What’s new in Breast Imaging – February 2021

3 years ago


Repeat Screening Outcomes with Digital Breast Tomosynthesis Plus Synthetic Mammography for Breast Cancer Detection: Results from the Prospective Verona Pilot Study

Caumo, F., Montemezzi, S., Romanucci, G., Brunelli, S., Bricolo, P., Cugola, L., & Gennaro, G.

Radiology, 298(1), 49-57. doi:10.1148/radiol.2020201246


In this study, authors sought to determine differences in diagnostic accuracy in patients who underwent initial screening with digital breast tomosynthesis and synthetic mammography (DBT+SM) with DBT+SM or full field digital mammography (FFDM) repeat screening compared to patients who underwent screening with FFDM. Nearly 33,000 women underwent repeat screening with approximately half receiving DBT+SM and half receiving FFDM. Cancer detection rate (CDR), recall rate, positive predictive value of recall, and detected cancer stages were compared between enrolled women undergoing repeat screening and the control group (screened with FFDM). The CDR was significantly higher for women who underwent repeat screening with DBT+SM compared to the control group (P<0.1). The proportion of cancers stage II or higher was significantly lower in both repeat screening groups (DBT+SM or FFDM) when compared to the control group (FFDM only) (P≤0.01). The authors concluded repeat screening with DBT+SM detected more cancers compared to FFDM screening, in addition to detecting fewer stage II or higher cancers.


Artificial Intelligence Applied to Breast MRI for Improved Diagnosis

Jiang, Y., Edwards, A. V., & Newstead, G. M.

Radiology, 298(1), 38-46. doi:10.1148/radiol.2020200292


In this study, authors sought to compare differences in diagnostic performance of radiologists when distinguishing cancer from non-cancer on dynamic contrast-enhanced (DCE) breast MRI while using conventional software versus an Artificial Intelligence system. Nineteen breast imaging radiologists interpreted 111 DCE breast MRI examinations twice. For the first interpretation, breast radiologists were supplied with conventional software including kinetic maps. For the second interpretation, radiologists were also provided computer-aided diagnosis software with AI analytics. When using the AI system, radiologists’ average area under the ROC curve (AUC) improved from 0.71 to 0.76 (P=0.04). Sensitivity improved from 90% to 94% with the use of the AI system when using BIRADS-3 lesions as a cut point, however specificity did not differ with conventional and AI software. The authors concluded that AI system software improved radiologists’ diagnostic performance when distinguishing cancer from non-cancer on DCE breast MRI.


Physiologic and Hypermetabolic Breast 18-F FDG Uptake on PET/CT during Lactation

Nissan, N., Sandler, I., Eifer, M., Eshet, Y., Davidson, T., Bernstine, H., Domachevsky, L.

European Radiology, 31(1), 163-170. doi:10.1007/s00330-020-07081-4


In this study, the authors sought to examine lactation-related and breast cancer-related 18F-FDG uptake patterns in patients with pregnancy-associated breast cancer (PABC) and patients without breast cancer. Sixteen lactating patients without breast cancer (controls) and 16 lactating patients with PABC were retrospectively assessed. 18F-FDG uptake (measured in SUVmean and SUVmax) was measured in breast tumors of patients with PABC and in normal physiologic lactating tissue in both study groups. In the control group, uptake in physiologic lactating breast tissue was typically high (SUVmax = 5.0+/-1.7). In PABC patients, breast tumor uptake was high at SUVmax 7.8+/-7.2, which was at least 3 times higher than physiologic uptake in non-affected lactating breast tissue. When compared to the control group, PABC patients demonstrated a 59% decrease in 18F-FDG uptake in non-affected lactating breast tissue (p<.0001). The authors concluded that physiologic uptake in normal lactating breast tissue is significantly lower in patients with PABC compared to controls. In addition, tumors in PABC patients are well seen on PET/CT due to high uptake within the tumor on a background of comparatively decreased physiologic uptake in non-affected lactating breast tissue.


Diagnostic Value of Diffusion-Weighted Imaging with Synthetic b-values in Breast Tumors: Comparison with Dynamic Contrast-Enhanced and Multiparametric MRI.

Naranjo, I. D., Gullo, R. L., Saccarelli, C., Thakur, S. B., Bitencourt, A., Morris, E. A., Pinker-Domenig, K.

