Focal Asymmetric Density Research Articles

Deep learning model to predict Ki-67 expression of breast cancer using digital breast tomosynthesis.

Developing a deep learning (DL) model for digital breast tomosynthesis (DBT) images to predict Ki-67 expression. The institutional review board approved this retrospective study and waived the requirement for informed consent from the patients. Initially, 499 patients (mean age: 50.5years, range: 29-90years) referred to our hospital for breast cancer were participated, 126 patients with pathologically confirmed breast cancer were selected and their Ki-67 expression measured. The Xception architecture was used in the DL model to predict Ki-67 expression levels. The high Ki-67 vs low Ki-67 expression diagnostic performance of our DL model was assessed by accuracy, sensitivity, specificity, areas under the receiver operating characteristic curve (AUC), and by using sub-datasets divided by the radiological characteristics of breast cancer. The average accuracy, sensitivity, specificity, and AUC were 0.912, 0.629, 0.985, and 0.883, respectively. The AUC of the four subgroups separated by radiological findings for the mass, calcification, distortion, and focal asymmetric density sub-datasets were 0.890, 0.750, 0.870, and 0.660, respectively. Our results suggest the potential application of our DL model to predict the expression of Ki-67 using DBT, which may be useful for preoperatively determining the treatment strategy for breast cancer.

Multiple angiosarcomas of both breasts: a case report

BackgroundPrimary angiosarcomas of the breast are rare and highly aggressive. We herein report a rare case of multiple angiosarcomas detected concurrently in both breasts.Case presentationA 49-year-old woman visited a doctor after noticing a lump in her right breast. At that time, mammography and ultrasonography revealed no abnormal findings in either breast. She was referred to our hospital 5 months later, because screening mammography had revealed a focal asymmetric density in her right breast. Ultrasonography showed ill-defined hyper- and hypo-echoic lesions in both breasts. Magnetic resonance imaging disclosed five heterogeneously enhanced masses (5.8 cm in maximum diameter) in the right breast and six enhanced masses (approximately 1–3 cm in diameter) in the left breast. Histological examination of core needle biopsies revealed proliferation of irregularly shaped vascular channels lined by atypical endothelial cells throughout the adipose tissue and lobules of the breasts, leading to a diagnosis of well-differentiated angiosarcoma. The lesions were assumed to be primary angiosarcomas, because she had neither a history of breast surgery nor of radiation therapy. She underwent bilateral mastectomies and postoperative chest wall irradiation. Computed tomography 11 weeks after the surgery revealed multiple, small, subcutaneous nodules in the chest wall that were suspected of being angiosarcoma metastases. We started chemotherapy (weekly paclitaxel 80 mg/m2), which achieved shrinkage of these nodules within 2 months.ConclusionsEarly diagnosis, immediate initiation of local and systemic therapies, and intensive follow-up are important in improving the prognosis of angiosarcomas.

Anaplastic lymphoma kinase-positive inflammatory myofibroblastic tumor of the breast: a case report and review of the literature

BackgroundFew reports of inflammatory myofibroblastic tumor (IMT) of the breast have been published worldwide. Furthermore, primary anaplastic lymphoma kinase (ALK)-positive IMT of the breast is extremely rare. To date, only six patients with ALK-positive IMT have been reported in the literature.Case presentationA 52-year-old woman underwent a medical examination, and a left breast mass was detected. She did not feel a mass in her chest. Mammography showed a focal asymmetric density at the lower outer portion of the left breast. Breast ultrasonography showed a 1.2-cm hypoechoic lesion with relatively clear boundaries and poor blood flow. Magnetic resonance imaging and computed tomography revealed a solitary heterogeneous mass in the left breast. Pathologic examination revealed a fibrosing lesion with proliferation of fibroblastic cells arranged in a storiform pattern and admixed inflammatory cells. Immunohistochemical examination showed that the tumor cells were positive for ALK. Under the preoperative diagnosis of IMT, we performed partial mastectomy with adequate margins. The postoperative diagnosis was pathologically confirmed as IMT. Immunohistochemical staining also showed overexpression of ALK-1 in the tumor. The patient had a good clinical course for 24 months postoperatively, without recurrence or metastasis.ConclusionsIMT of the breast shows nonspecific imaging findings, making preoperative diagnosis difficult. Nevertheless, IMT has the characteristics of low-grade neoplasms with recurrence, invasion, and metastatic potential. Our report emphasizes the importance of determining a treatment plan as soon as possible based on an accurate diagnosis to improve the prognosis of this disease.

