•KS shows high diagnostic performance with low interobserver variability in patients with breast cancer.•Subcentimeter lesions and presence of personal breast cancer history are factors significantly ...associated with false-negative KS results.•Radiologists need to consider these factors in clinical practice as potential pitfalls for KS, which may be compensated by a multimodality approach combined with clinical evaluation.
To investigate the factors associated with false-negative results in the diagnosis of breast cancer via breast magnetic resonance imaging (MRI) using the Kaiser score (KS).
This institutional review board (IRB)-approved, single-center, retrospective study enrolled 219 consecutive histopathologically proven breast cancer lesions in 205 women who underwent preoperative breast MRI. Two breast radiologists evaluated each lesion according to the KS. The clinicopathological characteristics and imaging findings were also analyzed. Interobserver variability was assessed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was used to investigate factors associated with false-negative KS results for breast cancer diagnosis.
Of 219 breast cancers, KS yielded 200 (91.3%) true-positive and 19 (8.7%) false-negative results. The interobserver ICC for the KS between the two readers was good, with a value of 0.804 (95% CI 0.751–0.846). Multivariate regression analysis revealed that small lesion size (≤1 cm) (adjusted OR 6.86, 95% CI 2.14–21.94, p = 0.001) and personal breast cancer history (adjusted OR 7.59, 95% CI, 1.55–37.23, p = 0.012) were significantly associated with false-negative KS results.
Small lesion size (≤1 cm) and presence of personal breast cancer history are factors significantly associated with false-negative KS results. Our results suggest that radiologists should consider these factors in clinical practice as potential pitfalls of KS, which may be compensated for by a multimodal approach combined with clinical evaluation.
Background/aims
To investigate the diagnostic performance of breast MRI in revealing mammographically and sonographically occult lesions requiring excision in patients with pathologic nipple ...discharge.
Materials and methods
In this retrospective study, 57 women with pathologic nipple discharge who had normal or inconclusive mammography and ultrasonography results and underwent breast MRI were determined. Patients who had histopathological diagnosis or ≥ 1-year imaging follow-up were included. MRIs were classified as positive and negative according to final BI-RADS assessment categories. Diagnostic performance of MRI, including sensitivity, specificity, negative predictive value, and positive predictive value, was calculated for detecting both malignancy and lesions requiring surgery.
Results
Abnormal contrast enhancement on the pathologic nipple discharge side was detected in 29 MRIs (50.8%), categorized as BI-RADS 4. Abnormal findings were solid masses in 17 cases (58.6%) and non-mass enhancement in 12 cases (41.3%). Despite normal conventional imaging results, 4 malignant lesions and 16 lesions requiring surgery were detected with MRI. The sensitivity and specificity of MRI for detecting lesions requiring surgery were 100% and 68.2%, respectively. The positive predictive value (PPV) and negative predictive value were 55.1% and 100%, respectively.
Conclusion
In conclusion, this study confirmed that MRI is a reliable tool to detect lesions requiring surgery in patients with pathologic nipple discharge. MRI should be used in routine workup in patients with normal conventional imaging and imaging follow-up can be safely applied in patients with negative MRI.
Objectives
Tumor-infiltrating lymphocytes (TILs) have been determined as a new prognostic indicator of immunotherapy response in breast cancer (BC). The aim of this study is to investigate the ...effectiveness of imaging features in predicting the TIL levels in invasive BC patients.
Methods
A total of 158 patients with invasive BC were included in our study. All lesions were evaluated based on the BIRADS lexicon. US was performed for all the patients and 89 of them underwent MRI. The histologic stromal TIL (sTIL) levels were assessed and associations between the sTIL levels and imaging features were evaluated.
