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1.
Medicine (Baltimore) ; 99(46): e23112, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181680

RESUMO

To determine the association between mammographic density (MD) and the risk of breast cancer (BC) in Chinese women and to investigate the role of fertility risk factors in regulating the relationship between MD and BC.We used Quantra software and the BI-RADS classification to assess MD in 466 patients and 932 controls. Conditional matched logistic multiple regression analysis was used to determine the relationship between MD and BC, and risk was evaluated with the odds ratio (OR) and 95% confidence interval (CI).The ORs for category 4 versus category 2 were 1.95 (95% confidence interval [95% CI] (1.42∼2.66)) and 1.76 (95% CI (1.28∼2.42)) for the BI-RADS and Quantra classifications, respectively. The ORs for category 5 volumetric breast density (VBD) versus category 2 VBD and 5 fibroglandular tissue volume (FGV) versus category 2 FGV were 1.63 (95% CI (1.20∼2.23)) and 1.92 (95% CI (1.40∼2.63)), respectively. Females with category 5 VBD whose age at menarche was ≤13 years had the highest risk of BC (OR = 2.16, 95% CI (1.24∼3.79)), and females with category 5 FGV whose age at menarche was = 15 years had the lowest risk of BC (OR = 1.65, 95% CI (1.05∼2.62)). Females with categories 3-5 VBD and categories 3-5 FGV had reduced risks of BC with increasing number of births. Females with category 5 VBD had an increased risk of BC with increasing age at first childbirth (the OR increased from 1.49 to 1.95). Those with category 5 VBD had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 2.08 to 1.55). Females with category 5 FGV had a reduced risk of BC with increasing breastfeeding duration (the OR decreased from 4.12 to 1.62).Both the BI-RADS density classification and Quantra measures indicated that MD is positively associated with the risk of BC in Chinese women and that associations between MD and BC risk differ by age at menarche, parity, age at first childbirth and breastfeeding duration.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico , Mama , Mamografia/métodos , Medição de Risco/métodos , Fatores Etários , Mama/diagnóstico por imagem , Mama/patologia , Aleitamento Materno/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , China/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Menarca , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , História Reprodutiva , Software
2.
PLoS One ; 15(9): e0239271, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941537

RESUMO

PURPOSE: To evaluate the kinetic patterns of benign and malignant breast lesions using contrast-enhanced digital mammogram (CEDM). METHODS: Women with suspicious breast lesions on mammography or ultrasound were enrolled. Single-view mediolateral oblique (MLO) CEDM of an affected breast was acquired at 2, 3, 4, 7, and 10 min after injection of contrast agent. Three readers visually and semi-quantitatively analyzed the enhancement of suspicious lesions. The kinetic pattern of each lesion was classified as persistent, plateau, or washout over two time intervals, 2-4 min and 2-10 min, by comparing the signal intensity at the first time interval with that at the second. RESULTS: There were 73 malignant and 75 benign lesions in 148 patients (mean age: 52 years). Benign and malignant breast lesions showed the highest signal intensity at 3 min and 2 min, respectively. Average areas under receiver operating characteristic (ROC) curve for diagnostic accuracy based on lesion enhancement at different time points were 0.73 at 2 min, 0.72 at 3 min, 0.69 at 4 min, 0.67 at 7 min, and 0.64 at 10 min. Diagnostic performance was significantly better at 2, 3, and 4 min than at 7 and 10 min (all p < 0.05). A washout kinetic pattern was significantly associated with malignant lesions at 2-4 min and 2-10 min frames according to two of the three readers' interpretations (all p ≤ 0.001). CONCLUSION: Applications of optimal time intervals and kinetic patterns show promise in differentiation of benign and malignant breast lesions on CEDM.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Ultrassonografia Mamária/métodos , Adulto , Neoplasias da Mama/epidemiologia , Meios de Contraste/farmacocinética , Feminino , Humanos , Mamografia/normas , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Ultrassonografia Mamária/normas , Ultrassonografia Mamária/estatística & dados numéricos
3.
Medicine (Baltimore) ; 99(39): e22405, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991467

