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1.
Bull Cancer ; 107(3): 295-307, 2020 Mar.
Artículo en Francés | MEDLINE | ID: mdl-32115178

RESUMEN

OBJECTIVES: To evaluate the impact of systematic radiological review by breast specialist radiologist of malignant breast lesion imaging on the therapeutic management of patients. MATERIALS AND METHODS: Data collection was performed for patients with histopathologically proved breast cancer or suspicious breast lesion on imaging realized out of our institution. Patients underwent systematic mammary and axillary ultrasound, imaging review and if necessary complementary mammographic images. We analyzed the number of additional breast biopsies and axillary lymph node fine needle aspiration (FNA) with their histopathological results. We assessed their impact by comparing the final surgical treatment to the one planned before review. RESULTS: Two hundred and seventeen patients were included, with a total of 230 BIRADS 0, 4, 5 or 6 breast lesions. Seventy-six additional breast core biopsies were realized, leading to diagnose 43 additional BIRADS 6 lesions (24 infiltrative carcinomas, 9 DCIS and 10 atypical lesions) in 30 patients (13.82%). Thirty-five additional lymph node FNA were realized with 12 metastatic nodes and 3 false negative samples. Imaging review lead to change surgical treatment in 59 patients (27.19%, P<0.01) with modification in breast surgery in 37 patients, axillary surgery in 8 patients and both sites surgery in 12 patients. CONCLUSION: This study shows an impact of systematic radiological review by breast specialist radiologist in therapeutic management of patients treated for malignant breast lesion.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/terapia , Ganglios Linfáticos/diagnóstico por imagen , Radiólogos , Adulto , Anciano , Axila , Biopsia con Aguja Fina/estadística & datos numéricos , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Calcinosis/diagnóstico por imagen , Quimioterapia Adyuvante/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Mamografía , Mastectomía/estadística & datos numéricos , Mastectomía Simple/estadística & datos numéricos , Persona de Mediana Edad , Periodo Preoperatorio , Oncología por Radiación , Estudios Retrospectivos , Estadísticas no Paramétricas , Ultrasonografía Mamaria/estadística & datos numéricos
2.
J Comput Assist Tomogr ; 44(2): 269-274, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32195807

RESUMEN

OBJECTIVE: To prospectively compare the performance of model-based and model-free dynamic contrast-enhanced (DCE) pharmacokinetic parameters in monitoring breast cancers' early response to neoadjuvant chemotherapy (NACT). METHODS: Sixty patients, with 61 pathology-proven breast cancers, were examined using DCE magnetic resonance imaging before, after the first cycle, and after full cycles of NACT. Both model-based (Ktrans and others) and model-free parameters, mainly time-intensity curve (TIC), were measured. According to Miller-Payne grading, patients were divided into response and nonresponse group. Mann-Whitney U test, Fisher exact test, multivariate logistic regression, and receiver operating characteristic curve were used in analysis. RESULTS: After the first cycle, among all the parameters, Ktrans and TIC were strongly associated with tumors' early response. There was no significant difference between the areas under receiver operating characteristic curve of Ktrans and TIC (0.768, 0.852, respectively). CONCLUSIONS: Model-based and model-free DCE parameters, especially Ktrans and TIC, have similar performance in predicting the efficacy of NACT for breast cancers.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/tratamiento farmacológico , Medios de Contraste/farmacocinética , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Terapia Neoadyuvante/métodos , Adulto , Mama/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Resultado del Tratamiento
3.
Zhonghua Wai Ke Za Zhi ; 58(3): 165-169, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187919

RESUMEN

Image-guided percutaneous placement of breast tissue marker clip (breast marker) is mainly used for precisely marking and localizing breast cancer lesion and metastatic axillary lymph node. Until now, there is no clinical guideline in the field worldwide. This consensus established by Chinese Society of Breast Surgery, Chinese Surgical Society of Chinese Medical Association is based on our clinical practice and literature review, and particularly focuses on indications and contraindications, key placement procedures and evaluation methods, complications prevention and treatment, to provide guidance for the safe and standard clinical applications of breast marker.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Mama/diagnóstico por imagen , Marcadores Fiduciales , Ganglios Linfáticos/diagnóstico por imagen , Axila , Consenso , Femenino , Humanos , Instrumentos Quirúrgicos
4.
JAMA ; 323(8): 746-756, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32207768

RESUMEN

Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02933489.


