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1.
Medicine (Baltimore) ; 98(39): e17061, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574804

RESUMO

To study the imaging and clinical features of breast sclerosing adenosis (SA), and to enhance the recognition of this disease, as well as to help the clinic to give a correct diagnosis.Imaging findings were retrospectively reviewed in 47 women with SA lesions confirmed by pathology (including 39 cases of mammography, 40 cases of ultrasound [US], and 34 cases magnetic resonance imaging [MRI]).Of 47 patients confirmed with SA, 18 cases were pure SA, and 29 cases coexist with other proliferative lesions and malignancies; the maximum diameter of SA lesions was 0.5 to 3.5 cm with an average of 1.6 cm. On the mammogram of 39 SA cases, the percentage of architectural distortion, calcifications, mass/nodular, asymmetric density, and mass combining with calcifications were 30.8%, 23.1%, 17.9%, 12.8%, and 7.7%, respectively; and 3 cases had no abnormal findings. On the sonogram (excluding 5 normal finding cases), the majority of lesions showed regular shaped (57.1%), well defined margined (60.0%), heterogenous low echoed (71.4%) nodulus. 85.3% lesions showed high signal on T2-weighted images, and all lesions were enhanced markedly, including 82.4% lesions appearing mass-like enhancement (17 star-shaped enhanced masses included); and the percentage of the time-signal intensity curve in type 1, type 2, and type 3 were 52.9%, 41.2%, and 5.9%, respectively. If the category breast imaging-reporting and data system ≥4b was considered to be a suspicious malignant lesion, the misdiagnostic rates of mammography, US, and MRI would be 17.9%, 17.5%, and 35.3%, respectively.The SA lesions are small and can occur with other diseases histologically. The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogenous echo on US and mass-like lesion with or without star shape on enhanced MRI.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Mama/diagnóstico por imagem , Mama/patologia , Adulto , Idoso , Calcinose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose/diagnóstico por imagem , Ultrassonografia Mamária
2.
Isr Med Assoc J ; 21(10): 666-670, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599508

RESUMO

BACKGROUND: Male breast cancer (MBC) is a rare disease representing less than 1% of breast cancers. In the absence of a screening program, such as for females, the diagnostic workup is critical for early detection of MBC. OBJECTIVES: To summarize our institutional experience in the workup of male patients referred for breast imaging, emphasizing the clinical, imaging, and histopathological characteristics of the MBC cohort. METHODS: All male patients who underwent breast imaging between 2011 and 2016 in our institution were retrospectively reviewed. Clinical, radiological, and histopathological data were collected and statistically evaluated. All images were reviewed using the American College of Radiology Breast Imaging Reporting and Data System. RESULTS: 178 male patients (average age 61 years, median age 64), underwent breast imaging in our institution. The most common indication for referral was palpable mass (49%) followed by gynecomastia (16%). Imaging included mostly mammography or ultrasound. Biopsies were performed on 56 patients, 38 (68%) were benign and 18 (32%) were malignant. In all, 13 patients had primary breast cancer and 5 had metastatic disease to the breast. Palpable mass at presentation was strongly associated with malignancy (P = 0.007). CONCLUSIONS: Mammography and ultrasound remain the leading modalities in breast imaging among males for diagnostic workup of palpable mass, with gynecomastia being the predominant diagnosis. However, presentation with palpable mass was also associated with malignancy. Despite a notable MBC rate in our cohort, the likelihood of cancer is low in young patients and in cases of gynecomastia.


Assuntos
Neoplasias da Mama Masculina/diagnóstico por imagem , Neoplasias da Mama Masculina/patologia , Ginecomastia/diagnóstico por imagem , Ginecomastia/patologia , Mamografia/métodos , Ultrassonografia Mamária/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Mama/diagnóstico por imagem , Mama/patologia , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Medicine (Baltimore) ; 98(37): e17082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517829