RESUMO

This study aims to compare Quantra, as an automated volumetric breast density (Vbd) tool, with visual assessment according to ACR BI-RADS density categories and to determine its potential usage in clinical practice.Five hundred randomly selected screening and diagnostic mammograms were included in this retrospective study. Three radiologists independently assigned qualitative ACR BI-RADS density categories to the mammograms. Quantra automatically calculates the volumetric density data into the system. The readers were blinded to the Quantra and other readers assessment. Inter-reader agreement and agreement between Quantra and each reader were tested. Region under the curve (ROC) analysis was performed to obtain the cut-off value to separate dense from a non-dense breast. Results with P value <.05 was taken as significant.There were 40.4% Chinese, 27% Malays, 19% Indian and 3.6% represent other ethnicities. The mean age of the patients was 57. 15%, 45.6%, 30.4%, and 9% of patients fall under BI-RADS A, B, C and D density category respectively. Fair agreement with Kappa (κ) value: 0.49, 0.38, and 0.30 were seen for Reader 1, 2 and 3 versus Quantra. Moderate agreement with κ value: 0.63, 0.64, 0.51 was seen when the data were dichotomized (density A and B to "non-dense", C and D to "dense"). The cut-off Vbd value was 13.5% to stratify dense from non-dense breasts with a sensitivity of 86.2% and specificity of 83.1% (AUC 91.4%; confidence interval: 88.8, 94.1).Quantra showed moderate agreement with radiologists visual assessment. Hence, this study adds to the available evidence to support the potential use of Quantra as an adjunct tool for breast density assessment in routine clinical practice in the Asian population. We found 13.5% is the best cut-off value to stratify dense to non-dense breasts in our study population. Its application will provide an objective, consistent and reproducible results as well as aiding clinical decision-making on the need for supplementary breast ultrasound in our screening population.


Assuntos
Densidade da Mama , Mama/diagnóstico por imagem , Mamografia/métodos , Software , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
AJR Am J Roentgenol ; 215(3): 760-764, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755154

RESUMO

OBJECTIVE. The objective of our study was to compare the performance of digital breast tomosynthesis (DBT)-guided prone and upright breast biopsies. MATERIALS AND METHODS. In this retrospective study, we reviewed all consecutive DBT-guided breast biopsies performed at our institution from May 1, 2018, to July 31, 2019. We recorded patient age, breast density, biopsy indications and technique, number of samples obtained, number of exposures performed, procedure times, percentage of calcifications removed, biopsy complications, histopathologic diagnosis, and radiology-pathology concordance. These characteristics were then compared between biopsy methods using the chi-square test or Wilcoxon rank sum test. RESULTS. There were 282 patients in our study: 215 patients (76.2%) underwent prone DBT-guided biopsy, and 67 (23.8%) underwent upright DBT-guided biopsy. All patients (100%) had technically successfully biopsies. The mean number of exposures for upright biopsies was significantly lower than the mean number of exposures for prone biopsies (p < 0.001). Otherwise, there was no significant difference between the two biopsy methods in the mean number of samples acquired (p = 0.26), mean procedure time (p = 0.67), percentage of calcifications removed (p = 0.31), or biopsy complications (p = 0.56). CONCLUSION. Besides the mean number of exposures acquired, prone and upright DBT-guided biopsies have similar clinical performance. Other factors, such as room utilization and patient comfort, should be considered when deciding between prone and upright DBT-guided biopsies.


Assuntos
Neoplasias da Mama/patologia , Biópsia Guiada por Imagem , Mamografia/métodos , Posicionamento do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade da Mama , Feminino , Humanos , Pessoa de Meia-Idade , Decúbito Ventral , Estudos Retrospectivos
5.
Radiología (Madr., Ed. impr.) ; 62(4): 252-265, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194243

RESUMO

En mujeres con alto riesgo de padecer cáncer de mama, la detección precoz tiene un importante papel. Debido a la alta incidencia de cáncer mamario y a edades más tempranas que en la población general, se recomienda que el cribado comience en edad más joven, y existe amplia evidencia de que la resonancia magnética es la herramienta diagnóstica más sensible: las principales guías americanas y europeas coinciden en la recomendación de realizar resonancia magnética anual (con mamografía anual suplementaria) como modalidad óptima de cribado. No obstante, no hay un total consenso actual entre las guías sobre algunos subgrupos de pacientes a incluir en la recomendación de cribado con resonancia magnética. El objetivo de esta primera parte de nuestro trabajo es, mediante una revisión de la bibliografía, explicar y valorar las ventajas que este tipo de cribado con resonancia magnética proporciona respecto al cribado solo con mamografía, como son: mayor detección de cánceres de menor tamaño y con menor afectación ganglionar asociada y una reducción de los cánceres de intervalo, lo que puede tener repercusión en supervivencia y mortalidad, con efectos comparables a otras medidas de prevención. Pero, a su vez, también queremos reflejar los inconvenientes que el cribado con resonancia magnética conlleva, y que dificultan su aplicabilidad


Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability


Assuntos
Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Programas de Triagem Diagnóstica , Espectroscopia de Ressonância Magnética/métodos , Neoplasias da Mama/epidemiologia , Diagnóstico Precoce , Espectroscopia de Ressonância Magnética/efeitos adversos , Mamografia/métodos , Mamografia/tendências , Fatores de Risco , Predisposição Genética para Doença/epidemiologia , Predisposição Genética para Doença/prevenção & controle
6.
PLoS One ; 15(8): e0237674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790772

RESUMO

Breast cancer is the most common cancer in women and poses a great threat to women's life and health. Mammography is an effective method for the diagnosis of breast cancer, but the results are largely limited by the clinical experience of radiologists. Therefore, the main purpose of this study is to perform two-stage classification (Normal/Abnormal and Benign/Malignancy) of two- view mammograms through convolutional neural network. In this study, we constructed a multi-view feature fusion network model for classification of mammograms from two views, and we proposed a multi-scale attention DenseNet as the backbone network for feature extraction. The model consists of two independent branches, which are used to extract the features of two mammograms from different views. Our work mainly focuses on the construction of multi-scale convolution module and attention module. The final experimental results show that the model has achieved good performance in both classification tasks. We used the DDSM database to evaluate the proposed method. The accuracy, sensitivity and AUC values of normal and abnormal mammograms classification were 94.92%, 96.52% and 94.72%, respectively. And the accuracy, sensitivity and AUC values of benign and malignant mammograms classification were 95.24%, 96.11% and 95.03%, respectively.


Assuntos
Neoplasias da Mama/diagnóstico , Aprendizado Profundo , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Programas de Rastreamento/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Mama/diagnóstico por imagem , Bases de Dados Factuais , Conjuntos de Dados como Assunto , Feminino , Humanos
7.
Korean J Radiol ; 21(8): 955-966, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677380

RESUMO

Ultrasound (US) is an attractive diagnostic approach to identify both common and uncommon nipple pathologies, such as duct ectasia, nipple abscess, nipple leiomyoma, nipple adenoma, fibroepithelial polyp, ductal carcinoma in situ (restricted to nipple), invasive carcinoma, and Paget's disease. US is the reliable first-line imaging technique to assess nipple pathologies. It is useful to identify and characterize nipple lesions. Additionally, we have presented the mammography and MRI outcomes correlated with histopathologic features for the relevant cases.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Papiloma/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Idoso , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/diagnóstico , Doença de Paget Mamária/patologia , Papiloma/patologia
8.
Anticancer Res ; 40(7): 3915-3924, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620632

RESUMO

BACKGROUND: Wire-guided localization (WGL) has been the mainstay for localizing non-palpable breast lesions before excision. Due to its limitations, various wireless alternatives have been developed. In this prospective study, we evaluate the role of radiation-free wireless localization using the SAVI SCOUT® localization at a European centre. PATIENTS AND METHODS: This technique was evaluated in a prospective cohort of 20 patients. The evaluation focused on clinical and pathological parameters in addition to patient and physician acceptance. RESULTS: SAVI SCOUT reflectors (n=23) were deployed to localize 22 occult breast lesions and one axillary lymph node in 20 patients. The mean deployment duration was 5.6 min, with a mean distance from the lesion of 0.6 mm. The migration rate was 0% and the mean identification and retrieval time was 25.1 min. In patients undergoing therapeutic excision for malignancy (n=17), only one (5.9%) required reoperation for positive surgical margins. Radiologists and surgeons rated the technique as better than WGL and patient satisfaction was high. CONCLUSION: Our study demonstrates that wireless localization using SAVI SCOUT® is an effective and time-efficient alternative to WGL with excellent physician and patient acceptance.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Adulto , Idoso , Neoplasias da Mama/cirurgia , Diagnóstico por Imagem/instrumentação , Feminino , Humanos , Raios Infravermelhos , Mamografia/instrumentação , Mamografia/métodos , Pessoa de Meia-Idade , Radar
9.
Medicine (Baltimore) ; 99(28): e20847, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664078