European Radiology, 31(1), 356-367. doi:10.1007/s00330-020-07094-z


In this study, authors sought to determine the utility of adding different synthetic b-values when assessing tumor visibility on diffusion-weighted imaging (DWI). Eighty-four women with enhancing lesions on dynamic contrast-enhancing (DCE) breast MRI underwent additional breast multiparametric-MRI (mpMRI). Three radiologists evaluated DWI examinations with acquired b-800 and additional synthetic b-values ranging from 1000-1800 s/mm2 to determine lesion visibility and preferred b-value for interpretation. A b-value of 800 received the highest image quality score, but b-1200-1800 s/mmvalues received higher scores for lesion conspicuity, particularly in patients with dense breasts. Although DWI was more specific for breast cancer detection compared to DCE breast MRI (p<.001), DCE-MRI was more sensitive (p<.001) and accurate (p=.003) than DWI. Of note, the modality with the fewest false positive cases and highest accuracy was mpMRI. The authors concluded that synthetic b-values increase tumor conspicuity, especially in patients with dense breasts.


Heterogeneity of Enhancement Kinetics in Dynamic Contrast-Enhanced MRI and Implication of Distant Metastasis in Invasive Breast Cancer.

Zhao, R., Ma, W., Tang, J., Chen, Y., Zhang, L., Lu, H., & Liu, P.

Clinical Radiology, 75(12). doi:10.1016/j.crad.2020.07.030


In this study, the authors sought to determine the relationship between heterogeneity of enhancement kinetics in breast cancers on dynamic contrast-enhanced (DCE) breast MRI and occurrence of distant metastatic disease. One hundred and twenty-eight patients with invasive breast cancer underwent pixel-based DCE-MRI analysis to generate time-signal intensity curve (TIC) patterns. With this technique, various TIC patterns, including non-enhancement, washout, plateau, and persistent, were categorized and quantified as percentages within each breast tumor. Compositions of TIC patterns were compared between patients with and without distant metastasis (DM). In patients with distant metastatic disease, the predominating TIC patterns were persistent and non-enhancement, with an area under the receiver operator curve (AUC) of 0.87 (0.87 specificity and 0.7 sensitivity). The authors concluded that increased heterogeneity in breast tumors is associated with distant metastatic disease, and TIC pattern analysis can assist in predicting distant metastasis.


Value of Contrast-Enhanced Ultrasound in the Diagnosis of Breast US-BI-RADS 3 and 4 Lesions with Calcifications.

Cheng, M., Tong, W., Luo, J., Li, M., Liang, J., Pan, F., & Xie, X.

Clinical Radiology, 75(12), 934-941. doi:10.1016/j.crad.2020.07.017


In this study, the authors sought to establish the diagnostic utility of contrast-enhanced ultrasound (CEUS) in BI-RADS-3 and 4 lesions with calcifications. One hundred and sixty-eight breast lesions with calcifications were detected on both mammography and conventional ultrasound (US) and classified as BI-RADS-3 or 4. Each lesion was subsequently evaluated with CEUS and given a CEUS score to generate a Rerated BI-RADS (also known as CEUS-BI-RADS). When compared to US, diagnostic accuracy and sensitivity values for CEUS-BI-RADS significantly improved (p=.004 and p=.003, respectively). In addition, CEUS-BI-RADS diagnostic efficacy was significantly greater than conventional US (p=.004). The authors concluded that the addition of CEUS in the evaluation of BI-RADS 3 and 4 lesions with calcifications significantly improves diagnostic accuracy.


Assessing the Positive Predictive Value of Architectural Distortion Detected with Digital Breast Tomosynthesis in BI-RADS 4 Cases.

Dou, E., Ksepka, M., Dodelzon, K., Shingala, P. Y., & Katzen, J. T.

Journal of Breast Imaging, 2(6), 552-560. doi:10.1093/jbi/wbaa078


In this study, authors sought to assess the positive predictive value of biopsy (PPV3) of digital breast tomosynthesis (DBT)-detected BI-RADS 4 architectural distortion (AD). One hundred and seventy-nine DBT and digital mammography (DM) screening and diagnostic mammograms demonstrating BI-RADS 4 AD were included in the study. Sixty-three of these cases were pathology-proven malignancies with a PPV3 of 35%. There were no significant differences in PPV3 between mammogram type, presence or microcalcifications, or personal history of breast cancer. When an ultrasound (US) correlate was present, AD was more likely to be malignant (P<.0001). In addition, PPV3 increased from 26% to 44% (P=.01) if AD was detected on both DBT and DM, compared to DBT alone. The authors concluded that DBT-detected BI-RADS 4 AD has a PPV3 of 35%, and likelihood of malignancy increases with an US correlate and when AD is detected on both DBT and DM.

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