What’s new in Breast Imaging – June 2021

3 years ago


Evaluation of Breast Edema Findings at T2-weighted Breast MRI Is Useful for Diagnosing Occult Inflammatory Breast Cancer and Can Predict Prognosis after Neoadjuvant Chemotherapy. 

Harada, T. L., Uematsu, T., Nakashima, K., Kawabata, T., Nishimura, S., Takahashi, K., Sugino, T. (2021).

Radiology,299(1), 53-62. doi:10.1148/radiol.2021202604 


In this study, authors sought to determine the relationship between the degree of breast edema on T2-weighted images and prognosis of breast cancer patients treated with neoadjuvant chemotherapy (NAC). Breast MRIs from 408 women treated with NAC obtained between January 2011 and December 2018 were retrospectively reviewed. Breast edema was scored 1-4 (1=no edema, 2=peritumoral edema, 3=prepectoral edema, 4=subcutaneous edema suspicious for occult inflammatory breast cancer). Differences in progression-free survival and overall survival (OS) between breast edema scores were determined using the log-rank test. Statistically significant differences in PFS were present between breast edema scores of 4 versus 1, 5 versus 1, 5 versus 2, and 5 versus 3. OS rates were lower in breast edema scores of 4 and 5 versus scores of 1-3. The authors concluded that prognosis of patients treated with NAC was related to a breast edema classification score. 


Breast Cancer Screening with Abbreviated Breast MRI: 3-year Outcome Analysis. 

Kwon, M., Choi, J. S., Won, H., Ko, E. Y., Ko, E. S., Park, K. W., & Han, B. (2021).

Radiology,299(1), 73-83. doi:10.1148/radiol.2021202927 


In this study, authors sought to determine the diagnostic performance of abbreviated screening MRI and to compare yearly screening outcomes between three consecutive years. Between September 2015 and August 2018, 1,975 women underwent 3,037 abbreviated MRI exams, which included T2-weighted and contrast-enhanced dynamic sequences. There were no statistically significant differences between consecutive years for cancer detection rate (6.9-10.7 per 1,000 screening exams), sensitivity (70-85%), specificity (93.5-94.1%), positive predictive value for recall (9.7-15.6%), positive predictive value for biopsy (31.6-63.2%), abnormal interpretation rate, and interval cancer rate. All missed cancers were early-stage invasive disease without nodal involvement. Missed cancers were also statistically smaller than cancers detected on abbreviated screening MRI. The authors concluded that there were no significant differences in abbreviated MRI screening outcomes over three consecutive years. 


Supplemental MRI in Extremely Dense Breasts: Sharp Reduction in False-Positive Rate in the Second Screening Round of the DENSE Trial. 

Veenhuizen, S. G. A., de Lange, S. V., Bakker, M. F., Pijnappel, R. M., Mann, R. M., Monninkhof, E. M., de Koning, H. J. (2021).

Radiology, 299(2), 278–286. 


In this study, authors sought to compare performance indicators between first and second MRI screening rounds in the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial conducted between December 2011 and January 2016. This trial was associated with the Dutch population-based mammography screening program for women ages 50-75 years old. Enrolled women with dense breasts and a prior negative mammogram underwent an initial round of supplemental MRI screening. A second round of MRI screening was performed if women had a subsequent negative mammogram after their first MRI. Approximately 3,400 women underwent a second MRI. The false positive rate was 26.3 per 1,000 screening exams compared to 79.8 in the first round. The cancer detection rate for the second MRI was 5.8 per 1,000 screening exams compared to 16.5 in the first round. The positive predictive values for recall and biopsy were comparable between the two screening rounds. The authors concluded that lower cancer detection rates and false positive rates were likely due to availability of prior MRI exams and overall smaller pool of prevalent cancers. 


Shear-Wave Elastography of the Breast: Impact of Technical Image Quality Parameters on Diagnostic Accuracy. 

Chou, S. S., Baikpour, M., Zhang, W., Mercaldo, S. F., Lehman, C. D., & Samir, A. E. (2021).

American Journal of Roentgenology,216(5), 1205-1215. doi:10.2214/ajr.19.22728 


In this study, authors sought to investigate the effects of shear-wave elastography (SWE) image quality parameters on the diagnostic quality of calculating elasticity measurements to categorize breast lesions. From October 2017 to August 2018, 281 breast lesions that underwent SWE and ultrasound-guided biopsy were retrospectively reviewed. Three blinded radiologists rated the image quality of the SWE exams as poor (score of 0) or high (score of 1), which included parameters like B-mode visualization of the lesion, presence of a near-field red pattern, field of view (FOV) placement, and appearance of surrounding tissues. SWE images were considered high quality if near-field red pattern and B-mode visualization received scores of 1. When compared to low quality SWE images, high quality images had significantly greater AUC values. The authors concluded that the use of SWE quality parameters to generate high quality exams can improve distinction between benign and malignant breast lesions. 


Background Parenchymal Uptake on Molecular Breast Imaging and Breast Cancer Risk: A Cohort Study. 

