Corrigendum: Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

This corrects the article on p. 57 in vol. 25, PMID: 35133093.

Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x.

PURPOSE: Artificial intelligence (AI)-based computer-aided detection/diagnosis (CADe/x) has helped improve radiologists' performance and provides results equivalent or superior to those of radiologists' alone. This prospective multicenter cohort study aims to generate real-world evidence on the overall benefits and disadvantages of using AI-based CADe/x for breast cancer detection in a population-based breast cancer screening program comprising Korean women aged ≥ 40 years. The purpose of this report is to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of Korean women with average breast cancer risk. METHODS: Approximately 32,714 participants will be enrolled between February 2021 and December 2022 at 5 study sites in Korea. A radiologist specializing in breast imaging will interpret the mammography readings with or without the use of AI-based CADe/x. If recall is required, further diagnostic workup will be conducted to confirm the cancer detected on screening. The findings will be recorded for all participants regardless of their screening status to identify study participants with breast cancer diagnosis within both 1 year and 2 years of screening. The national cancer registry database will be reviewed in 2026 and 2027, and the results of this study are expected to be published in 2027. In addition, the diagnostic accuracy of general radiologists and radiologists specializing in breast imaging from another hospital with or without the use of AI-based CADe/x will be compared considering mammography readings for breast cancer screening. DISCUSSION: The Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM) study is a prospective multicenter study that aims to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of women with average breast cancer risk. AI-STREAM is currently in the patient enrollment phase. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05024591.

Comparison of Abbreviated MRI with Mammography and Ultrasound in Women with a Personal History of Breast Cancer.

RATIONALE AND OBJECTIVES: To compare abbreviated MRI with mammography and US for screening in women with a personal history of breast cancer. In addition, the first and subsequent rounds of abbreviated MRI were compared. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study. Nine hundred and thirty-nine abbreviated MRI scans of 710 women with a personal history of breast cancer were included (mean age, 54.1±9.4 years). The diagnostic performances of abbreviated MRI, mammography, and US for the detection of the second breast cancer were compared. When more than one round of abbreviated MRI was performed, we compared the scans of the first and subsequent rounds. RESULTS: There were 15 (2.1%) cases of second breast cancer. Thirty-nine of the 939 abbreviated MRI scans were diagnosed as positive; of them, 11 were diagnosed as breast cancer, with a PPV2 of 28.2% (US, 19.0%; mammography, 28.6%). The AUC, sensitivity, and cancer detection rate (per 1000) were the highest for abbreviated MRI (0.829, 68.8% and 11.7) (US: 0.616, 25.0%, and 4.3; mammography: 0.560, 12.5%, and 2.1, respectively). Two hundred women underwent multiple rounds of abbreviated MRI. AUC, PPV2, and the cancer detection rates were higher during the subsequent rounds (0.987, 45.5, and 21.8) than during the first round (0.605, 11.1, and 5). CONCLUSION: Abbreviated MRI for women with a personal history of breast cancer was more sensitive for the diagnosis of second breast cancer than US or mammography. In addition, subsequent rounds of MRI showed better performance than the first round.

Diagnostic value of mammography for accompanying non-mass enhancement on preoperative breast MRI.

BACKGROUND: Successful surgical treatment for localized breast cancer can depend on accurate diagnosis for accompanying non-mass enhancement (NME) on preoperative breast magnetic resonance imaging (MRI). PURPOSE: To evaluate the diagnostic value of mammography for accompanying NME adjacent to index cancer on preoperative breast MRI. MATERIAL AND METHODS: Among 569 consecutive patients who underwent preoperative breast MRI from January 2016 to August 2018 for ultrasound-guided biopsy-proven breast cancer, 471 patients who underwent initial mammography and subsequent surgery were finally included. Two radiologists retrospectively reviewed preoperative MRI findings of the 471 patients and detected accompanying NME adjacent to index cancer. MRI, mammography, and histopathology findings of the accompanying NME were evaluated using Pearson's chi-square test, Mann-Whitney U test, and logistic regression analysis. The area under the receiver operating characteristic curve (AUC) of MRI and combined MRI and mammography was calculated in differentiating benign from malignant accompanying NME. The reference standard was surgical pathologic findings. RESULTS: MRI revealed 93 accompanying NME lesions in 92 (19.5%) of the 471 patients, showing 55 (59.1%) malignant and 38 (40.9%) benign lesions. On multivariate analysis, malignant NME lesions were more associated with mammography-positive findings (P = 0.000), clumped or clustered ring internal enhancement (P = 0.015), and extensive intraductal component presence of index tumor (P = 0.007) compared with benign lesions. The AUC increased after correlation with mammography showing 0.649 (95% confidence interval [CI] 0.533-0.765) for MRI and 0.833 (95% CI 0.747-0.919) for combined MRI and mammography. CONCLUSION: Mammography is valuable in predicting malignancy for accompanying NME on preoperative breast MRI.

