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 The PROCEM study protocol: Added value of preoperative contrast-enhanced mammography in staging of malignant breast lesions - a prospective randomized multicenter study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristina Åhsberg ◽  
Anna Gardfjell ◽  
Emma Nimeus ◽  
Lisa Ryden ◽  
Sophia Zackrisson
Keyword(s):  
Breast Cancer ◽  
Randomized Study ◽  
Preoperative Staging ◽  
Added Value ◽  
Breast Cancer Surgery ◽  
Imaging Method ◽  
Link Type ◽  
Contrast Enhanced ◽  
Patient Reported ◽  
Additional Imaging

Abstract Background Correct preoperative estimation of the malignant extent is crucial for optimal planning of breast cancer surgery. The sensitivity of mammography is lower in dense breasts, and additional imaging techniques are sometimes warranted. Contrast-enhanced mammography (CEM) has shown similar sensitivity and in some cases better specificity, than magnetic resonance imaging (MRI) in small, observational studies. CEM may be more cost-effective than MRI, and may provide better identification of the tumor extent, however, no randomized trials have been performed to date to investigate the added value of CEM. In a feasibility study, we found that the treatment was changed in 10/47 (21%) cases after additional CEM. The purpose of the present study is to evaluate the added value of CEM in preoperative staging of breast cancer in a randomized study. Method This prospective randomized study will include 440 patients with strongly suspected or established diagnosis of breast malignancy, based on assessment with mammography, ultrasound and core biopsy/cytology, and for whom primary surgery is planned. Patients will be randomized 1:1 using a web-based randomization tool to additional investigation with CEM or no further imaging. The CEM findings will be taken into consideration, which may lead to changes in primary treatment, which is the primary endpoint of this study. Secondary endpoints include rate of reoperation and number of avoidable mastectomies, as well as a cost-benefit analysis of additional CEM. Patient-reported health-related quality of life will be investigated at 1 year with the validated Breast-Q™ questionnaire. The rate of local recurrence or new cancer ipsi- or contralaterally within 5 years will be assessed from medical records and pathology reports. Discussion The aim of this trial is to explore the added value of CEM in preoperative staging of breast cancer. The results obtained from this study will contribute to our knowledge on CEM as an additional imaging method to standard investigation with digital mammography and ultrasound. The findings may also provide additional information on which patient groups would benefit from CEM, and on the economic aspects of CEM in standard preoperative practice. Trial registration This trial is registered at clinicaltrials.gov, registration no: NCT04437602, date of registration: June 18, 2020.

scholarly journals New technologies in breast cancer detection – contrast enhanced dual-energy spectral mammography

2019 ◽  
pp. 49-61
Author(s):  
A. V. Chernaya ◽  
S. N. Novikov ◽  
P. V. Krivorotko ◽  
R. Kh. Ulyanova ◽  
V. V. Danilov
Keyword(s):  
Breast Cancer ◽  
Digital Mammography ◽  
Predictive Value ◽  
New Technologies ◽  
Malignant Tumors ◽  
Dual Energy ◽  
Post Contrast ◽  
Morphological Studies ◽  
Contrast Enhanced ◽  
Sensitivity Specificity

Purpose: to study the possibilities of contrast enhanced dual-energy spectral mammography (CESM) in the diagnostics of malignant tumors in the breast.Material and methods. Forty-seven patients with suspicious for breast cancer (BC) lesions underwent CESM. Digital mammography (MMG) and post-contrast images were correlated with the results of path morphological studies after surgery or puncture biopsy was performed.Results. Sensitivity, specificity and overall accuracy in the diagnostics of breast cancer were 83.3%, 85.7%, 85.1% for digital mammography and 91.6%, 91.4%, 91.4% for CESM, respectively. The positive predictive value was 66.6% for digital MMG and 78.5% for CESM. The negative predictive value (NPV) was 96.9% for the CESM and exceeded NPV of the digital MMG, which was 93.7%.Conclusion. Thus, these findings suggest that CESM is an effective method for the diagnostics of malignant tumors in the breast.

