Training Radiologists to Interpret Contrast-enhanced Mammography: Toward a Standardized Lexicon

2021 ◽  
Author(s):  
Wendie A Berg ◽  
Andriy I Bandos ◽  
Margarita L Zuley ◽  
Uzma X Waheed
Keyword(s):  
Breast Imaging ◽  
Kappa Statistic ◽  
Expert Consensus ◽  
Moderate Agreement ◽  
Background Parenchymal Enhancement ◽  
Consensus Mean ◽  
Contrast Enhanced ◽  
Lesion Type ◽  
Mass Enhancement ◽  
Irregular Mass

Abstract Objective Using terms adapted from the BI-RADS Mammography and MRI lexicons, we trained radiologists to interpret contrast-enhanced mammography (CEM) and assessed reliability of their description and assessment. Methods A 60-minute presentation on CEM and terminology was reviewed independently by 21 breast imaging radiologist observers. For 21 CEM exams with 31 marked findings, observers recorded background parenchymal enhancement (BPE) (minimal, mild, moderate, marked), lesion type (oval/round or irregular mass, or non-mass enhancement), intensity of enhancement (none, weak, medium, strong), enhancement quality (none, homogeneous, heterogeneous, rim), and BI-RADS assessment category (2, 3, 4A, 4B, 4C, 5). “Expert” consensus of 3 other radiologists experienced in CEM was developed. Kappa statistic was used to assess agreement between radiologists and expert consensus, and between radiologists themselves, on imaging feature categories and final assessments. Reproducibility of specific feature descriptors was assessed as fraction of consensus-concordant responses. Results Radiologists demonstrated moderate agreement for BPE, (mean kappa, 0.43; range, 0.05–0.69), and lowest reproducibility for “minimal.” Agreement was substantial for lesion type (mean kappa, 0.70; range, 0.47–0.93), moderate for intensity of enhancement (mean kappa, 0.57; range, 0.44–0.76), and moderate for enhancement quality (mean kappa, 0.59; range, 0.20–0.78). Agreement on final assessment was fair (mean kappa, 0.26; range, 0.09–0.44), with BI-RADS category 3 the least reproducible. Decision to biopsy (BI-RADS 2–3 vs 4–5) showed moderate agreement with consensus (mean kappa, 0.54; range, −0.06–0.87). Conclusion With minimal training, agreement for description of CEM findings by breast imaging radiologists was comparable to other BI-RADS lexicons.

scholarly journals Breast dynamic contrast enhanced MRI: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy

2017 ◽  
Vol 51 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Zorica C. Milosevic ◽  
Mirjan M. Nadrljanski ◽  
Zorka M. Milovanovic ◽  
Nina Z. Gusic ◽  
Slavko S. Vucicevic ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Time Intensity Curve ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Mri Examination ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Plateau Time ◽  
Diffuse Distribution ◽  
Mass Enhancement

Abstract Background We aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination. Patients and methods Forty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography. Results The predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia. Conclusions FCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.

scholarly journals Diagnostic accuracy of contrast-enhanced digital mammography in comparison with sonomammography for characterization of focal asymmetries

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Gelan Ali Mahmoud Soliman ◽  
Shaimaa Abdelsattar Mohammad ◽  
Mohamed El-Shinawi ◽  
Nermeen Nasry Keriakos
Keyword(s):  
Diagnostic Accuracy ◽  
Digital Mammography ◽  
Breast Imaging ◽  
Normal Tissue ◽  
Normal Breast ◽  
Ultrasound Evaluation ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Mass Enhancement

