Benign Breast Disease Research Articles

Detection of Breast Lumps with Fine Needle Aspiration Cytology: Experience of 50 Cases in Bangladesh

Background: Detection of breast lump is very crucial. Objective: This study was carried out to evaluate the effectiveness of FNAC as a diagnostic method for breast lump. Methodology: This cross sectional study was conducted among 50 women with breast lump at Popular Medical College Hospital, Dhaka, Dhaka Medical College Hospital and Ad-Din Barrister Rafique Ul Huq Hospital, Dhaka during the period of November 2021 to April 2022. This study was conducted using convenient type of non-probability sampling technique. Data were collected by face to face interview, clinical examination and findings of both cytological and histopathological examination. Results: The study revealed the most benign breast lesion (89.45%) were below the age of 40 years and most of the breast cancer (91.2%) were above the age of 40 years. The study showed that 29 cases (58.0%) were diagnosed as benign clinically but cytologically 30(60.0%) cases were benign. Clinically 14(27.0%) cases were malignant but cytologically 13(26.0%) cases malignant. Clinical diagnosis of 8(7.5%) cases were uncertain, whereas cytologically 2(4.0%) cases were suspicious of malignancy and 1(2.0%) case was atypical. The comparison study between cyological and final histopathological diagnosis showed that out of 28 benign lesions diagnosed cytologically among which only 2 cases were found malignant histologically like false negative 2 (7.20%). 13 malignant cases were diagnosed cytologically which were confirmed histologically like no false positive was found. The study found that sensitivity of FNAC 85.3% of the presence of breast cancer and specificity 100.0% for absence of breast cancer. They also showed that the negative predictive value of FNAC for benign breast lump was 93.5% and positive predictive value for malignant breast lump was 100.0% and the overall diagnostic accuracy was 95.40%. Conclusion: In conclusion, FNAC can be used as a diagnostic method in the management of breast lump which has reasonable sensitivity and specificity. Journal of Current and Advance Medical Research, July 2023;10(2):65-69

The Role of Salivary Vascular Endothelial Growth Factor A, Cytokines, and Amino Acids in Immunomodulation and Angiogenesis in Breast Cancer.

In this work, we focused on the analysis of VEGF content in saliva and its relationship with pro-inflammatory cytokines and amino acids involved in immunomodulation and angiogenesis in breast cancer. The study included 230 breast cancer patients, 92 patients with benign breast disease, and 59 healthy controls. Before treatment, saliva samples were obtained from all participants, and the content of VEGF and cytokines in saliva was determined by an enzyme-linked immunosorbent assay, as well as the content of amino acids by high-performance liquid chromatography. It was found that VEGF was positively correlated with the level of pro-inflammatory cytokines IL-1β (r = 0.6367), IL-6 (r = 0.3813), IL-8 (r = 0.4370), and IL-18 (r = 0.4184). Weak correlations were shown for MCP-1 (r = 0.2663) and TNF-α (r = 0.2817). For the first time, we demonstrated changes in the concentration of VEGF and related cytokines in saliva in different molecular biological subtypes of breast cancer depending on the stage of the disease, differentiation, proliferation, and metastasis to the lymph nodes. A correlation was established between the expression of VEGF and the content of aspartic acid (r = -0.3050), citrulline (r = -0.2914), and tryptophan (r = 0.3382) in saliva. It has been suggested that aspartic acid and citrulline influence the expression of VEGF via the synthesis of the signaling molecule NO, and then tryptophan ensures tolerance of the immune system to tumor cells.

Associations of stem cell markers CD44, CD24 and ALDH1A1 with mammographic breast density in women with benign breast biopsies.