Follicular lymphoma without lymphadenopathy incidentally diagnosed by sentinel lymph node biopsy during breast cancer surgery: a case report

BackgroundConcurrent breast cancer and malignant lymphoma is a rare phenomenon. This report describes malignant lymphoma that was incidentally diagnosed from a sentinel lymph node biopsy (SLNB) during breast cancer surgery.Case presentationA 73-year-old woman with a history of ovarian cancer and diabetes presented with right focal asymmetric density on a mammogram acquired during routine breast cancer screening. Ultrasonography (US) and magnetic resonance imaging (MRI) showed a 13.5-mm tumor in the upper lateral region of the right breast. A US-guided Mammotome biopsy revealed invasive ductal carcinoma of the right breast. Preoperative assessments including positron emission tomography–computerized tomography, found no evidence of axillary lymphadenopathy or distant metastasis. Because the breast cancer was stage I, the patient underwent a right mastectomy and a sentinel lymph node biopsy (SLNB) at our hospital. Pathological assessment of the biopsy revealed follicular lymphoma (FL), but no metastatic breast cancer. The patient was referred to hematology to stage the FL. Bone marrow findings were negative and stage I FL was diagnosed. After the mastectomy, she was monitored and given adjuvant therapy with an aromatase inhibitor.ConclusionsFollicular lymphoma was incidentally diagnosed from an SLNB obtained to determine the dissemination of early-stage breast cancer. Collaboration with hematologists is important to determine optimal treatment plans for such patients regardless of the rarity of such events.

Breast cancer screening using digital breast tomosynthesis compared to digital mammography alone for Japanese women.

The purpose of this study is to confirm the position of DBT in breast cancer screening in Japan, to assess cancer detection rates, recall rates, positive predictive value (PPV), and to evaluate the type of mammographic findings of cancer with the use of digital mammography alone (2DDM) and combined with digital breast tomosynthesis (DBT). 11,894 examinations of the opportunistic breast cancer screening using only 2DDM and 2DDM plus DBT were performed from May 1, 2017 to March 31, 2019. The 11,894 women [3535 women who received DBT in addition to 2DDM (3D group) and 8359 who received 2DDM only (2D group)] participated in this study. The study was approved by the Institute's Ethics Committee and all participants provided written informed consent. The recall rate was 2.6% for the 3D group and 3.6% for the 2D group (p < 0.01). The cancer detection rate was 0.17% in both 3D and 2D groups (p = 0.978). The positive predictive value (PPV) was 6.5% for the 3D group and 4.7% for the 2D group (p = 0.484). The cause of the decrease in recall rate was due to a decrease in the finding of focal asymmetric density (FAD). The recall rate was improved by using DBT for breast cancer screening in Japanese women. Cancer detection rates were exactly the same in DBT and 2DDM groups, so only DBT non-inferiority could be verified. We have verified that breast cancer screening combined with DBT is useful even for Japanese women to reduce unnecessary further examination.

Mammographic, Ultrasonographic and Pathologic Correlations of Focal Asymmetric Breast Densities among a Sample of Iraqi Women

Objectives: is to evaluate the mammographic focal asymmetric breast densities FABD in order to highlight which FABD might need further workup through detailed ultrasonographic characterization and comparison with the pathological results in indicated cases.&#x0D; Methods: A cross sectional analytic study was performed in the Oncology Teaching Hospital/Medical City from March 2018 to November 2018. The study included 70 women who attended the Main Referral Center for Early Detection of Breast Tumors with focal asymmetric breast densities FABD were detected by mammography. The focal asymmetry was analyzed and the other associated findings were assessed and registered. While breast ultrasound was performed for all patients, fine needle aspiration (FNA) was carried out for cases with suspicious findings on ultrasound and any FNA suspicious or malignant lesion was subsequently biopsied and the results were recorded.&#x0D; Results: mammographic FABD was found in the right breast in 37 cases (52.9%) and in the left in 33 cases (47.1%). The upper outer quadrant (UOQ) was the most common location of FABD (43 cases). In 25 cases (34.2%) with FABD, there was no abnormality found on ultrasound, but normal looking breast parenchymal tissue. Ultrasound had shown benign findings in 30 cases (44.2%). On the other hand, suspicious and/or malignant features were observed in 15 cases (22.4%) which subsequently proved to be malignant by FNA and biopsy. Architectural distortion or grouped microcalcifications and a clinically palpable FABD were associated with malignant FABD; no benign FABD revealed to be associated with these findings.&#x0D; Conclusion: The finding of FABD is common on mammography and mostly represents a benign entity of normal breast parenchymal tissue. However; it may indicate an underlying hidden malignancy especially in the presence of superadded mammographic findings as ill-defined mass, architectural distortion or grouped microcalcification.

