Measurement of breast density with digital breast tomosynthesis—a systematic review

Digital breast tomosynthesis (DBT) has gained acceptance as an adjunct to digital mammography in screening. Now that breast density reporting is mandated in several states in the USA, it is increasingly important that the methods of breast density measurement be robust, reliable and consistent. Breast density assessment with DBT needs some consideration since quantitative methods are modelled for two-dimensional (2D) mammography. A review of methods used for breast density assessment with DBT was performed. Existing evidence shows Cumulus has better reproducibility than that of the breast imaging reporting and data system (BI-RADS®) but still suffers from subjective variability; MedDensity is limited by image noise, whilst Volpara and Quantra are robust and consistent. The reported BI-RADs inter-reader breast density agreement (k) ranged from 0.65 to 0.91, with inter-reader correlation (r) ranging from 0.70 to 0.93. The correlation (r) between BI-RADS and Cumulus ranged from 0.54–0.94, whilst that of BI-RADs and MedDensity ranged from 0.48–0.78. The reported agreement (k) between BI-RADs and Volpara is 0.953. Breast density correlation between DBT and 2D mammography ranged from 0.73 to 0.97, with agreement (k) ranging from 0.56 to 0.96. To avoid variability and provide more reliable breast density information for clinicians, automated volumetric methods are preferred.Breast cancer accounts for approximately 23% of all cancers in females and is the most frequent cause of cancer deaths in females worldwide.^1–3 The exact aetiology of the disease is complex, but many risk factors have been documented in the literature amongst which is breast density.^4–7 Breast density refers to the proportion of the breast that is composed of fibroglandular tissue. Breasts with high density contain more epithelial and stromal cells and collagen, which are significant for tumorigenesis as well as tissue-specific progenitor cells that are at risk of transformation to cancer cells.^8,9 Studies have shown that breast density is a strong, modifiable and measureable risk factor for breast cancer.^10–13 Additionally, the masking effect from breast density reduces the performance of screening mammography and limits early detection and treatment of breast cancer.¹⁴ Encouragingly, breast density is reducible, and its reduction has been shown to mitigate breast cancer risk.¹³ Therefore, mammographic breast density measurement can be used for breast cancer risk prediction and personalization of breast cancer prevention and control strategies, such as the selection of females who may require breast density reduction interventions. It may also be used for selection of more appropriate imaging pathways for earlier detection of breast cancer.^5,13 Utilization of breast density for these purposes requires robust and consistent methods for its assessment.Breast density depicted by the radio-opaque areas on a mammogram can be assessed using qualitative and quantitative (semi-automated and automated) methods.^15–17 Qualitative methods assign breast density grades based on visual assessment of the relative proportions of dense tissue, fat and prominence of ducts and include breast imaging reporting and data system (BI-RADS®), visual analogue scale and Wolfe, Tabar and Boyd assessment methods.^15,18,19 Semi-automated methods use segmentation and thresholding techniques to quantify the percentage of dense tissue on a mammogram and include planimetry and interactive thresholding methods such as Cumulus and Madena.^20,21 Automated methods use mathematical, statistical and physical modelling to calculate breast density; such automated methods include computerized texture-based techniques, calibration approaches and dual X-ray absorptiometry.^22–24 Others are automated thresholding approaches, such as Autodensity and MedDensity,^25,26 and three physical model-based techniques: standard mammographic form (SMF), Volpara and Quantra.^27–29 Irrespective of the method of measurement, breast density has been shown to be a potent risk factor for breast cancer.Many studies on mammographic breast density measurement are based on film–screen mammography and digital mammography (DM), which produce two-dimensional (2D) images of a three-dimensional (3D) breast. Qualitative methods have been shown to be poorly reproducible with these modalities; they have wide inter-reader agreement with Kappa (k) values ranging from 0.37 to 0.91.^26,30 Quantitative methods have better reproducibility with these modalities; however, there are concerns that quantitative area measurement of breast density as percentage mammographic density (PMD) is not representative of the tissue at risk of breast cancer, and that it is more reasonable to measure the volume of only the fibroglandular tissue, which is more related to the dense tissue at risk instead of PMD.^16,31 Another concern is that volumetric breast density measurement with 2D mammography is limited owing to the absence of depth information in such mammograms;³¹ methods estimating mammographic breast density with 2D mammography attempt to take into account variation in breast tissue thickness by modelling; however, with all models, there are assumptions made that may not be necessarily correct for an individual patient.Digital breast tomosynthesis (DBT) has gained acceptance as a tool for imaging of the symptomatic breast and as an adjunct to DM in screening.^32,33 Breast density assessment with DBT needs some consideration since quantitative methods are modelled for 2D mammography. DBT is a 3D imaging modality utilizing the concept of conventional tomography but a limited angle of tube movement (11–60^°) to acquire depth information from the breast (Figure 1a,b).³⁴ With the removal of anatomical noise (superimposed skin and subcutaneous tissue) in DBT images, quantitatively assessed breast density is expected to be lower than DM. On the other hand, more dense tissue becomes apparent to a subjective reader and qualitatively assessed breast density with DBT is expected to be higher relative to DM. It is therefore important to have a standardized robust, reliable and reproducible assessment method to avoid variability in breast density measurement as this will impact on clinical decision-making for females undergoing breast screening. There are several contending methods (Figure 2), each of which has its own merits; this review briefly examines the links between breast density and breast cancer. It also examines methods that have been used for measurement of mammographic breast density with DBT to ascertain which can be considered the best approach.Open in a separate windowFigure 1.Principles of digital breast tomosynthesis: (a) tube rotations relative to the detector and (b) acquired image slices. Image courtesy of Hologic Inc.; Bedford, MA © 2011. All rights reserved.Open in a separate windowFigure 2.Methods of breast density measurement. BI-RADS®, breast imaging reporting and data systems; SMF, standard mammographic form.     

Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer?

Objective  

The purpose of this study was to assess the influence of background enhancement on the detection and staging of breast cancer using MRI as an adjunct to mammography or ultrasound.     

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

Aim

of this study is to determine the temporal resolution of therapy-induced pneumonitis, and to assess promoting factors in adjuvant treated patients with unilateral mammacarcinoma.

Patients and methods

A total of 100 post-surgery patients were recruited. The cohort was treated by 2 field radiotherapy (2FRT; breast and chest wall, N?=?75), 3 field radiotherapy (3FRT; + supraclavicular lymphatic region, N?=?8), or with 4 field radiotherapy (4FRT; + parasternal lymphatic region, N?=?17). Ninety-one patients received various systemic treatments prior to irradiation. Following an initial screening visit post-RT, two additional visits after 12 and 25 weeks were conducted including radiographic examination. In addition, general anamnesis and the co-medication were recorded. The endpoint was reached as soon as a pneumonitis was developed or at maximum of six months post-treatment.

Results

A pneumonitis incidence of 13% was determined. Of 91 patients with prior systemic therapy, 11 patients developed pneumonitis. Smoking history and chronic obstructive pulmonary disease (COPD) appeared to be positive predictors, whereas past pneumonia clearly promoted pneumonitis. Further pneumonitis-promoting predictors are represented by the applied field extensions (2 field radiotherapy [2FRT]?<?3 field radiotherapy [3FRT]?<?4 field radiotherapy [4FRT]) and the type of combined initial systemic therapies. As a consequence, all of the three patients in the study cohort treated with 4FRT and initial chemotherapy combined with anti-hormone and antibody protocols developed pneumonitis. A combination of the hormone antagonists tamoxifen and goserelin might enhance the risk for pneumonitis. Remarkably, none of the 11 patients co-medicated with statins suffered from pneumonitis.

Conclusions

The rapidly increasing use of novel systemic therapy schedules combined with radiotherapy (RT) needs more prospective studies with larger cohorts. Our results indicate that contribution to pneumonitis occurrence of various (neo)adjuvant therapy approaches followed by RT is of minor relevance, whereas mean total lung doses of >10 Gy escalate the risk of lung tissue complications. The validity of potential inhibitors of therapy-induced pneumonitis as observed for statin co-medication should further be investigated in future trials.

     

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T

The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred. MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.     

Digital breast tomosynthesis within a symptomatic “one-stop breast clinic” for characterization of subtle findings

Objective:

The aim of the study was to evaluate the diagnostic accuracy of combination of full-field digital mammography [two dimension (2D)] and digital breast tomosynthesis [DBT, three dimension (3D)] by comparing the combination with 2D imaging in a symptomatic setting.

Methods:

A retrospective analysis was conducted involving 103 patients who attended symptomatic breast clinics between March 2012 and September 2012. All had subtle signs on 2D images or ultrasound. Mammographic score distribution was compared between 2D imaging and 2D + 3D imaging, followed by comparison with the gold-standard histopathology. Receiver operative characteristic curves and area under curve (AUC) were calculated for 2D imaging and the combination imaging (2D + 3D). SPSS^® v. 21 (IBM Corp., New York, NY; formerly SPSS Inc., Chicago, IL) was used for data analysis with p < 0.05 as statistically significant.