We examined associations of CD44, CD24 and ALDH1A1 breast stem cell markers with mammographic breast density (MBD), a well-established breast cancer (BCa) risk factor. We included 218 cancer-free women with biopsy-confirmed benign breast disease within the Nurses' Health Study (NHS) and NHSII. The data on BCa risk factors were obtained from biennial questionnaires. Immunohistochemistry (IHC) was done on tissue microarrays. For each core, the IHC expression was assessed using a semi-automated platform and expressed as percent of positively stained cells for each marker out of the total cell count. MBD was assessed with computer-assisted techniques. Generalised linear regression was used to examine the associations of each marker with square root-transformed percent density (PD), absolute dense and non-dense areas (NDA), adjusted for BCa risk factors. Stromal CD44 and ALDH1A1 expression was positively associated with PD (≥ 10% vs. <10% β = 0.56, 95% confidence interval [CI] [0.06; 1.07] and β = 0.81 [0.27; 1.34], respectively) and inversely associated with NDA (β per 10% increase = -0.17 [-0.34; -0.01] and β for ≥10% vs. <10% = -1.17 [-2.07; -0.28], respectively). Epithelial CD24 expression was inversely associated with PD (β per 10% increase = -0.14 [-0.28; -0.01]. Stromal and epithelial CD24 expression was positively associated with NDA (β per 10% increase = 0.35 [0.2 × 10-2; 0.70] and β per 10% increase = 0.34 [0.11; 0.57], respectively). Expression of stem cell markers is associated with MBD.

Radial sclerosing lesions found on core needle biopsy: excision can be safely avoided.

Radial sclerosing lesions (RSLs) are benign breast lesions composed of glandular and epithelial proliferations with stellate architecture and fibro-elastotic stroma, which can mimic invasive carcinoma on imaging. Surgical management following a core biopsy diagnosis of RSLs remains controversial. We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades. This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.

A survey of breastfeeding among women with previous surgery for benign breast disease: a descriptive exploratory study

BackgroundSurgery is the primary treatment for benign breast disease and causes some disruption to the normal physiology of the breast, even when this disruption is localised, it remains unclear whether it affects women’s ability to breastfeed. There are only a few studies describing the experience of breastfeeding in women who have undergone benign breast disease (BBD) surgery.MethodsWe retrospectively analysed data from patients aged 20–40 years in Guangdong, China, who underwent breast lumpectomy for BBD in our department between 01 January 2013 and 30 June 2019, with a follow-up date of 01 February 2022. Patients were included who had a history of childbirth between the time of surgery and the follow-up date. By collecting general information about this group of patients and information about breastfeeding after surgery, we described the breastfeeding outcomes of women of a fertile age who had previously undergone surgery for benign breast disease.ResultsWith a median follow-up of 5.9 years, a total of 333 patients met the inclusion criteria. From the breastfeeding data of the first child born postoperatively, the mean duration of ‘exclusive breastfeeding’ was 5.1 months, and the mean duration of ‘any breastfeeding’ was 8.8 months. The rate of ‘ever breastfeeding’ is 91.0%, which is lower than the national average of 93.7%, while the exclusive breastfeeding rate at six months was 40.8%, was higher than the 29.2% national average. The any breastfeeding rate at 12 months was 30.0%, which was well below the 66.5% national average. The common reason for early breastfeeding cessation was insufficient breast milk. A total of 29.0% of patients who had ever breastfed after surgery voluntarily reduced the frequency and duration of breastfeeding on the operated breast because of the surgery.ConclusionsThere are some impacts of BBD surgery on breastfeeding and some may be psychological. Institutions should provide more facilities for mothers who have undergone breast surgery to help them breastfeed, such as conducting community education on breastfeeding after breast surgery, training professional postoperative lactation consultants in hospitals, and extending maternity leave. Families should encourage mothers to breastfeed with both breasts instead of only the non-operated breast.

Free Salivary Amino Acid Profile in Breast Cancer: Clinicopathological and Molecular Biological Features.

