The diagnostic performance of quantitative mapping in breast cancer patients: a preliminary study using synthetic MRI

Abstract Background Previous studies have indicated that quantitative MRI (qMR) is beneficial for diagnosis of breast cancer. As a novel qMR technology, synthetic MRI (syMRI) may be advantageous by offering simultaneous generation of T1 and T2 mapping in one scan within a few minutes and without concern to the deposition of the gadolinium contrast agent in cell nucleus. In this study, the potential of quantitative mapping derived from Synthetic MRI (SyMRI) to diagnose breast cancer was investigated. Methods From April 2018 to May 2019, a total of 87 patients with suspicious breast lesions underwent both conventional and SyMRI before treatment. The quantitative metrics derived from SyMRI, including T1 and T2 values, were measured in breast lesions. The diagnostic performance of SyMRI was evaluated with unpaired Student’s t-tests, receiver operating characteristic curve analysis and multivariate logistic regression analysis. The AUCs of quantitative values were compared using Delong test. Results Among 77 patients who met the inclusion criteria, 48 were diagnosed with histopathological confirmed breast cancers, and the rest had benign lesions. The breast cancers showed significantly higher T1 (1611.61 ± 215.88 ms) values and lower T2 (80.93 ± 7.51 ms) values than benign lesions. The area under the ROC curve (AUC) values were 0.931 (95% CI: 0.874–0.989) and 0.883 (95% CI: 0.810–0.956) for T1 and T2 maps, respectively, in diagnostic discrimination between breast cancers and benign lesions. A slightly increased AUC of 0.978 (95% CI: 0.915–0.993) was achieved by combining those two relaxation-based quantitative metrics. Conclusion In conclusion, our preliminary study showed that the quantitative T1 and T2 values obtained by SyMRI could distinguish effectively between benign and malignant breast lesions, and T1 relaxation time showed the highest diagnostic efficiency. Furthermore, combining the two quantitative relaxation metrics further improved their diagnostic performance.

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Comparing Low and High-Temporal Resolution DCE-MRI Texture Analysis for Discrimination of Breast Lesions from Background Enhancement

10.21203/rs.3.rs-132466/v1 ◽

2020 ◽

Author(s):

Yufeng Liu ◽

Jiaying Li ◽

Jingjing Qu ◽

Rui Tang ◽

Kun Lv ◽

...

Keyword(s):

Breast Cancer ◽

Temporal Resolution ◽

Diagnostic Performance ◽

Roc Analysis ◽

Pharmacokinetic Parameters ◽

High Temporal Resolution ◽

Breast Lesions ◽

Benign Lesions ◽

Dce Mri ◽

Background Enhancement

Abstract Background Breast cancer is the most common cancer in women worldwide, high-resolution dynamic contrast-enhanced MRI (DCE-MRI) can better evaluate the tissue microenvironment and texture characteristics. The purpose of this study was to investigate the value of the texture-based analysis for breast DCE-MRI in the diagnosis of breast lesions and background enhancement. Methods This study prospectively enrolled 128 patients with clinically suspected breast lesions in our hospital from April 2015 to June 2017. Among them, 62 patients underwent preoperative high temporal resolution DCE-MRI (1 + 26 phases) scan with 39 malignant and 23 benign lesions. The control group retrospectively and randomly contained 78 patients who underwent preoperative low temporal resolution DCE-MRI (1 + 5 phases) scans with 46 malignant and 32 benign lesions. Quantitative parameters were obtained using a two-compartment Extended Tofts and volume of interest model for the lesion center, surrounding peripheral area and background enhancement, including pharmacokinetic parameters (Ktrans, Kep, Ve and Vp) and texture features based on the Ktrans map. The Student’s t-test was used to compare the differences of means. LASSO was used for dimension reduction and logistic regression analysis was used for model construction. A receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance. Results Pharmacokinetic parameters were significantly different between high temporal resolution and low temporal resolution DCE-MRI (P < 0.05). In the malignant group, the average Ktrans of the lesion area on high temporal resolution DCE-MRI was significantly correlated to the pathological grading (r = 0.400, P = 0.012). In the differentiation between benign and malignant lesions, the ROC analysis demonstrated that the diagnostic value of high temporal resolution DCE-MRI offered slightly significant advantages in the realms of the lesion, peripheral areas and background enhancement. Conclusions The use of texture analysis based on high temporal resolution DCE-MRI may potentially improve breast cancer diagnostic performance. Specifically, combining the lesion, peripheral, BE area, and Ktrans-mean parameters can contribute to the diagnosis of breast lesions, background enhancement and the pathological grading of malignant tumors.

