differentiating malignant from benign breast tumors was evaluated. RESULTS Of all cases, 89.4 % of the malignant cases were Type 3 and 86.6 % of the benign cases were Type 1 or 2 according to 3D RTE images. 3D RTE Type 3 and ES ≥ 4 on 2D RTE examination diagnosed malignant tumors with an accuracy of 87.4 and 88.6 %, respectively. In addition, among 34 patients with an ES of 3, the presence of 3D RTE Type 3 diagnosed malignant tumors with an accuracy of 82.4 %. CONCLUSION In this study, the utility of 3D RTE images was comparable to that of ES on 2D RTE examination in differentiating malignant from benign breast tumors. In addition, utilizing 3D RTE images in cases with an ES of 3 on 2D RTE may increase the diagnostic accuracy for breast tumors.
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Affiliation(s)
- Sachiyo Konno
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Etsuo Takada
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Natsuki Ejiri
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Misaki Kawamata
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Naotoshi Takase
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yoshimasa Nakazato
- Department of Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Hidehiro Takekawa
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.,Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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28
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Cirrito D, Orlando AAM, Narese F, Narese D, Curatolo C, Midiri F, Virzì G, Virzì V. Diagnostic and therapeutic management of diabetic mastopathy: a case report. Clin Ter 2015; 166:e169-72. [PMID: 26152627 DOI: 10.7417/ct.2015.1849] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sclerosing lymphocytic lobulitis (SLL) is a benign breast lesion, better known as diabetic mastopathy (DMP), since it tipically occurs in diabetic patients. This very uncommon condition is strongly associated with type I diabetes mellitus. We report a case of a 61-year-old woman, with type II insulin-dependent diabetes mellitus, who presented mammography and ultrasonography images suspicious for breast carcinoma. As histopathology surprisingly demonstrated SLL and breast MRI showed benign characteristics, unnecessary surgery was avoided. The aim of this report is to underline that DMP is an uncommon clinicopathological entity which can clinically and radiologically mimic breast cancer but also that breast carcinoma may be hidden within these dense fibrotic lesions. In the light of cases reported in literature, breast MRI can be considered an essential tool in the diagnostic and therapeutic management of DMP.
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Affiliation(s)
- D Cirrito
- Departments of Surgery, "Regina Pacis" Clinic, San Cataldo (CL), Italy
| | - A A M Orlando
- Department of Biopatologia e Biotecnologie Mediche - Sezione di Scienze Radiologiche Università degli Studi di Palermo, Palermo, Italy
| | - F Narese
- Departments of Radiology, "Regina Pacis" Clinic, San Cataldo (CL), Italy
| | - D Narese
- Department of Biopatologia e Biotecnologie Mediche - Sezione di Scienze Radiologiche Università degli Studi di Palermo, Palermo, Italy
| | - C Curatolo
- Departments of Radiology, "Regina Pacis" Clinic, San Cataldo (CL), Italy
| | - F Midiri
- Department of Biopatologia e Biotecnologie Mediche - Sezione di Scienze Radiologiche Università degli Studi di Palermo, Palermo, Italy
| | - G Virzì
- Departments of Surgery, "Regina Pacis" Clinic, San Cataldo (CL), Italy
| | - V Virzì
- Departments of Radiology, "Regina Pacis" Clinic, San Cataldo (CL), Italy
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Mo M, Liu GY, Zheng Y, Di LF, Ji YJ, Lv LL, Chen YY, Peng WJ, Zhu JR, Bao PP, Ding JH, Chang C, Luo JF, Cao ZG, Xu WH, Shao ZM. Performance of breast cancer screening methods and modality among Chinese women: a report from a society-based breast screening program (SBSP) in Shanghai. Springerplus 2013; 2:276. [PMID: 23961381 DOI: 10.1186/2193-1801-2-276] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 12/12/2022]
Abstract
To evaluate the screening performance of individual and combined use of clinical breast examination, ultrasonography and mammography in Chinese women, we conducted a biennial breast cancer screening program among 14,464 women aged 35 to 74 years old who lived in Qibao County, Minhang district of Shanghai, China, between May 2008 and Sept 2012. All participants were submitted to clinical breast examination, and then women with positive results and all women at age of 45-69 years old were preformed breast ultrasonography and mammography. The examination results were compared against pathological findings as the gold standard of reference. A total of 66 women were diagnosed with breast cancer in the two rounds of the screening, yielding an incident rate of 194 per 100,000 person-years. The sensitivity of clinical breast examination, ultrasonography and mammography alone were 61.4%, 53.7% and 67.3%, respectively. While mammography performed better in elder age groups and hormone receptor positive disease groups, ultrasonography had a higher sensitivity in younger age group and did not differ in sensitivity by estrogen receptor or progesterone receptor status. Combined use of the two imaging examinations increased the sensitivity in almost all age groups, but had a higher sensitivity in hormone receptor positive cancers than in those negative. Our results suggest that the Qibao modality is an effective strategy for breast cancer screening among Chinese women, especially for early detection of elder and hormone receptor positive breast cancer.
