Differentiation Of Breast Lesions Research Articles

The added value of quantitative multi-voxel MR spectroscopy in breast magnetic resonance imaging

ObjectiveTo determine whether quantitative multivoxel MRS improves the accuracy of MRI in the assessment of breast lesions.MethodsTwenty-five consecutive patients with 26 breast lesions ≥1 cm assessed as BI-RADS 3 or 4 with mammography underwent quantitative multivoxel MRS and contrast-enhanced MRI. The choline (Cho) concentration was calculated using the unsuppressed water signal as a concentration reference. ROC analysis established the diagnostic accuracy of MRI and MRS in the assessment of breast lesions.ResultsRespective Cho concentrations in 26 breast lesions re-classified by MRI as BI-RADS 2 (n = 5), 3 (n = 8), 4 (n = 5) and 5 (n = 8) were 1.16 ± 0.43 (mean ± SD), 1.43 ± 0.47, 2.98 ± 2.15 and 4.94 ± 3.10 mM. Two BI-RADS 3 lesions and all BI-RADS 4 and 5 lesions were malignant on histopathology and had Cho concentrations between 1.7 and 11.8 mM (4.03 ± 2.72 SD), which were significantly higher (P = 0.01) than that in the 11 benign lesions (0.4–1.5 mM; 1.19 ± 0.33 SD). Furthermore, Cho concentrations in the benign and malignant breast lesions in BI-RADS 3 category differed (P = 0.01). The accuracy of combined multivoxel MRS/breast MRI BI-RADS re-classification (AUC = 1.00) exceeded that of MRI alone (AUC = 0.96 ± 0.03).ConclusionsThese preliminary data indicate that multivoxel MRS improves the accuracy of MRI when using a Cho concentration cut-off ≤1.5 mM for benign lesions. Key Points • Quantitative multivoxel MR spectroscopy can improve the accuracy of contrast-enhanced breast MRI. • Multivoxel-MRS can differentiate breast lesions by using the highest Cho-concentration. • Multivoxel-MRS can exclude patients with benign breast lesions from further invasive diagnostic procedures.

Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring

There has been controversy regarding the accuracy of breast ultrasound elastography (USE) compared to conventional B-mode Ultrasound (USB). The purpose of this study was to conduct a direct comparative effectiveness analysis of USB versus USE or their combination in differentiating breast lesions through systematically reviewing recent literature. An extensive literature search of PubMed and other medical and general purpose databases from inception through August 2011 was conducted. Published studies that reported a direct comparison of the diagnostic performance of USE, using elasticity score versus USB, using breast imaging reporting and data system (BIRADS) for characterization of focal breast lesions were included. Summary diagnostic performance measures were assessed for each of the tests and their combination using bivariate generalized linear mixed modeling. The two tests were combined as: (1) conjunctive, where the outcome of the combination of tests is positive only if both test results are positive; (2) disjunctive, where the outcome of a combination of tests is negative only if both tests are negative. Twenty nine studies provided relevant information on 5,511 breast masses (2,065 cancers, 3,446 benign lesions). Sensitivity of USB, USE, and their conjunctive and disjunctive combinations were 96% (95% credible interval (CrI), 93-98%), 79% (95% CrI, 74-83%), 73% (95% CrI, 67-78%), and 99% (95% CrI, 98-99%), respectively. Specificity of USB, USE, and their conjunctive and disjunctive combinations were 70% (95% CrI, 55-83%), 88% (95% CrI, 82-92%), 97% (95% CrI, 95-99%), and 56% (95% CrI, 43-69%), respectively. The application of USE as a single test is not superior to USB alone. However, in low risk patients it is recommended to perform an USE following a positive USB result to decrease the rate of unnecessary biopsies.

Real-time elastography for the differentiation of benign and malignant breast lesions: a meta-analysis

The prognostic significance of ultrasound real-time elastography (RTE) in patients with breast lesions is controversial. There are two different diagnostic methods: the elasticity score (ES) and the strain ratio (SR). A meta-analysis was performed using a random-effect model to assess the overall sensitivity and specificity of RTE in the differentiation of breast lesions. MEDLINE, EMBASE, PubMed, and the Cochrane Library before February 2011 were searched. A total of 22 studies, which included 4,713 breast nodules in 4,266 patients were analyzed. The overall mean sensitivity and specificity for the diagnosis of malignant breast lesions by RTE were 0.834 [95% confidence interval (CI) 0.814-0.853] and 0.842 (95% CI, 0.829-0.854) for ES, and 0.883 (95% CI, 0.844-0.916) and 0.814 (95% CI, 0.786-0.839) for SR, respectively. RTE has a high sensitivity and specificity in the evaluation of breast lesions and can potentially reduce unnecessary breast biopsies.