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Wire- and Ultrasound-Guided Localization: A Novel Technique for Excision of Nonpalpable Breast Tumors

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223420938068 ◽

2020 ◽

Vol 14 ◽

pp. 117822342093806

Author(s):

Siddhant Khare ◽

Tulika Singh ◽

Irrinki Santosh ◽

Ishita Laroiya ◽

Gurpreet Singh

Keyword(s):

Breast Cancer ◽

Preoperative Diagnosis ◽

Standard Technique ◽

Positive Margin ◽

Breast Lesions ◽

Benign Lesions ◽

Ultrasound Guided ◽

Novel Technique ◽

Widespread Acceptance ◽

Nonpalpable Breast Lesions

Background: Excision of nonpalpable breast lesions requires intraoperative guidance. Wire-guided localization and intraoperative ultrasounds have been used successfully but suffer from some disadvantages. We describe a new modification of the standard technique using a combination of preoperative ultrasound in conjunction with standard wire-guided localization. Methods: Wire and ultrasound-guided localization (WUGL) technique was used for the excision of nonpalpable breast lesions. Results: Sixty-nine patients with nonpalpable breast lesions were subjected to excision using WUGL, out of whom 63 patients had a preoperative diagnosis of invasive/noninvasive breast cancer. Six patients had a preoperative diagnosis of benign lesions, out of which 3 patients were converted to invasive breast cancer on final pathology. Only 1 patient had positive margin. Conclusions: WUGL is a technique that uses a combination of well-accepted and easily available techniques. It has given good results and has the potential for widespread acceptance in resource-constrained situations.

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Doppler Flowmetry and the Diagnosis of Breast Lumps

Tumori Journal ◽

10.1177/030089169107700604 ◽

1991 ◽

Vol 77 (6) ◽

pp. 468-471 ◽

Cited By ~ 2

Author(s):

Enrico Gallo ◽

Emanuele Galante ◽

Gabriele Martelli ◽

Marco Stanzani ◽

Grazia Landi ◽

...

Keyword(s):

Breast Cancer ◽

Flow Analysis ◽

Mean Value ◽

Doppler Signal ◽

Breast Cancers ◽

Benign Lesions ◽

Histologic Diagnosis ◽

Doppler Flowmetry ◽

Blood Flow Analysis ◽

Breast Lumps

The aim of the study was to ascertain the reliability of a Doppler signal in the diagnosis of breast cancer. Computerized blood flow analysis was performed on 117 patients who presented with a breast lump at the Division of Diagnostic Oncology of the Istituto Nazionale Tumori of Milan. The values of systolic peak and diastolic frequency were evaluated in relation to the histologic diagnosis. Ten patients had a spontaneous regression of the lump and were excluded from the study. The number of evaluable cases with histologic confirmation was 107: 69 carcinomas and 38 benign lesions. Systolic peak values for the 69 carcinomas ranged from 1500 to 7400 Hz, with a mean value of 3243.4 Hz; diastolic frequency ranged from 200 to 3700 Hz, with mean value of 1413.9 Hz. No diagnostic signals were found in 4 breast cancers (false negatives). Twenty-three of 38 benign lesions (60.5 %) and 65 of 69 malignant nodes (94.2 %) were correctly diagnosed. The Doppler signal with computerized spectral analysis in addition to more specific ultrasonographic parameters could be considered a useful tool in the diagnosis of breast cancer.

