Magnetic Resonance Mammography Research Articles

MAMMOGRAPHICALLY DETERMINED ASYMMETRIES OF THE MAMMARY PARENCHYMA: CAUSES AND OPPORTUNITIES OF THEIR MAMMOGRAPHIC AND ULTRASOUND DIFFERENTIAL DIAGNOSIS

The incidence of asymmetries is 1-2% of all mammographic studies performed. However, there is no data in the literature on the prevalence of individual causes for mammographically determined asymmetries, as well as information about the opportunities of mammography and ultrasound examination (U/S) in their differential diagnosis. The aim of the study is to assess the incidence of individual causes for mammographically determined asymmetries and the opportunities of mammography and ultrasound of the mammary glands in their differential diagnosis. Material and methods. The results of mammographic and ultrasound examination of 202 patients were analyzed, in whom zones of asymmetrically distributed breast tissue were detected during mammography. Results. Technical asymmetries were detected in 14 out of 202 cases (6.93%) and could not be adequately analyzed. The true ones were asymmetries without space-occupying lesions caused by asymmetric uneven distribution of glandular (as a rule) or fibrous tissue (161 out of 202; 79.70%), as well as asymmetric edema of the breast parenchyma not associated with edematous infiltrative form of breast cancer (1 out of 202; 0.50%). These cases have always required performing breast ultrasound. The causes of true asymmetries caused by the presence of a space-occupying lesion were malignant neoplasms (breast cancer; 7 out of 202; 3.47%), benign formations (cysts, fibroadenomas, granulomas, abscesses, hematomas, chronic mastitis and other focal benign processes; 11 out of 202; 5.45%). These cases also required to perform breast ultrasound. The cause of the true asymmetries were also postoperative scars (8 out of 202; 3.96%), the differential diagnosis of which did not require ultrasound, but it and/or magnetic resonance mammography were required to assess the condition of the scar for its possible malignant transformation. Conclusions. The largest proportion of mammographically determined asymmetries in the density of mammary parenchyma (79.70%) are physiological variants of asymmetrically distributed tissues of this organ; their differential diagnosis and that of asymmetries caused by space-occupying lesions, according to mammography findings, is difficult, which requires additional ultrasound of the mammary glands. At the same time, mammography makes it possible to confidently identify technical asymmetries of the breast requiring no use of ultrasound, however, the interpretation of such sets of mammograms does not seem correct.

Role of Magnetic Resonance Mammography in the Evaluation of Indeterminate Breast Lesions.

Background: Malignancy of the breast is one of the most common cancers among females worldwide. Magnetic resonance mammography (MRM) is a valuable complement to conventional methods for the early diagnosis of disease, thereby providing patients with a better prognosis. The number of unnecessary biopsies and repeated excisions in cases of indeterminate breast lesions detected on conventional imaging is high. Aims: The purpose of this study was to evaluate the role of MRM in the evaluation of indeterminate breast lesions [Breast Imaging Reporting and Data System (BIRADS) 3/4] found in conventional mammography and ultrasonography (USG), taking the histopathological examination (HPE) as the gold standard. Materials and methods: A total of 38 patients with conventional radiological imaging diagnosis of indeterminate breast lesions (BIRADS 3/4) were included in this study and evaluated using contrast-enhanced MRM according to the MR-BIRADS lexicon (5th edition). Morphological characteristics of lesions were evaluated to determine the probability of malignancy. Histopathology was kept as the gold standard for comparing all the statistical parameters. Results: There were a total of 40 lesions, 35 masses, and five nonmass enhancement (NME) available for evaluation out of the 38 patients. The sensitivity of margins to detect malignancy approached 100%; however, it had a slightly lower specificity of 66.67%. Magnetic resonance imaging (MRI) showed good diagnostic performance with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 85, 90, 89.47, 85.71, and 87.50%, respectively. Conclusion: The MRI has been shown to be useful as a problem-solving tool in breast cancer screening, clarifying indeterminate findings and avoiding unnecessary short follow-ups and percutaneous biopsies. How to cite this article: Mishra E, Kaur N, Kaur R, et al. Role of Magnetic Resonance Mammography in the Evaluation of Indeterminate Breast Lesions. J Assoc Physicians India 2023;71(11):76-84.