The study of salivary amino acid profiles has attracted the attention of researchers, since amino acids are actively involved in most metabolic processes, including breast cancer. In this study, we analyzed the amino acid profile of saliva in a sample including all molecular biological subtypes of breast cancer to obtain a more complete picture and evaluate the potential utility of individual amino acids or their combinations for diagnostic purposes. This study included 116 patients with breast cancer, 24 patients with benign breast disease, and 25 healthy controls. From all patients, strictly before the start of treatment, saliva samples were collected, and the quantitative content of 26 amino acids was determined. Statistically significant differences between the three groups are shown in the content of Asp, Gly, Leu + Ile, Orn, Phe, Pro, Thr, and Tyr. To differentiate the three groups from each other, a decision tree was built. To construct it, we selected those amino acids for which the change in concentrations in the subgroups was multidirectional (GABA, Hyl, Arg, His, Pro, and Car). For the first time, it is shown that the amino acid profile of saliva depends on the molecular biological subtype of breast cancer. The most significant differences are shown for the luminal B HER2-positive and TNBC subgroups. In our opinion, it is critically important to consider the molecular biological subtype of breast cancer when searching for potential diagnostic markers.

Study of Benign Breast Diseases from a Clinicopathological Perspective and Considering Management

Study of Benign Breast Diseases from a Clinicopathological Perspective and Considering Management

Efficient serum lipids profiling by TiO2-dopamin-assisted MALDI-TOF MS for breast cancer detection

Lipids serve as fundamental constituents of cell membranes and organelles. Recent studies have highlighted the significance of lipids as biomarkers in the diagnosis of breast cancer. Although liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) is widely employed for lipid analysis in complex samples, it suffers from limitations such as complexity and time-consuming procedures. In this study, we have developed dopamine-modified TiO2 nanoparticles (TiO2-DA) and applied the materials to assist the analysis of lipids by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The TiO2-DA can provide large specific surface area and acidic environment, well suited for lipid analysis. The method was initially validated using standard lipid molecules. Good sensitivity, reproducibility and quantification performance was observed. Then, the method was applied to the analysis of 90 serum samples from 30 patients with breast cancer, 30 patients with benign breast disease and 30 healthy controls. Five lipid molecules were identified as potential biomarkers for breast cancer. We constructed a classification model based on the MALDI-TOF MS signal of the 5 lipid molecules, and achieved high sensitivity, specificity and accuracy for the differentiation of breast cancer from benign breast disease and healthy control. We further collected another 60 serum samples from 20 healthy controls, 20 patients with benign breast disease and 20 patients with breast cancer for MALDI-TOF MS analysis to verify the accuracy of the classification model. This advancement holds great promise for the development of diagnostic models for other lipid metabolism-related diseases.

Molecular Breast Imaging Biopsy with a Dual-Detector System.

Purpose To develop a molecular breast imaging (MBI)-guided biopsy system using dual-detector MBI and to perform initial testing in participants. Materials and Methods The Stereo Navigator MBI Accessory biopsy system comprises a lower detector, upper fenestrated compression paddle, and upper detector. The upper detector retracts, allowing craniocaudal, oblique, or medial or lateral biopsy approaches. The compression paddle allows insertion of a needle guide and needle. Lesion depth is calculated by triangulation of lesion location on the upper detector at 0° and 15° and relative lesion activity on upper and lower detectors. In a prospective study (July 2022-June 2023), participants with Breast Imaging Reporting and Data System category 2, 3, 4, or 5 breast lesions underwent MBI-guided biopsy. After injection of 740 MBq technetium 99m sestamibi, craniocaudal and mediolateral oblique MBI (2-minute acquisition per view) confirmed lesion visualization. A region of interest over the lesion permitted depth calculation in the system software. Upper detector retraction allowed biopsy device placement. Specimen images were obtained on the retracted upper detector, confirming sampling of the target. Results Of 21 participants enrolled (mean age, 50.6 years ± 10.1 [SD]; 21 [100%] women), 17 underwent MBI-guided biopsy with concordant pathology. No lesion was observed at the time of biopsy in four participants. Average lesion size was 17 mm (range, 6-38 mm). Average procedure time, including preprocedure imaging, was 55 minutes ± 13 (range, 38-90 minutes). Pathology results included invasive ductal carcinoma (n = 1), fibroadenoma (n = 4), pseudoangiomatous stromal hyperplasia (n = 6), and fibrocystic changes (n = 6). Conclusion MBI-guided biopsy using a dual-head system with retractable upper detector head was feasible, well tolerated, and efficient. Keywords: Breast Biopsy, Molecular Breast Imaging, Image-guided Biopsy, Molecular Breast Imaging-guided Biopsy, Breast Cancer Clinical trial registration no. NCT06058650 © RSNA, 2024.