Breast Cancer: Early- and Late-Fluorescence Near-Infrared Imaging with Indocyanine Green—A Preliminary Study

To assess early- and late-fluorescence near-infrared imaging, corresponding to the vascular (early-fluorescence) and extravascular (late-fluorescence) phases of indocyanine green (ICG) enhancement, for breast cancer detection and benign versus malignant breast lesion differentiation. The study was approved by the ethical review board; all participants provided written informed consent. Twenty women with 21 breast lesions were examined with near-infrared imaging before, during, and after intravenous injection of ICG. Absorption and fluorescence projection mammograms were recorded simultaneously on a prototype near-infrared imaging unit. Two blinded readers independently assessed the images and assigned visibility scores to lesions seen on the absorption and absorption-corrected fluorescence mammograms. Imaging results were compared with histopathologic findings. Lesion contrast and diameter on the fluorescence mammograms were measured, and Cohen κ, Mann-Whitney U, and Spearman ρ tests were conducted. The absorption-corrected fluorescence ratio mammograms showed high contrast (contrast value range, 0.25-0.64) between tumors and surrounding breast tissue. Malignant lesions were correctly defined in 11 (reader 1) and 12 (reader 2) of 13 cases, and benign lesions were correctly defined in six (reader 1) and five (reader 2) of eight cases with late-fluorescence imaging. Lesion visibility scores for malignant and benign lesions were significantly different on the fluorescence ratio mammograms (P = .003) but not on the absorption mammograms (P = .206). Mean sensitivity and specificity reached 92% ± 8 (standard error of mean) and 75% ± 16, respectively, for fluorescence ratio imaging compared with 100% ± 0 and 25% ± 16, respectively, for conventional mammography alone. Preliminary data suggest that early- and late-fluorescence ratio imaging after ICG administration can be used to distinguish malignant from benign breast lesions.

In vivo Breast Sound-Speed Imaging with Ultrasound Tomography

We discuss a bent-ray ultrasound tomography algorithm with total-variation (TV) regularization. We have applied this algorithm to 61 in vivo breast datasets collected with our in-house clinical prototype for imaging sound-speed distributions in the breast. Our analysis showed that TV regularization could preserve sharper lesion edges than the classic Tikhonov regularization. Furthermore, the image quality of our TV bent-ray sound-speed tomograms was superior to that of the straight-ray counterparts for all types of breasts within BI-RADS density categories 1 through 4. Our analysis showed that the improvements for average sharpness (in the unit of ( m · s) −1) of lesion edges in our TV bent-ray tomograms are between 2.1 to 3.4-fold compared with the straight ray tomograms. Reconstructed sound-speed tomograms illustrated that our algorithm could successfully image fatty and glandular tissues within the breast. We calculated the mean sound-speed values for fatty tissue and breast parenchyma as 1422 ± 9 m/s (mean ± SD) and1487 ± 21 m/s, respectively. Based on 32 lesions in a cohort of 61 patients, we also found that the mean sound-speed for malignant breast lesions (1548 ± 17 m/s) was higher, on average, than that of benign ones (1513 ± 27 m/s) (one-sided p < 0.001). These results suggest that, clinically, sound-speed tomograms can be used to assess breast density (and therefore, breast cancer risk), as well as detect and help differentiate breast lesions. Finally, our sound-speed tomograms may also be a useful tool to monitor the clinical response of breast cancer patients to neo-adjuvant chemotherapy. (E-mail: lic@karmanos.org)

Diffusion-weighted MR for Differentiation of Breast Lesions at 3.0 T: How Does Selection of Diffusion Protocols Affect Diagnosis?