The usefulness of ultrafast MRI evaluation for predicting histologic upgrade of ductal carcinoma in situ.

PURPOSE: The purpose of this study was to investigate the usefulness of ultrafast MRI with conventional dynamic contrast-enhanced (DCE)-MRI for predicting histologic upgrade of ductal carcinoma in situ (DCIS) to invasive cancer. METHODS: This retrospective study enrolled 53 biopsy-proven DCIS lesions in 53 patients and divided into two groups based on postoperative histopathologic diagnoses: non-upgrade and upgrade to invasive cancer groups. Imaging features of conventional DCE-MRI and ultrafast MRI, and histopathologic features were reviewed and compared between the two groups. Interobserver agreements for MRI features were analyzed by two radiologists. The radiologic and histopathologic parameters for predicting histologic upgrade of DCIS were identified using multiple linear regression. RESULTS: Seventeen lesions (32.1 %) were histologically upgraded to invasive cancer after surgery. The interobserver agreement for ultrafast MRI parameters was excellent, and maximum slope (MS) and maximum enhancement (ME) showed the highest reliability (intraclass correlation coefficients, 0.907 and 0.897, respectively). The upgrade group showed significantly larger lesion size on MRI (median 40 mm [25th to 75th percentiles 16.0-83.0] vs. 18.5 mm [10.0-29.8], p < 0.001), higher MS (12.1 %/s [8.2-13.9] vs. 8.7 %/s [6.4-11.1], p = 0.004), and higher ME (236.5 % [153.7-253.7] vs. 175.4 % [140.1-207.7], p = 0.027) than non-upgrade group. Lesion size (≥ 20 mm), MS (> 11.5 %), and ME (> 229.1 %) were significant predictors for histologic upgrade, which could predict 10 cases of histologic upgrade (10/17, 58.8 %) without a false-positive case. CONCLUSION: Preoperative ultrafast MRI with conventional DCE-MRI could be useful in management decisions for DCIS patients.

Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer.

The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ±â€Š6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ±â€Š6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.

The additional utility of ultrafast MRI on conventional DCE-MRI in evaluating preoperative MRI of breast cancer patients.

PURPOSE: To investigate whether the additional use of ultrafast MRI can improve the diagnostic performance of conventional dynamic contrast-enhanced MRI (DCE-MRI) in evaluating MRI-detected lesions in breast cancer patients. METHODS: This retrospective study enrolled 101 consecutive breast cancer patients with 202 breast lesions (62 benign and 140 malignant) who underwent preoperative DCE-MRI with ultrafast imaging (9 image sets with 6.5-second temporal resolution). Two reviewers assessed the BI-RADS categories of breast lesions using conventional DCE-MRI and assessed the following parameters using the ultrafast MRI: initial enhancement phase, maximum relative enhancement, slope, and maximum slope (slopemax) on the kinetic curve. Interobserver agreement was analyzed between the two reviewers. The ultrafast MRI parameters were compared between benign and malignant tumors, and cut-off values were determined. For 97 additional MRI-detected lesions, the BI-RADS category was re-assessed using cut-off values, and the diagnostic performance was compared between the conventional DCE-MRI and the combined conventional and ultrafast DCE-MRI. RESULTS: All ultrafast MRI parameters differed significantly between malignant and benign tumors (p < 0.001). Initial enhancement phase by reviewer and slopemax were the top two parameters showing significant differences between benign and malignant tumors with high reliability. With the use of cut-off values for initial enhancement phase (≤phase 2) and slopemax (>9.8%/sec), the specificity of conventional DCE-MRI was significantly increased (29.4% vs 64.7%, p < 0.001) without significant loss of sensitivity (100% vs 88.2%, p = 0.157) in evaluating masses. CONCLUSIONS: The additional use of ultrafast MRI can improve the specificity of conventional DCE-MRI when evaluating MRI-detected masses in breast cancer patients.

MRI diagnostic features for predicting nipple-areolar-complex involvement in breast cancer.