Hruska, C. B., Geske, J. R., Conners, A. L., Whaley, D. H., Rhodes, D. J., Oconnor, M. K., Vachon, C. M. (2021).

American Journal of Roentgenology,216(5), 1193-1204. doi:10.2214/ajr.20.23854 


In this study, authors sought to examine the relationship between background parenchymal uptake (BPU) on molecular breast imaging (MBI) and risk of breast cancer. Nearly three thousand women without a history of breast cancer who underwent MBI between 2004 and 2015 comprised the retrospective cohort. Radiologists were blinded to patients’ future breast cancer diagnoses and graded BPU on MBI as low (photopenic or minimal) or elevated (mild, moderate or marked). Within the cohort, 144 women were diagnosed with breast cancer after a median follow up time of 7.3 years. Overall, increased breast cancer risk was associated with elevated BPU (hazard ratio [HR] 2.39, p</= .001) but was only significant in postmenopasual women (HR 3.5, p<.001). The 5-year absolute risk for breast cancer in women with elevated BPU was 4.3% compared to 2.5% with low BPU. In postmenopasual women with dense breasts, the 5-year absolute risk for breast cancer increased to 8.1%. The authors concluded that elevated BPU is associated with an increased risk of breast cancer, particularly in postmenopasual women with dense breasts. 


Digital Mammography Has Persistently Increased High-Grade and Overall DCIS Detection Without Altering Upgrade Rate. 

Neal, C. H., Joe, A. I., Patterson, S. K., Pujara, A. C., & Helvie, M. A. (2021).

American Journal of Roentgenology,216(4), 912-918. doi:10.2214/ajr.20.23314 


In this study, authors sought to examine the relationship between digital mammography (DM) and sustained increased detection of ductal carcinoma in situ (DCIS), as well as upgrade rates of DCIS to invasive cancer. Four hundred and eighty-four cases of mammographic calcifications diagnosed as DCIS obtained between 2001 and 2014 were included in this retrospective study. During this time period, the institution used both film screen mammography (FSM) and DM with a full transition to DM in 2010. Of the included DCIS cases, DM had a higher detection rate compared to FSM (p<.001) with a doubled detection rate for high-grade DCIS (p<.001). These rates persisted after the prevalent peak of DM-detected DCIS in 2008. Upgrade rates of DCIS to invasive cancer were not statistically different between DM and FSM (p=.74), and 71% of upgraded invasive cancers were initially high-grade DCIS. The authors concluded that DM demonstrated doubled detection rates compared to FSM for DCIS detection, which were sustained after the prevalent peak. Additionally, authors determined that upgrade rates to invasive cancer were similar for FSM and DM. 


MRI-guided breast biopsy based on diffusion-weighted imaging: A feasibility study. 

Montemezzi, S., Cardano, G., Storer, S., Cardobi, N., Cavedon, C., & Camera, L. (2021).

European Radiology,31(5), 2645-2656. doi:10.1007/s00330-020-07396-2 


In this study, authors sought to examine the utility of DWI for targeting lesions in MRI-guided breast biopsies. Eighty-seven MRI-guided breast biopsies performed between March 2019 and June 2020 were included in this study. A preliminary DWI sequence (b=1300 s/mm2) was obtained to determine lesion visualization, and 64 lesions were seen on DWI. Mean size of mass and non-mass lesions was 10.7 mm and 33.9 mm, respectively. The biopsy needle was seen on DWI in 96.9% of cases. The biopsy site marker was confirmed with T1-weighted imaging per standard protocol but was identified in 95.5% of cases on DWI. The authors concluded that DWI is an effective and reliable sequence for targeting non-mass and mass lesions (at least 5 mm in size) when lesions are visualized on pre-procedure DWI. DWI also provides reliable detection of the needle device and biopsy site marker and may provide a more cost-effective alternative to contrast-enhanced MRI-guided breast biopsies. 


The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. 

Zhang, F., Jin, L., Li, G., Jia, C., Shi, Q., Du, L., & Wu, R. (2021).

The British Journal of Radiology,94(1120), 20200880. doi:10.1259/bjr.20200880 


In this study, authors sought to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in diagnosing malignant non-mass breast lesions (NMLs). Approximately 100 patients with NMLs seen on conventional ultrasound were included in the study.  Enhancement patterns on CEUS were compared between benign and malignant NMLs. Additionally, the authors compared the diagnostic performance of BI-RADS-US, CEUS, and combined BI-RADS-US with CEUS. Diagnostic indicators on CEUS included radial or penetrating vessels, enhancement area, and enhancement degree. Sensitivities for BI-RADS-US, CEUS, and combined BI-RADS-US with CEUS were 100%, 80.4%, and 94.6%, respectively. Specificities for BI-RADS-US, CEUS, and combined BI-RADS-US with CEUS were 30.2%, 74.6%, and 77.8%, respectively. The authors concluded that CEUS demonstrated the highest specificity but lowest sensitivity in the diagnosis of malignant NMLs. Combined BI-RADS-US with CEUS provides the highest sensitivity and specificity for diagnosing malignant NMLs. 

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