What’s new in Breast Imaging – September 2020

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Nonmass Enhancement Breast Lesions: Diagnostic Performance of Kinetic Assessment on Ultrafast and Standard Dynamic Contrast-Enhanced MRI in Comparison With Morphologic Evaluation

Mori, N., Sheth, D., & Abe, H. (2020).

American Journal of Roentgenology, 215(2), 511-518.

Link: https://pubmed.ncbi.nlm.nih.gov/32452698/

In this study, authors sought to determine if kinetic parameters from ultrafast and standard dynamic contrast-enhanced MRI (DCE-MRI) can differentiate benign from malignant nonmass enhancement (NME) when compared to lesion morphology. Seventy-seven consecutive patients with NME (54 malignant and 23 benign) underwent breast MRI. Experienced breast radiologists evaluated NME morphology and assigned each lesion a malignancy likelihood score from 0-100%. Kinetic parameters were calculated for both ultrafast and standard DCE-MRI and compared between benign and malignant lesions. Compared to benign lesions, malignant lesions had higher morphologic malignancy likelihood scores (p<0.0001). Malignant lesions had statistically significantly higher values compared to benign lesions for the following parameters: rate of signal increase, upper limit of signal intensity, AUC30 (integration of kinetic curve from 0 to 30 seconds), and initial slope of kinetic curve on ultrafast DCE-MRI. Additionally, signal enhancement ratio (SER) and initial enhancement rate on standard DCE-MRI were significantly greater for malignant lesions. However, there was no statistically significant difference between morphologic score, AUC 30, or SER. The authors concluded that when differentiating between benign and malignant NME, kinetic parameters on DCE-MRI were as efficacious as morphologic characterization.

 

Left–right breast asymmetry and risk of screen-detected and interval cancers in a large population-based screening population

Hudson, S. M., Wilkinson, L. S., Stavola, B. L., & Dos-Santos-Silva, I. (2020).

The British Journal of Radiology, 93(1112), 20200154.

Link: https://pubmed.ncbi.nlm.nih.gov/32525693/

In this study, authors sought to investigate the relationship between mammographic asymmetry and breast cancer detection at various time intervals. Automated calculations from nearly 80,000 mammographic images were utilized to determine asymmetrical dense volume (DV) and breast volume (BV) in a large ethnically diverse population of a UK breast cancer screening program. The association between asymmetry measurements and the odds of breast cancer detection on a contemporaneous (same day) screen were calculated using logistic regression models. Additionally, nested case-control studies determined the association between breast asymmetries and breast cancer detection at subsequent screenings or between screenings (interval diagnosis). The authors discovered a positive association between the odds of contemporaneous breast cancer and asymmetrical DV (but not BV), with a stronger association for first-time screens. There was a positive association between odds of interval cancer detection and both BV and DV asymmetry. Neither BV nor DV asymmetry were associated with increased odds of cancer detection on subsequent screens. The authors concluded that the risk of contemporaneous or interval breast cancer diagnosis is associated with increased DV asymmetry. Likewise, interval breast cancer diagnosis is positively associated with BV asymmetry.

 

Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI.

Pan, J., Tong, W., Luo, J., Liang, J., Pan, F., Zheng, Y., & Xie, X. (2020).

The British Journal of Radiology, 93(1112), 20200195.

Link: https://pubmed.ncbi.nlm.nih.gov/32463295/

In this study, the authors sought to compare the diagnostic efficiency of contrast-enhanced ultrasound BI-RADS (CEUS-BI-RADS) to MRI-BI-RADS in diagnosing breast lesions with calcifications. Fifty-one patients were included in the study, and 52 breast lesions with calcifications were detected on ultrasound as hyperechoic foci. Each lesion was assigned a BI-RADS 3-5 score on conventional ultrasound. Patients then underwent CEUS and MRI and received additional BI-RADS classifications. Among the three modalities, the authors did not find a statistically significant difference in sensitivity or area under ROC (p>0.05). However, the authors did find that the specificity and accuracy of CEUS-BI-RADS were significantly greater compared to US-BI-RADS and MRI-BI-RADS (p<0.05). The authors concluded that the use of CEUS-BI-RADS increased diagnostic efficacy of breast lesions with calcifications when compared to MRI-BI-RADS.

