Objectives
The loss of skeletal muscle mass is widely considered a predictor of poor survival and toxicity in breast cancer patients. The aim of this study is to evaluate if there is pectoralis ...muscle area (PMA) variation, reflecting loss of skeletal muscle mass, on consecutive MRI examinations after neoadjuvant chemotherapy.
Methods
The retrospective study protocol was approved by our institutional review board. A total of
n
= 110 consecutive patients (mean age 56 ± 11 years) who were treated with neoadjuvant chemotherapy (NAC) for histologically proven primary breast cancer between January 2017 and January 2019 and in whom tumor response was checked with standard breast MRI were included. Two radiologists calculated the pectoralis muscle cross-sectional area before and after NAC.
Results
Time between the MRI examinations, before starting NAC and after completing NAC, was 166.8 ± 50 days. PMA calculated pre-NAC (8.14 cm
2
) was larger than PMA calculated post-NAC (7.03 cm
2
) (
p
< 0.001). According to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, there were no significant differences between responders (complete or partial response) and non-responders (
p
= 0.362). The multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI exams, estrogen and progesterone receptor status, human epidermal growth factor receptor status (HER-2), Ki-67 expression, lymph node status, RECIST criteria, histological type, average lesion size, molecular categories, and grade. Inter-reader (
k
= 0.72) and intra-reader agreement (0.69 and 0.71) in PMA assessment were good.
Conclusions
Pectoralis muscle mass varies in breast cancer patients undergoing NAC and this difference can be estimated directly on standard breast MRI.
Key Points
• Pectoralis muscle area variation reflects loss of skeletal muscle mass.
• Pectoralis muscle area on MRI is reduced after NAC.
• Pectoralis muscle mass loss seems independent from other variables.
Background
Breast density is an independent risk factor for breast cancer. Mammography is supplemented with handheld ultrasound (HHUS) to increase sensitivity. Automatic breast ultrasound (ABUS) is ...an alternative to HHUS. Our study wanted to assess the difference in execution and reading time between ABUS and HHUS.
Methods and materials
N
= 221 women were evaluated consecutively between January 2019 and June 2019 (average age 53 years; range 24–89). The execution and reading time of ABUS and HHUS was calculated with an available stopwatch. Time started for both procedures when the patient was ready on the examination table to be examined to the end of image acquisition and interpretation.
Results
No patients interrupted the exam due to pain or discomfort.
N
= 221 women underwent ABUS and HHUS;
N
= 11 patients refused to undergo both procedures due to time constraints and refused ABUS; therefore, 210 patients were enrolled with both ABUS and HHUS available. The average time to perform and read the exam was 5 min for HHUS (DS ± 1.5) with a maximum time of 11 min and a minimum of 2 min. The average time with ABUS was 17 min (DS ± 3.8, with a maximum time of 31 min and a minimum time of 9 min). The ABUS technique took longer to be performed in all patients, with an average difference of 11 min (range 3–23 min) per patient,
P
< 0,001. Separating ABUS execution from reading time we highlighted as ABUS execution is more time-consuming respect HHUS. In addition, we can underline that time required by radiologists is longer for ABUS even only considering the interpretation time of the exam.
Conclusion
A significant difference was observed in the execution and reading time of the two exams, where the HHUS method was more rapid and tolerated.
Objective
To assess if digital breast tomosynthesis (DBT) is at least equal to digital spot compression view (DSCV).
Methods
Following institutional approval and written informed consent, both DBT ...and DSCV were obtained in women with a screening abnormality. The diagnostic accuracy of DBT and DSCV was evaluated by two radiologists of varying experience (Reader1 and Reader2).
Results
52 consecutive recalled women without calcification (mean age: 51 ± 12 years) underwent DSCV and DBT. Overall sensitivity was equal for both techniques (100% 95% CI, 91–100% for DBT and 100% 95% CI, 91–100% for DSCV). Overall specificity was higher for DBT (100% 95%CI, 91–100%) than for DSCV (94% 95% CI, 91–100%). Specificity for DSCV was higher for Reader1 (95% 95% CI, 91–100%). Reader2 had lower values of specificity (92% 95% CI, 90–92%). On DSCV, three and two false positives were recorded by Reader2 and Reader1, respectively. Overall, the area under the curve (AUC) was greater for DBT (AUC = 1) than for DSCV (AUC = 0.963). The mean difference between the two techniques was not significantly different (
P
= 0.43).
