scholarly journals Quantitative breast density in Contrast-Enhanced Mammography

2021 ◽  
Author(s):  
Gisella Gennaro ◽  
Melissa L. Hill ◽  
Elisabetta Bezzon ◽  
Francesca Caumo
Keyword(s):  
Breast Cancer ◽  
Breast Density ◽  
Breast Imaging ◽  
High Energy ◽  
Multiple Correlation Coefficient ◽  
Low Energy ◽  
Wilcoxon Test ◽  
Coefficient Of Determination ◽  
Contrast Enhanced ◽  
Significant Difference

Abstract Background: Breast density is an independent risk factor for breast cancer, and cancer detection in mammography is reduced in dense breasts. Quantitative tools are available to measure breast density from digital mammography (DM) or tomosynthesis (DBT). Contrast-enhanced mammography (CEM) is an emerging breast imaging technique, consisting of the acquisition of an image pair (low-energy, LE, and high-energy, HE) for each mammography view. LE-CEM images have been demonstrated to be visually equivalent to a standard mammogram, thereby, CEM examinations do not require additional mammography to complete the clinical information. In this study, volumetric breast density (VBD) measured in LE-CEM was compared with VBD obtained from DM/DBT images.Methods: Between Mar 2019 and Dec 2020 222 women were enrolled in a prospective clinical trial aiming to compare clinical performance of CEM with breast MRI in a population of women at intermediate and high risk for breast cancer. In this observational cohort study, 150 women enrolled in this trial having at least a DM/DBT study performed before/after CEM were selected. CEM and previous/subsequent DM/DBT images were processed by an automatic algorithm to calculate VBD for each view. VBD from LE-CEM and DM/DBT views were compared using a paired Wilcoxon test. P < 0.05 was considered indicative of a statistically significant difference. A multivariate regression model was applied to analyze the relationship between paired VBD differences and multiple independent variables certainly or potentially affecting VBD.Results: Mean age of women included in this study was 51.0±8.4 years. Median VBD was comparable for LE-CEM and previous/subsequent DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (P = 0.5855). VBD differences between LE-CEM and DM were associated to significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance i.e. variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761).Conclusions: Volumetric breast density can be obtained from low-energy contrast-enhanced spectral mammography and is not significantly different from volumetric breast density measured from standard mammograms.

scholarly journals Quantitative Breast Density in Contrast-Enhanced Mammography

2021 ◽  
Vol 10 (15) ◽  
pp. 3309
Author(s):  
Gisella Gennaro ◽  
Melissa L. Hill ◽  
Elisabetta Bezzon ◽  
Francesca Caumo
Keyword(s):  
Breast Density ◽  
Potential Role ◽  
Multiple Correlation Coefficient ◽  
Low Energy ◽  
Coefficient Of Determination ◽  
Contrast Enhanced ◽  
Increased Risk ◽  
Significant Difference ◽  
Automatic Software ◽  
The Relationship

Contrast-enhanced mammography (CEM) demonstrates a potential role in personalized screening models, in particular for women at increased risk and women with dense breasts. In this study, volumetric breast density (VBD) measured in CEM images was compared with VBD obtained from digital mammography (DM) or tomosynthesis (DBT) images. A total of 150 women who underwent CEM between March 2019 and December 2020, having at least a DM/DBT study performed before/after CEM, were included. Low-energy CEM (LE-CEM) and DM/DBT images were processed with automatic software to obtain the VBD. VBDs from the paired datasets were compared by Wilcoxon tests. A multivariate regression model was applied to analyze the relationship between VBD differences and multiple independent variables certainly or potentially affecting VBD. Median VBD was comparable for LE-CEM and DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (p = 0.5855). VBD differences between LE-CEM and DM were associated with significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance, i.e., variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761). Volumetric breast density was obtained from low-energy contrast-enhanced spectral mammography and was not significantly different from volumetric breast density measured from standard mammograms.