RESUMO

High-grade ductal carcinoma in situ (DCIS) requires resection due to the high risk of developing invasive breast cancer. The predictive powers of noninvasive predictors for high-grade DCIS remain contradictory. This study aimed to explore the predictive value of calcification for high-grade DCIS in Chinese patients.This was a retrospective study of Chinese DCIS patients recruited from the Women's Hospital, School of Medicine, Zhejiang University between January and December 2018. The patients were divided into calcification and non-calcification groups based on the mammography results. The correlation of calcification with the pathologic stage of DCIS was evaluated using the multivariable analysis. The predictive value of calcification for DCIS grading was examined using the receiver operating characteristics (ROC) curve.The pathologic grade of DCIS was not associated with calcification morphology (P = .902), calcification distribution (P = .252), or breast density (P = .188). The multivariable analysis showed that the presence of calcification was independently associated with high pathologic grade of DCIS (OR = 3.206, 95% CI = 1.315-7.817, P = .010), whereas the age, hypertension, menopause, and mammography BI-RADS were not (all P > .05) associated with the grade of DCIS. The ROC analysis of the predictive value of calcification for DCIS grading showed that the area under the curve was 0.626 (P = .019), with a sensitivity of 73.1%, specificity of 52.2%, positive predictive value of 72.2%, and negative predictive value of 53.3%.The presence of calcification is independently associated with high pathologic grade of DCIS and could predict high-grade DCIS in Chinese patients.


Assuntos
Neoplasias da Mama/patologia , Calcinose/patologia , Carcinoma Intraductal não Infiltrante/patologia , Gradação de Tumores/métodos , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Asiático/etnologia , Neoplasias da Mama/diagnóstico por imagem , Calcinose/classificação , Carcinoma Intraductal não Infiltrante/etnologia , Feminino , Humanos , Hipertensão/epidemiologia , Mamografia/métodos , Menopausa/fisiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
S Afr Med J ; 110(2): 118-122, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657681

RESUMO

BACKGROUND: Data on the association between HIV and breast cancer mammographic patterns and histological subtypes are limited. OBJECTIVES: To determine whether specific mammographic findings, histological features and patient profiles were unique to a cohort of HIV-positive patients who developed breast cancer, by comparing them with a HIV-negative cohort. METHODS: This was a descriptive study in which we conducted a retrospective chart review and mammographic and pathology analysis of newly diagnosed breast cancer patients referred to the Addington Hospital breast clinic between August 2008 and June 2012 and entered into a prospective database. RESULTS: Thirty-eight HIV-positive and 38 HIV-negative patients were included in the study. HIV-positive patients were more likely to have multifocal breast cancer (p=0.007), but not multicentric disease (p=0.05). The presence of grouped and fine pleomorphic microcalcifications and positive HIV status demonstrated statistical significance (p=0.000). A statistically significant relationship between grouped and fine pleomorphic microcalcifications with biopsies confirming high-grade ductal carcinoma in situ (HGDCIS) and HIV status was demonstrated (p=0.001). The mean age of the HIV-positive patients was 42.5 years (p=0.000). CONCLUSIONS: We demonstrated a statistically significant relationship between HIV status, the presence of multifocal breast cancer, and mammographically detected grouped and fine pleomorphic microcalcifications. A statistically significant relationship between HGDCIS and HIV status, and the presence of grouped and fine pleomorphic microcalcifications in HIV-positive patients with biopsies confirming HGDCIS, was demonstrated. Our study also showed that there is a relationship between age of presentation and HIV status.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Infecções por HIV/epidemiologia , Mamografia/métodos , Adulto , Fatores Etários , Biópsia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Calcinose/patologia , Carcinoma Intraductal não Infiltrante/epidemiologia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(27): e20977, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629712