BI-RADS CLASSIFICATION FOR BREAST ULTRASOUND : A REVIEW

Breast cancer is the most common form of cancer in women worldwide. According to statistics from GLOBOCAN 2020, 1.2 million women are diagnosed with breast cancer each year, and 410,000 (35%) will die from this disease. Breast cancer is the most prevalent type of cancer among women in Indonesia, accounting for 30.8% of all female cancer cases in 2020 and causing 20.4% of female cancer-related deaths in the same year. Breast cancer screening plays a vital role in reducing deaths caused by breast cancer. Various breast cancer imaging techniques have been introduced for diagnosing breast cancer, such as Magnetic Resonance (MR) mammography, Ultrasound, Elastography, Mammography, and Automated Breast Ultrasound (ABUS). Ultrasound (US) and mammography are the two most important modalities for breast imaging. In younger women under the age of 35, ultrasound is the primary tool used to investigate breast problems. Even in the older age group, ultrasound plays a crucial role in breast imaging, particularly for the assessment of mass lesions. Breast ultrasound can be used for both screening and diagnostic purposes. Ultrasound evaluates breast tissue without the use of ionizing radiation or the injection of contrast material and is affordable, readily available, and well-tolerated by patients. The American College of Radiology (ACR) proposed the Breast Imaging Reporting and Data System (BI-RADS) to standardize the characterization of sonographic breast lesions according to five criteria categories: mass shape, orientation, margin, echo pattern, and posterior features.

Phase II study on feasibility of sentinel lymph node biopsy for ycN0 patients treated with primary chemotherapy in cT1-3N1M0 breast cancer (SHARE study).

583 Background: Sentinel lymph node biopsy (SLNB)-guided axillary management is still debated for clinically node-positive breast cancer (BC) patients treated with neoadjuvant chemotherapy (NAC). Several phase II studies demonstrated high false-negative rates (FNR) in ycN0 BC, but precise diagnostic imaging for nodal involvement may reduce FNR. To explore ideal imaging and lymphatic mapping, the Japanese Society for Sentinel Node Navigation Surgery conducted a prospective non-randomized phase 2 study (SHARE study, UMIN000030558). Methods: Clinical T1-3N1M0 BC was eligible under multimodal imaging of breast ultrasound, CT and/or MR mammography. Nodal metastasis was histologically confirmed. Standard regimen for NAC was performed by physician’s choice. In case of ycN0 BC, SLNB was planned and lymphatic mapping depended on each institutional practice. The primary endpoint is FNR of SLNB and secondary endpoints are the identification rate and outcome of ycN0 BC patients at 2 years after surgery. Moreover, in cases of pN0(sn), pN0(i+)(sn) and pN1mi(sn), SLNB followed by lymph node sampling had been allowed instead of axillary lymph node dissection. Based on an estimated FNR of 5%, 224 patients were needed to give 80% power to reject the null hypothesis that the threshold of FNR is 15% with a one-sided type I error rate of 5%. Results: Between February 2018 and May 2021, 185 patients from 19 institutes were registered. After 27 ineligible cases of protocol deviation, non-ycN0 or withdrawal of SLNB were excluded, 158 ycN0 cases underwent SLNB and sentinel lymph nodes were detected in 153 cases. Among them, the median age was 52 years old. Clinical stage was IIA in 40 cases, IIB in 105 and IIIA in 8. Luminal subtype classified by ER, PR and HER2 expression was found in 60 cases, HER2 in 34, Luminal-HER2 in 35 and triple-negative in 24. Finally, 61 cases had positive nodes, which included 7 false-negative cases. FNR was 11.5% (90% confidence interval, 5.5% and 20.5%). The identification rate was 96.8% and the accuracy rate was 95.4%. Before NAC, multimodal imaging was performed in 148 cases (96.7%) and 1 nodal metastasis was detected in 62 cases (40.5%). When multimodal imaging, 1 nodal metastasis, multiple tracers, multiple sentinel lymph nodes were considered for subset analysis, the FNR was 12.1%, 9.1%, 11.1%, and 10.6%, respectively. If isolated tumor cells in lymph nodes had been defined as pathologically negative even after NAC, the FNR was 7.1%. Conclusions: Multimodal imaging could not improve FNR in ycN0 BC. However, SLNB-guided axillary management should be considered when one positive-node is clinically converted to ycN0 after NAC. We will report the outcome of ycN0 BC cases next year. Clinical trial information: UMIN000030558 .

