Inter-observer agreement on the evaluation of automated breast volume scanner for breast masses

Objective: To explore inter-observer agreement on the evaluation of automated breast volume scanner (ABVS) for breast masses. Methods: A total of 846 breast masses in 630 patients underwent ABVS examinations. The imaging data were independently interpreted by senior and junior radiologists regarding the mass size ([Formula: see text][Formula: see text]cm, [Formula: see text][Formula: see text]cm and total). We assessed inter-observer agreement of BI-RADS lexicons, unique descriptors of ABVS coronal planes. Using BI-RADS 3 or 4a as a cutoff value, the diagnostic performances for 331 masses with pathological results in 253 patients were assessed. Results: The overall agreements were substantial for BI-RADS lexicons ([Formula: see text]–0.779) and the characteristics on the coronal plane of ABVS ([Formula: see text]), except for associated features ([Formula: see text]). However, the overall agreement was moderate for orientation ([Formula: see text]) for the masses [Formula: see text][Formula: see text]cm. The agreements were substantial to be perfect for categories 2, 3, 4, 5 and overall ([Formula: see text]–0.918). However, the agreements were moderate to substantial for categories 4a ([Formula: see text]), 4b ([Formula: see text]), and 4c ([Formula: see text]), except for category 4b of the masses [Formula: see text][Formula: see text]cm ([Formula: see text]). Moreover, for radiologists 1 and 2, there were no significant differences in sensitivity, specificity, accuracy, positive and negative predictive values with BI-RADS 3 or 4a as a cutoff value ([Formula: see text] for all). Conclusion: ABVS is a reliable imaging modality for the assessment of breast masses with good inter-observer agreement.

Automated Breast Volume Scanner (ABVS)-Based Radiomic Nomogram: A Potential Tool for Reducing Unnecessary Biopsies of BI-RADS 4 Lesions

Improving the assessment of breast imaging reporting and data system (BI-RADS) 4 lesions and reducing unnecessary biopsies are urgent clinical issues. In this prospective study, a radiomic nomogram based on the automated breast volume scanner (ABVS) was constructed to identify benign and malignant BI-RADS 4 lesions and evaluate its value in reducing unnecessary biopsies. A total of 223 histologically confirmed BI-RADS 4 lesions were enrolled and assigned to the training and validation cohorts. A radiomic score was generated from the axial, sagittal, and coronal ABVS images. Combining the radiomic score and clinical-ultrasound factors, a radiomic nomogram was developed by multivariate logistic regression analysis. The nomogram integrating the radiomic score, lesion size, and BI-RADS 4 subcategories showed good discrimination between malignant and benign BI-RADS 4 lesions in the training (AUC, 0.959) and validation (AUC, 0.925) cohorts. Moreover, 42.5% of unnecessary biopsies would be reduced by using the nomogram, but nine (4%) malignant BI-RADS 4 lesions were unfortunately missed, of which 4A (77.8%) and small-sized (<10 mm) lesions (66.7%) accounted for the majority. The ABVS radiomics nomogram may be a potential tool to reduce unnecessary biopsies of BI-RADS 4 lesions, but its ability to detect small BI-RADS 4A lesions needs to be improved.

Risk Factors Related to Acute Radiation Dermatitis in Breast Cancer Patients After Radiotherapy: A Systematic Review and Meta-Analysis