RESUMO

BACKGROUND: Screening mammography has led to reduced breast cancer-specific mortality and is recommended worldwide. However, the resultant doctors' workload of reading mammographic scans needs to be addressed. Although computer-aided detection (CAD) systems have been developed to support readers, the findings are conflicting regarding whether traditional CAD systems improve reading performance. Rapid progress in the artificial intelligence (AI) field has led to the advent of newer CAD systems using deep learning-based algorithms which have the potential to reach human performance levels. Those systems, however, have been developed using mammography images mainly from women in western countries. Because Asian women characteristically have higher-density breasts, it is uncertain whether those AI systems can apply to Japanese women. In this study, we will construct a deep learning-based CAD system trained using mammography images from a large number of Japanese women with high quality reading. METHODS: We will collect digital mammography images taken for screening or diagnostic purposes at multiple institutions in Japan. A total of 15,000 images, consisting of 5000 images with breast cancer and 10,000 images with benign lesions, will be collected. At least 1000 images of normal breasts will also be collected for use as reference data. With these data, we will construct a deep learning-based AI system to detect breast cancer on mammograms. The primary endpoint will be the sensitivity and specificity of the AI system with the test image set. DISCUSSION: When the ability of AI reading is shown to be on a par with that of human reading, images of normal breasts or benign lesions that do not have to be read by a human can be selected by AI beforehand. Our AI might work well in Asian women who have similar breast density, size, and shape to those of Japanese women. TRIAL REGISTRATION: UMIN, trial number UMIN000039009. Registered 26 December 2019, https://www.umin.ac.jp/ctr/.


Assuntos
Aprendizado Profundo , Mamografia/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Neoplasias da Mama/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Japão , Estudos Retrospectivos
12.
Medicine (Baltimore) ; 99(27): e21063, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629735

RESUMO

BACKGROUND: Overflow breast disease (OBD), also known as breast nipple discharge, refers fluid or liquid that comes out of nipple. Many patients with breast cancer experience such condition. However, it is not easy to detect it at early stage, especially for pathological OBD. Previous study found low-dose CT combined mammography (LDCTMG) could help in diagnosis of OBD. However, there is no systematic review investigating this issue. Therefore, this study will examine the accuracy of LDCTMG in diagnosis of OBD. METHODS: This study protocol will search literature sources in electronic databases and other sources. The electronic databases will be retrieved in The Cochrane Library, the Cochrane Register of Diagnostic Test Accuracy Studies, PUBMED, EMBASE, Web of Science, CINAHL, CNKI, and WANGFANG from inception to the present. We will also search other sources. All literature sources will be sought without restrictions to the language and publication status. Two researchers will independently carry out study selection, data extraction, and study quality assessment. Statistical analysis will be performed using RevMan 5.3. RESULTS: This study will exert a high-quality synthesis of eligible studies on the analysis of LDCTMG in diagnosis of OBD. CONCLUSIONS: The results of this study may provide evidence to help judge whether LDCTMG is accurate in diagnosis of OBD. STUDY REGISTRATION: INPLASY202050116.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mamografia/métodos , Derrame Papilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Doenças Mamárias/epidemiologia , Doenças Mamárias/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Imagem Multimodal/métodos
13.
Br J Radiol ; 93(1112): 20190908, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32501766

RESUMO

This review details the aetiology of the PERFORMS self-assessment scheme in breast screening, together with its subsequent development, current implementation and future function. The purpose of the scheme is examined and the importance of its continuing role in a changing screening service described, together with current evolution.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Idoso , Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Reino Unido
14.
Br J Radiol ; 93(1112): 20200301, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32574075

RESUMO

OBJECTIVES: Neoadjuvant chemotherapy (NAC) is an important method for breast cancer treatment. By monitoring its pathological response, the selection of clinical treatment strategies can be guided. In this study, the meta-analysis was used to compare the accuracy of contrast-enhanced MRI (CE-MRI) and contrast-enhanced spectral mammography (CESM) in detecting the pathological response of NAC. METHODS: Literatures associated to CE-MRI and CESM in the evaluation of pathological response of NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the quality of studies. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to evaluate the diagnostic accuracy of CE-MRI and CESM in monitoring the pathological response of NAC. RESULTS: There were 24 studies involved, 18 of which only underwent CE-MRI examination, three of which only underwent CESM examination, and three of which underwent both CE-MRI and CESM examination. The pooled sensitivity and specificity of CE-MRI were 0.77 (95%CI, 0.67-0.84) and 0.82 (95%CI, 0.73-0.89), respectively. The pooled sensitivity and specificity of CESM were 0.83 (95%CI, 0.66-0.93) and 0.82 (95%CI, 0.68-0.91), respectively. The AUCs of SROC curve for CE-MRI and CESM were 0.86 and 0.89, respectively. CONCLUSIONS: Compared to CE-MRI, CESM has equal specificity, greater sensitivity and excellent performance, which may have a brighter prospect in evaluating the pathological response of breast cancer to NAC. ADVANCES IN KNOWLEDGE: CESM showed equal specificity, greater sensitivity, and excellent performance than CE-MRI.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Meios de Contraste , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Terapia Neoadjuvante , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Terapia Neoadjuvante/métodos , Resultado do Tratamento
15.
Clin Imaging ; 66: 84-86, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32460152