Clinical Outcomes of Benign Concordant MRI-Guided Breast Biopsies

IntroductionMRI-guided biopsy is the standard of care for breast imaging findings seen only by MRI. Although a non-zero false-negative rate of MRI-guided breast biopsy has been reported by multiple studies, there are varied practice patterns for imaging follow-up after a benign concordant MRI guided biopsy. This study assessed the outcomes of benign concordant MRI-guided biopsies at a single institution. Patients and MethodsThis IRB-approved, retrospective study included patients with MRI-guided biopsies of breast lesions from November 1, 2014, to August 31, 2020. Only image-concordant breast lesions with benign histopathology and those follow up with MRI imaging or excision were included in the study. ResultsOut of 275 lesions in 216 patients that met the inclusion criteria, 274 lesions were followed with MRI (range, 5-79 months; average, 25.5 months) and showed benign or stable features upon follow-up. One out of 275 lesions (0.4%), a 6 mm focal nonmass enhancement, was ultimately found to represent malignancy after initial MRI-guided biopsy yielded fibrocystic changes. The lesion was stable at a 6-month follow-up MRI but increased in size at 18 months. Repeat biopsy by ultrasound guidance yielded invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). ConclusionBreast MRI-guided biopsy has a low false-negative rate. Our single malignancy from a total of 275 lesions gives a false negative rate of 0.4%. This data also supports a longer follow-up interval than the commonly performed 6-month follow-up, in order to assess for interval change.

Outcomes of a program to improve breast cancer early detection in Cote d’Ivoire.

10553 Background: In Côte d'Ivoire &gt;70% of women with breast cancer are diagnosed with Stage III/IV disease. Patients pay for all diagnosis and treatment costs. We evaluated the effect of provider education, patient navigation and financial support on time from presentation to diagnosis and treatment uptake. Methods: Setting. Five participating primary healthcare centers in Bouaké. Intervention: (1) Breast health training curricula for primary care providers (PCPs), community health workers (CHWs), and patient advocates/cancer survivors (PAs), based on findings from a qualitative assessment. Content included benign breast disease, cancer diagnosis and treatment (PCPs); raising awareness about breast cancer (CHWs); and patient navigation and treatment adherence support (PAs). 36 PCPs, 5 CHWs, and 2 cancer survivors were trained. (2) For indigent patients (almost all patients), the program paid for imaging and pathology diagnosis; for those diagnosed with cancer, costs of bloodwork, imaging, and chemotherapy. Participants: Women with breast symptoms presenting to health centers from December 2022-September 2023. Primary outcome: mean time from presentation to diagnostic resolution. Results: 223 women enrolled in the study. Mean age was 33.7 (st. dev 13.2). 195 (87.3%) were pre-menopausal. 16 (7.1%) had a family history of cancer. 96 (43%) had no formal education, 42 (18.8%) completed primary school or high school, while 85 (38.1%) completed college or university. Time from noticing symptoms to presenting to healthcare center was &lt; 1 month for 96 (43%), 1-3 months for 33 (15%), 3-12 months for 28 (13%), and &gt; 12 months for 62 (28%). The most common symptoms were breast pain in 150 (67.3%) and painless mass in 119 (53.3%). 175 (78.5%) were referred to the gynecology service at the University Teaching Hospital Bouaké for evaluation. 71 (31.8%) were treated with plan for follow-up as needed; 37 (16.6%) continued with surveillance; 90 (43.4%) were referred for breast ultrasound; 26 (11.7%) for mammography; 42 (18.8%) for breast biopsy; 2 receive antibiotics. Among 106 (91.4%) who had imaging, mean time from presentation to the healthcare center to imaging was 14.5 days (st. dev 15.6 days). Among 42 who had a breast biopsy, mean time from presentation to biopsy was 34.5 days (st. dev 27.4). Mean time from presentation to biopsy result was 64.7 days (st. dev 33.0 days). Seventeen (7.6%) patients were diagnosed with breast cancer. Five (29.4%) are undergoing treatment, one was lost to follow-up, and one died. Nine (52.9%) patients declined treatment despite many discussions with patient advocates, mainly citing fear of side-effects. Conclusions: Our program achieved the mean time of &lt; 60 days from presenting to a healthcare center to diagnostic resolution either by imaging or biopsy recommended by the World Health Organization. Despite improving access to early diagnosis, program impact was limited due to suboptimal acceptance of treatment.