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Gene Expression Profile Analysis of T1 and T2 Breast Cancer Reveals Different Activation Pathways

ISRN Oncology ◽

10.1155/2013/924971 ◽

2013 ◽

Vol 2013 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Margit L. H. Riis ◽

Xi Zhao ◽

Fateme Kaveh ◽

Hilde S. Vollan ◽

Anne-Jorunn Nesbakken ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Size ◽

Profile Analysis ◽

Distant Metastases ◽

Molecular Signature ◽

Receptor Interaction ◽

Lymph Node Status ◽

Breast Cancers ◽

Significant Difference ◽

T1 And T2

Breast cancers today are of predominantly T1 (0.1≥2.0 cm) or T2 (>2≤5 cm) categories due to early diagnosis. Molecular profiling using microarrays has led to the notion of breast cancer as a heterogeneous disease both clinically and molecularly. Given the prognostic power and clinical use of tumor size, the purpose of this study was to search for molecular signatures characterizing clinical T1 and T2. In total 46 samples were included in the discovery dataset. After adjusting for hormone receptor status, lymph node status, grade, and tumor subclass 441 genes were differently expressed between T1 and T2 tumors. Focal adhesion and extracellular matrix receptor interaction were upregulated in the smaller tumors while p38MAPK signaling and immune-related pathways were more dominant in the larger tumors. The T-size signature was then tested on a validation set of 947 breast tumor samples. Using the T-size expression signatures instead of tumor size leads to a significant difference in risk for distant metastases (P<0.001). If further confirmed, this molecular signature can be used to select patients with tumor category T1 who may need more aggressive treatment and patients with tumor category T2 who may have less benefit from it.

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Incidental breast lesions detected on diagnostic CT scans: A 3-year prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.69 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 69-69

Author(s):

A. R. Ismail

Keyword(s):

Breast Cancer ◽

Prospective Study ◽

Cancer Patients ◽

Ct Scans ◽

Breast Lesions ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Breast Clinic ◽

Rapid Access ◽

One Stop

69 Background: With increasing usage of diagnostic cross sectional radiology tests, patients are presenting to rapid access one-stop breast clinic with incidental breast lesions. Methods: A prospective study over a 3-year period, collecting details of all patients shown to have breast abnormalities detected by computed tomography (CT) scans done for various reasons. These patients were assessed by clinical breast examination coupled with mammography, ultrasonography and tissue biopsy if indicated. Results: An increasing trend has been seen in the total number of thoracic CT scans with 1,939 scans in 2005 and 5,215 scans in 2010 (169% increase). 26 patients were included in this study with CT scans showing incidental breast lesions in the last three years. They were all women with age range of 50-92 (median 82.5) years. The clinical indications of CT scans included evaluation of the abnormal chest radiograph (8, 31%), preoperative evaluation of non-breast malignancy (3, 11%), infectious diseases (3, 11%), weight loss (7, 27%) and miscellaneous (5, 20%). These 13 breast cancer patients constitute 1.36% of 956 breast cancers diagnosed over this three-year period. 8 out of 13 breast cancer patients in this group (62%) had metastases at the time of diagnosis. Conclusions: A significant number of breast lesions incidentally found on CT scans are shown to be breast cancers (50%). These patients need rapid access to one-stop breast clinic for full evaluation. [Table: see text]

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ROLE OF ULTRASONOGRAPHIC ELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF BREAST MASSES AND ITS CONTRIBUTION TO CLASSICAL ULTRASONOGRAPHIC EVALUATION

10.36106/ijsr/0733120 ◽

2021 ◽

pp. 48-50

Author(s):

