To evaluate the diagnostic utility of second-look ultrasonography (US) in the assessment of lesions identified at breast magnetic resonance (MR) imaging.
A systematic review of the PubMed database ...for articles published up to January 6, 2013, was performed by using predefined search terms applied in a standardized manner. Second-look US studies for the assessment of breast lesions identified at MR imaging were eligible for this meta-analysis. Two independent reviewers performed the literature review and data extraction. Eligible studies presented data on the number of lesions examined and the number of lesions detected at second-look US. The reference standard for lesion diagnosis was either histopathologic or follow-up examination. Sources of bias were assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool. Statistical analysis included data pooling, heterogeneity testing, and meta-regression.
Seventeen studies that included benign and malignant lesions met the inclusion criteria. The general lesion detection rate at second-look US was very heterogeneous and ranged between 22.6% and 82.1% (pooled rate, 57.5% 1266 of 2201; 95% confidence interval CI confidence interval : 50.0%, 64.1% random-effects model; I(2) = 90.9%; P < .0001). The highest second-look US detection rates were observed for mass lesions (as opposed to nonmass lesions) and malignant (vs benign) lesions (P < .001 for both). Pooled positive and negative predictive values (positive or negative second-look US correlates of MR imaging-detected malignant or benign lesions) were calculated as 30.7% (95% CI confidence interval : 25.3%, 36.4%; I(2) = 75.4%; P < .0001) and 87.8% (95% CI confidence interval : 82.0%, 92.7%; I(2) = 82.1%; P < .0001), respectively, by using random-effects models.
The results of this study demonstrated variable utility of second-look US in MR imaging-detected lesions, as lesion detection rates were very heterogeneous. Subgroup analysis showed that malignant and mass lesions were more likely to be detected at second-look US. Furthermore, malignancy was not excluded if a lesion was not detected at second-look US.
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts ...face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method.
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The recommendations in Figure 1 summarize the key points of the manuscript
Purpose To assess the use of magnetic resonance (MR) imaging for diagnosis of malignancy in lesions that manifest as microcalcifications at mammography. Materials and Methods Two independent readers ...performed a systematic review of the literature published as of February 1, 2016, by using predefined search terms. All studies in which contrast material-enhanced MR imaging was used for assessment of mammographic microcalcifications that were assigned Breast Imaging Reporting and Data System (BI-RADS) scores of 3-5 were deemed eligible. The standard of reference was established at clinical follow-up examination or histopathologic evaluation. Study design, technical parameters, number of true- and false-positive and true- and false-negative results were extracted to fit a cross-tabulation. Quality Assessment of Diagnostic Accuracy Studies-2 applet was used to probe for bias. Statistical analysis included data pooling, meta-regression, heterogeneity testing, and forest plot construction. Results Twenty studies met the inclusion criteria. These comprised 1843 lesions with a mean prevalence of malignancy of 40.6%. Bivariate analysis revealed pooled sensitivity and specificity of 87% (95% confidence interval CI: 81%, 92%) and 81% (95% CI: 75%, 86%) for all lesions, respectively; 95% (95% CI: 91%, 98%) and 61% (95% CI: 52%, 69%) for invasive lesions only, respectively; 57% (95% CI: 59%, 81%) and 32% (95% CI: 15%, 92%) for BI-RADS 3 lesions, respectively; 92% (95% CI: 85%, 96%) and 82% (95% CI: 74%, 88%) for BI-RADS 4 lesions, respectively; and 95% (95% CI: 87%, 99%) and 66% (95% CI: 26%, 92%) for BI-RADS 5 lesions. Diagnostic criteria other than presence of enhancement were inversely associated with sensitivity (P ≤ .013). Conclusion Breast MR imaging is not recommended for diagnosis of malignancy in BI-RADS 3 and 5 mammographic microcalcifications, but can be considered for BI-RADS 4 mammographic microcalcifications. The presence or absence of enhancement is the preferable diagnostic criterion to rule out malignancy in mammographic microcalcifications at breast MR imaging.
RSNA, 2016 Online supplemental material is available for this article.
To evaluate the performance of MRI for diagnosis of breast cancer in non-calcified equivocal breast findings.
We performed a systematic review and meta-analysis of peer-reviewed studies in PubMed ...from 01/01/1986 until 06/15/2015. Eligible were studies applying dynamic contrast-enhanced breast MRI as an adjunct to conventional imaging (mammography, ultrasound) to clarify equivocal findings without microcalcifications. Reference standard for MRI findings had to be established by histopathological sampling or imaging follow-up of at least 12 months. Number of true or false positives and negatives and other characteristics were extracted, and possible bias was determined using the QUADAS-2 applet. Statistical analyses included data pooling and heterogeneity testing.