scholarly journals Texture Analysis of Dynamic Contrast-Enhanced MRI in Evaluating Pathologic Complete Response (pCR) of Mass-Like Breast Cancer after Neoadjuvant Therapy

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Kun Cao ◽  
Bo Zhao ◽  
Xiao-Ting Li ◽  
Yan-Ling Li ◽  
Ying-Shi Sun
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Neoadjuvant Therapy ◽  
Texture Analysis ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Imaging Method ◽  
First Order ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

Objectives. MRI is the standard imaging method in evaluating treatment response of breast cancer after neoadjuvant therapy (NAT), while identification of pathologic complete response (pCR) remains challenging. Texture analysis (TA) on post-NAT dynamic contrast-enhanced (DCE) MRI was explored to assess the existence of pCR in mass-like cancer. Materials and Methods. A primary cohort of 112 consecutive patients (40 pCR and 72 non-pCR) with mass-like breast cancers who received preoperative NAT were retrospectively enrolled. On post-NAT MRI, volumes of the residual-enhanced areas and TA first-order features (19 for each sequence) of the corresponding areas were achieved for both early- and late-phase DCE using an in-house radiomics software. Groups were divided according to the operational pathology. Receiver operating characteristic curves and binary logistic regression analysis were used to select features and achieve a predicting formula. Overall diagnostic abilities were compared between TA and radiologists’ subjective judgments. Validation was performed on a time-independent cohort of 39 consecutive patients. Results. TA features with high consistency (Cronbach’s alpha >0.9) between 2 observers showed significant differences between pCR and non-pCR groups. Logistic regression using features selected by ROC curves generated a synthesized formula containing 3 variables (volume of residual enhancement, entropy, and robust mean absolute deviation from early-phase) to yield AUC = 0.81, higher than that of using radiologists’ subjective judgment (AUC = 0.72), and entropy was an independent risk factor (P<0.001). Accuracy and sensitivity for identifying pCR were 83.93% and 70.00%. AUC of the validation cohort was 0.80. Conclusions. TA may help to improve the diagnostic ability of post-NAT MRI in identifying pCR in mass-like breast cancer. Entropy, as a first-order feature to depict residual tumor heterogeneity, is an important factor.

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.

Diagnostic Values of Breast Imaging Reporting and Data System and ultrasound Elastography in Benign and Malignant Breast Tumor

2016 ◽  
Vol 13 (10) ◽  
pp. 6509-6513
Author(s):  
Xin-Hua Lu
Keyword(s):  
Breast Cancer ◽  
Roc Curve ◽  
Predictive Value ◽  
Breast Tumor ◽  
Breast Imaging ◽  
Data System ◽  
Ultrasound Elastography ◽  
Malignant Breast Tumor ◽  
Diagnostic Values ◽  
Malignant Breast

Objective: To evaluate the diagnostic values of Breast Imaging Reporting and Data System (BI-RADS), ultrasound elastography (UE) and the combination in differentiating benign and malignant breast tumor. Methods: The BI-RADS and UE image features of 248 breast cancer patients (a total of 260 lesions) proved by surgery and pathology from February 2013 to March 2015 were retrospectively analyzed. With the pathologic results as the gold standard, the sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for BI-RADS, UE and the combination. On the basis of the sensitivity and specificity, they were analyzed by receiver operating characteristic (ROC) curve. Results: In all 260 lesions, 71 lesions were benign and 189 were malignant according to UE diagnosis; 50 lesions were benign and 210 were malignant proved by BI-RADS; 55 lesions were benign and 205 were malignant diagnosed by the combination. The sensitivity (86.09%), specificity (61.64%), positive predictive value (85.19%), negative predictive value (63.38%), and accuracy (79.23%) of ultrasound elastography were all less than that of BI-RADS (98.39%, 64.38%, 88.85%, 87.62%, 94.00%) and the combination (99.47%, 73.97%, 92.31%, 90.73%, 98.18%). The areas under the ROC curve for UE, BI-RADS and the combination were respectively 0.746[95%CI(0.673–0.818)], 0.814[95%CI(0.744–0.884)] and 0.867[95%CI(0.805–0.929)]. Conclusion: Ultrasonic BI-RADS can be the first choice for diagnosing breast cancer, with UE as the auxiliary method. The combined application can further improve the diagnosis rate of benign and malignant breast tumor.

