What’s New in Breast Imaging – August 2021

4 months ago

Ultrafast Dynamic Contrast-Enhanced MRI Using Compressed Sensing: Associations of Early Kinetic Parameters With Prognostic Factors of Breast Cancer

Kim, J. J., Kim, J. Y., Hwangbo, L., Suh, H. B., Son, Y., Nickel, M. D., & Grimm, R. (2021). Ultrafast Dynamic Contrast-Enhanced MRI Using Compressed Sensing: Associations of Early Kinetic Parameters With Prognostic Factors of Breast Cancer. American Journal of Roentgenology,217(1), 56-63. doi:10.2214/ajr.20.23457

In this study, authors sought to determine if early kinetic parameters obtained from ultrafast dynamic contrast-enhanced MRI (DCE-MRI) with compressed sensing correlated with breast cancer prognostic factors. Two hundred and one consecutive women with breast cancer underwent DCE-MRI and subsequent surgery from 2018 to 2019. For each breast lesion, time to enhancement (TTE) and maximum slope (MS) were calculated by two radiologists. These data points were associated with histopathological prognostic factors. The authors determined that MS values were significantly higher for invasive lesions compared to ductal carcinoma in situ. Shorter TTE values were significantly associated with estrogen receptor-negative status and larger tumor size (greater than 2 cm) (p<.001). Larger MS values were significantly associated with histologic grade 3 cancers (p=.01). The authors concluded that early kinetic parameters from ultrafast DCE-MRI correlated with breast cancer prognostic factors.

Preoperative Breast MRI in Women 35 Years of Age and Younger with Breast Cancer: Benefits in Surgical Outcomes by Using Propensity Score Analysis

Park, A. R., Chae, E. Y., Cha, J. H., Shin, H. J., Choi, W. J., & Kim, H. H. (2021). Preoperative Breast MRI in Women 35 Years of Age and Younger with Breast Cancer: Benefits in Surgical Outcomes by Using Propensity Score Analysis. Radiology,300(1), 39-45. doi:10.1148/radiol.2021204124

In this study, authors sought to determine the impact of preoperative breast MRI in women 35 years old or younger by investigating surgical outcomes. Data from 964 women 35 years old or younger with breast cancer between 2007 and 2017 was retrospectively reviewed. To balance the two study groups (those who received or did not receive preoperative breast MRI) were balanced with propensity score (PS) analysis and inverse probability weighting (IPW). Sixty-nine percent of women underwent a preoperative breast MRI. Of those women, 27% had an additional suspicious lesion detected, and 15% of these patients had a change in surgical management. Forty-nine percent of this subgroup had an additional malignant lesion. Women undergoing preoperative breast MRI had a higher odds ratio of undergoing total mastectomy and a lower rate of repeat surgery (OR=1.62 and 0.13, respectively). However, authors did not find a statistical difference between groups regarding overall mastectomy rate. The authors concluded that preoperative breast MRI in women aged 35 years and younger is beneficial for improving surgical outcomes and diagnosing additional malignancies.

 

 

Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post–ACOSOG Z0011 Trial Era

Byon, J. H., Park, Y. V., Yoon, J. H., Moon, H. J., Kim, E., Kim, M. J., & You, J. K. (2021). Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post–ACOSOG Z0011 Trial Era. Radiology,300(1), 46-54. doi:10.1148/radiol.2021202683

 

In this study, authors sought to determine the effectiveness of a standard MRI protocol for evaluating high level or advanced axillary lymph node metastasis (ALNM) and whether an entire axilla MRI provided additional clinical benefit. Four hundred and thirty-five women with breast cancer who underwent neoadjuvant chemotherapy (NAC) or initial surgery between April 2015 and December 2016 were retrospectively reviewed. Effectiveness of detecting high-level or advanced ALNM was compared between a standard MRI protocol including the lower axilla and combined standard MRI protocol with entire axilla MRI. In women who underwent standard MRI protocol, positive axillae (OR=5.9) and peritumoral edema (OR=12.3) were positive predictors of ALNM. Of the 298 women without peritumoral edema and negative axillae on standard protocol MRI, only three women had high-level ALNM. The authors concluded that in most breast cancer patients a standard MRI protocol effectively excludes high-level or advanced ALNM. In the setting of positive axillae or peritumoral edema, a combined MRI protocol may be of benefit.