Abstract Background Mammographic focal asymmetry represents normal breast tissue, benign, or malignant lesions. Accurate characterization is important for better management. The study evaluates diagnostic accuracy of contrast-enhanced digital mammography (CEDM) for characterization of focal asymmetries seen in 2D mammography. Results The study was done prospectively on 38 females among 360 patients who underwent baseline sonomammographic assessment for diagnostic and screening purposes. Complementary ultrasound was performed only when a finding was detected in cases of screening mammograms. Focal asymmetries were evaluated according to Breast Imaging Reporting and Data System (BI-RADS) lexicon 2013. CEDM was performed and followed by ultrasound (US) guided core biopsy for solid lesions or aspiration for cystic lesions. CEDM processing resulted in recombined image showing enhancing abnormality. Low energy image and recombined image findings were analyzed blindly and classified into focus enhancement, mass enhancement, non-mass enhancement, and non-enhanced lesions. CEDM and sonomammography findings were compared regarding pathological probability and multiplicity. Histopathology was the reference standard. Mass enhancement showed strong correlation with malignant pathology. Non-mass enhancement showed no correlation with particular pathology. All non-enhanced focal asymmetries were benign in pathology or normal tissue. Rim enhancement needed second look ultrasound evaluation. CEDM was superior to sonomammography with higher sensitivity (77.8%, 65.7% respectively), NPV (0.8, 0.6), accuracy (0.6, 0.2) but lower specificity (81.8% vs. 100%). Multiplicity detection by CEDM was 26.3% and by sonomammography was 10.5%. Conclusion CEDM is more accurate than sonomammography in determination of normal tissue, benign, or malignant lesions in cases of mammographic focal asymmetry. CEDM is more accurate in detection of multiplicity. Undesired biopsies were avoidable with proper management of suspicious and malignant lesions.

scholarly journals The Usefulness of Spectral Mammography in Surgical Planning of Breast Cancer Treatment—Analysis of 999 Patients with Primary Operable Breast Cancer

2021 ◽  
Vol 28 (4) ◽  
pp. 2548-2559
Author(s):  
Andrzej Lorek ◽  
Katarzyna Steinhof-Radwańska ◽  
Anna Barczyk-Gutkowska ◽  
Wojciech Zarębski ◽  
Piotr Paleń ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Predictive Value ◽  
Breast Imaging ◽  
Incidence Rates ◽  
Diagnostic Sensitivity ◽  
Breast Cancer Surgery ◽  
Imaging Method ◽  
Treatment Change ◽  
Contrast Enhanced ◽  
General Number

Contrast-enhanced spectral mammography (CESM) is a promising, digital breast imaging method for planning surgeries. The study aimed at comparing digital mammography (MG) with CESM as predictive factors in visualizing multifocal-multicentric cancers (MFMCC) before determining the surgery extent. We analyzed 999 patients after breast cancer surgery to compare MG and CESM in terms of detecting MFMCC. Moreover, these procedures were assessed for their conformity with postoperative histopathology (HP), calculating their sensitivity and specificity. The question was which histopathological types of breast cancer were more frequently characterized by multifocality–multicentrality in comparable techniques as regards the general number of HP-identified cancers. The analysis involved the frequency of post-CESM changes in the extent of planned surgeries. In the present study, MG revealed 48 (4.80%) while CESM 170 (17.02%) MFMCC lesions, subsequently confirmed in HP. MG had MFMCC detecting sensitivity of 38.51%, specificity 99.01%, PPV (positive predictive value) 85.71%, and NPV (negative predictive value) 84.52%. The respective values for CESM were 87.63%, 94.90%, 80.57% and 96.95%. Moreover, no statistically significant differences were found between lobular and NST cancers (27.78% vs. 21.24%) regarding MFMCC. A treatment change was required by 20.00% of the patients from breast-conserving to mastectomy, upon visualizing MFMCC in CESM. In conclusion, mammography offers insufficient diagnostic sensitivity for detecting additional cancer foci. The high diagnostic sensitivity of CESM effectively assesses breast cancer multifocality/multicentrality and significantly changes the extent of planned surgeries. The multifocality/multicentrality concerned carcinoma, lobular and invasive carcinoma of no special type (NST) cancers with similar incidence rates, which requires further confirmation.

scholarly journals Degree of Enhancement on Contrast Enhanced Spectral Mammography (CESM) and Lesion Type on Mammography (MG): Comparison Based on Histological Results