Analysis of the Value of Quantitative Features in Multimodal MRI Images to Construct a Radio-Omics Model for Breast Cancer Diagnosis.

To analyze the diagnostic value of quantitative features in multimodal magnetic resonance imaging (MRI) images to construct a radio-omics model for breast cancer. Ninety-five patients with breast-related diseases from January 2020 to January 2021 were grouped into the benign group (n=57) and malignant group (n=38) according to the pathological findings. All cases were randomized as the training group (n=66) and validation group (n=29) in a 7:3 ratio based on the examination time. All subjects were examined by T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), dynamic contrast enhancement (DCE), and apparent diffusion coefficient (ADC) multimodality MRI. The MRI findings were analyzed against pathological findings. A diagnostic breast cancer radiomics model was constructed. The diagnostic efficacy of the model in the validation group was analyzed, and the diagnostic efficacy was analyzed via the ROC curve. Fibroadenoma accounted for 49.12% of benign breast diseases, and invasive ductal carcinoma accounted for 73.68% of malignant breast diseases. The sensitivity of T1WI, T2WI, DWI, ADC, and DCE in diagnosing breast cancer was 61.14%, 66.67%, 73.30%, 78.95%, and 85.96%, using the four-fold table method. The area under the curves (AUCs) of T1WI, T2WI, DWI, ADC, and DCE for diagnosing breast cancer were 0.715, 0.769, 0.785, 0.835, and 0.792, respectively. The AUCs of plain scan, diffuse, enhanced, plain scan + diffuse, plain scan + enhanced, enhanced + diffuse, and plain scan + enhanced + diffuse for diagnosing breast cancer were 0.746, 0.798, 0.816, 0.839, 0.890, 0.906, and 0.927, respectively. The construction of a radio-omics model by quantitative features in multimodal MRI images was valuable in the diagnosis of breast cancer. The value of radio-omics models such as plain scan + enhanced + diffuse was higher than the other models in diagnosing breast cancer and could be widely applied in clinical practice.

The results of clinical monitoring of phytotherapeutic correction in the presence of benign breast diseases