RESUMO

To compare the accuracy of breast lesion size measurement of cone-beam breast-CT (CBBCT), digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM).Patients scheduled for mastectomy due to at least 1 malignant breast lesion were included. Mastectomy specimens were examined by CBBCT, DBT, FFDM, and histopathology.A total of 94 lesions (40 patients) were included. Histopathological analyses revealed 47 malignant, 6 high-risk, and 41 benign lesions. Mean histopathological lesion size was 20.8 mm (range 2-100). Mean absolute size deviation from histopathology was largest for FFDM (5.3 ±â€Š6.7 mm) and smallest for CBBCT 50 mA, high-resolution mode (4.3 ±â€Š6.7 mm). Differences between imaging modalities did not reach statistical significance (P = .85).All imaging methods tend to overestimate breast lesion size compared to histopathological gold standard. No significant differences were found regarding size measurements, although in tendency CBBCT showed better lesion detection and cT classification over FFDM.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Tomografia Computadorizada de Feixe Cônico , Mamografia , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Mamografia/métodos , Mastectomia , Estudos Prospectivos , Estudos Retrospectivos , Carga Tumoral
4.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
5.
Niger J Clin Pract ; 22(8): 1169-1171, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417064

RESUMO

Phylloides tumor in the breast is a rare fibroepithelial tumor, which is often seen in young adult women. Phylloides tumor of the breast accounts for about 1% of all breast tumors and approximately 3% of all fibroepithelial tumors. Pre-operative diagnosis is difficult. Since there aren't any specific mammography and ultrasound findings, they cannot be distinguished from fibroadenomas through these imaging methods and are mostly followed up as if they are fibroadenomas. Patients often present with the complaint of a mass that has been present for a long time and had started to grow suddenly. The primary preferred approach for treatment is wide local excision with negative surgical margins. Coexistence of invasive ductal carcinoma with phylloides tumor in the same breast is a very rare occurrence. We present in this article, a 42-year-old female patient with an invasive ductal carcinoma inside a phylloides tumor in the same breast.


Assuntos
Neoplasias da Mama/patologia , Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Tumor Filoide/patologia , Adulto , Biópsia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Mamografia , Tumor Filoide/cirurgia , Resultado do Tratamento , Ultrassonografia Mamária
6.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 290-293, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460724

RESUMO

In this paper, the focus of technical review of the registration application data of digital Breast Tomosynthesis Mammography System was sorted out, so as to provide reference for researchers and manufacturers in China when applying for registration and preparation of such products.


Assuntos
Mamografia , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , China , Humanos , Mamografia/instrumentação , Mamografia/normas , Intensificação de Imagem Radiográfica/normas , Fatores de Risco
7.
Br J Radiol ; 92(1102): 20190057, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287719

RESUMO

Breast cancer is the most common cancer among females worldwide and large volumes of breast images are produced and interpreted annually. As long as radiologists interpret these images, the diagnostic accuracy will be limited by human factors and both false-positive and false-negative errors might occur. By understanding visual search in breast images, we may be able to identify causes of diagnostic errors, find ways to reduce them, and also provide a better education to radiology residents. Many visual search studies in breast radiology have been devoted to mammography. These studies showed that 70% of missed lesions on mammograms attract radiologists' visual attention and that a plethora of different reasons, such as satisfaction of search, incorrect background sampling, and incorrect first impression can cause diagnostic errors in the interpretation of mammograms. Recently, highly accurate tools, which rely on both eye-tracking data and the content of the mammogram, have been proposed to provide feedback to the radiologists. Improving these tools and determining the optimal pathway to integrate them in the radiology workflow could be a possible line of future research. Moreover, in the past few years deep learning has led to improving diagnostic accuracy of computerized diagnostic tools and visual search studies will be required to understand how radiologists interact with the prompts from these tools, and to identify the best way to utilize them. Visual search in other breast imaging modalities, such as breast ultrasound and digital breast tomosynthesis, have so far received less attention, probably due to associated complexities of eye-tracking monitoring and analysing the data. For example, in digital breast tomosynthesis, scrolling through the image results in longer trials, adds a new factor to the study's complexity and makes calculation of gaze parameters more difficult. However, considering the wide utilization of three-dimensional imaging modalities, more visual search studies involving reading stack-view examinations are required in the future. To conclude, in the past few decades visual search studies provided extensive understanding about underlying reasons for diagnostic errors in breast radiology and characterized differences between experts' and novices' visual search patterns. Further visual search studies are required to investigate radiologists' interaction with relatively newer imaging modalities and artificial intelligence tools.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Erros de Diagnóstico , Reconhecimento Visual de Modelos/fisiologia , Radiologistas , Atenção/fisiologia , Aprendizado Profundo , Diagnóstico por Computador/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pesquisa , Ultrassonografia Mamária/métodos
8.
Br J Radiol ; 92(1102): 20190317, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295011

