What’s New In Breast Imaging – November 2021

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Reducing False-Positive Screening MRI Rate in Women with Extremely Dense Breasts Using Prediction Models Based on Data from the DENSE Trial

 

Dekker, B. M., Bakker, M. F., Lange, S. V., Veldhuis, W. B., Diest, P. J., Duvivier, K. M., . . . Koning, H. J. (2021). Reducing False-Positive Screening MRI Rate in Women with Extremely Dense Breasts Using Prediction Models Based on Data from the DENSE Trial. Radiology,301(2), 283-292. doi:10.1148/radiol.2021210325

 

In this study, authors sought to reduce the false positive rate in screening MRI for women with extremely dense breasts by creating and applying prediction models using clinical data and MRI findings. Data was obtained from Dutch women enrolled in the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial between 2011 and 2015. Specifically, data for the prediction models was obtained from women with a first-time positive screening MRI after a normal mammogram. Out of 454 women with a positive screening breast MRI, 375 had false-positive results and 79 were diagnosed with breast cancer. The authors determined that the full prediction model using MRI findings and clinical characteristics could have prevented 21.3% of benign breast biopsies and 45.5% of false-positive recalls. A prediction model using only MRI findings and age demonstrated similar reductions in both benign breast biopsies and false-positive recalls. The authors concluded that false-positive rates for screening breast MRIs for women with extremely dense breasts can be reduced with prediction models using MRI findings and clinical characteristics.

 

 

Breast MRI during neoadjuvant chemotherapy: Lack of background parenchymal enhancement suppression and inferior treatment response

 

Onishi, N., Author AffiliationsAuthor affiliations: From the Department of Radiology & Biomedical Imaging, EA, M., C, K., Et Al, JH, C., . . . Philpotts, L. (2021, August 24). Breast MRI during neoadjuvant chemotherapy: Lack of background parenchymal enhancement suppression and inferior treatment response.

 

In this study, authors sought to characterize the relationship between pathologic response and lack of background parenchymal enhancement (BPE) suppression on contrast-enhanced breast MRI. The authors postulated that an inferior response to neoadjuvant chemotherapy (NAC) was associated with nonsuppressed BPE. Data was retrospectively collected from menopausal women treated with NAC between 2010 and 2016. Women underwent contrast-enhanced breast MRI before treatment (T0), early treatment (T1), interregimen (T2) and before surgery (T3). BPE was quantitatively measured on each exam, compared to T0, and classified as suppressed or nonsuppressed at each time point.  Approximately 3,500 breast MRIs were reviewed. There was an association between nonsuppressed BPE and inferior pathologic response in the hormone receptor positive study group at times T2 and T3 (P=.02 and .003, respectively). An association between inferior pathologic response and nonsppressed BPE was seen at all times points in hormone receptor negative breast cancer patients, however these results were not statistically significant. The authors concluded that nonsuppressed BPE may be associated with inferior treatment response in hormone receptor positive breast cancer patients.

 

 

Glandular tissue component and breast cancer risk in mammographically dense breasts at screening breast US

 

Lee, S., Author AffiliationsFrom the Departments of Radiology (S.H.L., NF, B., Al, E., EA, S., SR, W., . . . SD, B. (2021, July 20). Glandular tissue component and breast cancer risk in mammographically dense breasts at screening breast US.

 

In this study, authors sought to investigate the relationship between breast cancer risk and glandular tissue component (GTC) at screening breast ultrasound in women with dense breasts, in addition to the relationship between lobular involution and GTC. Screening breast ultrasounds in women with negative mammograms obtained between 2012 and 2015 were retrospectively reviewed, and both GTC and lobular involution were categorized. Approximately 8,400 women were included in the study, of which 137 developed cancer. After adjusting for breast density and age, it was determined that increased cancer risk was associated with moderate and marked GTC (hazard ratio 1.5, p=.03). Additionally, it was determined that lobular involution and GTC demonstrated an inverse relationship (p=.004).  The authors concluded that GTC was associated with increased breast cancer risk and inversely representative of lobular involution. The authors suggest that these results can be considered during risk stratification for women undergoing screening breast ultrasound.