Could Apparent Diffusion coefficient (ADC) be used as an imaging marker for proliferative activity in breast carcinoma?

<p>Introduction. Multiparametric magnetic resonance mammography (mMRM) has an important role in detection, evaluation and follow-up of breast lesions. The aim of this study was to explore whether imaging parameters, in particular ADC, can be used as a biomarker of cell proliferation in breast cancer. Methods. This cohort-study included 67 lesions in 50 female patients who underwent mMRM on a 3T scanner. Percutaneous biopsies and surgical excisions were performed after imaging in period up to 3 weeks. The Ki67 index was assessed microscopically. Seven Ki67 categories were defined: 0–5%, 10–20%, 20–40%, 40–50%, 50–80% and over 80%. Methods of descriptive statistics were used; correlations were determined using Pearson’s correlation test. ROC curve was constructed and analyzed for determination of “cut-off” values for diagnostic potential. Statistical significance was set at p < 0.05. Results. Different subtypes of breast carcinomas were involved: ductal carcinoma (59.9%), lobular carcinoma (17.9%), metastatic carcinoma (10.5%), ductal carcinoma in situ (9%), and tubular carcinoma (3%). It was not possible to determine whether there was significant difference in values of ADC for histological subtypes of breast carcinoma because of small number of samples in some groups. The cut off value of ADC for breast carcinoma was 0.792 (sensitivity 98.6%, specificity 65.7%). There was no significant difference in values of ADC for categories of Ki67. There was no significant correlation between ADC mean and Ki67 for all histological subtypes of breast carcinomas (r = 0.156, p = 0.243). Conclusion. ADC cannot be used as a reliable imaging marker for proliferative activity in breast cancer.</p>

Possibilities of MRI in the differential diagnosis of non-lactative mastitis and cancer

Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration. MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.

ROLE OF DIFFUSION WEIGHTED IMAGING AND ADC VALUES IN CHARACTERISING BREAST LESIONS ON MR MAMMOGRAPHY

Background- Dynamic contrast enhanced MRI (DCE MR) is an important imaging modality to detect and evaluate the breast lesions with high sensitivity. Aim of study was to characterize breast lesions detect Objective- ed on MR mammography by diffusion weighted imaging and quantify ADC values to differentiate benign and malignant mass and non mass lesions. Methods- This prospective study was performed in thirty female patients on 1.5T GE Healthcare HDXT MRI machine. Thirty three breast lesions were included in this study. Final diagnosis was correlated with histopathological diagnosis. Out of total thirty three lesions, mean ADC value Results- of malignant lesions was 1.01 ± 0.24 x 10-3mm2/sec and for benign lesions was 1.48 ± 0.29 x 10-3 mm2/sec. The calculated ADC cut off value of 1.22x 10-3 mm2/sec gave a sensitivity of 86.96% and specicity of 90% to differentiate malignant and benign breast lesions. As a Conclusion- conclusion Diffusion weighted imaging and quantitative analysis with ADC values can be used with conventional DCE MR to differentiate benign and malignant breast lesions with high sensitivity and specicity

Comparison of Amritsar scoring system using quantitative contrast enhanced ultrafast magnetic resonance mammography and diffusion technique with conventional Kaiser scoring system