PURPOSE: To evaluate magnetic resonance imaging (MRI) features including tumor-nipple enhancement for predicting nipple-areolar-complex (NAC) involvement in breast cancer. METHODS: A total of 249 breast cancer cases with available preoperative MRI data were studied. On MRI, tumor-nipple enhancement was evaluated 2 min (early) and 6 min (delayed) after contrast injection. Asymmetric nipple enhancement, mass size, tumor-nipple distance, presence of nipple discharge, and enhancement type (mass or non-mass enhancement) were evaluated. RESULTS: Of the 249 breast cancers, 24 (9.6%) showed NAC involvement. Early tumor-nipple enhancement was found in 37 (14.9%) cancers and delayed tumor-nipple enhancement in 12 (4.8%) cancers. On comparing early and delayed enhancement, 43.2% (16/37) of early tumor-nipple enhancements showed NAC involvement while 25.0% (3/12) of delayed tumor-nipple enhancements showed NAC involvement (P = 0.323). On multivariate analysis, tumor-nipple enhancement (P = 0.004) and tumor-nipple distance with 2 cm cut-off (P = 0.044) were significant. The area under the receiver-operating-characteristic curve (AUC) of early tumor-nipple enhancement was significantly higher (0.787) than that of delayed tumor-nipple enhancement (0.542, P = 0.001). The AUC was the highest when any kind of tumor-nipple enhancement was combined with a tumor-nipple distance of 1 cm (0.878). CONCLUSIONS: Tumor-nipple enhancement and tumor-nipple distance on MRI could predict NAC involvement in breast cancer. When enhancement was evaluated on both early and delayed phase images with a combined tumor-nipple distance of ≤1 cm, the prediction of NAC involvement showed the best performance.

Can Ultrasonographic Vascular and Elastographic Features of Invasive Ductal Breast Carcinoma Predict Histologic Aggressiveness?

RATIONALE AND OBJECTIVES: To investigate if preoperative ultrasonographic vascular and shear-wave elastographic examinations can predict histologic aggressiveness. MATERIALS AND METHODS: Preoperative ultrasonographic vascular features and shear-wave elasticities were retrospectively evaluated for 147 invasive ductal carcinomas. Vascular feature was assessed using four-tier vascularity score. Mean and maximum elasticities (Emean and Emax), and the lesion-to-fat ratio (Eratio) were documented. Histologic parameters were reviewed for tumor size, multiplicity, axillary lymph node status, lymphovascular invasion, histologic grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor2 (HER2), Ki-67, p53, and histologic subtype. Vascularity score and elasticities were correlated with histologic parameters and histologic parameters were compared between the group with low vascularity score and elasticities and the group with high vascularity score and elasticities using ANOVA, chi-squared test, and regression analysis. RESULTS: Vascularity score was independently associated with tumor size (p = 0.010) and HER2 (p = 0.007). Emean and Emax were associated with tumor size, histologic grade, and lymphovascular invasion, and Eratio was associated with tumor size, histologic grade, estrogen receptor, progesterone receptor, Ki-67, and histologic subtype (p < 0.05). Emean and Emax were independently associated with tumor size (p < 0.001). The group with high vascularity score and Eratio showed large tumor size (p < 0.001) and HER2 positivity (p = 0.039) in comparison to the group with low vascularity score and Eratio. CONCLUSION: Ultrasonographic vascular features were associated with tumor size and HER2. SWE elasticities were associated with tumor size, histologic grade, hormonal receptor, and histologic subtype. Therefore, preoperative vascular and elastographic examinations could predict histologic aggressiveness of invasive ductal breast carcinoma.

Can enhancement types on preoperative MRI reflect prognostic factors and surgical outcomes in invasive breast cancer?