Results
Tumors with high sTIL levels had more circumscribed margins, round shape, heterogeneous echogenicity, and larger size on ultrasonography (
p
< 0.005). There was a statistically significant positive correlation between the sTIL levels and ADC value (
p
< 0.001). Tumors with high sTIL levels had significantly more homogeneous enhancement than the tumors with low sTIL levels (
p
= 0.001). Logistic regression analysis showed that the ADC was the most statistically significant parameter in predicting the sTIL levels (the odds ratio was 90.952;
p
= 0.002). The optimal cutoff value for ADC in predicting low and high sTIL levels was found to be 0.87 × 10
−3
mm
2
s
−1
(AUC = 0.726, 73% specificity, and 60% sensitivity).
Conclusions
Imaging findings, especially the ADC, may play an important role as an adjunct tool in cases of uncertain situations and may improve the accuracy of biopsy results. The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis.
Key Points
• Preoperative assessment of TILs is an important biomarker of prognosis and treatment efficacy.
• ADC value can be a useful tool in distinguishing high and low sTIL levels as a non-invasive method.
• The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis and an optimal treatment for the BC patients.
Objectives
In this study, we aimed to determine reference values for normal breast and areolar skin elasticity using shear wave elastography.
Methods
The right breasts of 200 female participants were ...evaluated. The age, weight, body mass index, menopausal status, and parity number of all participants were noted. The elasticity values and thickness of the areolar skin and 4 quadrants of the breast skin of all participants were measured. To assess the reproducibility of shear wave elastography, a randomly selected subgroup of 35 participants was reevaluated by a second observer.
Results
The mean age of the participants ± SD was 48.79 ± 10.74 years (range, 18–79 years). The mean elasticity measurements for the superior, inferior, lateral, and medial regions of the breast and areolar skin were 33.54, 29.84, 30.16, 29.20, and 31.35 kPa, respectively. The mean of the 4‐quadrant measurements of breast skin elasticity was 30.68 ± 9.11 kPa. Age had a moderate negative correlation with breast skin elasticity (r = –0.353; P < .001) and a weak negative correlation with areolar skin elasticity (r = –0.237; P = .001). The parity number had weak negative correlations with breast (r = –0.150; P = .034) and areolar (r = –0.207; P < .001) skin elasticity. The interobserver agreement varied from good to excellent (intraclass correlation coefficients, 0.67–0.91) for the breast and areolar skin elasticity measurements.
Conclusions
Shear wave elastography is a reproducible imaging modality for evaluations of breast and areolar skin elasticity, and our results may provide important pilot data for evaluations of clinical entities that affect the breast and areolar skin structures.
The aim of this study was to assess the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography (SM) in tumor size measurements compared with histological ...tumor sizes.
71 breast cancer patients who underwent DM and DBT acquisitions simultaneously were included in this study. One radiologist with 8 years of experience in breast imaging measured tumor sizes independently in three separate sessions which include DM, DBT and SM images, respectively. The correlations between the measured tumor sizes on each imaging technique and histological sizes were analyzed using Spearman correlation test. The patients were categorized into two subgroups according to assigned breast density categories (dense and non-dense), and histological tumor sizes (≤2 cm and > 2 cm). To assess the agreement levels between the measured tumor sizes and histological sizes Bland-Altman analyses were performed for each imaging technique.
The mean of histological size of tumors was 23.85 ± 16.57 mm (median: 20). The means of measured tumor sizes were 21.21 ± 13.59 mm (median: 19), 21.52 ± 13.42 mm (median: 19) and 18.97 ± 11.21 mm (median: 17) in DM, DBT and SM, respectively. The Spearman correlation values with histologic sizes were 0.814 (P < 0.001), 0.887 (P < 0.001), and 0.852 (P < 0.001) for DM, DBT and SM, respectively. In subgroup analyses, the correlation values showed decrement for tumors >2 cm in size compared to tumors ≤2 cm in size.
DBT provides the most accurate tumor size measurements among mammographic imaging techniques and if mammography will be used in tumor size measurements, DBT should be preferred.
•DBT provides the most accurate tumor size measurements.•DBT demonstrated the highest correlation with histological tumor sizes.•The correlation values show decrement for tumors above 2 cm in size.•Breast density did not affect the accuracy of tumor size measurements.
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