Ashok Kumar Verma ◽

Rashmi Rashmi ◽

Rakesh Kumar Verma ◽

Mahendra Kumar Pandey

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Diagnostic Performance ◽

Breast Biopsy ◽

Strain Ratio ◽

Breast Lesions ◽

Breast Masses ◽

Screening Programs ◽

Imaging Department ◽

Malignant Breast

Introduction: India is experiencing an unprecedented rise in the number of breast cancer cases across all sections of society. Breast cancer is now the most common malignancy in women and the second leading cause of cancer- related mortality. Breast cancer is quite easily and effectively treated, provided it is detected in it's early stages. There is a drastic drop in the survival rates when women present with advanced stage of breast cancer, regardless of the setting. Unfortunately, women in resource-poor and developing countries, like India, generally present at a later stage of disease than women elsewhere, partly due to the absence of effective awareness programs and partly due to the lack of proper mass screening programs Aims And Objectives: The diagnostic performance of elastography in differentiating benign from malignant breast lesions. To assess whether elastography has the potential to reduce the need for breast biopsy /FNAC. Cut off value of Strain Ratio for benign versus malignant breast lesions. Further characterize BI-RADS 3 lesions using elastography Materials And Methods: The study was approved by the GSVM MEDICAL COLLEGE AND LLR HOSPITAL Ethics Committee. All patients that presented to the Radiology and Imaging Department of LLR HOSPITAL for diagnostic work up for breast pathology were included in the study. After obtaining a written and signed informed consent from all patients, they were subjected to conventional B-Mode ultrasonography followed by elastography. All diagnostic breast imaging was done with Samsung RS80A ultrasound machine using linear array transducer of frequency 5-12MHz.Observations & Results: The elastography patterns for each lesion were assessed and documented in color scale. Color images were constructed automatically and displayed as a color-overlay on the B-mode image. The color pattern of each lesion was then evaluated on a scale of 1-5 according to the Tsukuba elasticity scoring system. Conclusion: Strain Ratio cutoff of 3.3 is a sensitive parameter to differentiate benign and malignant breast lesions. Elastography is a specic test for differentiating benign and malignant breast lesions. The combined use of elasticity score, strain ratio and B- Mode sonographyincreases the diagnostic performance in distinguishing benign from malignant breast masses.

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The incidence and outcome of incidental breast lesions detected by computed tomography

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12518836439083 ◽

2010 ◽

Vol 92 (2) ◽

pp. 124-126 ◽

Cited By ~ 16

Author(s):

A Hussain ◽

A Gordon-Dixon ◽

H Almusawy ◽

P Sinha ◽

A Desai

Keyword(s):

Breast Cancer ◽

Computed Tomography ◽

Breast Lesion ◽

Chest Ct ◽

Ct Scans ◽

Breast Lesions ◽

Breast Cancers ◽

The Mean ◽

The Uk ◽

Symptomatic Breast

INTRODUCTION In the UK, the majority of breast cancers are diagnosed through symptomatic breast clinics and the breast screening programmes. With increased use of computed tomography (CT) to assess various pathologies, breast lesions are picked up incidentally. The aim of this study was to investigate the incidence and outcomes of breast lesions detected incidentally on CT scans. PATIENTS AND METHODS A retrospective study was conducted to assess the incidence and outcome of incidentally found breast lesions, which were detected on chest CT scans that were conducted for other pathologies during the period from February 2007 to October 2008. RESULTS A total of 432 chest CT scans were performed over 18 months. Thirty-three (7.63%) patients were found to have an incidental breast lesion. The mean age was 73 years (range, 50–86 years). Of these, 17 (52%) were benign, eight (24%) were primary breast cancer and the remaining eight (24%) had no definite pathology. The detection rate of breast cancer was 1.85%. CONCLUSIONS CT is emerging as an important contributor to the detection of occult breast lesions. Radiological awareness of incidental breast lesions is important so that appropriate referral to a specialised breast unit is made.

