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Bozzini A, Nicosia L, Pruneri G, Maisonneuve P, Meneghetti L, Renne G, Vingiani A, Cassano E, Mastropasqua MG. Clinical performance of contrast-enhanced spectral mammography in pre-surgical evaluation of breast malignant lesions in dense breasts: a single center study. Breast Cancer Res Treat 2020; 184:723-731. [PMID: 32860166 PMCID: PMC7655556 DOI: 10.1007/s10549-020-05881-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the efficacy of contrast-enhanced spectral mammography, with ultrasound, full field digital mammography and magnetic resonance imaging in detection and size estimation of histologically proven breast tumors. METHODS This open-label, single center, prospective study, included 160 dense breast women with at least one suspicious mammary lesion evaluated by ultrasound, full field digital mammography and magnetic resonance imaging in whom a mammary tumor was histologically proven after surgery performed at the European Institute of Oncology between January 2013 and December 2015. Following the complete diagnostic procedure, the patients were further investigated by contrast-enhanced spectral mammography prior to surgery. RESULTS Overall, the detection rate of malignant breast lesions (in situ and invasive) was 93.8% (165/176) for contrast-enhanced spectral mammography, 94.4% (168/178) for ultrasound, 85.5 (147/172) for full field digital mammography and 97.7% (173/177) for magnetic resonance imaging. Radiological measurements were concordant with the post-surgical pathological measurements of the invasive tumor (i.e., within 5 mm) in: 64.6% for contrast-enhanced spectral mammography, 62.0% for ultrasound, 45.2% for full field digital mammography (p < 0.0001) and 69.9% for magnetic resonance imaging (p = 0.28); underestimated in: 17.4% for contrast-enhanced spectral mammography, 19.6% for ultrasound, 24.2% for full field digital mammography (p = 0.03) and 6.7% for magnetic resonance imaging (p = 0.0005); and overestimated in: 16.2% for contrast-enhanced spectral mammography, 16.6% for ultrasound, 16.6% for full field digital mammography and 22.7% for magnetic resonance imaging (p = 0.02). CONCLUSIONS Our data suggest that contrast-enhanced spectral mammography improves on full field digital mammography and is comparable to ultrasound and magnetic resonance imaging in terms of detection sensitivity and size estimation of malignant lesions in dense breasts.
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Affiliation(s)
- Anna Bozzini
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Luca Nicosia
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Giancarlo Pruneri
- School of Medicine, University of Milan, Milan, Italy
- Department of Pathology, Fondazione IRCCS Istituto Nazionali Tumori Milano, Via G. Venezian, 1, 20133 Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Giuseppe Renne
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141 Milan, Italy
| | - Andrea Vingiani
- School of Medicine, University of Milan, Milan, Italy
- Department of Pathology, Fondazione IRCCS Istituto Nazionali Tumori Milano, Via G. Venezian, 1, 20133 Milan, Italy
| | - Enrico Cassano
- Division of Breast Radiology, IEO, European Institute of Oncology IRCCS, Via G.Ripamonti, 435, 20141 Milan, Italy
| | - Mauro Giuseppe Mastropasqua
- School of Medicine, University of Bari, Bari, Italy
- Department of Emergency and Organ Transplantations, Section of Anatomic Pathology, Piazza G. Cesare 11, 70124 Bari, Italy
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Lee JM, Partridge SC, Liao GJ, Hippe DS, Kim AE, Lee CI, Rahbar H, Scheel JR, Lehman CD. Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening. Clin Imaging 2019; 55:119-125. [PMID: 30807927 DOI: 10.1016/j.clinimag.2019.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/08/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening. METHODS From April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test. RESULTS Of 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT. CONCLUSIONS Adding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.
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Affiliation(s)
- Janie M Lee
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America.