Asunto(s)
Densidad de la Mama , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Intraductal no Infiltrante/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Mamografía/métodos , Adulto , Anciano , Biopsia , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Estudios Transversales , Detección Precóz del Cáncer , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/efectos adversos , Mamografía/efectos adversos , Persona de Mediana Edad , Invasividad Neoplásica , Valor Predictivo de las Pruebas , Estándares de Referencia , Sensibilidad y Especificidad
5.
JAMA ; 323(8): 746-756, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096852

RESUMEN

Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02933489.


Asunto(s)
Densidad de la Mama , Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Intraductal no Infiltrante/diagnóstico por imagen , Detección Precóz del Cáncer/métodos , Imagen por Resonancia Magnética , Mamografía , Invasividad Neoplásica/diagnóstico por imagen , Adulto , Anciano , Mama/diagnóstico por imagen , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Mamografía/métodos , Persona de Mediana Edad , Sensibilidad y Especificidad
7.
J Comput Assist Tomogr ; 44(2): 275-283, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32004189

RESUMEN

OBJECTIVE: The objective of this study was to develop a nomogrom for prediction of pathological complete response (PCR) to neoadjuvant chemotherapy in breast cancer patients. METHODS: Ninety-one patients were analyzed. A total of 396 radiomics features were extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator was selected for data dimension reduction to build a radiomics signature. Finally, the nomogram was built to predict PCR. RESULTS: The radiomics signature of the model that combined DCE-MRI and ADC maps showed a higher performance (area under the receiver operating characteristic curve [AUC], 0.848) than the models with DCE-MRI (AUC, 0.750) or ADC maps (AUC, 0.785) alone in the training set. The proposed model, which included combined radiomics signature, estrogen receptor, and progesterone receptor, yielded a maximum AUC of 0.837 in the testing set. CONCLUSIONS: The combined radiomics features from DCE-MRI and ADC data may serve as potential predictor markers for predicting PCR. The nomogram could be used as a quantitative tool to predict PCR.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/terapia , Medios de Contraste , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Terapia Neoadyuvante/métodos , Nomogramas , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad
9.
Int J Cancer ; 146(3): 850-860, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31001839

RESUMEN

Advanced breast cancer (BC) is associated with heavier treatments and poorer prognosis than early BC. Despite mammographic screening, advanced BC incidence remains stable. Little is known about risk factors differentially associated with advanced BC. We analyzed factors predicting for postmenopausal advanced vs. early BC in the E3N cohort. E3N has been prospectively following 98,995 French women aged 50-65 years at baseline since 1990. Hazard ratios (HRs) and 95% confidence intervals (CIs) for advanced and early invasive BC were estimated with multivariate Cox competing risk hazard models. With a median follow-up of 15.7 years, 4,941 postmenopausal BC were diagnosed, including 1,878 (38%) advanced BC. Compared to early BC, advanced BC was differentially associated with excess weight (HR 1.39 [95% CI = 1.26-1.53] vs. 1.08 [95% CI = 1.00-1.17], phomogeneity < 0.0001) and living in a rural area (HR 1.14 [95% CI = 1.00-1.31] vs. 0.93 [95% CI = 0.82-1.04], phomogeneity 0.02). Excess weight was the only differential risk factor for advanced BC for hormone-dependent BC and for women compliant with screening recommendations. Previous mammography was associated with reduced advanced BC risk (HR 0.86 [95% CI = 0.73-1.00]) and increased early BC risk (HR 1.36 [95% CI = 1.18-1.56], phomogeneity < 0.0001), but only for hormone-dependent BC. Excess weight appears to be mostly associated with advanced BC, especially hormone-dependent BC. These results add to the evidence for maintaining weight within the recommended limits.