OBJECTIVES: This study was conducted in order to evaluate whether enhancement types on preoperative MRI can reflect prognostic factors and surgical outcomes in invasive breast cancer. METHODS: Among 484 consecutive patients who underwent preoperative breast MRI from October 2014 to July 2017 for biopsy-proven breast cancer, 313 patients with 315 invasive breast cancers who underwent subsequent surgery were finally included in this study. Two radiologists retrospectively reviewed preoperative MRI findings of these 315 lesions and categorized them to mass, nonmass, and combined type according to enhancement features. Combined type was defined as coexisted mass and nonmass enhancement. Histopathologic results focusing on prognostic factors and surgical outcomes were compared among the three types of lesion using Pearson's chi-square, linear-by-linear association, Kruskal-Wallis, one-way ANOVA test, and multinomial logistic regression. RESULTS: Of the cancers analyzed, 198 (62.9%) were mass, 59 (18.7%) were nonmass, and 58 (18.4%) were combined type. The nonmass type showed the smallest invasive tumor size (p < 0.001) and the most common positive HER2 receptor status (p = 0.001). The combined type had the most frequent lymphovascular invasion (p = 0.011), axillary lymph node-positive status (p = 0.031), operation changes (p < 0.001), and first resection margin-positive status (p < 0.001). Initial operation of mastectomy was more frequent in the nonmass and combined types than that in the mass type (p < 0.001). But HER2 receptor status and operation changes showed no statistical significance on multivariate analysis. CONCLUSIONS: Enhancement types on preoperative MRI reflect different prognostic factors and surgical outcomes in invasive breast cancer. KEY POINTS: • Morphologic features of contrast media uptake on contrast-enhanced MRI may be related with fundamental biological differences of invasive breast cancers. • Mass or nonmass enhancement type on preoperative MRI might reflect different prognostic factors and surgical outcomes in invasive breast cancer. • The combined mass and nonmass enhancement type might be associated with poorer prognosis and worse surgical outcomes.

Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study.

Objective: To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer. Materials and Methods: We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27-79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins. Results: In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076). Conclusion: Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.

New Doppler imaging technique for assessing angiogenesis in breast tumors: correlation with immunohistochemically analyzed microvessels density.

BACKGROUND: Microvessel density (MVD) is associated with grade and prognosis in breast tumors. However, conventional color Doppler flow (CDF) imaging has been limited to represent MVD of breast tumors. PURPOSE: To evaluate whether a new Doppler imaging technique (AngioPLUS) can represent MVD of breast tumors. MATERIAL AND METHODS: The institutional review board approved this retrospective study, and patients' informed consent was waived. CDF and AngioPLUS were available in pathologically confirmed 55 breast tumors of 53 women. For each lesion, vascular flow patterns (distribution and amount) of both Doppler images were retrospectively reviewed, and MVD was measured using immunohistochemical analysis of the biopsied tissue sections. MVD was subcategorized as low or high group with reference to the median. The associations between the Doppler features and MVD were evaluated using Fisher's exact test and Student's t test. RESULTS: Of the 55 masses, 28 (50.9%) were benign and 27 (49.1%) were malignant. Vascular flow distribution and amount of both Doppler imaging were different between the benign and malignant lesions (CDF, P = 0.020 and P = 0.010; AngioPLUS, P = 0.002 and P = 0.005). MVD had no significant relationships with CDF features, but vascular flow distribution on AngioPLUS showed significant differences between the lesions with low and high MVD ( P = 0.020); Combined distribution was more frequent in the high MVD lesions than in the low MVD lesions (17/28, 60.7% vs. 6/27, 22.2%). CONCLUSION: Our data confirmed the correlation between a new Doppler imaging technique, AngioPLUS, and MVD. We suggest that AngioPLUS can be used for assessing MVD in breast tumors.

Accuracy of Ultrasound for Preoperative Assessment of Tumor Size in Patients With Newly Diagnosed Breast Cancer: Is It Affected by the Background Parenchymal Echotexture?

OBJECTIVES: To assess the impact of the background parenchymal echotexture on the accuracy of tumor size estimation using breast ultrasound (US). METHODS: A total of 140 women with newly diagnosed invasive breast cancer from January 2014 to December 2015 were enrolled in this study. Two radiologists retrospectively reviewed US images in consensus for background parenchymal echotexture interpretation. The maximum tumor diameter from static images was recorded. Tumor size measurements were considered as having agreement with histologic results if they were within ±5 mm compared to the pathologic size. The relationship between the accuracy of tumor size measurement by the background parenchymal echotexture and clinicopathologic characteristics was evaluated. RESULTS: Of these 140 patients, 77 (55.0%) showed a homogeneous background parenchymal echotexture, whereas 63 (45.0%) showed a heterogeneous echotexture. The mean tumor size was 1.9 cm (range, 0.5-4.9 cm). The overall accuracy of tumor size measurement was 76.4% (104 of 140). Tumors of women with a homogeneous background parenchymal echotexture were more accurately measured than those of women with a heterogeneous echotexture (87.0% versus 63.5%; P = .001). Tumors with a small size (<2 cm; P = .018) and ductal carcinoma in situ-negative (P = .031), human epidermal growth factor receptor 2 (HER2)-negative (P = .053), and triple-negative (P = .016) types were also more accurately measured. The independent factors associated with inaccurate tumor size measurement were a heterogeneous background parenchymal echotexture, a large tumor size, and the HER2-enriched type (P < .05). CONCLUSIONS: The background parenchymal echotexture affected the accuracy of tumor size estimation using breast US. Invasive breast cancers with large (≥2 cm) tumors and the HER2-enriched type showed significantly lower breast US accuracy compared to others.

