Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer.

BACKGROUND: The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE: To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS: Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS: Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION: In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.

Simple and complex fibroadenomas: are there any distinguishing sonographic features?

OBJECTIVES: Complex fibroadenomas are fibroadenomas harboring 1 or more complex pathologic features: epithelial calcifications, apocrine metaplasia, sclerosing adenosis, and cysts larger than 3 mm. No sonographic features have been clearly defined for the distinction of simple fibroadenomas from complex ones, which are associated with an increased cancer risk. We aimed to evaluate the accuracy of sonographic features for the prediction of complexity in fibroadenomas. METHODS: A total of 252 fibroadenomas were found at consecutive percutaneous needle or excisional surgical biopsy. Sixty-three were excluded because their respective imaging examinations were not recorded on digital support and consequently were not available. According to histologic diagnoses, fibroadenomas (n = 189) were classified into simple (n = 159) and complex (n = 30). The size, number, and sonographic features were assessed, and their respective accuracy rates for prediction of complexity were analyzed. RESULTS: All patients were women. Complex fibroadenomas presented more frequently as solitary nodules (n = 21 [70%]) and were significantly larger than simple fibroadenomas (1.9 versus 1.3 cm; P = .009). Image predictors of complexity were an irregular shape (P< .001), noncircumscribed contours (indistinct, angular, microlobulated, or spiculated; P < .001), a complex echo structure (P < .001), the presence of microcalcifications (P = .002), and posterior acoustic enhancement (P < .001). By logistic multivariate regression, a complex echo structure (odds ratio [OR], 9.5; 95% confidence interval [CI], 2.8-32.3), noncircumscribed contours (OR, 3.7; 95% CI, 1.1-12.8), and posterior acoustic enhancement (OR, 4.0; 95% CI, 1.1-14.6) were independent predictors of complexity. Receiver operating characteristic curve analysis showed that a complex echo structure was the most accurate sonographic finding for identification of complex fibroadenomas (area under the curve, 0.74). CONCLUSIONS: Certain sonographic features are associated with complex fibroadenomas and can help the radiologist decide which ones require biopsy.