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Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software

Scientific Reports ◽

10.1038/s41598-021-96137-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ernst Michael Jung ◽

Friedrich Jung ◽

Christian Stroszczynski ◽

Isabel Wiesinger

Keyword(s):

Breast Cancer ◽

Mean Transit Time ◽

Scar Tissue ◽

Surrounding Tissue ◽

Breast Lesions ◽

Contrast Enhanced Ultrasound ◽

Benign Lesions ◽

Asymptomatic Patients ◽

Contrast Enhanced ◽

Malignant Lesions

AbstractThe aim of this present clinical pilot study is the display of typical perfusion results in patients with solid, non-cystic breast lesions. The lesions were characterized using contrast enhanced ultrasound (CEUS) with (i) time intensity curve analyses (TIC) and (ii) parametric color maps. The 24 asymptomatic patients included were genetically tested for having an elevated risk for breast cancer. At a center of early detection of familial ovary and breast cancer, those patients received annual MRI and grey-scale ultrasound. If lesions remained unclear or appeared even suspicious, those patients also received CEUS. CEUS was performed after intravenous application of sulfur hexafluoride microbubbles. Digital DICOM cine loops were continuously stored for one minute in PACS (picture archiving and communication system). Perfusion images and TIC analyses were calculated off-line with external perfusion software (VueBox). The lesion diameter ranged between 7 and 15 mm (mean 11 ± 3 mm). Five hypoechoic irregular lesions were scars, 6 lesions were benign and 12 lesions were highly suspicious for breast cancer with irregular enhancement at the margins and a partial wash out. In those 12 cases, histopathology confirmed breast cancer. All the suspicious lesions were correctly identified visually. For the perfusion analysis only Peak Enhancement (PE) and Area Under the Curve (AUC) added more information for correctly identifying the lesions. Typical for benign lesions is a prolonged contrast agent enhancement with lower PE and prolonged wash out, while scars are characterized typically by a reduced enhancement in the center. No differences (p = 0.428) were found in PE in the center of benign lesions (64.2 ± 28.9 dB), malignant lesions (88.1 ± 93.6 dB) and a scar (40.0 ± 17.0 dB). No significant differences (p = 0.174) were found for PE values at the margin of benign lesions (96.4 ± 144.9 dB), malignant lesions (54.3 ± 86.2 dB) or scar tissue (203.8 ± 218.9 dB). Significant differences (p < 0.001) were found in PE of the surrounding tissue when comparing benign lesions (33.6 ± 25.2 dB) to malignant lesions (15.7 ± 36.3 dB) and scars (277.2 ± 199.9 dB). No differences (p = 0.821) were found in AUC in the center of benign lesions (391.3 ± 213.7), malignant lesions (314.7 ± 643.9) and a scar (213.1 ± 124.5). No differences (p = 0.601) were found in AUC values of the margin of benign lesions (313.3 ± 372.8), malignant lesions (272.6 ± 566.4) or scar tissue (695.0 ± 360.6). Significant differences (p < 0.01) were found in AUC of the surrounding tissue for benign lesions (151.7 ± 127.8), malignant lesions (177.9 ± 1345.6) and scars (1091 ± 693.3). There were no differences in perfusion evaluation for mean transit time (mTT), rise time (RT) and time to peak (TTP) when comparing the center to the margins and the surrounding tissue. The CEUS perfusion parameters PE and AUC allow a very good assessment of the risk of malignant breast lesions and thus a downgrading of BI-RADS 4 lesions. The use of the external perfusion software (VueBox, Bracco, Milan, Italy) did not lead to any further improvement in the diagnosis of suspicious breast lesions and does appears not to have any additional diagnostic value in breast lesions.

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Section Discrepancy and Diagnostic Performance of Breast Lesions in Two-dimensional Ultrasound by Dynamic Videos versus Static Images

BIO Integration ◽

10.15212/bioi-2021-0021 ◽

2021 ◽

Author(s):

Dinghong Yang ◽

Xiaoyun Xiao ◽

Haohu Wang ◽

Huan Wu ◽

Wei Qin ◽

...