Asunto(s)
Neoplasias de la Mama/epidemiología , Mamografía/estadística & datos numéricos , Posmenopausia , Aumento de Peso , Anciano , Índice de Masa Corporal , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama/prevención & control , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Incidencia , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo
10.
Br J Radiol ; 93(1105): 20190328, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31661305

RESUMEN

OBJECTIVE: Exposure to sex hormones is important in the pathogenesis of breast cancer and inability to tolerate such exposure may be reflected in increased asymmetrical growth of the breasts. This study aims to characterize, for the first time, asymmetry in breast volume (BV) and radiodense volume (DV) in a large ethnically diverse population. METHODS: Automated measurements from digital raw mammographic images of 54,591 cancer-free participants (aged 47-73) in a UK breast screening programme were used to calculate absolute (cm3) and relative asymmetry in BV and DV. Logistic regression models were fitted to assess asymmetry associations with age and ethnicity. RESULTS: BV and DV absolute asymmetry were positively correlated with the corresponding volumetric dimension (BV or DV). BV absolute asymmetry increased, whilst DV absolute asymmetry decreased, with increasing age (P-for-linear-trend <0.001 for both). Relative to Whites, Blacks had statistically significantly higher, and Chinese lower, BV and DV absolute asymmetries. However, after adjustment for the corresponding underlying volumetric dimension the age and ethnic differences were greatly attenuated. Median relative (fluctuating) BV and DV asymmetry were 2.34 and 3.28% respectively. CONCLUSION: After adjusting for the relevant volumetric dimension (BV or DV), age and ethnic differences in absolute breast asymmetry were largely resolved. ADVANCES IN KNOWLEDGE: Previous small studies have reported breast asymmetry-breast cancer associations. Automated measurements of asymmetry allow the conduct of large-scale studies to further investigate these associations.


Asunto(s)
Densidad de la Mama/etnología , Mama/anomalías , Mama/diagnóstico por imagen , Grupos Étnicos/estadística & datos numéricos , Factores de Edad , Anciano , Femenino , Humanos , Mamografía , Persona de Mediana Edad , Estudios Retrospectivos
11.
Eur Radiol ; 30(1): 514-522, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31375867

RESUMEN

OBJECTIVES: To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS). METHODS: After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and "non-comedo" grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals. RESULTS: We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77-96%) and 92% (95% CI, 84-97%), respectively. CONCLUSION: Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance. KEY POINTS: • Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated. • Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time. • Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Intraductal no Infiltrante/diagnóstico por imagen , Uso Excesivo de los Servicios de Salud/prevención & control , Tomografía de Emisión de Positrones/métodos , Adulto , Anciano , Anciano de 80 o más Años , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , China , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , España
12.
Presse Med ; 48(10): 1169-1174, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31669007

RESUMEN

A wide diversity of diagnostic or therapeutic percutaneous biopsies exists under sonography, under mammography, under MRI or under CT. This review will detail the different techniques for helping diagnosis or therapeutic management.


Asunto(s)
Neoplasias de la Mama/patología , Mama/patología , Biopsia Guiada por Imagen/métodos , Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Marcadores Fiduciales , Humanos , Imagen por Resonancia Magnética Intervencional/métodos , Mamografía/métodos , Cuidados Preoperatorios , Radiología Intervencional/métodos , Ultrasonografía Intervencional
13.
Chirurgia (Bucur) ; 114(5): 664-667, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31670643

RESUMEN

Fibromatosis is a benign lesion of the breast that can rarely occur in men, and requires good imaging and biopsy to make a differential diagnosis to breast carcinoma. Primary breast fibromatosis predominately affects females but can rarely affect the male breast (1,2). Due toits rarity, the condition has often been confused with breast carcinoma. Significant variability has been reported regarding imaging characteristics of fibromatosis using ultrasound and MRI. MRI is particularly useful in the evaluation of tumor extent and preoperative planning (3). We report the case of a 66-year old male who presented with a palpable mass within the external quadrant of his right breast. Ultrasound-guided core needle biopsy revealed diagnosis of fibromatosis. Follow-up performed 11 months after resection demonstrated no radiographic evidence of recurrence.