Benign breast diseases (BBDs) are the most common group of diseases among women that negatively affect their quality of life. In fact, these pathological conditions are diagnosed at least 10 times more often than breast cancer. Up to 30% of women with BBDs will need treatment at some point in their lives. A triple assessment which is performed using imaging methods of clinical examination (ultrasound examination, mammography) and histopathological examination after a puncture biopsy during the initial consultation allows to exclude breast cancer in the majority of patients. `The main clinical manifestation of BBDs is mastalgia. In recent years, a variety of natural herbal remedies have played a significant role in the symptom-modifying therapy of mastalgia.The objective: to study the possibility of using an innovative phytocomplex as a symptom-modifying agent in the presence of BBDs, which is manifested by mastalgia.Materials and methods. Clinical monitoring of 60 patients between the ages of 22 and 46 years old with BBDs of various genesis was carried out. The study group included 30 women who used a phytocomplex containing 3,3`-diindolylmethane (200 mg), vitex extract (100 mg), epigallocatechin (45 mg), broccoli extract (0.4 mg), 1 tablet twice daily for 90 days. The reference group included 30 women who used a dietary supplement with indole-3-carbinol (200 mg) according to a similar scheme.Assessment of clinical symptoms of BBDs, measurement of interleukin-6 level in blood serum, fine-needle aspiration biopsy of pathological foci and immunocytochemical analysis of biopsies, assessment of patients’ quality of life were performed before and after treatment.Results. The innovative phytocomplex (diindolylmethane – DIM, Agni casti fructus) compared to the indole-3-carbinol monopreparation demonstrated a higher efficiency in creating conditions for the elimination of clinical manifestations of BBDs: discomfort, swelling, pain at rest and during palpation.A pronounced regression of clinical symptoms was observed in the study group: a decreased frequency of patients with chest discomfort from 100 to 36.7%, a decrease in pain at rest and during pressure – from 53.3 to 13.3% and from 33.3 to 13.3%, respectively, swelling – from 46.7 to 16.7%. The index of the quality of life of patients, which was determined by the sum of the scores of the questionnaire filled out by the patients themselves, showed a more pronounced tendency to increase in the study group.Conclusions. The innovative phytocomplex can be recommended as a preparation for phytotherapeutic correction in order to help reduce the intensity and eliminate mastalgia and other symptoms of BBDs.

Expansive Receptive Field and Local Feature Extraction Network: Advancing Multiscale Feature Fusion for Breast Fibroadenoma Segmentation in Sonography.

Fibroadenoma is a common benign breast disease that affects women of all ages. Early diagnosis can greatly improve the treatment outcomes and reduce the associated pain. Computer-aided diagnosis (CAD) has great potential to improve diagnosis accuracy and efficiency. However, its application in sonography is limited. A network that utilizes expansive receptive fields and local information learning was proposed for the accurate segmentation of breast fibroadenomas in sonography. The architecture comprises the Hierarchical Attentive Fusion module, which conducts local information learning through channel-wise and pixel-wise perspectives, and the Residual Large-Kernel module, which utilizes multiscale large kernel convolution for global information learning. Additionally, multiscale feature fusion in both modules was included to enhance the stability of our network. Finally, an energy function and a data augmentation method were incorporated to fine-tune low-level features of medical images and improve data enhancement. The performance of our model is evaluated using both our local clinical dataset and a public dataset. Mean pixel accuracy (MPA) of 93.93% and 86.06% and mean intersection over union (MIOU) of 88.16% and 73.19% were achieved on the clinical and public datasets, respectively. They are significantly improved over state-of-the-art methods such as SegFormer (89.75% and 78.45% in MPA and 83.26% and 71.85% in MIOU, respectively). The proposed feature extraction strategy, combining local pixel-wise learning with an expansive receptive field for global information perception, demonstrates excellent feature learning capabilities. Due to this powerful and unique local-global feature extraction capability, our deep network achieves superior segmentation of breast fibroadenoma in sonography, which may be valuable in early diagnosis.

Role of Ultrasound in Diagnosis of Fibrocystic Breast Disease

Background: Fibrocystic breast disease is the most typical benign breast disease, which is seen in women worldwide with features of pain and feeling of nodules. Its diagnosis is based on clinical symptoms, ultrasound, mammography, and in doubt cases, biopsy is indicated. For assessment of the breast, we clinically examined the breast, axilla, and both supra and infraclavicular regions for lymph node assessment, followed by ultrasound examination. Detection of lesions in any breast quadrant assessed by BIRADs, Breast Imaging Reporting, and Data System grouped in five brackets. Scanning by sonography using B-mode and Doppler study was improved for detecting and characterizing benign and malignant lesions. Objective: To assess a breast lesion by ultrasound with features suggestive of a benign or malignant nature. Method: This study included 210 women aged 20 - 45 who visited a clinic from October 2020 to April 2022 and were examined by ultrasound machine Samsung HS50 (KOREA) with an LA3-14AD probe. B-mode images obtained detection of the lesion, and we also used Doppler ultrasound for assessment of the vascularity of the lesion. The BI-RADS system was used for the categorization of all findings. Result: In 210 women, complaints of lumps were involved in our study. Imaging by B-mode ultrasound using the Doppler study assesses the vascularity of the lesion and provides more characterization of benign and malignant lesions. By B–mode imaging, 99 patients had regular ultrasound study, and 79 patients had simple cysts that appeared well defined, had familiar outlines, and had an anechoic rounded or oval shape with posterior enhancement. Twenty-eight patients with fibroadenoma visualized as round or oval-shaped hypoechoic lesions horizontally oriented to the planes of the breast with lateral shadowing. 2 patients had complex cysts that appear as well-defined, irregular outlines, rounded shape, a thick wall with internal echoes with posterior enhancement. 2 patients have a malignant lesion that appears ill-defined rough outline vertically oriented with breast planes and show posterior shadowing. Conclusion: Ultrasound was established as the most suitable imaging modality for the categorization of breast lesions and exclusion of malignancy, which is helpful for evading unnecessary biopsies.