 

 

Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study

Duffy, S. W., Tabár, L., Yen, A. M., Dean, P. B., Smith, R. A., Jonsson, H., . . . Chen, T. H. (2021). Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study. Radiology,299(3), 541-547. doi:10.1148/radiol.2021203935

 

In this study, authors sought to determine the relationship between breast cancer mortality and completion of two consecutive mammographic screenings prior to breast cancer diagnosis. Data from approximately 550,000 Swedish women collected between 1992 and 2016 was retrospectively reviewed. The authors determined that women who underwent two consecutive mammograms prior to breast cancer diagnosis had a 49% lower risk of breast cancer mortality (p<.001). Within 10 years of diagnosis, these same women had a 50% lower risk of death from breast cancer when compared to women who did not undergo two consecutive mammograms. These outcomes were also significantly lower in women who underwent two consecutive mammograms compared to women who underwent only one of two most recent mammograms. The authors concluded that the most significant reduction in breast cancer death was in women who underwent two consecutive mammograms prior to breast cancer diagnosis. Women who missed at least one of two consecutive mammograms had a significant increase in risk of death from breast cancer.

 

 

Annual Screening Mammography Associated With Lower Stage Breast Cancer Compared With Biennial Screening

Moorman, S. E., Pujara, A. C., Sakala, M. D., Neal, C. H., Maturen, K. E., Swartz, L., . . . Helvie, M. A. (2021). Annual Screening Mammography Associated With Lower Stage Breast Cancer Compared With Biennial Screening. American Journal of Roentgenology,217(1), 40-47. doi:10.2214/ajr.20.23467

 

In this study, authors compared treatment approach and breast cancer features in women who underwent annual versus non-annual screening mammograms. Data from 490 patients diagnosed with breast cancer between 2016-2017 derived from a breast cancer database was retrospectively reviewed. Two hundred and forty-five patients had discernable screening frequency, and 200 of these patients had annual screening. Patients with late-stage presentations (AJCC stage II, III, or IV) were 48 out of 200 annual screeners, 14 out of 32 biennial screeners, and 20 out of 45 non-annual screeners. Annual screeners also had significantly smaller mean tumor diameter (p</=.04) and decreased interval cancers (p<.001) when compared to biennial and non-annual screeners. These findings were redomnstrated in postmenopausal women. The authors concluded that mean tumor diameter, interval cancers, and initial late-stage breast cancer diagnoses were significantly decreased in women undergoing annual screening compared to biennial or non-annual screening.

 

 

Quantitative Measures of Background Parenchymal Enhancement Predict Breast Cancer Risk

Niell, B. L., Abdalah, M., Stringfield, O., Raghunand, N., Ataya, D., Gillies, R., & Balagurunathan, Y. (2021). Quantitative Measures of Background Parenchymal Enhancement Predict Breast Cancer Risk. American Journal of Roentgenology,217(1), 64-75. doi:10.2214/ajr.20.23804

 

In this study, authors sought to compare radiologist-assigned background parenchymal enhancement (BPE) categories to algorithm-driven calculated quantitative BPE values in determining breast cancer risk. Ninety-five women at high risk for breast cancer were included in this retrospective case-control study, of which 19 women became cases after developing breast cancer. Four control patients were age-matched to each case patient. Quantitative BPE values were calculated with an algorithm using data from dynamic contrast-enhanced breast MRI. Women with mild, moderate, or marked BPE were more likely to develop breast cancer (OR=3.0, p=.07). A BPE category greater than minimal resulted in an AUC value of 0.62 in distinguishing cases from controls. The authors preliminarily concluded that algorithm-derived quantitative BPE values are useful in predicting breast cancer risk and may perform better than radiologist-assigned BPE categories.

 

 

Breast tumour volume and blood flow measured by MRI after one cycle of epirubicin and cyclophosphamide-based neoadjuvant chemotherapy as predictors of pathological response

Stevens, W., Farrow, I. M., Georgiou, L., Hanby, A. M., Perren, T. J., Windel, L. M., . . . Buckley, D. L. (2021). Breast tumour volume and blood flow measured by MRI after one cycle of epirubicin and cyclophosphamide-based neoadjuvant chemotherapy as predictors of pathological response. The British Journal of Radiology,94(1123), 20201396. doi:10.1259/bjr.20201396

In this study, authors sought to evaluate functional imaging findings to determine treatment response in women with breast cancer undergoing neoadjuvant chemotherapy (NACT).  Specifically, the authors investigated if decreased tumor blood flow after one cycle of NACT correlated with positive treatment response. Thirty-five women with breast cancer underwent dynamic contrast-enhanced breast MRI after one cycle of cyclophosphamide and epirubicin-based NACT. Subjective treatment response was obtained at surgery after completion of NACT, which was then compared to tumor blood flow and tumor volume values obtained from breast MRI. No statistically significant relationship was determined between pathologic response to NACT and tumor blood flow values. However, a positive treatment response was associated with smaller tumor volumes both at baseline and after one cycle of NACT (AUC 0.8 and 0.81, respectively). The authors concluded that tumor volume size may be a better predictor of pathologic response following cyclophosphamide and epirubicin-based NACT compared to tumor blood flow.

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