RESUMO

OBJECTIVE: In this study, we used the concept of organ-equivalent dose (OED) to evaluate the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for breast cancer. METHODS: Using CT data set of 12 patients, we generated three different whole-breast radiation treatment plans using 50 Gy in 2 Gy fractions: three-dimensional conformal radiotherapy with a field-in-field (FinF) technique, intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The OEDs were calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models. Secondary cancer risks of the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL) were estimated and compared. RESULTS: The lowest EARs for the CB, CL, and IL were achieved with FinF, which reduced the EARs by 77%, 88%, and 56% relative to those with IMRT, and by 77%, 84%, and 58% relative to those with VMAT, respectively. The secondary cancer risk for FinF was significantly lower than those of IMRT and VMAT. OED-based secondary cancer risks for CB and IL were similar when IMRT and VMAT were used, but the risk for CL was statistically lower when VMAT was used. CONCLUSION: The overall estimation of EAR indicated that the radiation-induced cancer risk of breast radiation therapy was lower with FinF than with IMRT and VMAT. Therefore, when secondary cancer risk is a major concern, FinF is considered to be the preferred treatment option in irradiation of whole-breast. ADVANCES IN KNOWLEDGE: Secondary malignancy estimation after breast radiotherapy is becoming an important subject for comparative treatment planning.When secondary cancer risk a major concern, FinF technique is considered the preferred treatment option in whole breast patients.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias Induzidas por Radiação/etiologia , Segunda Neoplasia Primária/etiologia , Radioterapia Conformacional/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Mama/diagnóstico por imagem , Mama/efeitos da radiação , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Feminino , Coração/diagnóstico por imagem , Coração/efeitos da radiação , Humanos , Pulmão/diagnóstico por imagem , Pulmão/efeitos da radiação , Neoplasias Pulmonares/etiologia , Números Necessários para Tratar , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Medição de Risco/métodos , Tomografia Computadorizada por Raios X , Neoplasias Unilaterais da Mama/etiologia
9.
Br J Radiol ; 92(1100): 20180978, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291125

RESUMO

OBJECTIVES: To assess the value of computed diffusion-weighted imaging (cDWI) and voxelwise computed diffusion-weighted imaging (vcDWI) in breast cancer. METHODS: This retrospective study involved 130 patients (age range, 25-70 years; mean age ± standard deviation, 48.6 ± 10.5 years) with 130 malignant lesions, who underwent MRI examinations, including a DWI sequence, prior to needle biopsy or surgery. cDWIs with higher b-values of 1500, 2000, 2500, 3000, 3500, and 4000 s/mm2, and vcDWI were generated from measured (m) DWI with two lower b-values of 0/600, 0/800, or 0/1000 s/mm2. The signal-to-noise ratio (SNR) and contrast ratio (CR) of all image sets were computed and compared among different DWIs by two experienced radiologists independently. To better compare the CR with the SNR, the CR value was multiplied by 100 (CR100). RESULTS: The CR of vcDWI, and cDWIs, except for cDWI1000, differed significantly from that of measured diffusion-weighted imaging (mDWI) (cDWI1000: CR = 0.4904, p = 0.394; cDWI1500: CR = 0.5503, p = 0.006; cDWI2000: CR = 0.5889, p < 0.001; cDWI2500: CR = 0.6109, p < 0.001; cDWI3000: mean = 0.6214, p < 0.001; cDWI3500: CR = 0.6245, p < 0.001; cDWI4000: CR = 0.6228, p < 0.001). The vcDWI provided the highest CR, while the CRs of all cDWI image sets improved with increased b-values. The SNR of neither cDWI1000 nor vcDWI differed significantly from that of mDWI, but the mean SNRs of the remaining cDWIs were significantly lower than that of mDWI. The SNRs of cDWIs declined with increasing b-values, and the initial decrease at low b-values was steeper than the gradual attenuation at higher b-values; the CR100 rose gradually, and the two converged on the b-value interval of 1500-2000 s/mm2 . CONCLUSIONS: The highest CR was achieved with vcDWI; this could be a promising approach easier detection of breast cancer. ADVANCES IN KNOWLEDGE: This study comprehensively compared and evaluated the value of the emerging post-processing DWI techniques (including a set of cDWIs and vcDWI) in breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Mama/diagnóstico por imagem , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Razão Sinal-Ruído
10.
Medicine (Baltimore) ; 98(27): e16306, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277170