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Corcioni B, Santilli L, Quercia S, Zamagni C, Santini D, Taffurelli M, Mignani S. Contrast-enhanced US and MRI for assessing the response of breast cancer to neoadjuvant chemotherapy(). J Ultrasound 2008; 11:143-50. [PMID: 23396645 DOI: 10.1016/j.jus.2008.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the response of breast cancers to neoadjuvant chemotherapy (NAC) with second-generation contrast-enhanced ultrasound (CEUS) and magnetic resonance (MR). MATERIALS AND METHODS We studied 16 women aged 33-74 years (mean, 53 years; median, 38 years) with locally advanced breast carcinoma or large operable breast cancer (>2 cm; T2-T4, N0-N3, M0) that had been detected by mammography, conventional ultrasonography, and biopsy. CEUS (with SonoVue, 5 ml) and MR (with Gd-DTPA; 0.2 mM/kg) were performed under blinded conditions before, during, and after 6-8 cycles of NAC. Lesions were measured and time/signal intensity (T/SI) curves were calculated during both the examinations. The data obtained were analyzed in light of the results of surgical pathology. RESULTS Six patients had complete responses manifested by the disappearance of enhancement at both CEUS and MR. Six others had partial responses (reduction of lesion enhancement >50%). In 5/6, T/SI curves obtained with CEUS and MR were both indicative of malignancy (flat curves at CEUS, type I curves at MR); the sixth had a discontinuous curve at CEUS and a type II curve at MR. Four patients had lesional enhancement reductions of <50%. In 3, concordant pictures emerged from the analysis of T/SI curves (discontinuous curves in CEUS, type II and III curves in MR); the fourth had a flat CEUS curve and a type I MR curve. Responses to NAC classified on the basis of MR and CEUS findings showed good correlation with the pathological response. CONCLUSIONS T/SI curves recorded during CEUS correlate with those obtained during MR and may be a valid index of response to the therapy.
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Affiliation(s)
- B Corcioni
- Clinical Department of Radiological and Histocytopathological Sciences, Mammography Center, University of Bologna, Italy
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31
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De Felice C, Savelli S, Angeletti M, Ballesio L, Manganaro L, Meggiorini M, Porfiri L. Diagnostic utility of combined ultrasonography and mammography in the evaluation of women with mammographically dense breasts. J Ultrasound 2007; 10:143-51. [PMID: 23396266 PMCID: PMC3478707 DOI: 10.1016/j.jus.2007.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the diagnostic utility and additional cost of combined breast ultrasonography and mammography in the evaluation of asymptomatic women with mammographically dense breasts. MATERIALS AND METHODS Of 5108 asymptomatic women, who underwent mammography, 1754 had dense breasts (BI-RADS 3 or 4) and negative mammographic outcome. They were divided in 4 subgroups according to their age (<40 yrs; 40-49 yrs; 50-59 yrs; >59 yrs). Breast ultrasonography was performed immediately after mammography. Lesions detected at ultrasonography were examined cytologically/histologically. Mammograms from women, who were diagnosed carcinoma at ultrasonography, were reviewed by an external radiologist. Costs per diagnosed carcinoma and per examined woman were calculated on the basis of current regional charges. RESULTS Mammographies (5108) were performed, 67 cancers were detected (cancer detection rate 13.1‰): mammography identified 55 carcinomas and ultrasonography performed in women with dense breasts identified 12 cancers (17.9% of all cancers detected, overall cancer detection rate 6.8‰). Ultrasonography identified a benign condition in 1567 out of 1754 women (89.3%) (in 925 absence of focal lesions; 438 simple cysts; 56 ductal ectasia; 148 benign solid lesions); 97 complex cysts, 52 lesions that could not be differentiated as liquid or solid lesions, and 38 solid lesions suspicious for malignancy in the remaining 187 out of 1754 patients (10.7%). Cytology/histology confirmed carcinoma in 12 women (overall biopsy rate 26.2‰, benign biopsy rate 19.4‰). The additional costs were: € 6,123.45 per detected cancer, € 41.89 per examined woman. CONCLUSION Breast ultrasonography immediately after mammography in women with dense breasts is useful to avoid diagnostic delays and inconvenient medico-legal implications even though this procedure involves increased costs.
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Affiliation(s)
- C. De Felice
- Department of Gynaecological Sciences, University of Rome La Sapienza, Rome, Italy
| | - S. Savelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - M. Angeletti
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L. Ballesio
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L. Manganaro
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - M.L. Meggiorini
- Department of Gynaecological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L.M. Porfiri
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
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