Abstract
Objectives. To compare the differences in normalized average glandular dose (NAGD) between the breasts of healthy subjects and those of cancer patients and to determine if the NAGD difference is associated with breast cancer risk and improves breast cancer classification. Materials and Methods. Craniocaudal view and mediolateral view full-field digital mammography (FFDM) images were obtained from 1682 healthy subjects whose breasts were categorized as Breast Imaging-Reporting and Data System (BI-RADS) I or II and from 811 biopsy-confirmed unilateral breast cancer patients whose breasts on the contralateral side were category I or II. Both populations were randomized into training and test sets. Multivariate logistic regression analysis was used to build the breast cancer risk assessment model, and the area under the receiver operating characteristic curve ( A z ) was used to evaluate the model. Twenty-two breast cancer patients who were originally categorized as BI-RADS I or II for both breasts, but were diagnosed with unilateral biopsy-confirmed breast cancer subsequently, were included to validate the model. Results. The NAGD differences in both FFDM images between tumor-bearing breasts and the healthy breasts of patients were significantly higher than those in healthy subjects ( P < 0.001 ). The model with NAGD differences had a higher A z value than the model without NAGD differences. While there was no NAGD differences between originally healthy breasts of breast cancer patients, significant NAGD differences between now tumor-bearing breasts and the then previously healthy breasts were found in both FFDM images. Conclusions. NAGD differences between both breasts can be included in the breast cancer risk assessment model to evaluate breast cancer risk.
Highlights
Breast cancer is the leading cause of death among women globally [1, 2]
To investigate whether normalized average glandular dose (NAGD) differences between both breasts of healthy cohorts and patients with breast cancer were associated with breast cancer risk, we initially built a training set for a breast cancer risk assessment model, including 1869 subjects (1261 healthy subjects and 608 cancer patients) and 624 subjects (421 healthy subjects and 203 cancer patients) as a test set to validate the established model
Our results showed that the established breast cancer risk assessment model including NAGD differences between both breasts could be clinically beneficial to evaluate breast cancer risk for patients
Summary
Breast cancer is the leading cause of death among women globally [1, 2]. In China, breast cancer incidence in recent years has been the predominant contributor to overall cancer incidence in women [3]. A breast cancer risk assessment model was first proposed by Gail et al [11, 12] in 1989 to identify women with a higher risk for breast cancer for further screening and possible preventive therapies. A logistic regression model was later developed and validated to predict the probability of developing breast cancer for a woman based on the odds ratio (OR) of classical risk factors [13]. A detailed family history was incorporated as an independent factor for a breast cancer risk assessment model [14]. Because these models are solely based on demographic information, they have low positive predictive values; a breast cancer risk assessment model that includes more predictive cancer risk factors is clinically needed
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