Preoperative Evaluation Of Breast Cancer Research Articles

Breast Magnetic Resonance Imaging for Preoperative Evaluation of Breast Cancer: A Systematic Review and Meta-Analysis.

Purpose: Preoperative breast magnetic resonance imaging (MRI) is known to detect additional cancers that are occult on mammography and ultrasound. There is debate as to whether these additional lesions affect clinical outcomes. The objective of this systematic review was to summarize the evidence on whether additional information on disease extent obtained with preoperative breast MRI in patients with newly diagnosed breast cancer affects surgical management, rates of recurrence, survival, re-excision, and early detection of bilateral cancer. Methods: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched until January 2021 (partial update July 2022) for studies comparing outcomes with versus without pre-operative MRI. Included were both randomized controlled trials and other comparative studies provided MRI and control groups had equivalent disease and patient characteristics or methods such as multivariable analysis or propensity score matching were used to control potential confounders. Results: The search resulted in 26,399 citations, of which 8 randomized control trials, 1 prospective cohort study, and 42 retrospective studies met the inclusion criteria. Use of MRI resulted in decreased rates of reoperations (OR = 0.73, 95% CI = 0.63 to 0.85), re-excisions (OR = 0.63, 95% CI = 0.45 to 0.89), and recurrence (HR = 0.77, 95% CI = 0.65 to 0.90). Increased detection of synchronous contralateral breast cancers led to a reduction in metachronous contralateral breast cancer (HR = 0.71, 95% CI = 0.59 to 0.85). Hazard ratios for recurrence-free and overall survival were 0.77 (95% CI = 0.53 to 1.12) and 0.89 (95% CI = 0.74 to 1.07). Conclusion: This systematic review indicates substantial benefits of pre-operative breast MRI in decreasing reoperations and recurrence.

Diagnostic Value of Contrast-Enhanced Digital Mammography Versus Contrast-Enhanced MRI for Detecting Residual Disease After Neoadjuvant Chemotherapy for Breast Cancer

Purpose: Preoperative evaluation of breast cancer using contrast-enhanced digital mammography (CEDM) has gained acceptance as a possible alternative to contrast-enhanced magnetic resonance imaging (CEMRI). We aimed to compare the diagnostic performance of CEDM and CEMRI for chemotherapeutic response in breast cancer patients who underwent neoadjuvant chemotherapy (NAC).Methods: Fifty patients with invasive carcinoma who underwent both CEDM and CEMRI from November 2017 to October 2018 were included. The residual malignancy sizes after NAC were compared with the histopathological results. The diagnostic performance for detecting residual cancers was compared using Lin concordance and Pearson correlation coefficients.Results: Fifty patients were included in this analysis. The mean tumor size after NAC was 1.22 cm (range: 0–7.0) for CEDM and 1.13 cm (range: 0–5.1) for CEMRI compared with 1.89 cm (range: 0–12.0) at the final pathology measurement. The sensitivity for identifying residual lesions for CEDM and CEMRI were 62.5% (95% confidence interval [CI]: 40.6–81.2) and 66.7% (95% CI: 44.7–84.4), respectively. The positive predictive values for residual lesions were 93.8% (95% CI: 69.8– 99.8) for CEDM and 88.9% (95% CI: 65.3–98.6) for CEMRI. The mean difference in CEDM was 0.668 cm, with a concordance coefficient of 0.202 and Pearson correlation coefficient of 0.231 (<i>p</i>=0.220).Conclusion: The diagnostic value of CEDM for detecting the residual tumor extent after NAC was comparable to that of CEMRI.

Preoperative evaluation of breast cancer: Contrast-enhanced mammography versus contrast-enhanced magnetic resonance imaging: A systematic review and meta-analysis.

Breast cancer is the most common cancer in women worldwide. It is responsible for about 23% of cancer in females in both developed and developing countries. This study aimed to compare the diagnostic performance of contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations of breast lesions. We searched for published literature in the English language in MEDLINE via PubMed and EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. Metadisc1.4 software was used for statistical analysisRESULTS:A total of 1225 patients were included. The pooled sensitivity of CEM and CEMRI was 0.946 (95% CI, 0.931-0.958) and 0.935 (95% CI, 0.920-0.949), respectively. The pooled specificity of CEM and CEMRI was 0.783 (95% CI, 0.758-0.807) and 0.715 (95% CI, 0.688-0.741), respectively. The sensitivity of CEM was the most in the United States (97%) and the specificity of CEM was the most in Brazil (88%). MRI sensitivity was the most in USA and Egypt (99%) and China had the most MRI specificity (81%) in diagnosis of breast lesions. Contrast-enhanced mammography, a combination of high energy image and low energy image, can well display breast lesions and has the diagnostic efficacy equivalent to MRI. Importantly, CEM imaging shows higher specificity, positive predictive value, and diagnostic conformance rate than MRI. Despite some drawbacks such as higher irradiation and iodine usage, CEM has such advantages as convenient and fast examination, strong applicability, and low costs; thus, it can be popularized as a useful tool in breast disease.