Background: Magnetic resonance imaging (MRI) mammography has been recommended as a problem solving tool in patients with breast lump for which newer imaging protocols like abbreviated, ultrafast MRI and diffusion MRI are now available. For interpretation lexicons like BIRADS and Kaiser score system are available but there is a scope for improvement of results and need for newer lexicons.Methods: Retrospective study of 175 patients of breast lump who had MRI mammography was done. The lesions were labelled as malignant by Kaiser score system (KSS) and a newer scoring system “Amritsar score system” (AMSS). Final diagnoses was confirmed by histological examination with hormone and Her2neu receptor studies. Statistical analysis was done for correlation, sensitivity, specificity and accuracy along with area under curves and the results compared.Results: Study comprised 32/175 patients with malignant nodules. Mean age of 47.2 (range: 44.2-49.6) years with mean nodule size of 2.2 cm (range 1.8-5.5 cm). ADC and Ktrans, Kep, TTE, MS and IAUC60 showed high correlation with size of malignant nodule. Sensitivity of detection was 87.4%, 87.5%, 88.6%, 71.8% and 80% respectively for ADC, Ktrans, Kep, TTE, MS and IAUC60 while specificities were 94, 88.7, 88.7% 90% and 90% respectively. The sensitivity, specificity and accuracy for KSS and AMSS were 62.5%, 88.9%, 72% and 96.5%, 90% and 94% respectively.Conclusions: AMSS is more accurate than KSS and improves the sensitivity and specificity of cancer detection. Ktrans and ADC imaging parameters not only show high sensitivity for cancer detection but also have a good correlation with the size and nuclear grade to be used as imaging biomarkers.

The MR mammography of phyllodes tumors of different histological grades

Purpose: to evaluate retrospectively the MR data of the breast phyllodes tumors and to perform comparative analysis of the MR signs and the histological grade of the phyllodes tumors.Materials and methods. The analyses enrolled 27 pathologically confirmed phyllodes tumors (mean age of patient 37.8 y.o.). Following features were evaluated: tumor shape and structure, margins, size, type of contrast enhancement, foci of high signal intensity on the T1-WI, foci of hypo- or isointense signal on the T2-WI comparing with intact breast tissue, presence of cystic inclusions and the type of their margins.Results. The study included 18 benign, 4 borderline and 5 malignant phyllodes tumors. The following features showed significant correlation with the tumor grade: irregular margins of the cystic foci (p = 0.003), foci of hypoor isointense signal on the T2-WI compared with intact breast tissue (p = 0.005). Foci of high signal intensity on the T1-WI were often revealed in the malignant (3/5) and borderline tumors (2/4), but this dependence was not significant (p = 0.021). According to pathomorphological correlation the foci of the high signal intensity on the T1-WI corresponded to hemorrhages, while cystic foci with irregular margins were revealed to be foci of necrosis. The foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue corresponded to the hypercellular stroma.Conclusion. Specific features of phyllodes tumors are useful in differentiation of their histological types; furthermore the MR mammography provides accurate data for planning the point of biopsy.

Білатеральний синхронний і метахронний рак грудної залози: особливості топографії, етіологія, патогенез, чинники ризику, діагностика і прогноз

The purpose of the study was to analyze the data of the domestic and foreign specialized literature, which are devoted to the pathogenesis, features of the topography, risk factors, prognosis of the course of bilateral synchronous and metachronous breast cancer. Materials and methods. Analytical and bibliosemantic methods were used in the research. The search for scientific information on bilateral synchronous and metachronous breast cancer for the period from 1990 to 2021 was conducted in databases of electronic searching systems. Results and discussion. Bilateral cancer can be either primary or metastatic to the contralateral breast. Primary one, depending on the time of tumor development in the contralateral breast gland, is divided into synchronous (development interval up to 6 months) and metachronous (development interval more than 6 months). Synchronous tumors of the breast glands are found significantly less frequently (22.7%) than metachronous tumors (69.6%). Relative risk factors for the occurrence of bilateral metachronous breast cancer are the presence of a BRCA1 and BRCA2 gene mutation, a heavy family history of breast cancer in blood relatives, and a young age of up to 45 years. A higher risk was established in patients with a lobular histological type of carcinoma compared to ductal carcinoma and with the absence of expression of steroid hormone receptors in the tumor. Bilateral synchronous tumors are very often characterized by the same visual manifestations during mammography, and their location in the breast glands is a "mirror image". Metachronous tumors are characterized by a smaller size, with rare involvement of axillary lymph nodes. A peculiarity of the topography of metachronous breast cancer is the presence, mainly in the upper outer quadrants of the breast gland, of a fixed or slow-moving nodule of rounded or star shape with unclear contours. Magnetic resonance mammography of the glands is an effective method of comprehensive diagnosis of breast pathology and is performed when other imaging methods are ineffective (sensitivity 99.2%, specificity 97.9%, accuracy 98.9%). The duration of the recurrence-free period in patients with synchronous tumor was 126.3 months, while in patients with metachronous tumor it was 243.7 months. Conclusion. The problem of bilateral breast cancer remains complex and far from fully understood. There are many controversial issues related to the pathogenesis, risk factors, features of the topography, clinical and morphological manifestations, diagnosis, recurrence-free and overall survival of bilateral breast carcinoma, which is important for determining and evaluating the prognosis, as well as the choice of management tactics for such patients