scholarly journals 3–5 BI-RADs Microcalcifications: Correlation between MRI and Histological Findings

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Valeria Fiaschetti ◽  
Chiara Adriana Pistolese ◽  
Tommaso Perretta ◽  
Elsa Cossu ◽  
Chiara Arganini ◽  
...  
Keyword(s):  
Predictive Value ◽  
Breast Imaging ◽  
Breast Mri ◽  
Data Systems ◽  
Mri Findings ◽  
Day Range ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Stereotactic Vacuum Assisted Biopsy ◽  
Sensitivity Specificity

Purpose. To evaluate the correlation between MRI and histopathological findings in patients with mammographically detected 3–5 BI-RAD (Breast Imaging Reporting And Data Systems) microcalcifications and to allow a better surgical planning. Materials and Method. 62 female Patients (age ) with screening detected 3–5 BI-RAD microcalcifications underwent dynamic 3 T contrast-enhanced breast MRI. After 30-day (range 24–36 days) period, 55 Patients underwent biopsy using stereotactic vacuum-assisted biopsy (VAB), 5 Patients underwent stereotactic mammographically guided biopsy, and 2 Patients underwent MRI-guided VAB. Results. Microhistology examination demonstrated 36 malignant lesions and 26 benign lesions. The analysis of MRI findings identified 8 cases of MRI BI-RADS 5, 23 cases of MRI BI-RADS 4, 11 cases of MRI BI-RADS 3, 4 cases type A and 7 cases type B, and 20 cases of MRI BI-RADS 1-2. MRI sensitivity, specificity, positive predictive value, and negative predictive value were 88.8%, 76.9%, 84.2%, and 83.3%, respectively.

Magnetic Resonance Imaging of the Breast

2001 ◽  
Vol 8 (5) ◽  
pp. 399-406 ◽  
Author(s):  
Christopher P. Goscin ◽  
Claudia G. Berman ◽  
Robert A. Clark
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Studies ◽  
Breast Imaging ◽  
Breast Mri ◽  
Resonance Imaging ◽  
Valuable Adjunct ◽  
Interpretation Criteria ◽  
Contrast Enhanced

Background Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of invasive breast cancer. In clinical studies, breast MRI has often altered the course of patient care. Although promising results have been generated, MRI of the breast is currently in a development stage. Methods The authors reviewed the literature on the potential indications, sensitivity, specificity, and limitations of MRI of the breast. Results Reported advantages of MRI of the breast over conventional imaging techniques include improved staging and treatment planning, enhanced evaluation of the augmented breast, better detection of recurrence, and improved screening of high-risk women. Contrast-enhanced breast MRI is a sensitive modality for detecting breast cancer, but its variable specificity is a major limitation. Conclusions MRI of the breast is emerging as a valuable adjunct to mammography and sonography for specific clinical indications. Additional clinical studies that define indications, interpretation criteria, imaging parameters, and cost effectiveness are needed. A multi-institutional study designed to address these issues is in progress.

scholarly journals Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R Abdullah ◽  
L Abdelmonem ◽  
N Nasry ◽  
M Ayoub
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Malignant Tumors ◽  
High Energy ◽  
Added Value ◽  
Breast Lesions ◽  
Predictive Values ◽  
Dense Breasts ◽  
Contrast Enhanced

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

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