Digital Breast Tomosynthesis versus MRI as an Adjunct to Full-Field Digital Mammography for Preoperative Evaluation of Breast Cancer according to Mammographic Density.

To compare digital breast tomosynthesis (DBT) and MRI as an adjunct to full-field digital mammography (FFDM) for the preoperative evaluation of women with breast cancer based on mammographic density. This retrospective study enrolled 280 patients with breast cancer who had undergone FFDM, DBT, and MRI for preoperative local tumor staging. Three radiologists independently sought the index cancer and additional ipsilateral and contralateral breast cancers using either FFDM alone, DBT plus FFDM, or MRI plus FFDM. Diagnostic performances across the three radiologists were compared among the reading modes in all patients and subgroups with dense (n = 186) and non-dense breasts (n = 94) according to mammographic density. Of 280 patients, 46 (16.4%) had 48 additional (39 ipsilateral and nine contralateral) cancers in addition to the index cancer. For index cancers, both DBT plus FFDM and MRI plus FFDM showed sensitivities of 100% in the non-dense group. In the dense group, DBT plus FFDM showed lower sensitivity than that of MRI plus FFDM (94.6% vs. 99.6%, p < 0.001). For additional ipsilateral cancers, DBT plus FFDM showed specificity and positive predictive value (PPV) of 100% in the non-dense group, but sensitivity and negative predictive value (NPV) were not statistically different from those of MRI plus FFDM (p > 0.05). In the dense group, DBT plus FFDM showed higher specificity (98.2% vs. 94.1%, p = 0.005) and PPV (83.1% vs. 65.4%; p = 0.036) than those of MRI plus FFDM, but lower sensitivity (59.9% vs. 75.3%; p = 0.049). For contralateral cancers, DBT plus FFDM showed higher specificity than that of MRI plus FFDM (99.0% vs. 96.7%, p = 0.014), however, the other values did not differ (all p > 0.05) in the dense group. DBT plus FFDM showed an overall higher specificity than that of MRI plus FFDM regardless of breast density, perhaps without substantial loss in sensitivity and NPV in the diagnosis of additional cancers. Thus, DBT may have the potential to be used as a preoperative breast cancer staging tool.

Clinical practice guidelines for pre-operative evaluation of breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021.

Clinical practice guidelines for pre-operative evaluation of breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021.

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer.

ObjectiveTo objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer.Materials and MethodsThis retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Zeff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis.ResultsLow keV MEI (+) at 40–50 keV showed increased CNR and SNRbreast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNRbreast lesion: 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Zeff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively).ConclusionCompared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

3.0 T Magnetic Resonance Functional Imaging Quantitative Parameters for Differential Diagnosis of Benign and Malignant Lesions of the Breast.

Objective: To investigate value of quantitative dynamic contrast-enhanced magnetic resonance imaging (MRI) parameters and apparent diffusion coefficient (ADC) value in differential diagnosis of breast benign and malignant lesions, and their correlation with prognostic factors of breast cancer. Methods: The study collected MRI images and clinical data from 232 female patients suspected of breast cancer. Philips INGENIA 3.0T superconducting magnetic resonance scanner was used for imaging examination. Complete pathological data of patients were collected, and the expression of ER, PR, HER-2, and Ki-67 were further investigated. Results: Kep was higher in malignant breast lesion group than that in benign breast lesion group, and ADC value was lower in the former group than that in the latter group (both p < 0.05). The areas under the receiver operating characteristic curves for Kep, ADC, and extravascular volume fraction (Ve) were 0.904 (95% confidence interval [CI]: 0.863-0.945), 0.813 (95% CI: 0.752-0.875), and 0.774 (95% CI: 0.707-0.841), respectively. Furthermore, according to the maximum Youden index, the specificity of Kep and the sensitivity of ADC were high, which were 97.20% and 96.00%, respectively, with a cutoff value of 0.314 and 0.151, respectively. Kep value in ER-positive expression group was significantly higher than that in ER-negative expression group (p < 0.05). Kep value in PR-positive expression group was significantly higher than that in PR-negative expression group (p < 0.05). There was positive correlation between Kep and expression of Ki-67 (p < 0.05). ADC value was negatively correlated with Ki-67 expression (p < 0.05). Conclusion: Quantitative parameters Kep and ADC of 3.0 T MR functional imaging can be used as reference indexes for differential diagnosis of benign and malignant breast lesions and for biological behavior evaluation, indicating potential clinical value for noninvasive preoperative evaluation of breast cancer.