Conclusion
In this dataset, diagnostic accuracy of digital breast tomosynthesis is at least equal to that of digital spot compression.
Key Points
•
Digital spot compression views (DSCVs) are often needed in breast screening programmes.
•
Digital breast tomosynthesis (DBT) now offers an alternative to DSCV
•
In recalls without calcification, DBT was at least equally accurate as DSCVs
•
DBT has a lower mean glandular dose than DSCVs
•
Thus DBT has the potential to help reduce the recall rate.
Objectives
To report and analyse the characteristics and performance of the first cohort of Italian radiologists completing the national mammography self-evaluation online test established by the ...Italian Society of Medical Radiology (SIRM).
Methods
A specifically-built dataset of 132 mammograms (24 with screen-detected cancers and 108 negative cases) was preliminarily tested on 48 radiologists to define pass thresholds (62% sensitivity and 86% specificity) and subsequently made available online to SIRM members during a 13-month timeframe between 2018 and 2019. Associations between participants’ characteristics, pass rates, and diagnostic accuracy were then investigated with descriptive statistics and univariate and multivariable regression analyses.
Results
A total of 342 radiologists completed the test, 151/342 (44.2%) with success. All individual variables, except gender, showed a significant correlation with pass rates and diagnostic sensitivity, confirmed by univariate logistic regression, while only involvement in organised screening programs and number of mammograms read per year showed a positive association with specificity at univariate logistic regression. In the multivariable regression analysis, fewer variables remained significant: > 3000 mammograms read per year for success rate; female gender, public practice setting, and higher experience self-judgement for sensitivity; no variables were significantly associated with specificity.
Conclusions
This national self-evaluation test effectively differentiated multiple aspects of mammographic reading experience, but specific breast imaging experience was shown not to strictly guarantee good diagnostic accuracy. Due to its easy use and the validity of obtained results, this test could be extended to all Italian breast radiologists, regardless of their experience, also as a Breast Unit accreditation criterion.
Key Points
•
This self-evaluation test was found to be able to differentiate various degrees of mammographic interpretation experience.
•
Breast cancer screening readers should undergo a self-assessment test, since experience parameters alone do not guarantee diagnostic ability.
Ultrasound (US) is a fundamental diagnostic tool in breast imaging. However, US remains an operator-dependent examination. Research into and the application of artificial intelligence (AI) in breast ...US are increasing. The aim of this rapid review was to assess the current development of US-based artificial intelligence in the field of breast cancer.
Two investigators with experience in medical research performed literature searching and data extraction on PubMed. The studies included in this rapid review evaluated the role of artificial intelligence concerning BC diagnosis, prognosis, molecular subtypes of breast cancer, axillary lymph node status, and the response to neoadjuvant chemotherapy. The mean values of sensitivity, specificity, and AUC were calculated for the main study categories with a meta-analytical approach.
A total of 58 main studies, all published after 2017, were included. Only 9/58 studies were prospective (15.5%); 13/58 studies (22.4%) used an ML approach. The vast majority (77.6%) used DL systems. Most studies were conducted for the diagnosis or classification of BC (55.1%). At present, all the included studies showed that AI has excellent performance in breast cancer diagnosis, prognosis, and treatment strategy.
US-based AI has great potential and research value in the field of breast cancer diagnosis, treatment, and prognosis. More prospective and multicenter studies are needed to assess the potential impact of AI in breast ultrasound.