Asunto(s)
Neoplasias de la Mama Masculina/patología , Mama/patología , Fibroma/patología , Anciano , Biopsia con Aguja Gruesa , Mama/diagnóstico por imagen , Neoplasias de la Mama Masculina/diagnóstico por imagen , Fibroma/diagnóstico por imagen , Humanos , Biopsia Guiada por Imagen , Masculino , Resultado del Tratamiento , Ultrasonografía Mamaria
14.
N Engl J Med ; 381(22): 2091-2102, 2019 11 28.
Artículo en Inglés | MEDLINE | ID: mdl-31774954

RESUMEN

BACKGROUND: Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. METHODS: In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period. RESULTS: The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening. CONCLUSIONS: The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. (Funded by the University Medical Center Utrecht and others; DENSE ClinicalTrials.gov number, NCT01315015.).


Asunto(s)
Densidad de la Mama , Neoplasias de la Mama/diagnóstico por imagen , Detección Precóz del Cáncer/métodos , Imagen por Resonancia Magnética , Mamografía , Anciano , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/epidemiología , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Sensibilidad y Especificidad
15.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(5): 667-672, 2019 Oct 30.
Artículo en Chino | MEDLINE | ID: mdl-31699198

RESUMEN

Objective To compare the values of dynamic enhanced magnetic resonance imaging(DCE-MRI),digital breast tomosynthesis(DBT),and digital mammography(DM)in the early detection and diagnosis of breast cancer.Methods We retrospectively analyzed the clinical and imaging data of 65 cases with early breast cancer confirmed by surgical pathology from June 2017 to December 2018.All patients underwent breast DCE-MRI,DM and DBT before surgery.The receiver operating characteristic(ROC)curves were drawn,with the pathological results as the gold standard,to evaluate the diagnostic performance of different examination methods.The areas under ROC curves(AUCs)were compared using Z test.The differences among DCE-MRI,DBT and DM in detecting early breast cancer were compared using chi-square test in terms of positive rates,accuracy,sensitivity,and specificity.Pearson correlation analysis was performed to assess the accuracy of these imaging methods in detecting the size of early breast cancer.Results The AUCs of DCE-MRI,DBT,and DM based on the BI-RADS classification for early diagnosis of breast cancer were 0.910,0.832,and 0.700,respectively(z=2.132,P=0.001);the sensitivity of DCE-MRI,DBT,and DM for early breast cancer was 92.3%,70.8%,and 52.5%,the specificity was 65.0%,85.0%,and 79.3%,and the accuracy was 83.1%,70.8%,and 50.8%,indicating that DCE-MRI(χ 2=15.330,P=0.0001) and DBT(χ 2=5.450,P=0.020) had significantly higher diagnostic accuracy than DM.The measurement results of DM,DBT,and DCE-MRI were positively correlated with the pathological measurements(r=0.781,r=0.847,r=0.946;all P<0.01). Conclusions DCE-MRI and DBT have higher positive rates and accuracies than DM in detecting early breast cancer.Medical institutions where DCE-MRI is still not available can use DBT to improve the early detection of breast cancer.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Imagen por Resonancia Magnética , Mamografía/métodos , Mama/diagnóstico por imagen , Femenino , Humanos , Estudios Retrospectivos
16.
Eur J Radiol ; 120: 108701, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31610321