Abstract P5-01-03: Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography

Abstract Introduction Recently “Dense breast” has attracted numerous attention because of diagnostic difficulty in mammography among those harboring dense breast, which is far more frequent in Asian than Caucasian women. Therefore, in this study, we retrospectively evaluated the risks of subsequent development of malignancy through comparing the detailed mammographic characteristics between Japanese subjects harboring dense and non dense breasts. Methods We retrospectively examined mammorgraphic findings taken from March 2013 to March 2016 at Nahanishi Clinic, Okinawa, Japan. We stratified its density according to the suggestion of the Japan Central Organization on Quality Assurance of Breast Cancer Screening, which was defined by the proportion of fat area as follows; extremely high dense:10-20%, heterogeneously dense:40-50%, scattered fatty:70-90%, fatty: almost all the breast fat. “Dense breast” includes extremely high and heterogeneous dense. We evaluated the detailed radiological findings of each phenotypes including the characteristics of the mass, calcification and focal asymmetric density(FAD) and architectural distortion. We also compared the rates of subsequent cancer development and sensitivity of detecting cancer between those harboring dense and non dense breasts. Results We reviewed the mammography findings of 7747 Japanese women including 857 with breast cancers. When adjusted for age, the rate of dense breast was significantly associated with age, 88.6% in women in their 20s(vs40s p&amp;lt;0.001 OR3.402), with incremental decrease, 80.4% in 30s(P&amp;lt;0.001 OR1.802), 69.5% in 40s, 55.9% in 50s(P&amp;lt;0.001 OR0.512), 32.3% in 60s(P&amp;lt;0.001 OR 0.108), 19.5% in 70s(P&amp;lt;0.001 OR 0.106) and 5.3% in over 80s(P&amp;lt;0.001 OR0.024). The rate of malignancies was 9.1% (385) in dense and 13.6% (472) in non dense breasts. We then compared the mammographic findings between dense and non dense breast. Abnormal calcifications were detected more frequent(7.6%vs5.3% P&amp;lt;0.001 OR1.478) but masses less so(16.4%vs23.7% P&amp;lt;0.001 OR 0.632) in dense breast, while no significant differences detected in FADs(4.9%vs4.6% P=0.35 OR1.074) and distortions(1.2%vs1.4% P=0.29 OR=0.859) between dense and non dense breast. The rate of carcinoma was less frequent in dense breast among those associated with mammographic calcification(19%vs27.3% P&amp;lt;0.01 OR0.626) but more frequently in dense breast among those with masses (13%vs19% P&amp;lt;0.001 OR0.628). The rate of carcinoma was not different between dense and non dense breast in those with FADs (21.6vs20.6% P=0.72 OR1.067) and distortions(71.7%vs74.7% P=0.64 OR0.857). In addition, among 37 breast cancer patients who did not harbor the mammographic findings above (26 dense and 11 non dense breasts), the average mass length was significantly larger in dense (13.6mm) than non-dense breast (9.9mm) (P=0.018 used Welch's t test), respectively. Conclusion Results of our present study did demonstrate that detection of malignancy in those with mammographic dense breast is more difficult. Therefore, in those harboring dense breast in mammography, addition of other modalities such as US could improve the detection of breast carcinoma. Citation Format: Takigami N, Tamaki K, Kamada Y, Uehara K, Terukina S, Ishida T, Miyashita M, McNamara KM, Tamaki N, Sasano H. Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-03.

The results of examination in patients with focal asymmetric density on screening mammography

The results of examination in patients with focal asymmetric density on screening mammography

Use of Imaging for the Diagnosis of Idiopathic Granulomatous Mastitis: A Clinician's Perspective.