Results:

M3 lesions were reduced from 91 (85.8%) to 18 (16.9%) with the combination imaging. The mean AUC ± 95% confidence interval for 2D images alone was 0.721 (0.662–0.905) and for combined 2D and 3D images was 0.901 (0.765–1.00). The difference in AUCs between the two modalities was 0.180.

Conclusion:

DBT (3D imaging) increases diagnostic accuracy in a symptomatic breast clinic setting and reduces the number of M3 mammograms, when used as an adjuvant to 2D images. Therefore, DBT has the potential to increase workflow efficiency in a symptomatic setting by reducing benign biopsies.

Advances in knowledge:

DBT reduces the number of M3 mammograms when used in the symptomatic breast setting and has the potential to reduce benign biopsies.     

Consultant breast radiographers: Where are we now?: An evaluation of the current role of the consultant breast radiographer

IntroductionThe aim of this study is to:

• •Evaluate the current role of the consultant breast radiographer.
• •Compare current practice with the four key components for consultant practice.
• •Gauge the support of radiologist colleagues.
• •Determine the other professional commitments involved with the role.

This study could be the precursor for a macro study of all consultant radiographer practice in other specialities.MethodologyMethodology used was a comparative ethnographic study. Questionnaires to the 24 consultant breast radiographers currently in post, and consultant breast radiologists, who work with them, were conducted.Data collection was a qualitative thematic approach.ConclusionConsultant breast radiographers provide high quality care to patients through excellent clinical practice, leadership and good communication.However, this study shows hospital Trusts emphasis for non medical consultants is for clinical practice first. Some radiologists are still a barrier to progression for consultant breast radiographers, and radiologists have a big influence in recruitment decisions.Consultant breast radiographer posts are well established, their numbers are increasing through recognition of the role and of their abilities and performance. Consultant breast radiographers state that becoming a consultant is the major achievement of their career, proving the Society of Radiographers' vision of the four-tier career structure has been well received by the radiography profession.     

The imaging features of MACROLANE™ in breast augmentation

Macrolane? is an injectable, biocompatible, soft-tissue filler that has been available in the UK since 2008 and is promoted for use in breast augmentation. There are few data available on the long-term effects of this relatively new product and concerns have been raised about the implications for breast imaging, in particular breast screening. In this context we present a spectrum of imaging appearances and complications encountered to date.     

Gadolinium-enhanced MR angiography of the breast: Is breast cancer associated with ipsilateral higher vascularity?

The aim of this study was to assess a possible association between breast malignancy and ipsilateral higher vascularity on gadolinium-enhanced MR angiography. One hundred six patients were examined by dynamic gadolinium-enhanced 3D MR imaging. Magnetic resonance angiographic views were generated by image subtraction and maximum intensity projection. The study included 85 patients with unilateral malignant breast neoplasms and 21 with unilateral benign lesions. Three blinded readers independently reviewed the MR angiograms after masking the lesions and the corresponding contralateral sites. The readers were asked to determine whether vascularity was higher on the right side, higher on the left side, or equal on both sides. The results were analyzed by the Kappa statistic and Pearson's chi-square test. The blood vessels of the breasts were clearly seen in all cases. There was good agreement among the observers (kappa > 0.54 ) in assessing vascularity on both sides. Breasts harboring malignant neoplasms were found to have a higher vascularity than the contralateral breasts (p < 0.005). This sign of malignancy had a sensitivity of 76.5 %, a specificity of 57 %, and an accuracy of 72.6 %. Blood vessels of the breast can be depicted by MR angiography. Unilateral malignant neoplasms are associated with a higher ipsilateral vascularity. In conjunction with other indications of malignancy on gadolinium-enhanced MR images, a higher ipsilateral vascularity may serve as an additional sign of malignancy. Received: 4 April 2000 Revised: 14 August 2000 Accepted: 18 August 2000     

Do all mucocele-like lesions of the breast require surgery?

Aim

The objective of this study is to review the imaging features and percutaneous biopsy findings of mucocele-like lesions (MLLs) of the breast and correlate these with histopathology at surgical excision (SE), where available, to determine whether all MLLs of the breast require surgery for management.