RESUMO

This study investigated the effect of sex hormones on F-fluorodeoxyglucose (FDG) uptake in normal breast tissue.The retrospective study included 249 premenopausal women (median age, 45 years) who were diagnosed with unilateral breast cancer and underwent FDG positron emission tomography/computed tomography and hormone tests. The volume of interest was within the contralateral normal breast and the standardized uptake values (SUVs) were measured. The correlations of sex hormones (including estrogen, progesterone, testosterone, follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) with the SUVs of the normal breast were analyzed.There was a weak negative correlation between age and breast FDG uptake (P = .012, Spearman coefficient = -.16 for the maximum standardized uptake values [SUVmax]), especially in the luteal phase group (P = .005, Spearman coefficient = -.27 for SUVmax). The SUVs of normal breast tissue were increased when progesterone levels were higher (P = .043, Spearman coefficient = .13 for SUVmax). In the irregular menstrual cycle group, FDG uptake in the breast decreased as FSH (P = .027, Spearman coefficient = -.42 for SUVmax) and LH (P = .048, Spearman coefficient = -.44 for SUVmax) increased.Glucose metabolism of normal breast tissue decreases with age, and progesterone weakly affects breast FDG uptake. Gonadotropins may affect breast FDG uptake in premenopausal women with irregular menstrual cycles.


Assuntos
Mama/metabolismo , Estradiol/sangue , Fluordesoxiglucose F18/farmacocinética , Hormônio Foliculoestimulante/sangue , Hormônio Luteinizante/sangue , Progesterona/sangue , Testosterona/sangue , Adulto , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/farmacocinética , Valores de Referência , Estudos Retrospectivos
11.
Zhonghua Zhong Liu Za Zhi ; 41(7): 540-545, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31357843

RESUMO

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01). Conclusion: The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.


Assuntos
Doenças Mamárias/classificação , Mama/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Doenças Mamárias/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/normas , Feminino , Fibroadenoma , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia Mamária
12.
Br J Radiol ; 92(1099): 20190136, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31166769

RESUMO

OBJECTIVES: After a 500 ms presentation, experts can distinguish abnormal mammograms at above chance levels even when only the breast contralateral to the lesion is shown. Here, we show that this signal of abnormality is detectable 3 years before localized signs of cancer become visible. METHODS: In 4 prospective studies, 59 expert observers from 3 groups viewed 116-200 bilateral mammograms for 500 ms each. Half of the images were prior exams acquired 3 years prior to onset of visible, actionable cancer and half were normal. Exp. 1D included cases having visible abnormalities. Observers rated likelihood of abnormality on a 0-100 scale and categorized breast density. Performance was measured using receiver operating characteristic analysis. RESULTS: In all three groups, observers could detect abnormal images at above chance levels 3 years prior to visible signs of breast cancer (p < 0.001). The results were not due to specific salient cases nor to breast density. Performance was correlated with expertise quantified by the number of mammographic cases read within a year. In Exp. 1D, with cases having visible actionable pathology included, the full group of readers failed to reliably detect abnormal priors; with the exception of a subgroup of the six most experienced observers. CONCLUSIONS: Imaging specialists can detect signals of abnormality in mammograms acquired years before lesions become visible. Detection may depend on expertise acquired by reading large numbers of cases. ADVANCES IN KNOWLEDGE: Global gist signal can serve as imaging risk factor with the potential to identify patients with elevated risk for developing cancer, resulting in improved early cancer diagnosis rates and improved prognosis for females with breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Adulto , Idoso , Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
13.
Eur J Radiol ; 116: 21-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153567