A Prospective Multicenter Study on the Additive Value of Contrast-Enhanced Ultrasound for Biopsy Decision of Ultrasound BI-RADS 4 Breast Lesions

ObjectiveThe main aim of this study was to determine whether the use of contrast-enhanced ultrasound (CEUS) could improve the categorization of suspicious breast lesions based on the Breast Imaging Reporting and Data System (BI-RADS), thereby reducing the number of benign breast lesions referred for biopsy. MethodsThis prospective study, conducted between January 2017 and December 2018, enrolled consenting patients from eight teaching hospitals in China, who had been diagnosed with solid breast lesions classified as BI-RADS 4 using conventional ultrasound. CEUS was performed within 1 wk of diagnosis for reclassification of breast lesions. Histopathological results obtained from core needle biopsies or surgical excision samples served as the reference standard. The simulated biopsy rate and cancer-to-biopsy yield were used to compare the accuracy of CEUS and conventional ultrasound (US). ResultsAmong the 1490 lesions diagnosed as BI-RADS 4 with conventional ultrasound, 486 malignant and 1004 benign lesions were confirmed based on histology. Following CEUS, 2, 395, and 211 lesions were reclassified as CEUS-based BI-RADS 2, 3, and 5, respectively, while 882 (59%) remained as BI-RADS 4. The actual cancer-to-biopsy yield based on US was 32.6%, which increased to 43.4% when CEUS-based BI-RADS 4A was used as the cut-off point to recommend biopsy. The simulated biopsy rate decreased to 73.4%. Overall, in this preselected BI-RADS 4 population, only 2.5% (12/486) of malignant lesions would have been miscategorized as BI-RADS 3 using CEUS-based reclassification. The diagnostic accuracy, sensitivity, and specificity of contrast-enhanced ultrasound reclassification were 57.65%, 97.53%, and 38.35%, respectively. ConclusionOur collective findings indicate that CEUS is a valuable tool in further triage of BI-RADS category 4 lesions and facilitates a reduction in the number of biopsies while increasing the cancer-to-biopsy yield.

The diagnostic value of multimodal imaging based on MR combined with ultrasound in benign and malignant breast diseases

We aimed to construct and validate a multimodality MRI combined with ultrasound based on radiomics for the evaluation of benign and malignant breast diseases. The preoperative enhanced MRI and ultrasound images of 131 patients with breast diseases confirmed by pathology in Aerospace Center Hospital from January 2021 to August 2023 were retrospectively analyzed, including 73 benign diseases and 58 malignant diseases. Ultrasound and 3.0 T multiparameter MRI scans were performed in all patients. Then, all the data were divided into training set and validation set in a 7:3 ratio. Regions of interest were drawn layer by layer based on ultrasound and MR enhanced sequences to extract radiomics features. The optimal radiomic features were selected by the best feature screening method. Logistic Regression classifier was used to establish models according to the best features, including ultrasound model, MRI model, ultrasound combined with MRI model. The model efficacy was evaluated by the area under the curve (AUC) of the receiver operating characteristic, sensitivity, specificity, and accuracy. The F-test based on ANOVA was used to screen out 20 best ultrasonic features, 11 best MR Features, and 14 best features from the combined model. Among them, texture features accounted for the largest proportion, accounting for 79%.The ultrasound combined with MR Image fusion model based on logistic regression classifier had the best diagnostic performance. The AUC of the training group and the validation group were 0.92 and 091, the sensitivity was 0.80 and 0.67, the specificity was 0.90 and 0.94, and the accuracy was 0.84 and 0.79, respectively. It was better than the simple ultrasound model (AUC of validation set was 0.82) or the simple MR model (AUC of validation set was 0.85). Compared with the traditional ultrasound or magnetic resonance diagnosis of breast diseases, the multimodal model of MRI combined with ultrasound based on radiomics can more accurately predict the benign and malignant breast diseases, thus providing a better basis for clinical diagnosis and treatment.