Keyword(s):

Breast Imaging ◽

Diagnostic Performance ◽

Architectural Distortion ◽

Breast Lesions ◽

Two Dimensional ◽

Benign Lesions ◽

Static Image ◽

Malignant Breast ◽

Static Images ◽

Malignant Lesions

Background: Benign or malignant breast lesions with typical ultrasonic characteristics could be easily and correctly diagnosed with two-dimensional ultrasound (2D US). However, diagnosis of atypical lesions remains a challenge. Most atypical lesions have different ultrasonographic features with probe direction variation. Thus, the interpretation of ultrasonographic features based on static images empirically collected by sonographers might be inaccurate. We aimed to investigate the section discrepancy and diagnostic performance of breast lesions in 2D US by dynamic videos versus static images.Methods: Static images and dynamic videos based on two perpendicular planes of 468 breast lesions were collected and evaluated. The Breast Imaging and Reporting Data System (BI-RADS®) US lexicon was used. Category 3 was used as the cut-off point, and section discrepancy was defined as two perpendicular planes showing different BI-RADS categories (3 versus 4A, 4B, 4C, and 5).Results: This retrospective study included 315 benign and 153 malignant lesions. There were 53 and 50 lesions with section discrepancy during static and dynamic observations, respectively. The proportion of benign lesions with section discrepancy was significantly higher than that of malignant lesions (P < 0.05) either in dynamic or static observation, and the contingency coefficient was 0.2 between section discrepancy and histopathology. Duct changes were more clearly depicted in dynamic videos than in static images (P < 0.05) both in malignant and benign lesions. Calcification and architectural distortion were more sensitively detected by dynamic videos than with static images (P < 0.05) in malignant lesions. The interpretation of “margin” significantly differed in benign lesions between static images and dynamic videos (P < 0.05). The areas under the curve of static image-horizontal, static image-sagittal, dynamic video-horizontal, and dynamic video-sagittal were 0.807, 0.820, 0.837, and 0.846, respectively. The specificities of dynamic videos were higher than those of static images (P < 0.05).Conclusion: Breast lesions have section discrepancy in 2D US. Observations based on dynamic videos could more accurately reflect lesion features and increase the specificity of US in the differentiation of atypical breast lesions.

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Immunohistochemical Expression of p63 in Benign and Malignant Breast Lesions

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48358.15526 ◽

2021 ◽

Author(s):

Abhishek Saini ◽

Swaran Kaur Saluja ◽

MK Garg ◽

Deepti Agarwal ◽

Amrita Kulhria ◽

...

Keyword(s):

Breast Cancer ◽

Myoepithelial Cells ◽

Normal Breast ◽

High Morbidity ◽

Breast Lesions ◽

Benign Lesions ◽

Medical College ◽

Malignant Breast ◽

Malignant Lesions

Introduction: Breast carcinoma demands attention as it causes high morbidity and mortality. It is important to recognise benign lesions to distinguish them from in situ and invasive breast cancer and to assess a patient’s risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The p63 has been characterised as a reliable marker of myoepithelial cells of lactiferous duct. It is exclusively expressed in myoepithelial cells of normal breast tissue. Hence, p63 can be of great help in the differential diagnosis involving benign lesions. Also, p63 may aid in distinguishing benign from malignant lesions. Aim: To study the Immunohistochemistry (IHC) expression of p63 in benign and malignant breast lesions. Materials and Methods: The prospective study was conducted on 76 breast specimens for a period of one year, from 1st December 2018 to 30th November 2019 in the Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. IHC assessment for p63 nuclear protein was performed. The intensity of p63 expression was evaluated as continuous positive, discontinuous positive and negative. The extent was scored on the basis of percentage of positive cells and assigned a score of negative (0%), 1 (<25%), 2 (26-90%) and 3 (91-100%). Results: Out of 76 cases, 38 cases were diagnosed as benign and 38 cases as malignant. IHC staining with p63 showed nuclear positivity in all benign lesions. Among malignant lesions, four were positive and 34 were negative. Conclusion: According to the above results, p63 is a very useful IHC marker in diagnosing difficult cases, cases of carcinoma in situ, borderline cases and cases with inconclusive histomorphological diagnosis.

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