Breast Density Analysis Using an Automatic Density Segmentation Algorithm.

Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density.

Breast core biopsy reporting categories--An internal validation in a series of 3054 consecutive lesions.

We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.

Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study.

BACKGROUND: The axillary nodal status is essential to determine the stage of disease at diagnosis. Our aim was to prospectively assess the diagnostic accuracy of ultrasonography-guided fine-needle aspiration (US-FNA) for the detection of metastasis in axillary lymph nodes in patients with breast cancer (BC) and its impact on the therapeutic decision. MATERIALS AND METHODS: Ultrasonography (US) was performed in 407 axillae of 396 patients who subsequently underwent surgery. US-FNA was conducted when lymph nodes were detected by US. Axillary dissection (AD) was performed when US-FNA was positive for metastasis. Patients with negative US-FNA and breast tumors of 30 mm in size were candidates for selective sentinel lymph node biopsy (SLNB). The anatomopathological results of AD or SLNB were used as reference tests. RESULTS: Lymph nodes were detected by US in 207 (50.8%) axillae. Of these, US-FNA was performed on 180 (86.9%). 94 axillae (52.2%) were positive for carcinoma and 79 women received AD. US-FNA had 77.5% sensitivity, 100% specificity, 100% positive predictive value, 69.3% negative predictive value, and 85.1% diagnostic accuracy. US-FNA avoided SLNB in 18.1% of patients who underwent AD. CONCLUSIONS: Axillary US-FNA is an accurate technique in the staging of patients with BC. It allows reducing the number of SLNB and, when positive, offers a fast and useful tool.

Shear-wave elastography and immunohistochemical profiles in invasive breast cancer: evaluation of maximum and mean elasticity values.

PURPOSE: To evaluate the correlations of maximum stiffness (Emax) and mean stiffness (Emean) of invasive carcinomas on shear-wave elastography (SWE) with St. Gallen consensus tumor phenotypes. METHODS: We used an ultrasound system with SWE capabilities to prospectively study 190 women with 216 histologically confirmed invasive breast cancers. We obtained one elastogram for each lesion. We correlated Emax and Emean with tumor size, histologic type and grade, estrogen and progesterone receptors, HER2 expression, the Ki67 proliferation index, and the five St. Gallen molecular subtypes: luminal A, luminal B without HER2 overexpression (luminal B HER2-), luminal B with HER2 overexpression (luminal B HER2+), HER2, and triple negative. RESULTS: Lesions larger than 20 mm had significantly higher Emax (148.04 kPa) and Emean (118.32 kPa) (P=0.005) than smaller lesions. We found no statistically significant correlations between elasticity parameters and histologic type and grade or molecular subtypes, although tumors with HER2 overexpression regardless whether they expressed hormone receptors (luminal B HER2+ and HER2 phenotypes) and triple-negative tumors had lower Emax and Emean than the others. We assessed the B-mode ultrasound findings of the lesions with some of the Emax or Emean values less than or equal to 80 kPa; only four of these had ultrasound findings suggestive of a benign lesion (two with luminal A phenotype and two with HER2 phenotype). CONCLUSIONS: We were unable to demonstrate statistically significant differences among the subtypes of invasive tumors, although there appears to be a trend toward lower Emax and Emean in the aggressive phenotypes.

Breast peripheral area correction in digital mammograms.

Digital mammograms may present an overexposed area in the peripheral part of the breast, which is visually shown as a darker area with lower contrast. This has a direct impact on image quality and affects image visualisation and assessment. This paper presents an automatic method to enhance the overexposed peripheral breast area providing a more homogeneous and improved view of the whole mammogram. The method automatically restores the overexposed area by equalising the image using information from the intensity of non-overexposed neighbour pixels. The correction is based on a multiplicative model and on the computation of the distance map from the breast boundary. A total of 334 digital mammograms were used for evaluation. Mammograms before and after enhancement were evaluated by an expert using visual comparison. In 90.42% of the cases, the enhancement obtained improved visualisation compared to the original image in terms of contrast and detail. Moreover, results show that lesions found in the peripheral area after enhancement presented a more homogeneous intensity distribution. Hence, peripheral enhancement is shown to improve visualisation and will play a role in further development of CAD systems in mammography.

The great mimicker: fat necrosis of the breast--magnetic resonance mammography approach.

Fat necrosis of the breast is a common benign inflammatory process resulting from injury to breast fat. The pathogenesis of fat necrosis helps to explain its imaging features, which range from benign to malignant-appearing findings. This article reviews the role of magnetic resonance mammography and other conventional imaging techniques in the differential diagnosis of fat necrosis.

Interval breast cancers in a community screening programme: frequency, radiological classification and prognostic factors.

The frequency of interval cancers (IC) can be an indicator inversely related to the quality of a breast screening programme. The objectives were to estimate the frequency of IC, to classify IC by posterior radiological review, and to describe the prognostic factors of these IC. The setting was the Sabadell-Cerdanyola Breast Cancer Screening Programme, in Northeast Spain. We developed a population-based study of the IC occurring in the first three rounds (1995-2001). The indicators used were the incidence rate of invasive IC per 10 000 women screened and the proportional incidence, stratified by age group, type of screening and the round, and the time elapsed since the last screening mammogram. A radiological informed consensus review was used to classify the IC. No specific pattern of incidence rates was evident with respect to age, type of screening, or round, although screening was generally more sensitive in women aged 60-69 years. The proportional incidence for the period 0-11 months was always under 30%. Twenty-one percent of 38 IC evaluated (95% CI: 8.0-34.0) were attributed to errors in the screening process (false negatives). No major differences in the prognostic factors of the 57 IC were identified on examining the radiological type or the time since the last screening mammogram. We observed a high frequency of IC from 12 months after screening. It is necessary to reach a consensus regarding the definition and the analysis of IC and to establish mechanisms that would allow all the malignant tumours diagnosed in the target population to be identified.