 

 

Diagnostic accuracy of nonmass enhancement at Breast MRI in predicting tumor involvement of the nipple: A prospective study in a single institution

 

Bae, S. J., Cha, Y. J., Eun, N. L., Ji, J. H., Kim, D., Lee, J., . . . Jeong, J. (2021). Diagnostic accuracy of nonmass enhancement at Breast MRI in predicting tumor involvement of the nipple: A prospective study in a single institution. Radiology, 301(1), 47-56. doi:10.1148/radiol.2021204136

 

In this study, authors sought to determine the relationship between breast cancer patients with pathologic nipple involvement and the presence of subareolar NME (nonmass enhancement) on preoperative breast MRI. Sixty-nine breast cancer patients with NME within 2 cm of the nipple on preoperative breast MRI who underwent subsequent surgical removal of the nipple-areolar complex (NAC) were prospectively enrolled between November 2015 and November 2017. Forty-nine women had NME extension to the nipple, and it was determined that NME extension to the nipple had a positive predictive value of 86% for pathologic nipple involvement. Only one patient had pathologic nipple involvement out of 15 patients who did not have NME extension to the nipple (7%). It was also determined that NME extension to the nipple yielded a diagnostic accuracy of 88%. The authors concluded that NME extension to the nipple seen on preoperative breast MRI can positively predict pathologic nipple involvement, which can be considered in surgical planning.

 

 

Patient characteristics associated with patient-reported deterrents to adjunct breast cancer screening of patients with dense breasts

 

Miller, M. M., Repich, K., Patrie, J. T., Anderson, R. T., & Harvey, J. A. (2021). Patient characteristics associated with patient-reported deterrents to adjunct breast cancer screening of patients with dense breasts. American Journal of Roentgenology, 217(5), 1069-1079. doi:10.2214/ajr.20.24516

 

In this study, authors sought to determine features associated with patient-reported concerns involving adjuvant breast cancer screening in women with dense breasts. Five hundred and eight women with dense breasts completed surveys between Mary 2017 and February 2018. Fewer concerns about adjunct screening time and greater desire for a more sensitive screening method were independently associated with lower confidence in the mammographic screening of dense breasts. The most common deterrent for adjunct screening of women with dense breasts was concern about examination cost, which was independently associated with younger age. Additionally, younger age was associated with fewer concerns regarding IV contrast administration, additional imaging, and pain from examination. The authors concluded that fewer concerns regarding adjunct screening were associated with younger age and decreased confidence in mammography’s sensitivity in women with dense breasts.

 

 

Breast cancer skip metastases: Frequency, associated tumor characteristics, and role of staging nodal ultrasound in detection

 

Chung, H. L., Sun, J., & Leung, J. W. (2021). Breast cancer skip metastases: Frequency, associated tumor characteristics, and role of staging nodal ultrasound in detection. American Journal of Roentgenology, 217(4), 835-844. doi:10.2214/ajr.20.24371

 

In this study, authors evaluated staging nodal ultrasounds (US) in women with breast cancer to characterize frequency of skip metastases and patterns of nodal spread. The authors defined skip metastases as distant metastatic lesions in the absence of ipsilateral metastatic nodes or disease spread across discontiguous nodal levels. Nearly 1,300 patients with breast cancer underwent ultrasound of the ipsilateral nodal basin between January 2016 and March 2017, which were retrospectively reviewed. Suspicious lymph nodes were biopsied via fine needle aspiration (FNA), and patients with benign results or without suspicious nodes seen on US underwent sentinel lymph node biopsy. Five hundred and ninety-one patients (45.5%) had confirmed metastatic disease via needle or sentinel lymph node biopsy. It was determined that US and FNA had a specificity of 100%, sensitivity of 86%, and accuracy of 93.6%. Skip metastases occurred in 2.6% of all invasive cancers and 7.2% in metastatic cancers. Although cancers with skip metastases were not associated with tumor grade or molecular subtype, higher rates of lobular and mixed lobular/ductal histology were seen in cancers with skip metastases. The authors concluded that 7.2% of patients with metastatic breast cancer demonstrated skip metastases outside the typical axillary surgical bed and that staging nodal US can aid in more accurate pre-surgical staging.

 

 

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