Comparison of the Diagnostic Performance of Power Doppler Ultrasound and a New Microvascular Doppler Ultrasound Technique (AngioPLUS) for Differentiating Benign and Malignant Breast Masses.

This study was performed to compare the diagnostic performance of power Doppler ultrasound (US) and a new microvascular Doppler US technique (AngioPLUS; SuperSonic Imagine, Aix-en-Provence, France) for differentiating benign and malignant breast masses. Power Doppler US and AngioPLUS findings were available in 124 breast masses with confirmed pathologic results (benign, 80 [64.5%]; malignant, 44 [35.5%]). The diagnostic performance of each tool was calculated to distinguish benign from malignant masses using a receiver operating characteristic curve analysis and compared. The area under the curve showed that AngioPLUS was superior to power Doppler US in differentiating benign from malignant breast masses, but the difference was not statistically significant.

Complications and Radiologic Features of Breast Augmentation via Injection of Aquafilling Gel.

Many attempts have been made to augment breasts using injectable materials; however, various complications are associated with these materials. Aquafilling gel (Aquafilling, Podebrady, Czech Republic) is a new soft tissue filler that has been used as an implant material for the face and lip and recently for breast augmentation. This article describes 3 cases of augmentation mammoplasty using Aquafilling gel, focusing on their complications and radiologic features.

The antipsychotic agent clozapine induces autophagy via the AMPK-ULK1-Beclin1 signaling pathway in the rat frontal cortex.

Clozapine, a representative atypical antipsychotic, has superior efficacy compared to other antipsychotic agents and is used for the treatment of severe psychotic disorders. Therefore, studies on its mechanisms of action are important for understanding the mechanisms of therapeutic approaches to psychosis. Adenosine monophosphate-activated protein kinase (AMPK) is a serine-threonine kinase that plays a major role in maintaining metabolic homeostasis. Unc-51-like kinase 1 (ULK1) and Beclin1 are downstream substrates of AMPK and activate the autophagic process. In this study, we examined the effects of clozapine on the AMPK-ULK1-Beclin1 signaling pathway and autophagy in the frontal cortex of the rat. Clozapine (10mg/kg) administration increased the immunoreactivity of p-Thr172-AMPKα in the rat frontal cortex at 1, 2, and 4h after injection, as we previously reported. The immunoreactivity of p-Ser317-ULK1 and p-Ser93-Beclin1 was also increased at 2 and 4h after clozapine injection. At the same time, the immunoreactivity of LC3-II and the Atg5-Atg12 conjugate, which indicate activation of autophagy, was increased. Transmission electron microscopy clearly showed an increase in autophagosome number in the rat frontal cortex at 2h after clozapine injection. To investigate the role of AMPK in clozapine-induced autophagy, the effects of intracerebroventricular injection of compound C, an AMPK inhibitor, were examined. Administration of compound C attenuated the clozapine-induced increase in ULK1 and Beclin1 phosphorylation, as well the protein levels of LC3-II and the Atg5-Atg12 conjugate in the frontal cortex. In summary, the results showed that clozapine activates autophagy through the AMPK-ULK1-Beclin1 signaling pathway in the frontal cortex of the rat.

Analysis of background parenchymal echogenicity on breast ultrasound: Correlation with mammographic breast density and background parenchymal enhancement on magnetic resonance imaging.