MRI background enhancement: Its relationship with breast density and breast cancer risk

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1539-1539
Author(s):  
A. Kwong ◽  
J. Rosenberg ◽  
M. A. Van den Bosch ◽  
B. L. Daniel ◽  
G. Lo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Breast Density ◽  
Breast Imaging ◽  
Premenopausal Women ◽  
Breast Mri ◽  
Weighted Kappa ◽  
Contrast Enhanced ◽  
Background Enhancement

1539 Background: Increased breast density increases breast cancer risk. MRI breast is increasingly used for imaging as unlike mammography, the sensitivity of MRI breast is not affected by breast density but rather, the amount of background enhancement. It has been suggested that increased background enhancement may be related to the amount of proliferative breast tissue present; hence this may also be related to increased breast cancer risk. To date there have been no study published assessing background enhancement and its relation to breast cancer risk. Method: A retrospective review 45 mammography films and breast MRI scans of 36 patients (9 bilateral) with normal breast imaging was performed and scored independently by 3 radiologists for breast density using BI-RADS criteria. MRI breast density was scored on the non-contrast enhanced T1-weighted series whereas background enhancement was quantified on the first contrast-enhanced T1-weighted fat-suppressed series. Background enhancement was scored as none-minimal, mild, moderate, marked. Weighted kappa was used to assess the inter-modality agreement. A partial approximation to the Gail risk score was calculated from the available risk factors (age, menarche, number of biopsies, births and relatives with breast cancer), using coefficients from a Caucasian population; the resulting values were converted to ranks and was correlated with background enhancement. Result: There was substantial within-reader agreement between mammographic and MRI density (kappa=0.68; p=0.001). There were no correlation between background enhancement and breast density. All 6 patients with background-enhancement were pre-menopausal. Although not statistically significant (p<0.37), it is suggestive that 4 of the 6 (67%) had a history of breast cancer while only 6 of the 13 premenopausal non-enhancers (46%) had cancer. Moreover, the mean of the rank risk for enhancing premenopausal women was 29.5 while the non-enhancing pre-menopausal women was 16.6 (p=0.048 by one-tailed t-test). Conclusion: We found good correlation between mammographic and MRI breast density. There was no correlation between breast density and MRI background enhancement. There is a suggestion that MRI background enhancement may be associated with a higher risk of breast cancer. No significant financial relationships to disclose.

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 How Does Frailty Factor Into Mortality Risk Assessment of a Middle-Aged and Geriatric Trauma Population?

2017 ◽  
Vol 8 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Sanjit R. Konda ◽  
Ariana Lott ◽  
Hesham Saleh ◽  
Sebastian Schubl ◽  
Jeffrey Chan ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Functional Independence ◽  
High Energy ◽  
Low Energy ◽  
Geriatric Trauma ◽  
Inpatient Mortality ◽  
Middle Aged ◽  
Trauma Population ◽  
Increased Risk ◽  
Significant Difference

Introduction: Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population. Methods: A total of 1486 patients aged 55 years and older who met the American College of Surgeons Tier 1 to 3 criteria and/or who had orthopedic or neurosurgical traumatic consultations in the emergency department between September 2014 and September 2016 were included. The STTGMAORIGINAL and STTGMAFRAILTY scores were calculated. Additional “frailty variables” included preinjury assistive device use (disability), independent ambulatory status (functional independence), and albumin level (nutrition). The ability of the STTGMAORIGINAL and the STTGMAFRAILTY models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs). Results: There were 23 high-energy inpatient mortalities (4.7%) and 20 low-energy inpatient mortalities (2.0%). When the STTGMAORIGINAL model was used, the AUROC in the high-energy and low-energy cohorts was 0.926 and 0.896, respectively. The AUROC for STTGMAFRAILTY for the high-energy and low-energy cohorts was 0.905 and 0.937, respectively. There was no significant difference in predictive capacity for inpatient mortality between STTGMAORIGINAL and STTGMAFRAILTY for both the high-energy and low-energy cohorts. Conclusion: The original STTGMA tool accounts for important frailty factors including cognition and general health status. These variables combined with other major physiologic variables such as age and anatomic injuries appear to be sufficient to adequately and accurately quantify inpatient mortality risk. The addition of other common frailty factors that account for does not enhance the STTGMA tool’s predictive capabilities.