RESUMEN

PURPOSE: To evaluate which factors may influence magnetic resonance imaging (MRI) performance in the detection of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC). METHOD: This retrospective study included 219 patients diagnosed with invasive breast carcinoma who underwent breast MRI before and after NAC. The MRI findings were compared to gold standard pathological examinations. Resolution of invasive breast disease was defined as pCR. RESULTS: The mean age of our cohort was 48 years (range: 20-85). The molecular subtypes included: Luminal B/Her-2 negative (n = 89; 40%), triple-negative (n = 69; 32%), Luminal B/Her-2 positive (n = 43; 20%), and Her-2 overexpression (n = 18; 8%). MRI analysis after NAC showed complete response in 76 cases (35%), while pathological analysis of surgical specimens after NAC detected pCR in 85 cases (39%). The accuracy of MRI in diagnosing pCR was 80%, with 69% sensitivity, 87% specificity, and positive and negative predictive values of 78% and 82%, respectively. The only factor statistically associated with a higher discordance rate between MRI and pathologic response was the presence of non-mass enhancement at pre-treatment MRI (p = 0.003). CONCLUSIONS: MRI demonstrated good accuracy in predicting pCR after NAC among the breast cancer patients examined. However, non-mass enhancement at pre-treatment MRI negatively affected the diagnostic performance of MRI in assessing treatment response after NAC.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/tratamiento farmacológico , Imagen por Resonancia Magnética/métodos , Terapia Neoadyuvante/métodos , Adulto , Anciano , Anciano de 80 o más Años , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/métodos , Femenino , Humanos , Persona de Mediana Edad , Fenotipo , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Adulto Joven
17.
J Radiol Case Rep ; 13(2): 15-25, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31565168

RESUMEN

Primary angiosarcoma of the breast is a rare (0.04% of all malignant breast tumors) and potentially life-threatening disease. Given its variable and non-specific clinical, radiological and pathological presentation, accurate diagnosis is a challenge. Primary angiosarcoma of the breast predominantly occurs in younger patients and it is often overlooked and misdiagnosed at radiology and pathology. To ensure that this aggressive malignancy is not overlooked, radiologists need to be aware of the fact that such tumors may present with non-specific imaging features. We report a case of a 32-year-old female with primary angiosarcoma of the breast presenting with non-specific imaging features. It was initially interpreted as a capillary cavernous hemangioma at histopathology following an ultrasound-guided biopsy. This eventually turned out to be angiosarcoma after a second histopathology opinion was sought in light of the radiology-pathology discordance.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Hemangiosarcoma/diagnóstico por imagen , Hemangiosarcoma/patología , Adulto , Mama/diagnóstico por imagen , Mama/patología , Diagnóstico Diferencial , Femenino , Hemangioma Cavernoso/diagnóstico por imagen , Humanos , Biopsia Guiada por Imagen , Imagen por Resonancia Magnética , Mamografía , Ultrasonografía
18.
Eur J Radiol ; 120: 108686, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31586850

RESUMEN

PURPOSE: To determine whether imaging parameters derived from intravoxel incoherent motion (IVIM) diffusion weighted imaging (DWI) vary according to tumor-stroma ratio(TSR) or dominant stroma type of breast cancer. METHODS: We prospectively enrolled 77 patients with breast cancer who underwent IVIM DWI on a 3.0 T MR scanner. The values of IVIM parameters (D, D* and f) were measured. After surgery, TSR or dominant stroma type was evaluated. The relationship between imaging parameters and tumor stroma characteristics was analyzed. RESULTS: The mean D and f values were lower in stroma-poor tumor than in stroma-rich tumor (P = 0.012, 0.015). The mean D value was lower in the collagen-dominant type than in fibroblast-dominant or lymphocyte-dominant type (P = 0.032, 0.043). According to multivariate linear regression analyses, tumor size (P = 0.007), TSR (P = 0.008), dominant stroma type (collagen dominant, P = 0.012), and histological grade (P = 0.031) were independently correlated with D value; and tumor size (P = 0.011), TSR (P = 0.021) and histological grade (P = 0.037) were independently correlated with f value. CONCLUSION: In breast cancer, D and f values show significant differences according to TSR, and D value is lower in collagen dominant type than in fibroblast dominant or lymphocyte dominant types.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Interpretación de Imagen Asistida por Computador/métodos , Adulto , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/patología , Medios de Contraste , Femenino , Humanos , Persona de Mediana Edad , Movimiento (Física) , Estudios Prospectivos , Reproducibilidad de los Resultados
19.
Zhonghua Yi Xue Za Zhi ; 99(39): 3110-3113, 2019 Oct 22.
Artículo en Chino | MEDLINE | ID: mdl-31648457