Diagnostic Accuracy of MR Mammography in Comparison with Digital Mammography and Sonomammography

Background. Even though the sensitivity of contrast-enhanced breast magnetic resonance mammography (CE-MRM) is consistently high in the range of 94-100%, conventionally, digital mammography and sonomammography continue as standard imaging modalities for the detection and evaluation of breast disease.
 The objective of the study was to detect additional lesions that go undetected by routine digital mammography and sonomammography using CE-MRM.
 Materials and Methods. In a prospective study, 68 patients who came for screening diagnostic mammogram and had breast lesions of Breast Imaging-Reporting and Data System category 3-6 were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonomammography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral CE-MRM.
 Results. In this prospective study, we included 68 patients (mean age - 50.6 years, range - 30-73 years). A total of 74 lesions were evaluated. In detecting these lesions, digital mammography had a sensitivity of 40.0%, specificity of 100% and diagnostic accuracy of 63.5%. CE-MRM sensitivity was found to be 71.7%, specificity - 96.6% and diagnostic accuracy - 83.7%. Among the 27 additional lesions detected by CE-MRM, histopathological evaluation confirmed only 19, indicating the sensitivity of 100%, specificity of 85.4%, positive predictive value of 67.8%, negative predictive value of 100%, diagnostic accuracy of 89.2%.
 Conclusions. The diagnostic accuracy of CE-MRM was found to be 83.7%, with a specificity of 96.6%. CE-MRM detected 19 additional lesions that were undetected by either digital mammography or ultrasonography. CE-MRM is sensitive in detecting additional malignant lesions which are not detected by other imaging modalities.

Multiparametric Magnetic Resonance Imaging in Evaluation of Benign and Malignant Breast Masses with Pathological Correlation

BackgroundDynamic contrast-enhanced (DCE) MRI sequences plays a vital role in diagnosing breast masses with high sensitivity and specificity as compared to other diagnostic modalities. The addition of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values significantly improves diagnostic accuracy. This study aimed to study the breast masses on DCE-MRI, restricted diffusion on DWI, ADC values, and choline peak on spectroscopy in breast cancer diagnosis.Material and methodsThis study was a prospective observational study which involved subjects with breast lumps. Baseline data was collected from the patients along with pertinent clinical history and relevant laboratory investigations. MR mammography (MRM) was performed on a 1.5 Tesla MR Scanner (MAGNETOM® Avanto, Siemens AG, Munich Germany) using a dedicated double breast coil.ResultsForty-one subjects were included with a total of 54 breast masses in them. The mean age of the study population was 47.1±14.7 years. From the MRI final diagnosis, the majority (53.70%) were diagnosed as malignant lesions and 46.30% as benign. Out of 20 lesions diagnosed as benign on histopathology, only five percent had ADC value <1.3 ×10−3mm2/s, and the majority (95%) had ADC value >1.3 ×10−3mm2/s. All 20 lesions were circumscribed, ovoid, or round in shape showing no restricted diffusion on DWI, with corresponding ADC value of >1.3×10−3mm2/s, homogeneous post-contrast enhancement, or with dark internal septations, type I kinetic enhancement curve, and they showed no choline peak on spectroscopy. Out of 34 malignant lesions diagnosed on histopathology, the majority (85.29%) displayed restricted diffusion on DWI and had an ADC value of <1.3×10−3mm2/s, most of them had spiculated margins, type II/ III kinetic curve with choline peak on spectroscopy.ConclusionMultiparametric MR mammography, which included DCE-MRM, DWI, ADC values, and spectroscopy, correlated well with the histopathological diagnosis of benign and malignant breast masses.