2016 ◽  
Vol 22 ◽  
pp. 3886-3893 ◽  
Author(s):  
Elżbieta Łuczyńska ◽  
Joanna Niemiec ◽  
Edward Hendrick ◽  
Sylwia Heinze ◽  
Janusz Jaszczyński ◽  
...  
Keyword(s):  
Contrast Enhanced ◽  
Lesion Type ◽  
Histological Results

Contrast-enhanced spectral mammography in patients with MRI contraindications

2017 ◽  
Vol 59 (7) ◽  
pp. 798-805 ◽  
Author(s):  
Vivien Richter ◽  
Valerie Hatterman ◽  
Heike Preibsch ◽  
Sonja D Bahrs ◽  
Markus Hahn ◽  
...  
Keyword(s):  
Problem Solving ◽  
Diagnostic Accuracy ◽  
Breast Imaging ◽  
Diagnostic Yield ◽  
Therapy Response ◽  
Lesion Size ◽  
Size Estimation ◽  
Imaging Data ◽  
Technical Problems ◽  
Contrast Enhanced

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method’s technical limitations.

Workflow Considerations for Incorporation of Contrast-Enhanced Spectral Mammography Into a Breast Imaging Practice

2018 ◽  
Vol 15 (6) ◽  
pp. 881-885 ◽  
Author(s):  
Jordana Phillips ◽  
Jennifer Steinkeler ◽  
Komal Talati ◽  
Alexander Brook ◽  
Vandana Dialani ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Contrast Enhanced

The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria

2021 ◽  
Vol 94 (1120) ◽  
pp. 20200880
Author(s):  
Fan Zhang ◽  
Lifang Jin ◽  
Gang Li ◽  
Chao Jia ◽  
Qiusheng Shi ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Sensitivity And Specificity ◽  
Breast Imaging ◽  
Diagnostic Value ◽  
Binary Logistic Regression Analysis ◽  
Lower Sensitivity ◽  
Breast Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Histopathological Results

Objectives: To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. Methods: A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. Results: Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. Conclusions: CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. Advances in knowledge: In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.

Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

2018 ◽  
Vol 105 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Giulia Bicchierai ◽  
Jacopo Nori ◽  
Diego De Benedetto ◽  
Cecilia Boeri ◽  
Ermanno Vanzi ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Surgical Excision ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
B3 Lesions ◽  
Malignant Lesions ◽  
Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

Advanced Imaging Techniques for the Detection of Breast Cancer

2012 ◽  
pp. 65-69 ◽  
Author(s):  
Maxine Jochelson
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Breast Imaging ◽  
Early Stage ◽  
Imaging Techniques ◽  
Breast Cancer Mortality ◽  
Digital Breast Tomosynthesis ◽  
Ct Scanning ◽  
High Risk Women ◽  
Contrast Enhanced

Overview: Mammography is the only breast imaging examination that has been shown to reduce breast cancer mortality. Population-based sensitivity is 75% to 80%, but sensitivity in high-risk women with dense breasts is only in the range of 50%. Breast ultrasound and contrast-enhanced breast magnetic resonance imaging (MRI) have become additional standard modalities used in the diagnosis of breast cancer. In high-risk women, ultrasound is known to detect approximately four additional cancers per 1,000 women. MRI is exquisitely sensitive for the detection of breast cancer. In high-risk women, it finds an additional four to five cancers per 100 women. However, both ultrasound and MRI are also known to lead to a large number of additional benign biopsies and short-term follow-up examinations. Many new breast imaging tools have improved and are being developed to improve on our current ability to diagnose early-stage breast cancer. These can be divided into two groups. The first group is those that are advances in current techniques, which include digital breast tomosynthesis and contrast-enhanced mammography and ultrasound with elastography or microbubbles. The other group includes new breast imaging platforms such as breast computed tomography (CT) scanning and radionuclide breast imaging. These are exciting advances. However, in this era of cost and radiation containment, it is imperative to look at all of them objectively to see which will provide clinically relevant additional information.

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