BackgroundAcute radiation dermatitis (ARD) is the most common acute response after adjuvant radiotherapy in breast cancer patients and negatively affects patients’ quality of life. Some studies have reported several risk factors that can predict breast cancer patients who are at a high risk of ARD. This study aimed to identify patient- and treatment-related risk factors associated with ARD.MethodsPubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang literature databases were searched for studies exploring the risk factors in breast cancer patients. The pooled effect sizes, relative risks (RRs), and 95% CIs were calculated using the random-effects model. Potential heterogeneity and sensitivity analyses by study design, ARD evaluation scale, and regions were also performed.ResultsA total of 38 studies composed of 15,623 breast cancer patients were included in the analysis. Of the seven available patient-related risk factors, four factors were significantly associated with ARD: body mass index (BMI) ≥25 kg/m2 (RR = 1.11, 95% CI = 1.06–1.16, I2 = 57.1%), large breast volume (RR = 1.02, 95% CI = 1.01–1.03, I2 = 93.2%), smoking habits (RR = 1.70, 95% CI = 1.24–2.34, I2 = 50.7%), and diabetes (RR = 2.24, 95% CI = 1.53–3.27, I2 = 0%). Of the seven treatment-related risk factors, we found that hypofractionated radiotherapy reduced the risk of ARD in patients with breast cancer compared with that in conventional fractionated radiotherapy (RR = 0.28, 95% CI = 0.19–0.43, I2 = 84.5%). Sequential boost and bolus use was significantly associated with ARD (boost, RR = 1.91, 95% CI = 1.34–2.72, I2 = 92.5%; bolus, RR = 1.94, 95% CI = 1.82–4.76, I2 = 23.8%). However, chemotherapy regimen (RR = 1.17, 95% CI = 0.95–1.45, I2 = 57.2%), hormone therapy (RR = 1.35, 95% CI = 0.94–1.93, I2 = 77.1%), trastuzumab therapy (RR = 1.56, 95% CI = 0.18–1.76, I2 = 91.9%), and nodal irradiation (RR = 1.57, 95% CI = 0.98–2.53, I2 = 72.5%) were not correlated with ARD. Sensitivity analysis results showed that BMI was consistently associated with ARD, while smoking, breast volume, and boost administration were associated with ARD depending on study design, country of study, and toxicity evaluation scale used. Hypofractionation was consistently shown as protective. The differences between study design, toxicity evaluation scale, and regions might explain a little of the sources of heterogeneity.ConclusionThe results of this systematic review and meta-analysis indicated that BMI ≥ 25 kg/m2 was a significant predictor of ARD and that hypofractionation was consistently protective. Depending on country of study, study design, and toxicity scale used, breast volume, smoking habit, diabetes, and sequential boost and bolus use were also predictive of ARD.

Multicenter Study of Whole Breast Stiffness Imaging by Ultrasound Tomography (SoftVue) for Characterization of Breast Tissues and Masses

We evaluated whole breast stiffness imaging by SoftVue ultrasound tomography (UST), extracted from the bulk modulus, to volumetrically map differences in breast tissues and masses. A total 206 women with either palpable or mammographically/sonographically visible masses underwent UST scanning prior to biopsy as part of a prospective, HIPAA-compliant multicenter cohort study. The volumetric data sets comprised 298 masses (78 cancers, 105 fibroadenomas, 91 cysts and 24 other benign) in 239 breasts. All breast tissues were segmented into six categories, using sound speed to separate fat from fibroglandular tissues, and then subgrouped by stiffness into soft, intermediate and hard components. Ninety percent of women had mammographically dense breasts but only 11.2% of their total breast volume showed hard components while 69% of fibroglandular tissues were softer. All smaller masses (<1.5 cm) showed a greater percentage of hard components than their corresponding larger masses (p < 0.001). Cancers had significantly greater mean stiffness indices and lower mean homogeneity of stiffness than benign masses (p < 0.05). SoftVue stiffness imaging demonstrated small stiff masses, mainly due to cancers, amongst predominantly soft breast tissues. Quantitative stiffness mapping of the whole breast and underlying masses may have implications for screening of women with dense breasts, cancer risk evaluations, chemoprevention and treatment monitoring.