We describe the case of a 35-year-old woman who comes to our institute with a palpable lump on her left breast. Clinically the mass was mobile, nontender and with no nipple discharge. Sonography ...revealed a circumscribed, oval-shaped, and hypoechoic mass, suggestive of a benign lesion. We performed an ultrasound-guided core needle biopsy that demonstrated multiple foci of high-grade (G3) ductal carcinoma in situ arising on fibroadenoma (FA). Subsequently, the patient had surgical excision of the mass with a final diagnosis of triple-negative breast cancer arising on FA. After diagnosis, the patient performs a genetic test that detects the BRCA 1 gene mutation. A review of the literature demonstrated only two cases of triple-negative breast cancer on FA. In this report, we describe another such case.
Purpose
Loss of muscle mass is associated with negative clinical outcome in breast cancer (BC) patients. Therefore, the aim of the study is to evaluate if there is pectoralis muscle area (PMA) ...depletion, reflecting loss of muscle mass, in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy (NAC) and to correlate PMA with clinical and histopathological data.
Material and methods
This monocentric study, approved by our institutional review board, enrolled a total of 52 consecutive patients (mean age 37 ± 4.96 years) with histologically proven primary breast cancer between January 2019 and September 2021, treated with NAC and in whom tumor response and PMA were assessed with breast MRI. Two radiologists calculated PMA before and after NAC independently and blindly on axial 3D FLASH pre-contrast
T
1-weighted images. Wilcoxon–Mann–Whitney
U
test compared median values and percentage changes of pectoralis muscle area at the beginning and at the end of NAC (158 ± 25.5 days). Multivariate regression analysis on ΔPMA (difference between PMA pre-NAC and PMA post-NAC) was done according to clinical and histopathological data. Inter-reader and intra-reader agreement was estimated with
K
statistics.
Results
Pre-NAC PMA mean value was larger than post-NAC PMA mean value (9.6 ± 2.6 cm
2
vs. 8.7 ± 2.2 cm
2
,
p
< 0.001, delta value 1.41). According to the RECIST criteria, no significant differences between complete and partial response were found. Multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI examinations, estrogen and progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 expression, lymph node involvement, RECIST criteria, histological type, and different regimes of NAC. Inter-reader (
k
= 0.74) and intra-reader agreement (0.67 and 0.73) in PMA assessment was good.
Conclusions
PMA variation in BC young patients, directly estimated on breast MRI, could be a potential tool to monitor body composition during NAC with potential implications in improving outcome.
Aim of this study was to select all the cases of Primary (PBL) and Secondary (SBL) Breast Lymphoma from our breast unit since 01/01/2000, to obtain up-to-date data on the prevalence of this rare ...pathology and to analyze imaging features, with a special focus on CT. All pathological reports of breast biopsies performed from 01/01/2000 to 01/01/2019 were at first screened. Among them, we performed two different researches, looking for key words suggesting either a diagnosis of lymphoma or any other malignant disease. Using the Wiseman criteria, we identify PBL and SBL. All imaging features of PBL and SBL were analyzed. Prevalence of lymphoma amongst suspicious breast masses and amongst all breast malignancies were calculated. Out of 42,505 histopathology reports from mammary nodule biopsies, we found 19,354 malignancies. We were able to identify 11 patients affected by PBL (0,03% of suspicious breast lesions, 0.06% of breast malignancies), and 23 cases of SBL (0,05% of suspicious breast lesions, 0,12% of breast malignancies). Most common isotype in PBL was DLBC lymphoma, whereas in SBL that resulted Follicular lymphoma. In PBL group, we were able to retrieve images 7 CT or CT-PET study performed at diagnosis 7 US, 1 mammography and and 1 MR. In SBL group, we analyzed 14 CT/CT-PET examinations, 11 US studies and 3 mammography. PBL and SBL are rarer than considered until now. There is no definite imaging characteristic able to distinguish between these two pathologies and among them and breast cancer.
Purpose
Breast magnetic resonance imaging (MRI) can detect some malignant lesions that are not visible on mammography (MX) or ultrasound (US). If a targeted, second-look fails, MRI-guided breast ...biopsy is the only available tool to obtain a tissue sample and pathological proof of these “MRI-only lesions”. The aim of this study is to report the performance and underestimation rate of 9G MRI-guided vacuum-assisted breast biopsy (VABB) over 12 years at a single center.
Material and methods
All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard.
Results
A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed.
Conclusion
Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.
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