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disease with unknown etiology and nonspecific symptoms. Differentiation of breast cancer from granulomatous disease is a diagnostic and clinical challenge. Imaging features and decision of the surgeon, based on these findings, may be important steps during diagnosis and follow-up period. Articles in association with imaging of IGM were evaluated using a PubMed search in August, 2017. Hypo-echoic or heterogeneous mass/es with or without tubular extensions were the most common ultrasonographic findings. Focal asymmetric density with or without skin thickening and parenchymal distortion were detected in most of the patients during mammography. Magnetic resonance imaging most commonly revealed focal or diffuse asymmetrical signal intensity changes without significant mass effect. Although a specified and standardised criteria list for each type of the imaging modality has been lacking, the most commonly detected imaging findings, especially in cases of multiple lesions in accordance with the decision of the surgeon and/or clinician, can be used for the diagnosis and follow-up of IGM with acceptable safety margins. However, in the presence of any suspicious findings during imaging or clinical examination, histopathological analysis should be performed.

The Combined Assessment of Mammography and Ultrasound for Focal Asymmetric Densities

The Combined Assessment of Mammography and Ultrasound for Focal Asymmetric Densities

The Usefulness of the Combined Criteria in the Focal Asymmetric Density and Masses Observation

The Usefulness of the Combined Criteria in the Focal Asymmetric Density and Masses Observation

The utility of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation evolution following professional teeth cleaning.

The AIM of this study was to evaluate the usefulness of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation, following professional teeth cleaning. The study was performed on 18 teeth without restorations having subgingival calculus (upper and lower premolars and frontal teeth). After the clinical exam the Gingival Index and the Sulcus Bleeding Index were calculated. Then a 40MHz transducer (ULTRASONIX SonoTouch device) was used to obtain longitudinal sections in the frontal plane. Three measurements were performed: alveolar crest - cementum-enamel junction distance (ACJ), gingival height (GH), and gingival width (GW). Professional cleaning was performed by ultrasound scaling (SatelecP5 booster, France) and airflow (NSK, Japan). Two and seven days after the first evaluation, ultrasonographic and clinical examinations were repeated. Two days after the treatment the median value of the ACJ, was 2.70 (2.38; 2.95) mm, whereas 7 days after treatment it was 2.55 (2.45; 3.01) mm. The intraclass correlation coefficient for ACJ measurement was 98.8 (p<0.001).The values obtained measuring GH [3.84(3.44; 4.27) mm vs. 3.52 (3.00; 3.76) mm] and GW [(1.81 (1.65; 1.95) mm vs.1.62 (1.40; 1.95) mm) had statistically significant differences between the 2nd and 7th day. Periodontal ultrasonography is a highly precise and reproducible imagistic method, with which bone resorption, gingival inflammation as well as the presence or absence of subgingival calculus can be assessed.

How to Deal with Focal Asymmetric Densities on Mammography Screening Combined with Ultrasonography in Terms of Increased Specificity

How to Deal with Focal Asymmetric Densities on Mammography Screening Combined with Ultrasonography in Terms of Increased Specificity

Additional Breast Ultrasonography Helps Determine Need for Extra Examination Regarding Focal Asymmetric Densities Seen in Mammographic Screening

Additional Breast Ultrasonography Helps Determine Need for Extra Examination Regarding Focal Asymmetric Densities Seen in Mammographic Screening

Mammographic and clinicopathological features of triple-negative breast cancer

Triple-negative breast cancer (TNBC) lacks effective treatment and has a poor prognosis. This study assessed mammographic findings and clinicopathological features of TNBC by comparing with non-TNBC in order to improve clinical diagnosis of TNBC. A total of 426 patients with pathologically confirmed breast cancer were retrospectively assigned into two groups, TNBC (n = 54) and non-TNBC (n = 372), and then analysed. TNBC frequently showed a high histological grade, presented with a mass (79.6%) and was less frequently associated with focal asymmetric density (11.1%), microcalcifications (5.6%) and distortion (3.7%) on mammography. TNBC mammographic masses were most frequently round/oval (58.1%) or lobular (30.2%) in shape and were less frequently irregular in shape (11.6%). Masses with circumscribed margins were the most frequent (37.2%), with microlobulated (25.6%) and obscured (16.3%) margins being commonly observed, but masses with spiculated margins were rare (9.3%). TNBC could have distinct mammographic and clinicopathological features compared with non-TNBC, and thus mammography may be useful in the diagnosis of TNBC. This study demonstrated distinct mammographic and clinicopathological features to help in diagnosis of Chinese patients with TNBC.