RESUMEN

Objective: To explore the diagnostic efficiency of digital breast tomosynthesis (DBT) for mass lesions in dense breast by comparing with digital mammography (DM). Methods: A retrospective analysis was made of 125 female patients with breast masses confirmed by pathology in the First Affiliated Hospital of Jinzhou Medical University from June 2018 to April 2019, all of whom were dense breast. Pathological results were taken to compare the diagnostic value of DM, DBT and the combination of the two for breast mass lesions. Results: The overall detection rates of DM, DBT and their combination were 77.6% (97/125), 88.8%(111/125) and 92.8%(116/125) in dense breast. The detection rates of burr sign and lobulation sign by DM and DBT in malignant tumors were 39.7%(31/78), 60.3%(47/78) and 48.7%(38/78), 67.9%(53/78), respectively, with statistically significant differences (all P<0.05). The sensitivity of DM, DBT and their combination in differentiating benign from malignant breast mass lesions of dense breast was 75.6% (59/78), 83.3%(65/78), 93.6%(73/78), the specificity was 63.8%(30/47), 80.9% (38/47), 76.6%(36/47),and the area under ROC curve(AUC) was 0.697, 0.821 and 0.852, respectively. Conclusion: DBT is more effective than DM in the diagnosis of dense breast mass lesions, and the combination of DBT and DM is more significant.


Asunto(s)
Mama/diagnóstico por imagen , Neoplasias de la Mama , Femenino , Humanos , Mamografía , Curva ROC , Estudios Retrospectivos
20.
BMC Cancer ; 19(1): 955, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615463

RESUMEN

BACKGROUND: The purpose of the present meta-analysis was to provide evident data about use of Apparent Diffusion Coefficient (ADC) values for distinguishing malignant and benign breast lesions. METHODS: MEDLINE library and SCOPUS database were screened for associations between ADC and malignancy/benignancy of breast lesions up to December 2018. Overall, 123 items were identified. The following data were extracted from the literature: authors, year of publication, study design, number of patients/lesions, lesion type, mean value and standard deviation of ADC, measure method, b values, and Tesla strength. The methodological quality of the 123 studies was checked according to the QUADAS-2 instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without any further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malign lesions. RESULTS: The acquired 123 studies comprised 13,847 breast lesions. Malignant lesions were diagnosed in 10,622 cases (76.7%) and benign lesions in 3225 cases (23.3%). The mean ADC value of the malignant lesions was 1.03 × 10- 3 mm2/s and the mean value of the benign lesions was 1.5 × 10- 3 mm2/s. The calculated ADC values of benign lesions were over the value of 1.00 × 10- 3 mm2/s. This result was independent on Tesla strength, choice of b values, and measure methods (whole lesion measure vs estimation of ADC in a single area). CONCLUSION: An ADC threshold of 1.00 × 10- 3 mm2/s can be recommended for distinguishing breast cancers from benign lesions.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Mama/diagnóstico por imagen , Mama/patología , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética/métodos , Biomarcadores de Tumor , Estudios de Cohortes , Exactitud de los Datos , Femenino , Humanos , Sesgo de Publicación/tendencias , Sensibilidad y Especificidad
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