To compare the diagnostic quality of diffusion-weighted (DW) imaging schemes with regard to apparent diffusion coefficient (ADC) accuracy, ADC precision, and DW imaging contrast-to-noise ratio (CNR) for different types of lesions and breast tissue. Institutional review board approval and written, informed consent were obtained. Fifty-one patients with histopathologic correlation or follow-up performed with a 3.0-T MR imager were included in this study. There were 112 regions of interest drawn in 24 malignant, 17 benign, 20 cystic, and 51 normal tissue regions. ADC maps were calculated for combinations of 10 b values (range, 0-1250 sec/mm(2)). Differences in ADC among tissue types were evaluated. The CNRs of lesions at DW imaging were compared for all b values. A repeated-measures analysis of variance was used to assess lesion differentiation. ADCs calculated from b values of 50 and 850 sec/mm(2) were 0.99 x 10(-3) mm(2)/sec +/- 0.18 (standard deviation), 1.47 x 10(-3) mm(2)/sec +/- 0.21, 1.85 x 10(-3) mm(2)/sec +/- 0.22, and 2.64 x 10(-3) mm(2)/sec +/- 0.30 for malignant, benign, normal, and cystic tissues, respectively. An ADC threshold level of 1.25 x 10(-3) mm(2)/sec allowed discrimination between malignant and benign lesions with a diagnostic accuracy of 95% (P < .001). ADC calculations performed with multiple b values were not significantly more precise than those performed with only two. We found an overestimation of ADC for maximum b values of up to 1000 sec/mm(2). The best CNR for tumors was identified at 850 sec/mm(2). Optimum ADC determination and DW imaging quality at 3.0 T was found with a combined b value protocol of 50 and 850 sec/mm(2). This provided a high accuracy for differentiation of benign and malignant breast tumors.

MDCT of the Breast

The purpose of this study was to evaluate retrospectively the accuracy of low-dose MDCT in the differentiation of breast lesions suspected on mammography and sonography. MDCT was performed on 61 patients with mammographic or sonographic findings suggestive of breast cancer who could not undergo MR mammography. For each lesion, morphologic features, attenuation, and time-attenuation curve pattern were evaluated. The 1-minute cut point of attenuation was analyzed on the images. CT findings were compared with histopathologic results, which were the reference standard. Forty-seven of 61 patients underwent surgery, and the pathologic findings revealed 27 malignant and 20 benign lesions. With CT 25 of 27 malignant lesions and all 20 benign lesions were diagnosed correctly. CT had a sensitivity of 92.6%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.9%, and accuracy of 95.74%. The cutoff attenuation value, which had the best validity for differentiating malignant and benign lesions, was calculated to be 90 H on the 1-minute images. Our results confirm and strengthen the importance of all imaging parameters and not one in particular. Dynamic MDCT can be used in the evaluation of selected patients with suspected breast tumors.

Methodenanalyse zur Doppleruntersuchung der weiblichen Brust

Besides characteristic morphological differences, carcinomas of the breast show remarkable changes of vascularity, which are essential for their enhanced metabolism. High-frequency CW Doppler allows to investigate normal and pathological vascularisation in the breast. In our basic study we examined 200 patients, 37 with breast malignancies (6 non-palpable lesions). 33 of the carcinomas showed pathological vascularisation. In an extended examination procedure we investigated also normal breast vascularisation and compared it with blood flow in lesions. We developed therefrom an easy and rational method which allows physiological blood flow measurements as well as a differentiation of breast lesions within a few minutes' time.

Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion

The role of diffusion-weighted magnetic resonance imaging (DWI) to differentiate breast lesions in vivo was evaluated. Sixty women (mean age, 53 years) with 81 breast lesions were enrolled. A coronal echo planar imaging (EPI) sequence sensitised to diffusion (b value=1,000 s/mm(2)) was added to standard MR. The mean diffusivity (MD) was calculated. Differences in MD among cysts, benign lesions and malignant lesions were evaluated, and the sensitivity and specificity of DWI to diagnose malignant and benign lesions were calculated. The diagnosis was 18 cysts, 21 benign and 42 malignant nodules. MD values (mean +/- SD x 10(-3) mm(2)/s) were (1.48 +/- 0.37) for benign lesions, (0.95 +/- 0.18) for malignant lesions and (2.25 +/- 0.26) for cysts. Different MD values characterized different malignant breast lesion types. A MD threshold value of 1.1 x 10(-3) mm(2)/s discriminated malignant breast lesions from benign lesions with a specificity of 81% and sensitivity of 80%. Choosing a cut-off of 1.31 x 10(-3) mm(2)/s (MD of malignant lesions -2 SD), the specificity would be 67% with a sensitivity of 100%. Thus, MD values, related to tumor cellularity, provide reliable information to differentiate malignant breast lesions from benign ones. Quantitative DWI is not time-consuming and can be easily inserted into standard clinical breast MR imaging protocols.