臨床現場から見た乳がん検診ガイドラインの利点・欠点

本研究ではマンモグラフィ有所見症例13,418例を対象に，腫瘤，石灰化，局所非対称性陰影(focal asymmetric density: FAD)の有病率および統計学的根拠に基づいたマンモグラフィカテゴリー再分類に関する研究を行った。結果は，spiculated mass (98.7%)およびpleomorphic segmental calcification (89.5%)が有病率を背景とした場合，悪性を強く疑う所見であった。加えて統計学的検討においてはpleomorphic segmental, non-circumscribed/non-spiculated mass, pleomorphic grouped, FAD with distortion とamorphous segmentalが統計学的に悪性を強く疑う所見であった。本研究の結果で，悪性を強く疑う所見を予測することができるが，しかしながら本研究は2施設の限られた設備，放射線技師，医師によって行われた研究であるという限界がある。科学的根拠に基づいたガイドラインの作成のために全国規模の質の高い臨床試験を立案することが重要であると考えられた。

Role of Breast Tomosynthesis in Diagnosis of Breast Cancer for Japanese Women

Mammography is the most basic modality in breast cancer imaging. However, the overlap of breast tissue depicted on conventional two-dimensional mammography (2DMMG) may create significant obstacles to detecting abnormalities, especially in dense or heterogeneously dense breasts. In three-dimensional digital breast tomosynthesis (3DBT), tomographic images of the breast are reconstructed from multiple projections acquired at different angles. It has reported that this technology allows the generation of 3D data, therefore overcoming the limitations of conventional 2DMMG for Western women. We assessed the detectability of lesions by conventional 2DMMG and 3DBT in diagnosis of breast cancer for Japanese women. The subjects were 195 breasts of 99 patients (median age of 48 years, range 34~82 years) that had been pathologically diagnosed with breast cancer from December 20, 2010 through March 31, 2011. Both conventional 2DMMG and 3DBT imaging were performed for all patients. Detectability of lesions was assessed based on differences in category class. Of the affected breasts, 77 (75.5%) had lesions assigned to the same categories by 2DMMG and 3DBT. For 24 (23.5%) lesions, the category increased in 3DBT indicating improvement in diagnostic performance compared to 2DMMG. 3DBT improved diagnostic sensitivity for patients with mass, focal asymmetric density (FAD), and architectural distortion. However, 3DBT was not statistically superior in diagnosis of the presence or absence of calcification. In this study, 3DBT was superior in diagnosing lesions in form of mass, FAD, and/or architectural distortion. 3DBT is a novel technique that may provide a breakthrough in solving the difficulties of diagnosis caused by parenchyma overlap for Japanese women.

Posterior breast cancer: Mammographic and ultrasonographic features

Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers. The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BI-RADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered micro-calcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109). Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography.

Radiographic features for triple negative ductal carcinoma in situ of the breast

Triple negative (TN) breast cancer is characterized as having a high malignancy potential and a poor prognosis. An understanding of the radiological features of TN DCIS will enable the early detection of intractable TN invasive breast cancer. Our cohort of 494 DCIS patients, including 18 TN DCIS cases (3.6%), was diagnosed and treated between January 2006 and November 2009. We reviewed the TN DCIS cases in order to assess mammogram (MMG), ultrasound (US), magnetic resonance imaging (MRI), and pathology findings. Routine diagnostic MMG, US, and MRI were performed before surgery in our institution. The average age of TN DCIS patients was 54.2years (40-73). MMG findings were as follows: no abnormal findings (n=4), masses (n=3), focal asymmetric density (n=2), architectural distortion (n=5), and calcifications (n=4). US findings included low echoic masses (n=17) and architectural distortion (n=4). MRI findings (two patients did not undergo this examination) included mass (n=6) and non-mass-like enhancements (n=10). The average lesion measured 3.3cm in diameter (0.5-8.5cm). The histological findings were non-comedo type (n=9) and mixed type including some comedo components (n=9). Notably, our study revealed that only 22% of TN DCIS cases were detected via mammographic abnormal calcifications. This percentage was less than in non-TN DCIS cases. TN DCIS cases were detected mainly because of masses or asymmetry. US and MRI findings of TN DCIS revealed the same features considered to be common DCIS findings. We diagnosed TN DCIS in 3.6% of our cohort including 494 DCIS patients. Incidences of TN DCIS with mammographic abnormal calcifications were fewer than those of non-TN DCIS cases.

検診での局所的非対称性陰影(FAD)の診断における問題点

検診での局所的非対称性陰影(FAD)の診断における問題点