| | - Savannah C Partridge
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Geraldine J Liao
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Daniel S Hippe
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Adrienne E Kim
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Christoph I Lee
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Habib Rahbar
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - John R Scheel
- University of Washington, Department of Radiology, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109-1023, United States of America
| | - Constance D Lehman
- Massachusetts General Hospital, Department of Radiology, 15 Parkman St., Boston, MA 02114, United States of America
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Yang L, Li J, Zhou CW. [Value of digital breast tomosynthesis (DBT) in the diagnosis of breast lesions]. Zhonghua Zhong Liu Za Zhi 2017; 39:33-8. [PMID: 28104031 DOI: 10.3760/cma.j.issn.0253-3766.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the value of digital breast tomosynthesis (DBT) in the diagnosis of breast lesions. Methods: Two hundred and fifty-three breast lesions in 250 patients were selected in this study. All lesions were confirmed pathologically. Preoperative diagnosis was performed independently with full-field digital mammography (FFDM), DBT and DBT plus FFDM, respectively. The diagnostic value of DBT for breast lesions was evaluated based on the pathological diagnosis as the gold standard. The diagnostic performance of DBT and FFDM for breast lesions was compared between the groups with different ages, mammary gland densities and hormone levels. The sensitivity of DBT and FFDM was compared between the groups with different pathological types and different sizes of breast cancer. The correlation between the longest diameter of breast cancers and pathological measurements shown on DBT and FFDM was analyzed. Results: The areas under ROC curves were 0.890, 0.833 and 0.890 for DBT, FFDM and DBT plus FFDM, respectively. The areas under ROC curves for DBT or DBT plus FFDM were significantly greater than that for FFDM (P<0.05). In the group with breast density>50%, group with age ≤50 and non-menopause group, all the areas under ROC curves for DBT or DBT plus FFDM were all significantly larger than that for FFDM (P<0.05). No significant differences were observed in the group with breast density ≤50%, group with age>50 and menopause group (P>0.05). The sensitivity for both DBT and FFDM in the diagnosis of carcinoma in situ was 90.9% (10/11). The sensitivity for DBT and FFDM in the diagnosis of non-carcinoma in situ was 92.3% (120/130) and 83.8% (109/130), respectively. The sensitivity in the groups with the longest diameter of foci >0 mm but ≤10 mm, >10 mm but ≤20 mm, >20 mm but ≤30 mm, and >30 mm but ≤40 mm were 51.7% (4/7), 93.8% (61/65), 96.7% (30/31) and 100% (11/11), respectively, for DBT, and were 51.7% (4/7), 78.5% (51/65), 93.5% (29/31), and 100% (11/11), respectively, for FFDM. The correlation coefficients between the longest diameter of breast cancers and pathological measurements shown on DBT and FFDM were 0.905 and 0.849, respectively (P<0.001). Conclusions: Compared with FFDM, DBT shows a higher diagnostic efficiency in patients with breast density >50%, age ≤50 years and non-menopause, non-carcinoma in situ, and the longest diameter of lesions >10 mm but ≤ 20 mm. The longest diameter of breast lesions is more accurately shown on DBT.
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Knox M, O'Brien A, Szabó E, Smith CS, Fenlon HM, McNicholas MM, Flanagan FL. Impact of full field digital mammography on the classification and mammographic characteristics of interval breast cancers. Eur J Radiol 2015; 84:1056-61. [PMID: 25816990 DOI: 10.1016/j.ejrad.2015.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/19/2015] [Revised: 02/20/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Full field digital mammography (FFDM) is increasingly replacing screen film mammography (SFM) in breast screening programs. Interval breast cancers are an issue in all screening programs and the purpose of our study is to assess the impact of FFDM on the classification of interval breast cancers at independent blind review and to compare the mammographic features of interval cancers at FFDM and SFM. MATERIALS AND METHODS This study included 138 cases of interval breast cancer, 76 following an FFDM screening examination and 62 following screening with SFM. The prior screening mammogram was assessed by each of five consultant breast radiologists who were blinded to the site of subsequent cancer. Subsequent review of the diagnostic mammogram was performed and cases were classified as missed, minimal signs, occult or true interval. Mammographic features of the interval cancer at diagnosis and any abnormality identified on the prior screening mammogram were recorded. RESULTS The percentages of cancers classified as missed at FFDM and SFM did not differ significantly, 10.5% (8 of 76) at FFDM and 8.1% (5 of 62) at SFM (p=.77). There were significantly less interval cancers presenting as microcalcifications (alone or in association with another abnormality) following screening with FFDM, 16% (12 of 76) than following a SFM examination, 32% (20 of 62) (p=.02). CONCLUSION Interval breast cancers continue to pose a problem at FFDM. The switch to FFDM has changed the mammographic presentation of interval breast cancer, with less interval cancers presenting in association with microcalcifications.
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Affiliation(s)
- Mark Knox
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Angela O'Brien
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Endre Szabó
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Clare S Smith
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Helen M Fenlon
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Michelle M McNicholas
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Fidelma L Flanagan
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
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