Fourteen out of 514 studies comprising 2,316 lesions met our inclusion criteria. Pooled diagnostic parameters were: sensitivity (99%, 95%-CI: 93-100%), specificity (89%, 95%-CI: 85-92%), PPV (56%, 95%-CI: 42-70%) and NPV (100%, 95%-CI: 99-100%). These estimates displayed significant heterogeneity (P<0.001).
Breast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging. However, considering the substantial heterogeneity with regard to prevalence of malignancy, problem solving criteria need to be better defined.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVESThe aim of this study was to assess the potential of noncontrast magnetic resonance imaging (NC-MRI) with diffusion-weighted imaging (DWI) in characterization of breast lesions in ...comparison to dynamic contrast-enhanced MRI (DCE-MRI) at 3 T.
MATERIALS AND METHODSConsecutive patients with conventional imaging (mammography, ultrasound) BI-RADS 4/5 findings were included in this institutional review board–approved single-center study. All underwent 3 T breast MRI including readout-segmented DWI, DCE, and T2-weighted sequences. Final diagnosis was defined by histopathology or follow-up (>24 months). Two experienced radiologists (R1, R2) independently assigned lesion conspicuity (0 = minimal to 3 = excellent) and BI-RADS scores to NC-MRI (readout-segmented DWI including apparent diffusion coefficient maps) and DCE-MRI (DCE and T2-weighted). Receiver operating characteristics, κ statistics, and visual grading characteristics analysis were applied.
RESULTSSixty-seven malignant and 56 benign lesions were identified in 113 patients (mean age, 54 ± 14 years). Areas under the receiver operating characteristics curves were similarDCE-MRI0.901 (R1), 0.905 (R2); NC-MRI0.882 (R1), 0.854 (R2); P > 0.05, respectively. The κ agreement was 0.968 (DCE-MRI) and 0.893 (NC-MRI). Visual grading characteristics analysis revealed superior lesion conspicuity by DCE-MRI (0.661, P < 0.001).
CONCLUSIONSDiagnostic performance and interreader agreement of both NC-MRI and DCE-MRI is high, indicating a potential use of NC-MRI as an alternative to DCE-MRI. However, inferior lesion conspicuity and lower interreader agreement of NC-MRI need to be considered.
Diffusion-weighted imaging with the calculation of an apparent diffusion coefficient (ADC) has been proposed as a quantitative biomarker on contrast-enhanced MRI (CE-MRI) of the breast. There is a ...need to approve a generalizable ADC cutoff. The purpose of this study was to evaluate whether a predefined ADC cutoff allows downgrading of BI-RADS 4 lesions on CE-MRI, avoiding unnecessary biopsies.
This was a retrospective, multicentric, cross-sectional study. Data from five centers were pooled on the individual lesion level. Eligible patients had a BI-RADS 4 rating on CE-MRI. For each center, two breast radiologists evaluated the images. Data on lesion morphology (mass, non-mass), size, and ADC were collected. Histology was the standard of reference. A previously suggested ADC cutoff (≥1.5 × 10
mm
/second) was applied. A negative likelihood ratio of 0.1 or lower was considered as a rule-out criterion for breast cancer. Diagnostic performance indices were calculated by ROC analysis.
There were 657 female patients (mean age, 42; SD, 14.1) with 696 BI-RADS 4 lesions included. Disease prevalence was 59.5% (414/696). The area under the ROC curve was 0.784. Applying the investigated ADC cutoff, sensitivity was 96.6% (400/414). The potential reduction of unnecessary biopsies was 32.6% (92/282).
An ADC cutoff of ≥1.5 × 10
mm
/second allows downgrading of lesions classified as BI-RADS 4 on breast CE-MRI. One-third of unnecessary biopsies could thus be avoided.
We sought to compare the diagnostic performance of apparent diffusion coefficient (ADC) mapping with the Kaiser score (KS) to distinguish benign from malignant breast lesions and to assess the ...potential of this approach to help avoid unnecessary biopsies.
MATERIALS AND METHODSIn this multicentric study, individual patient data from 3 different centers were analyzed. Consecutive patients receiving standardized multiparametric breast magnetic resonance imaging for standard nonscreening indications were included. At each center, 2 experienced radiologists with more than 5 years of experience retrospectively interpreted the examinations in consensus and applied the KS to every histologically verified lesion. The corresponding mean ADC of each lesion was measured using a Wielema type 4 region of interest. According to established methods, the KS and ADC were combined, yielding the KS+ score. Diagnostic accuracy was evaluated by the area under the receiver operating characteristics curve (AUROC) and compared between the KS, ADC, and KS+ (DeLong test). Likewise, the potential to help avoid unnecessary biopsies was compared between the KS, ADC, and KS+ based on established high sensitivity thresholds (McNemar test).