Predictive performance of ultrasonography-based radiomics for axillary lymph node metastasis in the preoperative evaluation of breast cancer.

PurposeThe purpose of this study was to evaluate the predictive performance of ultrasonography (US)-based radiomics for axillary lymph node metastasis and to compare it with that of a clinicopathologic model.MethodsA total of 496 patients (mean age, 52.5±10.9 years) who underwent breast cancer surgery between January 2014 and December 2014 were included in this study. Among them, 306 patients who underwent surgery between January 2014 and August 2014 were enrolled as a training cohort, and 190 patients who underwent surgery between September 2014 and December 2014 were enrolled as a validation cohort. To predict axillary lymph node metastasis in breast cancer, we developed a preoperative clinicopathologic model using multivariable logistic regression and constructed a radiomics model using 23 radiomic features selected via least absolute shrinkage and selection operator regression. ResultsIn the training cohort, the areas under the curve (AUC) were 0.760, 0.812, and 0.858 for the clinicopathologic, radiomics, and combined models, respectively. In the validation cohort, the AUCs were 0.708, 0.831, and 0.810, respectively. The combined model showed significantly better diagnostic performance than the clinicopathologic model.ConclusionA radiomics model based on the US features of primary breast cancers showed additional value when combined with a clinicopathologic model to predict axillary lymph node metastasis.

Is contralateral breast ultrasound worthwhile in preoperative staging of breast cancer?

Women with invasive breast cancer are at higher risk of contralateral synchronous cancer. This study aimed at determining if contralateral breast ultrasound (CBUS) examination should be routinely performed in the preoperative evaluation of breast cancer patients. This is a retrospective study of preoperative CBUS examinations performed between January 2012 and April 2015. The charts of patients presenting for biopsy of a Breast Imaging Reporting and Data System (BIRADS) 5 lesion and who had undergone a concomitant contralateral breast US examination were reviewed. Index tumor, lymph node status, American College of Radiology (ACR) breast density on mammogram, total scanning time, and results of CBUS were recorded. Of the 3007 patients who underwent breast biopsies during the study period, 360 patients met the inclusion criteria. Index mass size was 19 ± 10 mm. CBUS examination led to 76 biopsies, of which 12 were positive in 11 patients. Detection rate for mammographically occult contralateral invasive cancers was 3.1% (11/360). Contralateral lesion size was 13 ± 10 mm. Breast density was rated ACR C/D for nine women and ACR B for two. In the ACR C/D subgroup (82%), the contralateral cancer detection rate was 4.1%. Average additional scanning time spent required to perform CBUS examination was 3.1 ± 4.9 min. Patients diagnosed with contralateral invasive breast cancer underwent surgery and/or chemotherapy. The treatment strategy was changed in all 11 patients after the detection of a second primary cancer. Preoperative CBUS is effective and most beneficial with women presenting ACR C/D breast density. Given its impact on decreasing future morbidity, its routine use should be considered to improve quality healthcare for women diagnosed with breast cancer.

250P - Diagnostic value of contrast enhanced digital mammography versus contrast enhanced MRI for preoperative evaluation of breast cancer

250P - Diagnostic value of contrast enhanced digital mammography versus contrast enhanced MRI for preoperative evaluation of breast cancer

2 Milisievert Low Dose Dedicated Breast CT with Iterative Model Reconstruction Technique in Evaluation of Breast Mass: Feasibility Study in Comparison with MRI