RESUMO

PURPOSE: To assess the effect on reducing the out-of-plane artifacts from metal objects in breast tomosynthesis (BT) using a novel artifact-reducing reconstruction algorithm in specimen radiography. METHODS AND MATERIALS: The study was approved by the Regional Ethical Review Board. BT images of 18 partial- and whole mastectomy specimens from women with breast cancer were acquired before and after a needle was inserted close to the lesion. The images were reconstructed using both a standard reconstruction algorithm, and a novel algorithm; the latter uses pre-segmentation to remove highly attenuating artifact-inducing objects from projection images before reconstruction. Images were separately reconstructed with and without segmentation, and combined into an artifact-reduced reconstruction. Standard and artifact-reduced BT-algorithms were compared visually and quantitatively using clinical images of mastectomy specimens and a physical anthropomorphic phantom. Six readers independently assessed the visibility of the lesion with and without artifact-reduction in a side-by-side comparison. A quantitative analysis was performed, comparing the signal-difference to background ratio (SDBR) and artifact spread function (ASF) between the two reconstruction methods. RESULTS: The magnitude of out-of-plane artifacts was clearly reduced with the novel reconstruction compared to BT-images without artifact reduction. Lesion masking by artifacts was largely averted; tumour visibility was comparable to standard BT images without a needle. In 76 ± 8% (standard deviation) of cases overall, readers could confidently state needle location. The same figure was 94 ± 6% for whole mastectomy cases, compared to 62 ± 17% for partial mastectomies. With metal artifact reduction, SDBR increased by 97% in the phantom, and by 69% in the mastectomies. The artifact spread function was substantially narrower. CONCLUSION: Artifact reduction in BT using a novel reconstruction method enables qualitatively and quantitatively improved clinical use of BT when metal artifacts can be a limiting factor such as in tomosynthesis-guided biopsy.


Assuntos
Algoritmos , Artefatos , Neoplasias da Mama/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Mamografia/métodos , Biópsia , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Mastectomia , Metais
14.
Eur J Radiol ; 116: 61-67, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153575

RESUMO

The MARIA® breast imaging system is a clinical diagnostic tool that uses a hemispherical array of radiowave antennas to generate three-dimensional images of the internal breast. The system utilises the variance of dielectric contrast within the breast volume in order to identify areas of interest for further diagnostic investigation. This multicentre study of 225 patients was conducted at three trial sites and recruited women with both malignant and benign lesions. The MARIA® images from the study were read by both clinicians who had access to the patient's clinical information, as well as by 'blind' reviewers who did not. Results from the study show an overall sensitivity of 76% for the system, which was similar across benign and malignant findings, and in denser breasts. The results from this study are outlined here and discussions on ongoing and future work with MARIA® are deliberated.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Radar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
16.
Br J Radiol ; 92(1099): 20180515, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31045431

RESUMO

OBJECTIVE: The study was conducted to study the role of strain wave elastography in evaluating the response to neo-adjuvant chemotherapy (NACT) in patients with locally advanced breast cancer (LABC). METHODS: In this Institutional review board approved study, 86 patients of LABC were investigated with strain wave elastography. Females receiving NACT had the affected breast scanned by strain wave elastography before each cycle of chemotherapy and immediately before surgery by two independent observers. Changes in elastographic parameters (size ratio, strain ratio) were documented and then compared to clinical and pathologic tumor response as evaluated after mastectomy. RESULTS: Elastographic strain ratio parameters demonstrated high sensitivity and moderate specificity for determining response even after the first cycle of neo-adjuvant chemotherapy [97.7% sensitivity (Sn), 68.7% specificity (Sp)]. Elastographic size ratio parameters showed moderate sensitivity and specificity for response detection after second and third cycle of neo-adjuvant chemotherapy (Sn, Sp: after second cycle of NACT Sn 83.3% Sp 80%; after third cycle of NACT Sn 77.8% Sp 100%). CONCLUSION: Strain ratio is the earliest predictor of treatment response in patients of LABC. Serial imaging with elastography has the potential to predict treatment response early during the course of NACT, which may prove vital in management of patients with breast cancer. ADVANCES IN KNOWLEDGE: Strain wave elastography is a powerful tool to predict chemoresponse early during the course of management, thereby providing an optimal window to change treatment protocols.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Técnicas de Imagem por Elasticidade/métodos , Terapia Neoadjuvante/métodos , Mama/diagnóstico por imagem , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Resultado do Tratamento
18.
Eur J Radiol ; 113: 74-80, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927963