RESUMO

Rapidly increasing U.S. healthcare spending has been a hot topic over the past few decades. Imaging studies, including screening mammography, are possible targets for cost savings. Radiologists need to be more proactive and take charge by actively participating in the cost reduction conversation, improving the quality of care, providing patients with accurate cost estimates and educating patients along with clinicians on the value we have provided and can provide in the future.


Assuntos
Mamografia/economia , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia/métodos , Programas de Rastreamento , Radiologistas
16.
Clin Imaging ; 66: 111-120, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32470708

RESUMO

Breast malignancy is the second most common cause of cancer death in women. However, less common breast masses can mimic carcinoma and can pose diagnostic challenges. This case-based review describes a spectrum of rare breast neoplastic and non-neoplastic masses ranging from malignant to benign entities. Malignant masses in this review include adenoid cystic carcinoma, spindle cell lipoma, granular cell tumor, angiosarcoma, glomus tumor, adenosquamous carcinoma, and myofibroblastoma. Benign masses include sarcoidosis, diabetic mastopathy, and cat scratch disease. Demographics and, when relevant, clinical presentation are summarized. Breast imaging appearance on mammography and ultrasound are highlighted along with radiology-pathology correlation with the appearance and characteristics of the histopathological specimen of these rare masses.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Adulto , Mama/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Tumor Glômico , Humanos , Lipoma/diagnóstico , Mamografia/métodos , Mastite/diagnóstico , Pessoa de Meia-Idade , Ultrassonografia , Ultrassonografia Mamária/métodos
17.
PLoS One ; 15(5): e0233369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433664

RESUMO

INTRODUCTION: Cadmium (Cd) is a heavy metal, which is widespread in the environment and has been hypothesized to be a metalloestrogen and a breast cancer risk factor. Mammographic density (MD) reflects the composition of the breast and was proposed to be used as a surrogate marker for breast cancer. The aim of our study was to investigate association between cadmium concentration in urine and mammographic density. METHODS: A cross-sectional study included 517 women aged 40-60 years who underwent screening mammography in Lódz, Poland. Data were collected through personal interviews and anthropometric measurements. Spot morning urine samples were obtained. The examination of the breasts included both craniocaudal and mediolateral oblique views. Raw data ("for processing") generated by the digital mammography system were analysed using Volpara Imaging Software, The volumetric breast density(%) and fibrograndular tissue volume(cm3) were determined. Cadmium concentration in urine was analysed using the standard ICP-MS method. RESULTS: After adjusting for key confounders including age, BMI, family breast cancer, mammographic device, season of the year of mammography, and age at menarche, an inverse association of Cd and volumetric breast density was found, which was attenuated after further adjustment for smoking. Associations of Cd with dense volume were null. CONCLUSIONS: These findings suggest that Cd is not positively associated with breast density, a strong marker of breast cancer risk, when examined in a cross-sectional fashion.


Assuntos
Densidade da Mama/efeitos dos fármacos , Neoplasias da Mama/etiologia , Cádmio/urina , Mamografia/métodos , Adulto , Neoplasias da Mama/diagnóstico , Cádmio/toxicidade , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Polônia/epidemiologia , Medição de Risco , Fatores de Risco , Software
18.
Anticancer Res ; 40(5): 2925-2932, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366444