Cancer Conspicuity on Low-energy Images of Contrast-enhanced Mammography Compared With 2D Mammography

2021 ◽  
Author(s):  
Christina Konstantopoulos ◽  
Tejas S Mehta ◽  
Alexander Brook ◽  
Vandana Dialani ◽  
Rashmi Mehta ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Analysis Of Variance ◽  
Digital Mammography ◽  
Regions Of Interest ◽  
Low Energy ◽  
Wilcoxon Test ◽  
Digital Mammogram ◽  
Contrast Enhanced ◽  
Improved Performance ◽  
2D Images

Abstract Objective Low-energy (LE) images of contrast-enhanced mammography (CEM) have been shown to be noninferior to digital mammography. However, our experience is that LE images are superior to 2D mammography. Our purpose was to compare cancer appearance on LE to 2D images. Methods In this IRB-approved retrospective study, seven breast radiologists evaluated 40 biopsy-proven cancer cases on craniocaudal (CC) and mediolateral oblique (MLO) LE images and recent 2D images for cancer visibility, confidence in margins, and conspicuity of findings using a Likert scale. Objective measurements were performed using contrast-to-noise ratio (CNR) estimated from regions of interest placed on tumor and background parenchyma. Reader agreement was evaluated using Fleiss kappa. Per-reader comparisons were performed using Wilcoxon test and overall comparisons used three-way analysis of variance. Results Low-energy images showed improved performance for visibility (CC LE 4.0 vs 2D 3.5, P &lt; 0.001 and MLO LE 3.7 vs 2D 3.5, P = 0.01), confidence in margins (CC LE 3.2 vs 2D 2.8, P &lt; 0.001 and MLO LE 3.1 vs 2D 2.9, P &lt; 0.008), and conspicuity compared to tissue density compared to 2D mammography (CC LE 3.6 vs 2D 3.2, P &lt; 0.001 and MLO LE 3.5 vs 2D 3.2, P &lt; 0.001). The average CNR was significantly higher for LE than for digital mammography (CC 2.1 vs 3.2, P &lt; 0.001 and MLO 2.1 vs 3.4, P &lt; 0.001). Conclusion Our results suggest that cancers may be better visualized on the LE CEM images compared with the 2D digital mammogram.

Correlation between contrast-enhanced cone-beam breast computed tomography features and prognostic staging in breast cancer

2021 ◽  
Author(s):  
Wei-mei Ma ◽  
Jiao Li ◽  
Shuang-gang Chen ◽  
Pei-qiang Cai ◽  
Shen Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Goodness Of Fit ◽  
Characteristic Curve ◽  
Cone Beam ◽  
Imaging Biomarkers ◽  
Training Set ◽  
Test Set ◽  
Ps Ii ◽  
Contrast Enhanced ◽  
Significant Difference

Objective: To evaluate whether contrast-enhanced cone-beam breast CT (CE-CBBCT) features can risk-stratify prognostic stage in breast cancer. Methods: Overall, 168 biopsy-proven breast cancer patients were analysed: 115 patients in the training set underwent scanning using v. 1.5 CE-CBBCT between August 2019 and December 2019, whereas 53 patients in the test set underwent scanning using v. 1.0 CE-CBBCT between May 2012 and August 2014. All patients were restaged according to the American Joint Committee on Cancer eighth edition prognostic staging system. Following the combination of CE-CBBCT imaging parameters and clinicopathological factors, predictors that were correlated with stratification of prognostic stage via logistic regression were analysed. Predictive performance was assessed according to the area under the receiver operating characteristic curve (AUC). Goodness-of-fit of the models was assessed using the Hosmer-Lemeshow test. Results: As regards differentiation between prognostic stage (PS) I and II/III, increased tumour-to-breast volume ratio (TBR), rim enhancement pattern, and the presence of penetrating vessels were significant predictors for PS II/III disease (p < 0.05). The AUCs in the training and test sets were 0.967 [95% confidence interval (CI) 0.938–0.996; p < 0.001] and 0.896 (95% CI, 0.809–0.983; p = 0.001), respectively. Two features were selected in the training set of PS II vs III, including tumour volume [odds ratio (OR)=1.817, p = 0.019] and calcification (OR = 4.600, p = 0.040), achieving an AUC of 0.790 (95% CI, 0.636–0.944, p = 0.001). However, there was no significant difference in the test set of PS II vs III (P＞0.05). Conclusion: CE-CBBCT imaging biomarkers may provide a large amount of anatomical and radiobiological information for the pre-operative distinction of prognostic stage. Advances in knowledge: CE-CBBCT features have distinctive promise for stratification of prognostic stage in breast cancer.