Benign and Malignant Breast Lesions: Efficacy of Real Time Contrast-Enhanced Ultrasound vs. Magnetic Resonance Imaging

To assess the efficacy of low mechanical index (MI) real time grey scale contrast-enhanced US (CEUS) in the differentiation of breast lesions in comparison to Magnetic Resonance Imaging (MRI). 50 lesions previously detected at mammography or conventional US were evaluated by means of CEUS and MRI. Contrast-enhanced examinations were performed with a dedicated equipment (Esatune, Esaote, Genoa, Italy), before and after injection of 4.8 ml of Sonovue (Bracco, Milan, Italy). MRI was conducted with a 1.5 T equipment (Siemens Vision Plus, Erlangen, Germany) with bilateral dedicated superficial coil, on T2w STIR and 3D Flash T1w before and 1, 2, 3, 4, 5 minutes after the administration of contrast agent (Gd-DTPA, 1.5 ml/kg). Wash-in and wash-out curves were assessed for both procedures. A specific sonographic quantification software (Qontrast, Bracco, Milan, Italy), based on pixel by pixel signal intensity over time, was used to obtain contrast-enhanced sonographic perfusion maps for each lesion. Mc Nemar test was then calculated. 24 invasive ductal carcinomas, 18 fibroadenomas, 4 fibro-cystic dysplasias, 1 mucinous carcinoma, 1 invasive ducto-lobular carcinoma, 1 intraductal florid papillomatosis and 1 phylloides tumour were diagnosed. Contrast-enhanced sonographic patterns correlated well with those provided by MRI. Sensitivity, specificity, and accuracy of US were: 69.2 %, 66.7 %, and 68 %, respectively. According to the different contrast enhancement patterns and the resulting perfusion maps, all the malignant lesions and 9 out of 12 benign lesions were correctly diagnosed, thus resulting in 87.5 % of specificity and 100 % of sensitivity. Regarding the specificity, there is no difference between US and CEUS with McNemar (p = 0.18). Regarding sensitivity, the difference between contrast-enhanced US and US is significant as calculated with McNemar test (p = 0.013). The three lesions which were incorrectly classified as malignant were two hypervascularised fibroadenomas in young women and a phylloides tumour. CEUS seems to be a reliable method to differentiate breast lesions, since it provides typical enhancement patterns. Contrast sonographic perfusion curves correlate well with MRI wash in--wash out curves.

Real-Time Sonoelastography Performed in Addition to B-Mode Ultrasound and Mammography: Improved Differentiation of Breast Lesions?

The goal of the present study was to compare the sensitivity and specificity of elastography with that of B-mode ultrasound (US) and mammography. A total of 300 patients with histologically confirmed breast lesions (168 benign, 132 malignant) were included. Evaluation was by means of the three-dimensional finite-element method. The data are color-coded and superimposed on the B-mode US scan. The images were evaluated by two independent readers. The results were compared with mammography, histology, and the data obtained by previous US investigations. Sensitivities and specificities were calculated. Sensitivity and specificity in the differentiation of benign and malignant lesions were 87% and 85%, respectively, for mammography and 94% and 83% for B-mode US. The two examiners were in very good agreement in their evaluation of the elastograms (kappa: 0.86). Elastography had a sensitivity of 82% and a specificity of 87%. Elastography was superior to B-mode US in diagnosing Breast Imaging Reporting and Data System (BI-RADS) 3 lesions (92% vs. 82% specificity) and in lipomatous involution (80% vs. 69% specificity). Elastography in breast lesions showed a higher specificity and a lower sensitivity in comparison with B-mode sonography. Elastography may be beneficial in BI-RADS 3 lesions and in lipomatous involution.

Evaluation of dynamic studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge

We assessed the utility of dynamic magnetic resonance imaging (MRI) in differentiating benign from malignant lesions of the breast and then applied MRI to diagnose intraductal breast tumors with nipple discharge. Gadolinium (Gd)-enhanced MR mammography was performed on 74 patients with breast tumors and 8 patients with nipple discharge. The steepest slopes of the contrast medium uptake (S slope) s from time-intensity curves were significantly different between malignant and benign lesions. At S slope threshold of 0.95% /second, malignancy was predicted with a sensitivity and specificity of 75% . Six of 8 cases with nipple discharge were successfully identified by MR ductography by injecting Gd-DTPA into discharging ducts. Among them, 2 non-invasive ductal carcinomas were differentiated from benign lesions by the S slope value. Dynamic MR mammography is an useful modality for differentiating breast lesions and has potential for evaluating intraductal lesions with nipple discharge.

Heterogeneity analysis of Gd-DTPA uptake: improvement in breast lesion differentiation.