Analysis of Discordant Histologically Benign Breast Lesions and Predictive Factors Associated with True Discordance on Imaging

Analysis of Discordant Histologically Benign Breast Lesions and Predictive Factors Associated with True Discordance on Imaging

Repository of MRI-derived models of the breast with single and multiple benign and malignant tumors for microwave imaging research.

The diagnosis of breast cancer through MicroWave Imaging (MWI) technology has been extensively researched over the past few decades. However, continuous improvements to systems are needed to achieve clinical viability. To this end, the numerical models employed in simulation studies need to be diversified, anatomically accurate, and also representative of the cases in clinical settings. Hence, we have created the first open-access repository of 3D anatomically accurate numerical models of the breast, derived from 3.0T Magnetic Resonance Images (MRI) of benign breast disease and breast cancer patients. The models include normal breast tissues (fat, fibroglandular, skin, and muscle tissues), and benign and cancerous breast tumors. The repository contains easily reconfigurable models which can be tumor-free or contain single or multiple tumors, allowing complex and realistic test scenarios needed for feasibility and performance assessment of MWI devices prior to experimental and clinical testing. It also includes an executable file which enables researchers to generate models incorporating the dielectric properties of breast tissues at a chosen frequency ranging from 3 to 10 GHz, thereby ensuring compatibility with a wide spectrum of research requirements and stages of development for any breast MWI prototype system. Currently, our dataset comprises MRI scans of 55 patients, but new exams will be continuously added.

Multiplicity of benign breast disease lesions and breast cancer risk in African American women.

The risk of developing subsequent breast cancer is higher in women diagnosed with benign breast disease (BBD) but these studies were primarily performed in non-Hispanic white populations. Still, these estimates have been used to inform breast cancer risk models that are being used clinically across all racial and ethnic groups. Given the high breast cancer mortality rates among African American (AA) women, it is critical to study BBD in this population, to ensure the risk models that include this information perform adequately. This study utilized data from AA women who underwent benign breast biopsies at a hospital served by the University Pathology Group in Detroit, Michigan, from 1998 to 2010. Patients were followed for subsequent breast cancers through the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). BBD lesion scores were assigned to represent the severity or extent of benign breast lesions, with higher scores indicating a greater number of distinct lesion types. Of 3,461 eligible AA women with BBD in the cohort, 6.88% (n=238) subsequently developed breast cancer. Examined individually, six of the eleven lesions (apocrine metaplasia, ductal hyperplasia, lobular hyperplasia, intraductal papilloma, sclerosing adenosis, columnar alterations and radial scars) were significantly associated with increased risk of breast cancer after adjustment for age and year of biopsy and were further considered in multiple lesion models. For every different type of benign breast lesion, subsequent risk of breast cancer increased by 25% (RR=1.25, 95% CI: 1.10, 1.42) after adjustment for age at biopsy and proliferative versus non-proliferative disease. In summary, this study affirms the increased breast cancer risk in AA women with BBD, particularly in those with multiple lesions. These findings have implications for the management of breast cancer risk in millions of women affected by BBD, a high risk group that could benefit from personalized surveillance and risk reduction strategies.