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.

scholarly journals Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

2020 ◽  
Vol 93 (1112) ◽  
pp. 20200195
Author(s):  
Jiamin Pan ◽  
Wenjuan Tong ◽  
Jia Luo ◽  
Jinyu Liang ◽  
Fushun Pan ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Breast Lesions ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
Score System ◽  
Contrast Enhanced ◽  
Significant Difference

Objective: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. Methods: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3–5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. Results: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). Conclusion: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. Advances in knowledge: •CEUS is a better method in differentiation of breast lesions with calcification. •CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.

scholarly journals Heterogenous Effect of Risk Factors on Breast Cancer across the Breast Density Categories in a Korean Screening Population

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1391
Author(s):  
Boyoung Park ◽  
Se-Eun Lim ◽  
HyoJin Ahn ◽  
Junghyun Yoon ◽  
Yun Su Choi
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Postmenopausal Women ◽  
Breast Density ◽  
Breast Imaging ◽  
Hormone Replacement ◽  
Cancer Development ◽  
Age At Menarche ◽  
Breast Cancer Development ◽  
Heterogeneous Association

We evaluated the heterogeneity of the effect of known risk factors on breast cancer development based on breast density by using the Breast Imaging-Reporting and Data System (BI-RADS). In total, 4,898,880 women, aged 40–74 years, who participated in the national breast cancer screening program in 2009–2010 were followed up to December 2018. Increased age showed a heterogeneous association with breast cancer (1-year hazard ratio (HR) = 0.92, 1.00 (reference), 1.03, and 1.03 in women with BI-RADS density category 1, 2, 3, and 4, respectively; P-heterogeneity < 0.001). More advanced age at menopause increased breast cancer risk in all BI-RADS categories. This was more prominent in women with BI-RADS density category 1 but less prominent in women in other BI-RADS categories (P-heterogeneity = 0.009). In postmenopausal women, a family history of breast cancer, body mass index ≥ 25 kg/m2, and smoking showed a heterogeneous association with breast cancer across all BI-RADS categories. Other risk factors including age at menarche, menopause, hormone replacement therapy after menopause, oral contraceptive use, and alcohol consumption did not show a heterogeneous association with breast cancer across the BI-RADS categories. Several known risk factors of breast cancer had a heterogeneous effect on breast cancer development across breast density categories, especially in postmenopausal women.

3,3'-Diindolylmethane (DIM): A nutritional intervention and its impact on breast density in healthy BRCA carriers compared to non-treated carriers—A prospective clinical trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1556-1556
Author(s):  
Rinat Yerushalmi ◽  
Sharon Bargil ◽  
Yaara Ber ◽  
Rachel Ozalvo ◽  
Sivan Sela ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Breast Density ◽  
Breast Imaging ◽  
Menopausal Status ◽  
Large Body ◽  
Independent Expert ◽  
Significant Change ◽  
One Year ◽  
Brca Carriers

1556 Background: Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol (I3C) found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast-cancer risk. Methods: Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mgx1/d for one year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention were scored by two independent expert radiologists using the Breast Imaging and Reporting Data System (BI-RADS). Each woman in the cohort was matched by age (within 3 years) and menopausal status to a woman attending the clinic who was not participating in the study and who underwent breast MRI in parallel year. Results: A decrease in the average score for FGT amount from 2.8±0.8 at onset to 2.65±0.842.8 after one year (p = 0.031), with no significant change in BPE (p = 0.429). A group of DIM-untreated age- and menopausal-status-matched clinic patients did not show a significant change in FGT amount (p = 0.33) or BPE (p = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/L (p = 0.01), and mean testosterone level, from 0.42 to 0.31 pmol/L (p = 0.007). Side effects were grade 1. Conclusions: One year’s supplementation with DIM 100 mgX1/d in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings. Clinical trial information: NCT02197000.

Sign in / Sign up

Export Citation Format

Share Document