A Prospective Investigation of Predictive Parameters for Preoperative Volume Assessment in Breast Reconstruction

Preoperative breast volume estimation is very important for the success of the breast surgery. In this study four different breast volume determination methods were compared. The end-point of this prospective study was to evaluate the concordance between different modalities of breast volume assessment (MRI, BREAST-V, mastectomy specimen weight, conversion from weight to volume of mastectomy specimen) and the breast prosthetic volume implanted. The study enrolled 64 patients between 2017 and 2019, who had all been treated by the same surgeons for monolateral nipple–areola complex-sparing mastectomy and implant breast reconstruction. Only patients who had a breast reconstruction classified as “excellent” from an objective (BCCT.core software) and subjective (questionnaire) point of view at the 6-month interval after the operation were included in the study. Data analysis highlighted a strong correlation between the volumes of the chosen prostheses and the weights of mastectomy converted into volume, especially for patients with grades B and C parenchymal density. The values of the agreement between the volumes of the chosen prostheses and the assessments from MRI and BREAST -V proved to be lower than expected from the literature. None of the four studied methods presented any strong correlation with the initial breast width. Our results suggest that conversion from weight to volume of mastectomy specimen should be used to assist in determining the volume of the breast implant to be implanted. This method would help the reconstructive surgeon guide the choice of the most appropriate implant preoperatively.

Assessment of Risk Factors Associated with Cardiovascular Diseases in Overweight Women

The assessment of anthropometric variables has been shown to be useful as a predictor of cardiovascular risk in overweight and obese patients. The aim of this study was to determine the usefulness of the relationship between breast volume and body mass index as an indicator of cardiovascular risk in premenopausal women with overweight and mild obesity. A prospective observational study of 93 premenopausal women was performed. Evaluation of anthropometric measures included age, body mass index, waist and hip circumferences, breast projection, and ptosis. Cardiovascular risk factors were evaluated using the Framingham cardiovascular risk score, the triglycerides/HDL cholesterol ratio and the waist-hip ratio. Ninety-three women were included, with a mean 36.4 ± 7.5 years. Mean BMI was 27.3 ± 1.9 kg/m2, waist-to-Hip ratio was 0.8 ± 0.07, and mammary volume was 1045 ± 657.4 cm3. Mean body fat mass was 30.6 + 3.6% and mean visceral fat was 6.6 + 3.2%. The mean triglycerides to HDL ratio was 1.7 ± 0.8 and waist-to-hip ratio was 0.8 ± 0.07. Breast volume related to body mass index can be used as a predictor of cardiovascular risk in premenopausal women who are overweight and mildly obese.

The role of estrone in feminizing hormone treatment

Context In trans women, hormone treatment induces feminization, however the degree of feminization varies from person to person. A possible contributing factor could be estrone, a weak estrogen that interferes with the estrogen receptor. Objective To assess whether estrone is involved in feminization induced by hormone treatment. Design Prospective cohort study, with one year follow-up. Setting Gender identity clinic. Participants 212 adult trans women, starting hormone treatment between July 2017 and December 2019, median age 25 years. Intervention Gender affirming hormone treatment. Main outcome measures Change in fat percentage and breast development. Results After 12 months of hormone treatment, estrone concentration was 187pmol/L (95%CI 153 – 220) in transdermal and 1516pmol/L (95%CI 1284 – 1748) in oral estradiol users. Fat percentage increased by 1.2% (IQR 0.3 – 4.8) in transdermal and 4.6% (IQR 2.5 – 5.9) in oral estradiol users. This was not associated with estrone concentrations in transdermal(+4.4% (95%CI -4.0 – 13) per 100pmol/L increase in estrone concentration) nor in oral estradiol users (-0.7% (95%CI -1.7 – 0.3)). Breast volume increased by 69ml (IQR 58 – 134) in transdermal and 62ml (IQR 32 – 95) in oral estradiol users. This was not associated with estrone concentrations in transdermal (+ 14% (95%CI -49 – 156) per 100pmol/L increase in estrone concentration) nor oral estradiol users (+ 11% (95%CI -14 – 43)). Conclusions Change in fat percentage and breast development in trans women were not associated with estrone concentrations nor with administration route. Therefore measurement of estrone concentrations does not have a place in the monitoring of feminization in trans women.