 

Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer

Samiei, S., Smidt, M. L., Vanwetswinkel, S., Engelen, S. M., Schipper, R., Lobbes, M. B., & Nijnatten, T. J. (2020).

European Radiology, 30(8), 4212-4222.

Link: https://pubmed.ncbi.nlm.nih.gov/32221685/

In this study, the authors compared the diagnostic efficacy of breast MRI with complete field of view (FOV) of the axillary region to dedicated axillary MRI in node-positive and node-negative breast cancer cases. The study included 47 patients who underwent both breast MRI and dedicated axillary MRI prior to surgery. Experienced breast radiologists reviewed unenhanced T2-weighted (T2W) and diffusion-weighted (DW) images of both MRI exams. The authors did not find a statistically significant difference in diagnostic performance between breast MRI and dedicated axillary MRI. Furthermore, the authors determined that benign and malignant lymph nodes had similar ADC values on DW imaging on both breast and dedicated axillary MRI exams. The authors concluded that T2W breast MRI with complete FOV of the axillary region is comparable to T2W dedicated axillary MRI when assessing node-positive and node-negative disease. Additionally, the authors discovered that DW imaging and ADC values did not add clinically significant information to differentiate between malignant and benign nodes.

 

Male patients with unilateral breast symptoms: An optimal imaging approach

Yoon, B., Chae, E. Y., Cha, J. H., Shin, H. J., Choi, W. J., & Kim, H. H. (2020).

European Radiology, 30(8), 4242-4250.

Link: https://pubmed.ncbi.nlm.nih.gov/32242274/

In this prospective study, the authors sought to determine the diagnostic utility of bilateral mammography for male patients with unilateral breast complaints. Two hundred and seventy-one men underwent bilateral mammography and were assigned a modified BI-RADS score from 1-5. Experienced breast radiologists performed both unilateral and bilateral reviews of the exams. Contralateral findings and average glandular dose for both breasts were recorded. Breast cancer was diagnosed in 10.7% of male patients with a unilateral breast complaint, and there were no cases of bilateral breast cancer. The authors did not find a statistically significant difference between the diagnostic performance of unilateral and bilateral reviews. The authors concluded that unilateral mammography is as good as bilateral mammography in the diagnosis of breast cancer in males with unilateral breast complaints.

 

Muscle mass loss after neoadjuvant chemotherapy in breast cancer: Estimation on breast magnetic resonance imaging using pectoralis muscle area

Rossi, F., Torri, L., Lambertini, M., Giorgis, S. D., Calabrese, M., & Tagliafico, A. S. (2020).

European Radiology, 30(8), 4234-4241.

Link: https://pubmed.ncbi.nlm.nih.gov/32232787/

In this study, authors sought to investigate the differences in pectoral muscle area (PMA) values before and after treatment with neoadjuvant chemotherapy (NAC). The authors note that quantifying changes in PMA is clinically significant, as loss of skeletal muscle mass is a known predictor of toxicity and poor outcomes in breast cancer patients. One hundred and ten patients who received pre- and post-NAC MRI exams were included in the study. Two experienced breast radiologists calculated the PMA for both exams. Post-NAC PMA values were significantly lower than pre-NAC values (p<0.001). The authors did not find a statistically significant difference between non-responders and complete or partial responders per RECIST criteria. Additionally, the authors did not find any significant associations between changes in PMA and age, hormone receptor status, Ki-67 expression, histological type/grade, or lymph node status. The authors concluded that PMA is significantly decreased in breast cancer patients after receiving NAC and that MRI is capable of estimating this metric.

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