RESULTSA total of 450 lesions in 414 patients (mean age, 51.5 years; interquartile range, 42–60.8 years) were included, with 219 lesions being malignant (48.7%; 95% confidence interval CI, 44%–53.4%). The performance of the KS (AUROC, 0.915; CI, 0.886–0.939) was significantly better than that of the ADC (AUROC, 0.848; CI, 0.811–0.880; P < 0.001). The largest difference between these parameters was observed when assessing subcentimeter lesions (AUROC, 0.909 for KS; CI, 0.849–0.950 vs 0.811 for ADC; CI, 0.737–0.871; P = 0.02).The use of the KS+ (AUROC, 0.918; CI, 0.889–0.942) improved the performance slightly, but without any significant difference relative to a single KS or ADC reading (P = 0.64).When applying high sensitivity thresholds for avoiding unnecessary biopsies, the KS and ADC achieved equal sensitivity (97.7% for both; cutoff values, >4 for KS and ≤1.4 × 10 mm/s for ADC). However, the rate of potentially avoidable biopsies was higher when using the KS (specificity65.4% for KS vs 32.9% for ADC; P < 0.0001). The KS was superior to the KS+ in avoiding unnecessary biopsies.
CONCLUSIONSBoth the KS and ADC may be used to distinguish benign from malignant breast lesions. However, KS proved superior in this task including, most of all, when assessing small lesions less than 1 cm. Using the KS may avoid twice as many unnecessary biopsies, and the combination of both the KS and ADS does not improve diagnostic performance.
To perform a systematic review and meta-analysis to estimate the diagnostic performance of breast proton magnetic resonance (MR) spectroscopy in differentiating benign from malignant lesions and to ...identify variables that influence the accuracy of MR spectroscopy.
A comprehensive search of the PubMed database was performed on articles listed until January 6, 2012. The Medical Subject Headings and text words for the terms "breast," "spectroscopy," and "magnetic resonance" were used. Investigations including more than 10 patients at 1.5 T or 3.0 T applying one-dimensional single-voxel MR spectroscopy or spatially resolved MR spectroscopy for differentiation between benign and malignant breast lesions were eligible. A reference standard had to be established either by means of histopathologic examination or imaging follow-up of 12 or more months. Statistical analysis included pooling of diagnostic accuracy, control for data inhomogeneity, and identification of publication bias.
Nineteen studies were used for general data pooling. The studies included a total of 1183 patients and 1198 lesions (773 malignant, 452 benign). Pooled sensitivity and specificity were 73% (556 of 761; 95% confidence interval CI: 64%, 82%) and 88% (386 of 439; 95% CI: 85%, 91%), respectively. The pooled diagnostic odds ratio (DOR) was 34.30 (95% CI: 16.71, 70.43). For breast cancers versus benign lesions, the area under the symmetric summary receiver operating characteristic curve of MR spectroscopy was 0.88, and the Q* index was 0.81. There was evidence of between-studies heterogeneity regarding sensitivity and DOR (P < .0001). No significant influences of higher field strength, postcontrast acquisition, or qualitative versus quantitative MR spectroscopy measurements were identified. Egger testing confirmed significant publication bias in studies including small numbers of patients (P < .0001).
Breast MR spectroscopy shows variable sensitivity and high specificity in the diagnosis of breast lesions, independent from the technical MR spectroscopy approach. Because of significant publication bias, pooled diagnostic measures might be overestimated.
OBJECTIVESThe aim of this study was to evaluate breast multiparametric ultrasound (mpUS) and its potential to reduce unnecessary breast biopsies with 1, 2, or 3 additional quantitative parameters ...(Doppler, elastography, and contrast-enhanced ultrasound CEUS) to B-mode and investigate possible variations with different reader experience.
MATERIALS AND METHODSThis prospective study included 124 women (age range, 18–82 years; mean, 52 years), each with 1 new breast lesion, scheduled for ultrasound-guided biopsy between October 2015 and September 2016. Each lesion was examined with B-mode, elastography (Virtual Touch IQ VTIQ), Doppler, and CEUS, and different quantitative parameters were recorded for each modality. Four readers (2 experienced breast radiologists and 2 in-training) independently evaluated B-mode images of each lesion and assigned a BI-RADS (Breast Imaging Reporting and Data System) score. Using the area under the receiver operating characteristic curve (AUC), the most accurate quantitative parameter for each modality was chosen. These were then combined with the BI-RADS scores of all readers. Descriptive statistics and AUC were used to evaluate the diagnostic performance of mpUS.
RESULTSSixty-five lesions were malignant. MpUS with B-mode and 2 additional quantitative parameters (VTIQ and CEUS or Doppler) showed the highest diagnostic performance for all readers (averaged AUCs, 0.812–0.789 respectively vs 0.683 for B-mode, P = 0.0001). Both combinations significantly reduced the number of false-positive findings up to 46.9% (P < 0.0001).
CONCLUSIONSQuantitative mpUS with 2 different triple assessment modalities (B-mode, VTIQ elastography, CEUS, or Doppler) shows the best diagnostic performance for breast cancer diagnosis and leads to a significant reduction of false-positive biopsy recommendations, for both experienced and inexperienced readers.
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