RESUMO

BACKGROUND/AIM: Contrast enhanced spectral mammography (CESM) is a novel method of breast cancer diagnosis. Benign lesions are enhanced after contrast injection on both CESM and breast magnetic resonance imaging (MRI). Kinetic curves on breast MRI facilitate differentiation between benign and malignant lesions, while on CESM there is no such possibility and we need to asses lesions based only on their level of enhancement and its patterns. The aim of this study was to compare two subjective assessments of enhancement level on CESM with numerical values measured using the region of interests (ROIs) and to categorize obtained enhancement level values. PATIENTS AND METHODS: Patients with suspicious findings on previously performed examinations were qualified for CESM. The qualitative assessment was based on the subjective classification of visible contrast enhancement as weak, medium or strong. The quantitative assessment was obtained by measurements of an average enhancement value and sigma value within the ellipsoidal shape ROI, inserted into the evaluated contrast enhancing lesion. RESULTS: The study group included 151 patients with total of 195 lesions diagnosed. It was verified how the classification based on the threshold values of %RS (percentage signal difference between enhancing lesion and background) and SDNR (signal-difference-to-noise Ratio) corresponds to a subjective assessment. CONCLUSION: Quantitative assessment of contrast enhancement on CESM is helpful in making decisions whether a lesion requires a biopsy. This can reduce the number of unnecessary biopsy procedures and reduce the cost of diagnostics.


Assuntos
Mamografia/métodos , Meios de Contraste , Feminino , Humanos
19.
BMJ ; 369: m1570, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32461218

RESUMO

OBJECTIVE: To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening. DESIGN: Population based observational cohort study. SETTING: Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service. PARTICIPANTS: All 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. MAIN OUTCOME MEASURES: Incident invasive breast cancer and death from breast cancer. RESULTS: By December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer. CONCLUSIONS: To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.


Assuntos
Neoplasias da Mama/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Programas de Rastreamento/estatística & dados numéricos , Idoso , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/epidemiologia , Carcinoma Intraductal não Infiltrante/radioterapia , Carcinoma Intraductal não Infiltrante/terapia , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Mamografia/métodos , Margens de Excisão , Programas de Rastreamento/tendências , Mastectomia/métodos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Mortalidade/tendências , Risco
20.
Br J Radiol ; 93(1111): 20191019, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32401540

RESUMO

OBJECTIVE: To establish a radiomics nomogram by integrating clinical risk factors and radiomics features extracted from digital mammography (MG) images for pre-operative prediction of axillary lymph node (ALN) metastasis in breast cancer. METHODS: 216 patients with breast cancer lesions confirmed by surgical excision pathology were divided into the primary cohort (n = 144) and validation cohort (n = 72). Radiomics features were extracted from craniocaudal (CC) view of mammograms, and radiomics features selection were performed using the methods of ANOVA F-value and least absolute shrinkage and selection operator; then a radiomics signature was constructed with the method of support vector machine. Multivariate logistic regression analysis was used to establish a radiomics nomogram based on the combination of radiomics signature and clinical factors. The C-index and calibration curves were derived based on the regression analysis both in the primary and validation cohorts. RESULTS: 95 of 216 patients were confirmed with ALN metastasis by pathology, and 52 cases were diagnosed as ALN metastasis based on MG-reported criteria. The sensitivity, specificity, accuracy and AUC (area under the receiver operating characteristic curve of MG-reported criteria were 42.7%, 90.8%, 24.1% and 0.666 (95% confidence interval: 0.591-0.741]. The radiomics nomogram, comprising progesterone receptor status, molecular subtype and radiomics signature, showed good calibration and better favorite performance for the metastatic ALN detection (AUC 0.883 and 0.863 in the primary and validation cohorts) than each independent clinical features (AUC 0.707 and 0.657 in the primary and validation cohorts) and radiomics signature (AUC 0.876 and 0.862 in the primary and validation cohorts). CONCLUSION: The MG-based radiomics nomogram could be used as a non-invasive and reliable tool in predicting ALN metastasis and may facilitate to assist clinicians for pre-operative decision-making. ADVANCES IN KNOWLEDGE: ALN status remains among the most important breast cancer prognostic factors and is essential for making treatment decisions. However, the value of detecting metastatic ALN by MG is very limited. The studies on pre-operative ALN metastasis prediction using the method of MG-based radiomics in breast cancer are very few. Therefore, we studied whether MG-based radiomics nomogram could be used as a predictive biomarker for the detection of metastatic ALN.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Mamografia/métodos , Análise de Variância , Axila/diagnóstico por imagem , Axila/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos
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