The aim of this study was to assess whether lesion heterogeneity through pixel-by-pixel analysis of contrast-enhanced MR parameter maps would improve breast lesion differentiation. Forty-nine female patients with primary tumors of the breast were imaged using contrast-enhanced MRI. The rate of transfer of contrast medium between the lesion and plasma was calculated via compartmental modeling over semiautomatically delineated regions of interest. The distributions of transfer rate values were subdivided into 10 segments for each lesion. The rate of change of the statistical moments of the transfer rate measured over the 10 segments allowed a quantitative measure of heterogeneity. In this patient group of 25 malignant and 25 benign lesions, improved differentiation was achieved by using a measure of lesion heterogeneity. The sensitivity and specificity obtained were 88 and 88%, respectively, compared with 84 and 76% when using the mean value of the transfer rate coefficient. Pixel-by-pixel analysis of contrast medium transfer rate maps allows the examination of lesion heterogeneity and offers improved lesion differentiation. The new method used to quantify lesion heterogeneity relies on the manner in which the exchange rate parameter varies when calculated over different segments of the distribution.

Implementation of Doppler Ultrasound for Therapy Control of Breast Malignancies Treated with Chemotherapy

Background: Doppler is used with increasing frequency for differentiation of breast lesions. Breast malignancies are characterized by increased vascularity which is associated with

THE ULTRASONIC DIAGNOSIS OF BREAST DISEASES BY A MANUAL CONTACT SCANNING METHOD WITH SPECIAL REFERENCE TO ULTRASONOGRAPHIC PATTERNS OF BREAST CANCER

For diagnosis and differentiation of breast lesions, we performed breast echography by a manual contact scanning method with 5-Hz frequency linear electroscan sound. Twenty-two out of 183 outpatients examined between January 1983 and March 1984 were diagnosed histologically as having breast cancer. The echographies of the 22 breast cancers were evaluated according to “The Criteria for Classification of Localized Pathological Processes” by Kossoff and divided into four patterns on the basis of three points (texture, overall distribution and internal structure) of the internal echoes: Type I: fine and uniform solid mass (8 patients), Type II: coarse and uniform solid mass (5 patients), Type III: coarse and complex solid mass (7 patients) and Type IV: intracystic tumor (2 patients). Of the boundary echo, five of the eight type I masses had a smooth spherical shape and a thick halo. All five type II masses had a smooth lobular shape and a halo. All seven type III masses had a irregular shape and posterior shadowing. Manual contact scanning is an easy method of breast echography and the four ultrasonographic patterns of breast cancer are useful for differentiation of breast diseases.

Temperature dependence of the ultrasonic velocity in cyclohexane: Taylor, E.W., Alpert, S.S. Vol 48, No 5 (November 1970) pp1287–1288

We discuss a bent-ray ultrasound tomography algorithm with total-variation (TV) regularization. We have applied this algorithm to 61 in vivo breast datasets collected with our in-house clinical prototype for imaging sound-speed distributions in the breast. Our analysis showed that TV regularization could preserve sharper lesion edges than the classic Tikhonov regularization. Furthermore, the image quality of our TV bent-ray sound-speed tomograms was superior to that of the straight-ray counterparts for all types of breasts within BI-RADS density categories 1 through 4. Our analysis showed that the improvements for average sharpness (in the unit of (m · s)−1) of lesion edges in our TV bent-ray tomograms are between 2.1 to 3.4-fold compared with the straight ray tomograms. Reconstructed sound-speed tomograms illustrated that our algorithm could successfully image fatty and glandular tissues within the breast. We calculated the mean sound-speed values for fatty tissue and breast parenchyma as 1422 ± 9 m/s (mean ± SD) and1487 ± 21 m/s, respectively. Based on 32 lesions in a cohort of 61 patients, we also found that the mean sound-speed for malignant breast lesions (1548 ± 17 m/s) was higher, on average, than that of benign ones (1513 ± 27 m/s) (one-sided p < 0.001). These results suggest that, clinically, sound-speed tomograms can be used to assess breast density (and therefore, breast cancer risk), as well as detect and help differentiate breast lesions. Finally, our sound-speed tomograms may also be a useful tool to monitor the clinical response of breast cancer patients to neo-adjuvant chemotherapy. (E-mail: [email protected])

A-mode ultrasound differentiation of soft-tissue masses.

Roentgenography is currently the principal diagnostic method available for the detection of suspected masses within the thorax, abdomen, and retroperitoneal space. Differentiation of these masses, however, is frequently difficult, despite the roentgen findings and the associated clinical data. A-mode ultrasound is a relatively simple technic that can differentiate cystic from solid masses. By utilizing this information in conjunction with the x-ray studies, the radiologist can offer a more accurate differential diagnosis. A-mode has been used successfully for differentiating breast lesions (1) and localizing liver cysts, which are referred to as “fluid flat segments” (2). The method has also been employed to study mediastinal and abdominal masses (3, 4) and to differentiate echinococcal cysts of the lung from solid tumors (5). In this country, ultrasound research has been directed mainly toward the more complex type of ultrasound, known as B-scan, in which cross-section images of organs and tumors are pro...