RESUMO

OBJECTIVES: To evaluate the diagnostic performance and the clinical benefit of Shear-Wave Elastography - Virtual Touch™ Imaging Quantification (SWE-VTIQ) as a complement to ultrasonography (US). METHODS: From October 2016 through Jun 2017, B-mode US and SWE-VTIQ were prospectively performed in 396 breast masses in 357 women who consented to undergo this study. Quantitative elastography values were recorded: Vmax (maximum elasticity), Vmean (median elasticity), Vratio(max) (ratio of Vmax and surrounding parenchyma) and Vratio(mean) (ratio of Vmean and surrounding parenchyma). The histopathology of the lesions was considered the reference standard for benign or malignant definition. The performance of the four elastographic parameters was evaluated trough sensitivity, specificity and AUC. The parameter with the best performance was tested in six different diagnostic approaches defined based on clinical practice. RESULTS: Of the 396 masses, 122 (30.8%) were benign and 274 (69.2%) were malignant. All SWE parameters were significantly higher in malignant masses (all p < 0.01). Vmax and Vratio(max) performed significantly better then Vratio(mean) (p = 0.01 and p = 0.03, respectively). SWE-VTIQ improved US specificity in all diagnostic approaches, except when applied to BI-RADS 3 lesions. SWE-VTIQ reduced the false positive rate in 25% if applied only to BI-RADS 4A masses, maintaining a high sensitivity (98.9%, 95% confidence interval 97.1-100%) and a negative predictive value of 95.5%. When applied to BI-RADS 4A and 4B masses, SWE-VTIQ reduced the false positive rate in 54.4%. However, 13 malignant cases would be missed in this approach (4.7% of all malignant cases). CONCLUSIONS: SWE-VTIQ increases US specificity when applied to BI-RADS 4 A lesions, significantly reducing unnecessary interventions and preserving the diagnosis of malignant lesions. When applied also to BI-RADS® 4B lesions, SWE-VTIQ increases the number of false negative cases, which should be evaluated with caution.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia Mamária/métodos , Adulto Jovem
19.
Eur J Radiol ; 113: 96-100, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927966

RESUMO

PURPOSE: To predict detection rates (DR) in second-look ultrasound of MRI-detected breast lesions by systematically combining clinical and anthropomorphic features. METHODS: A total of 104 suspicious breast-lesions, that were initially detected on breast MRI and underwent subsequent SLU from January 2013 through December 2013, were evaluated in this retrospective analysis. All images were reviewed by an experienced radiologist for this study. Both anthropomorphic, spatial and BI-RADS lesion features were recorded. Uni- and multivariate Classification and Regression Trees (CRT) statistics were used to predict SLU DR by these features. RESULTS: Among 104 MRI-detected lesions, 58 (55.8%) showed a correlate on SLU. In univariate analysis, homogeneous fatty or dense fibro-glandular-tissue-composition (FGT) as assessed by ultrasound, segmental non-mass-distribution pattern and small breast size as assessed by MRI were significantly associated with higher DR on SLU. The remaining BI-RADS features did not significantly affect SLU DR according to our data. The predictive model could stratify the likelihood of SLU correlates as high, intermediate and low according to FGT, lesion type, size and position. CONCLUSIONS: By systematically combining the features FGT, lesion type, size and position, we could predict SLU DR of MRI-detected breast lesions. This may help to decide the preferable method for lesion biopsy or follow-up in clinical practice.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Tomada de Decisão Clínica , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Mamária/métodos
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