Linfoma de mama: hallazgos por resonancia magnética con correlación mamográfica y ecográfica / Breast lymphoma: MRI findings with mammographic and echographic correlations

Objetivo: Describir la presentación clínica, hallazgos radiológicos y evolución del linfoma de mama en nuestra serie, centrándonos en el subgrupo de pacientes con resonancia magnética (RM).Material y métodos: Revisamos retrospectivamente los 13 casos de linfoma de mama (tres primarios, nueve secundarios y uno indeterminado) diagnosticados en nuestro centro desde 1990 a 2002. Se valora-ron parámetros clínico terapéuticos así como la apariencia mamográfica (n = 11), ecográfica (n = 7) y RM (n = 8).Resultados: La forma de presentación clínica más frecuente fue el nódulo palpable (n = 11). En mamografía, cinco tenían márgenes bien delimitados, cuatro mal delimitados, uno afectación difusa y uno únicamente engrosamiento cutáneo. Cuatro asociaron afectación cutánea y cuatro adenopatías. Ecográficamente, la mayoría se comportaron como lesiones sólidas. El comportamiento de las lesiones en secuencias RM potenciadas en T2 y T1 fue variable, observando un predominio de lesiones hiperintensas en T2 (n = 6). Los márgenes de la mayoría de las lesiones en RM fueron mal definidos (n = 5). En el estudio dinámico todas presentaron captación de contraste, de forma única o múltiple, con curvas de intensidad de señal/tiempo similares a las de los carcinomas infiltrantes de mama. La RM mostró focos tumorales no detecta-dos con las otras técnicas en tres casos, demostrando bilateralidad no conocida en dos de ellos. Conclusión: Los hallazgos radiológicos del linfoma de mama son inespecíficos, se pueden presentar como lesiones focales (en su mayo-ría) o difusas. La RM demuestra la extensión de la afectación tumoral de forma más exacta que con técnicas radiológicas convencionales, y es útil en la evaluación y seguimiento de pacientes con linfoma

Objective: To describe the clinical presentation, radiologic findings, and evolution of breast lymphoma in our series, with emphasis on the subgroup of patients undergoing MRI.Material and methods: This is a retrospective review of the 13 ca-ses of breast lymphoma (3 primary, 9 secondary, 1 indeterminate) diagnosed at our center between 1990 and 2002. Clinical and therapeu-tic variables are evaluated, as well as the appearance at mammography (n=11), ultrasound (n=7), and MRI (n=8).Results: The most common clinical presentation was a palpable no-dule (n=11). At mammography, 5 had well-defined margins, 4 poorly defined, 1 diffuse affection, and 1 only skin thickening. Skin thickening was associated in 4 and adenopathies in 4. At ultrasound, most behaved like solid lesions. MRI behavior in T2- and T1-weighted sequences was variable, with a predominance of lesions hyper-intense at T2 (n=6). Most lesions (n=5) showed poorly defined borders at MRI. In the dynamic study, all lesions showed single or multiple contrast up-take, with signal-intensity/time curves similar to those of invasive breast carcinoma. MRI showed tumor foci undetected on other imaging studies in 3 cases and additional lesions in the contralateral breast in 2 of these. Conclusion: Radiologic findings for breast lymphoma are non specific; it can present as a focal (most) or diffuse lesion. MRI demonstrates the extent of tumor affection more precisely than conventional radiologic techniques and is useful in the evaluation and follow-up patients with lymphoma

Adenoma de la lactancia: diagnóstico diferencial de las lesiones palpables durante el embarazo y la lactancia / Lactating adenoma: differential diagnosis of palpable lesions during pregnancy and lactation

Los cambios fisiológicos que se producen durante el embarazo y la lactancia hacen que sea difícil la valoración de las lesiones mamarias, tanto para el clínico como para el radiólogo. Entre las lesiones específicas que aparecen durante estos periodos se encuentra el adenoma de la lactancia, que es una lesión benigna de la mama que se presenta en forma de masa sólida palpable. Se presentan dos casos y se discute el manejo, los hallazgos radiológicos y el diagnóstico diferencial junto con una revisión de la bibliografía (AU)

Hallazgos por TC en la sarcoidosis torácica / CT findings in sarcoidosis with thoracic involvement

Objetivo: La sarcoidosis es una enfermedad sistémica idiopática, caracterizada por la presencia de granulomas epitelioides no caseificantes en múltiples órganos. La afectación intratorácica ocurre en el curso de la enfermedad en casi todos los pacientes. Describimos los hallazgos en nuestros pacientes por TC convencional y TCAR de esta enfermedad.Material y método: Se ha realizado un análisis retrospectivo de los estudios mediante TC realizados en nuestro servicio a 43 pacientes diagnosticados de sarcoidosis mediante biopsia y/o lavado broncoalveolar.Resultados: Hemos dividido los hallazgos según su localización en intra y extraparenquimatosos, resaltando hallazgos poco frecuentes como el engrosamiento pleural y pericárdico, adenopatías calcificadas o en localizaciones inusuales y esplenomegalia, patrón alveolar, patrón en panal y atrapamiento de aire.Conclusión: La TC convencional y la TCAR en la sarcoidosis, son técnicas más útiles que la radiología convencional en la detección y estudio de la extensión de las lesiones intra y extraparenquimatosas, así como en la valoración de la evolución. Permite, además, guiar la biopsia torácica en caso de ser necesaria (AU)