Sonoelastography and Dynamic Magnetic Resonance Mammogram in the Evaluation of BIRADS III and above Breast Lesions Categories- A Prospective Cohort Study

Introduction: Breast cancer has become a major health hazard in society. Early diagnosis of breast cancers plays a vital role in its management and control. Sonoelastography and Magnetic Resonance (MR) mammography are non invasive imaging methods in the diagnosis of breast lesions. Aim: To determine the accuracy of sonoelastography and dynamic MR mammogram in the evaluation of breast masses of Breast Imaging Reporting and Database System score (BIRADS)- III and above (BIRADS-IV, V and VI ) lesion categories. Materials and Methods: The present prospective cohort study conducted in the Department of Radiodiagnosis at Bowring and Lady Curzon Medical College and Research Institute and Prestige Medical Health Sciences, Bangalore, India from June 2019 to March 2020. A total of 60 female cases clinically and histopathologically diagnosed with breast cancers above 28 years of age were recruited. All the subjects underwent conventional B mode ultrasonogram. Cases with BIRADS-III and above lesion category were assessed through sonoelastography and dynamic contrast enhances MR mammogram. MR mammogram was performed by using 1.5 tesla GE Magnetic Resonance Imaging (MRI). The sequences like axial and sagittal Time (T)1 Weighted (W)1 and T2 WI, Diffusion Weighted Imaging (DWI), axial Short Inversion Time Inversion Recovery (STIR) were performed. The Chi-square test was used to compare the difference between study variables. Results: A total of 60 female cases, clinically and histopathologically diagnosed with breast cancers above 28 years of age were included in the study with maximum in age range of 41-50 years. The dynamic MRI curve category sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy as 91.8%, 95.3%, 96.3%, 92% and 94.8%, respectively. The study showed sonoelastography sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as 79.8%, 93%, 88.6%, 82.2% and 84%, respectively. Conclusion: The MR mammogram and sonoelastography are effective methods in the diagnosis of breast lesions; however, MR mammography has higher sensitivity, specificity and diagnostic accuracy.

Evaluation of the Extension of Benign and Malignant Microcalcifications by Breast Magnetic Resonance Imaging, Mammography, and Ultrasonography

Evaluation of the Extension of Benign and Malignant Microcalcifications by Breast Magnetic Resonance Imaging, Mammography, and Ultrasonography

Incorporating diffusion-weighted imaging in a diagnostic algorithm for multiparametric MR mammography.

Apparent diffusion coefficient (ADC) measurements are not incorporated in BI-RADS classification. To assess the probability of malignancy of breast lesions at magnetic resonance mammography (MRM) at 3 T, by combining ADC measurements with the BI-RADS score, in order to improve the specificity of MRM. A total of 296 biopsy-proven breast lesions were included in this prospective study. MRM was performed at 3 T, using a standard protocol with dynamic sequence (DCE-MRI) and an extra echo-planar diffusion-weighted sequence. A freehand region of interest was drawn inside the lesion, and ADC values were calculated. Each lesion was categorized according to the BI-RADS classification. Logistic regression analysis was employed to predict the probability of malignancy of a lesion. The model combined the BI-RADS classification and the ADC value. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. In total, 153 malignant and 143 benign lesions were analyzed; 257 lesions were masses and 39 lesions were non-mass-like enhancements. The sensitivity and specificity of the combined method were 96% and 86%, respectively, in contrast to 95% and 81% with BI-RADS classification alone. We propose a method of assessing the probability of malignancy in breast lesions by combining BI-RADS score and ADC values into a single formula, increasing sensitivity and specificity compared to BI-RADS classification alone.

Is Elevated Choline on Magnetic Resonance Spectroscopy a Reliable Marker of Breast Lesion Malignancy?