Objective To investigate the feasibility of low dose dedicated computed tomography (CT) with IMR technique compared with magnetic resonance imaging (MRI) in preoperative evaluation of breast cancer. Methods Dedicated CT and breast MRI were performed in 21 patients with diagnosed breast mass for preoperative evaluation. A dedicated protocol combined with chest diagnostic CT and dynamic scans of breast was developed with the use of IMR technique as well as optimization of scan parameters to ensure acceptable radiation dose. Image quality evaluations of CT images were performed using a five-point scale. The number, site and size (maximum diameter) of breast lesion were recorded respectively in CT and MRI images. The enhancement patterns of breast lesion were classified to 3 types (washout, plateau, and persistence) according to time intensity curve derived from CT and time signal curve derived from MRI, respectively. Pearson’s correlation, Bland-Altman analysis, and Cohen’s kappa test were used for statistical assessment. Results The mean effective radiation dose of dedicated breast CT, with the image quality diagnostic acceptable for evaluation of breast lesion and pulmonary structures, was (2.15±0.39) mSv, which was no more than a routine chest diagnostic CT. Results of breast lesion number and lesion site obtained by CT and MRI was consistent, with a total of 24 lesions detected in 21 patients. The mean lesion size was (26.5±12.1) mm in CT and (26.1±12.9) mm in MR, respectively. CT showed an excellent correlation with MRI for lesion size (r=0.99, n=24, p<0.0001). Limits of agreement determined by Bland-Altman analysis for lesion extent was (-3.0mm, 3.8mm). Good agreement was observed between CT and MRI for lesion enhancement patterns (kappa value = 0.936, p=0.000). Conclusion Dedicated breast CT imaging with acceptable radiation dose enabled diagnostic image quality and showed good agreement with breast MR imaging in preoperative evaluation of breast cancer.

Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer.

PurposeThis study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer.MethodsThis single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings.ResultsEighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782).ConclusionCEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.

Triple assessment as a preoperative diagnostic tool for breast cancer at Bugando Medical Centre in northwestern Tanzania.

The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6%) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant.

Interest of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the preoperative evaluation of breast cancer.

e11506 Background: FDG-PET was applied to patients with breast cancer for the purpose of preoperative evaluation and surgical management. Methods: FDG-PET was performed preoperatively in 108 patients with breast cancer. The maximum standard uptake value (SUV-max) and the size of breast tumors were calculated. Axillary SUV-max and focal accumulation of FDG in the axillary region (with the help of tomodensitometry to locate the axillary region) were also evaluated. Results: Of the 108 patients, 108 had breast cancer on histopathology. PET showed focal accumulation in 101 patients. In these 101 patients, SUV-max and breast tumor size were ranged from 1.88 to 24.55 and 1.5 to 5 centimetres respectively. In all 101 cases, focal accumulation of FDG was superior at the histopathology measurement. Of the 108 patients, 77 had lymph node metastasis on histopathology. PET-FDG showed axillary focal accumulation in 40 cases (37 %), SUV-max ranged from 1.3 to 12. Of the 108 patients, 31 had not lymph node metastasis on histopathology; SUV-max was noted at zero in all 31 patients. So, what about modifications for the clinical management of breast cancer due to FDG-PET conclusions. On 45 patients (42%), FDG-PET results changed the management of the disease. In 13 cases (28.5%), clinical tumor size were noted T2 stage without focal accumulation of FDG in the axillary region, then, Sentinel Lymph Node Biopsy procedure was nevertheless initiated and total axillary dissection was avoided. In 11 cases (24%), patients had focal accumulation of FDG in axillary region but no suspect lymph node at physical examination. During surgery, node was histological studied and total axillary dissection was performed when node had metastases. In 13 cases (28.5%), FDG-PET showed unknown distant metastasis avoiding large surgery replaced by chemotherapy. In 8 cases (17%), the treatment changes for others raisons (lymphoma diagnosis, thymus cancer diagnosis, benign controlateral nodes). Only in 1 (2%) case, we mistake because of the negative axillary FDG-PET about a T2 tumor. Conclusions: FDG-PET seems to be important in the management of breast cancer to make the right choice for the treatment avoiding over treatment or under treatment. No significant financial relationships to disclose.

Targeted Ultrasound for MR-Detected Lesions in Breast Cancer Patients

ObjectiveTo investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US.Materials and MethodsOne-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification.ResultsOf the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision.ConclusionTargeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.

Indications for bone scans in preoperative evaluation of breast cancer

Breast cancer is a common disease and remains a therapeutic dilemma. Radical surgery is often ineffective in eradicating the disease because occult metastases have occurred prior to operation. Detection of early metastases would allow selection of patients who may not benefit from radical surgery. Skeletal imaging using radionuclides has been found to be a sensitive method for detection of early bony metastases from breast carcinoma. Recent reports suggest that bone scanning should be part of the preoperative evaluation of any patient prior to breast surgery. Unfortunately, there is marked variation in the results from the various studies. We reviewed Hartford Hospital’s experience with bone scans in breast cancer patients to determine if any or all patients should have this procedure done routinely prior to surgical therapy.