The purpose of this study was to analyze the background parenchymal echotexture (BP echo) on breast ultrasound in detail and to evaluate the relation BP echo with menopausal status. In addition, we correlated BP echo with mammographic breast density (MGD) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI).The institutional review board of our hospital approved this retrospective study, and the requirement of informed consent was waived. We studied 138 women (mean age 51.6 years, range from 26 to 79 years) with newly diagnosed invasive breast cancer, who had performed preoperative mammography, ultrasound, and MR from June 2013 to June 2015. BP echo was classified as homogeneous and heterogeneous according to the BI-RADS US lexicon. MGD was described into fatty, scattered, heterogeneously dense, and extremely dense. BPE was categorized as minimal, mild, moderate, and marked. The relationship between the BP echo and menopausal status was investigated. Associations between the degree of BP echo with MGD grades and BPE grades were also evaluated.Of the 138 women, 74 (54%) were premenopausal and 64 (46%) were postmenopausal. Premenopausal women were more likely to have heterogeneous BP echo (60/74, 81%) compared with postmenopausal women (10/64, 16%) (P = .000). BP echo showed significant correlation with BPE in both premenopausal and postmenopausal women (P = .000). However, MGD showed no significant correlation with BP echo or BPE, regardless of menopausal states. In the postmenopausal group, 70% women (21/30) with dense MGD showed homogeneous BP echo and 77% women (23/30) with dense MGD showed nondense BPE.In conclusion, we demonstrated that the BP echo was influenced by menopausal status. Our data support the concept that BP echo is influenced by breast hormonal changes. Because there was a significant association between BP echo and BPE in pre- and post-menopausal women, the BP echo might be a good predictor for BPE.

Shear Wave Elastography for Surgically Verified Breast Papillary Lesions: Is It Effective for Differentiation Between Benign and Malignant Lesions?

OBJECTIVES: To evaluate the effectiveness of shear wave elastography (SWE) for differentiating benign from malignant breast papillary lesions METHODS: B-mode ultrasound (US) and SWE were available in 56 surgically confirmed papillary lesions (48 [85.7%] benign and 8 [14.3%] malignant). The diagnostic performances of US, SWE parameters, and combined US with SWE parameters were calculated by receiver operating characteristic curve analysis and compared. RESULTS: The highest area under the receiver operating characteristic curve (Az ) value for US was 0.500 (95% confidence interval [CI], 0.363, 0.637). The sensitivity was 100% (8 of 8), and the specificity was 0% (0 of 48). False-positive biopsy results were obtained in 48 (85.7%) of 56 lesions. The Az value for mean elasticity (0.721; 95% CI, 0.585, 0.833) was higher than that for B-mode US (P < .01) and the highest with the optimal cutoff value of 44.3 kPa (sensitivity, 75%; specificity, 75%). By adding the mean elasticity cutoff value of 44.3 kPa to B-mode US, the performance was increased (Az , 0.781; 95% CI, 0.585, 0.833) with sensitivity of 87.5% and specificity of 68.8%, and false-positive biopsy results were reduced to 26.8%. CONCLUSIONS: The additional use of SWE to B-mode US may be effective for differentiating benign and malignant breast papillary lesions, with a significant decrease in the false-positive biopsy rate.

Evaluation of Screening US-detected Breast Masses by Combined Use of Elastography and Color Doppler US with B-Mode US in Women with Dense Breasts: A Multicenter Prospective Study.

Purpose To investigate the value of the combined use of elastography and color Doppler ultrasonography (US) with B-mode US for evaluation of screening US-detected breast masses in women with dense breasts. Materials and Methods This prospective, multicenter study included asymptomatic women with dense breasts who were referred for screening US between November 2013 and December 2014. Eligible women had a newly detected breast mass at conventional B-mode US screening, for which elastography and color Doppler US were performed. The following outcome measures were compared between B-mode US and the combination of B-mode US, elastography, and color Doppler US: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and the number of false-positive findings at screening US. Results Among 1021 breast masses (mean size, 1.0 cm; range, 0.3-3.0 cm) in 1021 women (median age, 45 years), 68 were malignant (56 invasive). Addition of elastography and color Doppler US to B-mode US increased the AUC from 0.87 (95% confidence interval [CI]: 0.82, 0.91) to 0.96 (95% CI: 0.95, 0.98; P < .001); specificity from 27.0% (95% CI: 24.2%, 29.9%) to 76.4% (95% CI: 73.6%, 79.1%; P < .001) without loss in sensitivity (95% CI: -1.5%, 1.5%; P > .999); and PPV from 8.9% (95% CI: 7.0%, 11.2%) to 23.2% (95% CI: 18.5%, 28.5%; P < .001), while avoiding 67.7% (471 of 696) of unnecessary biopsies for nonmalignant lesions. Conclusion Addition of elastography and color Doppler US to B-mode US can increase the PPV of screening US in women with dense breasts while reducing the number of false-positive findings without missing cancers. © RSNA, 2017 Online supplemental material is available for this article.