BackgroundContemporary magnetic resonance imaging (MRI) of the breast represents a powerful diagnostic modality for cancer detection, with excellent sensitivity and high specificity. Magnetic resonance spectroscopy (MRS) is being explored as an additional tool for improving specificity in breast cancer detection, using multiparametric MRI. The aim of this study was to examine the possibility of 1H-MRS to discriminate malignant from benign breast lesions, using elevated choline (Cho) peak as an imaging biomarker.MethodsA total of 60 patients were included in this prospective study: 30 with malignant (average age, 55.2 years; average lesion size, 35 mm) and 30 with benign breast lesions (average age, 44.8 years; average lesion size, 20 mm), who underwent multiparametric MRI with multivoxel 3D 1H-MRS on a 1.5-T scanner in a 3-year period. Three patients with benign breast lesions were excluded from the study. All lesions were histologically verified. Peaks identified on 1H-MRS were lipid (0.9, 2.3, 2.8, and 5.2 ppm), choline (3.2 ppm), and water peaks (4.7 ppm). Sensitivity and specificity, as well as positive and negative predictive values, were defined using ROC curves. Cohen’s Kappa test of inter-test reliability was performed [testing the agreement between 1H-MRS and histologic finding, and 1H-MRS and MR mammography (MRM)].ResultsCholine peak was elevated in 24/30 malignant lesions and in 20/27 benign breast lesions. The sensitivity of 1H-MRS was 0.8, specificity was 0.741, positive predictive value was 0.774, and negative predictive value was 0.769. Area under ROC was 0.77 (CI 0.640–0.871). Inter-test reliability between 1H-MRS and histologic finding was 0.543 (moderate agreement) and that between 1H-MRS and MRM was 0.573 (moderate agreement). False-negative findings were most frequently observed in invasive lobular cancers, while false-positive findings were most frequently observed in adenoid fibroadenomas.ConclusionAlthough elevation of the choline peak has a good sensitivity and specificity in breast cancer detection, both are significantly lower than those of multiparametric MRM. Inclusion of spectra located on tumor margins as well as analysis of lipid peaks could aid both sensitivity and specificity. An important ratio of false-positive and false-negative findings in specific types of breast lesions (lobular cancer and adenoid fibroadenoma) suggests interpreting these lesions with a caveat.

Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening.

ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

Magnetic Resonance Mammography in the Diagnostics of Intraduсtal Cancer in situ (DCIS)

The improvement of methods of radiation diagnostics has led to an increase in the frequency of detection of breast cancer in the early stages. According to our study (a retrospective analysis of data from 195 MRM with DKU), the results of studies of women with a histologically verified diagnosis of intra-ductal carcinoma in situ (DCIS). For formations of more than 5 mm in 60 %, we obtained reliable criteria for the malignant process (contrast capture of more than 100 % for type II-III, the presence of feeding arteries). Various contrast zones without / or with the presence of less than 5 mm formation in 10–20 % of in situ carcinomas had a pattern of accumulation similar to benign proliferative changes, a statistically significant criterion was the strengthening of the vasculature on MIP reconstruction around the contrast zone, which in 31 % of cases coincided with the areas of accumulation of atypical microcalcinates detected in mammography (BI-RADS 4). MR mammography with dynamic contrast enhancement, having a high sensitivity in detecting vascularized areas, allows us to assess their nature with a high degree of probability against the background of any types of breast tissue structure.

Cost-effectiveness analysis in radiology: methods, results andimplications.

Diagnostic radiological examinations as well as interventional radiological therapies are performed at a steadily increasing rate amidst increasingly limited resources in healthcare systems. Given their potential to contribute decisively to optimized therapy, in most cases associated short-term direct costs can be well justified from a clinical perspective. However, to realize their clinical benefits, they must also succeed in justifying them to payers and policymakers. Therefore, the aim of this work is to present suitable methods for economic analysis of radiological precedures and to elaborate their relevance for radiology. Methods and metrics of cost-effectiveness analysis are presented and then exemplified using the example cases of MR mammography and interventional treatment of oligometastatic tumor disease of the liver. Cost-effectiveness considerations, taking into account long-term gains in lifespan and quality of life, as well as potential savings through improved treatment planning, do often objectively and credibly justify short-term additional costs. Cost-effectiveness analyses performed with radiological and health economic expertise can support the establishment of new radiological technologies in diagnostics and therapy. · When radiological procedures are employed, short-term costs are often offset by significant long-term benefits.. · Radiological examinations and therapies must be justified in the context of limited economic resources.. · Economic methodologies can be used to quantify the quality and cost-effectiveness of radiological methods.. · Such analyses as well as targeted training should be encouraged to provide greater transparency.. · Froelich MF, Kunz WG, Tollens F et al. Cost-effectiveness analysis in radiology: methods, results and implications. Fortschr Röntgenstr 2022; 194: 29 - 38.

Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice

BackgroundThis nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients.MethodsClinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate.ResultsThere were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women.ConclusionsGuidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care.