Materials and Methods

A search of two pathology databases was performed to identify 44 patients who had been diagnosed with MLL of the breast and who had corresponding imaging findings available for review. These patients' medical records were reviewed to determine patient age at diagnosis, site of disease/affected breast, symptoms at diagnosis, mammographic and sonographic findings and methods used for histopathologic diagnosis (percutaneous biopsy and/or SE).

Results

The mean age of all patients was 56 years (range, 35-76 years). Sixteen patients had MLLs diagnosed by core needle biopsy (CNB) or fine needle aspiration biopsy followed by SE. Eighteen patients had CNB without SE and had clinical and imaging follow-up. Ten patients had MLL diagnosed at SE without prior percutaneous biopsy. In total, 29 patients (66%) had MLLs without atypia, while 10 patients had MLLs associated with atypical ductal hyperplasia (ADH) (23%) and five patients had MLLs associated with ductal carcinoma in situ (DCIS) (11%). Findings were upgraded at SE following the percutaneous biopsy from ADH to DCIS in 19% (3/16) of patients.

Conclusion

Surgical excision following the identification of MLL is warranted to exclude coexisting in situ carcinoma in specific situations where CNB detects the presence of associated ADH or where a mass with indistinct or irregular margins is shown by mammography or sonography.     

Morphological and kinetic characteristics of dynamic contrast-enhanced MRI (DCE-MRI) correlated with histopathological factors of breast cancer: A potential prognostic role of breast MRI?

Purpose

To explore the correlation of morphological and kinetic DCE-MRI features with histopathological prognostic factors of invasive breast cancer.

Material and methods

Fifty-one women with 57 cancerous lesions underwent DCE-MRI prior to surgery. DCE-MRI findings were interpreted with a multifactorial classification system that included morphological (shape, margins and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behaviour of the time-signal intensity curve). Each morphological and kinetic parameter was scored with 0, 1 or 2 points and the total score was estimated. Finally each lesion was classified into one of the five categories that correspond to the five ACR BI-RADS categories. Statistical analysis was performed to correlate DCE-MR imaging parameters and histopathological findings using Fisher's exact test and stepwise multiple regression analysis.

Results

Increase of the signal intensity at the initial phase >100% was strongly correlated with positive lymph nodes (p = 0.008, OR 0.054). Types I and II time-signal intensity curves at the post-initial phase were associated with a fourfold increase in the likelihood of progesterone receptors positivity (p = 0.022, OR 4). Finally, high total score was positively correlated with affected lymph nodes (p = 0.033, OR 0.29).There was a trend regarding ill-defined margins of the tumor (p = 0.08) and vascular infiltration and also high score and neural infiltration (p = 0.072).

Conclusion

A multivariate interpretation model for DCE-MRI that includes morphological and kinetic characteristics has prognostic value for invasive breast cancer. Early initial contrast agent uptake and a high overall score are associated with poor prognostic factors.     

DEGRO practical guidelines: radiotherapy of breast cancer II

Purpose

To complement and update the 2007 practice guidelines of the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) for radiotherapy (RT) of breast cancer. Owing to its growing clinical relevance, in the current version, a separate paper is dedicated to non-invasive proliferating epithelial neoplasia of the breast. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indication and technique of RT in addition to breast conserving surgery.

Methods

The DEGRO expert panel performed a comprehensive survey of the literature comprising recently published data from clinical controlled trials, systematic reviews as well as meta-analyses, referring to the criteria of evidence-based medicine yielding new aspects compared to 2005 and 2007. The literature search encompassed the period 2008 to September 2012 using databases of PubMed and Guidelines International Network (G-I-N). Search terms were “non invasive breast cancer”, “ductal carcinoma in situ, “dcis”, “borderline breast lesions”, “lobular neoplasia”, “radiotherapy” and “radiation therapy”. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indications of RT and decision making of non-invasive neoplasia of the breast after surgery, especially ductal carcinoma in situ.

Results

Among different non-invasive neoplasia of the breast only the subgroup of pure ductal carcinoma in situ (DCIS; synonym ductal intraepithelial neoplasia, DIN) is considered for further recurrence risk reduction treatment modalities after complete excision of DCIS, particularly RT following breast conserving surgery (BCS), in order to avoid a mastectomy. About half of recurrences are invasive cancers. Up to 50?% of all recurrences require salvage mastectomy. Randomized clinical trials and a huge number of mostly observational studies have unanimously demonstrated that RT significantly reduces recurrence risks of ipsilateral DCIS as well as invasive breast cancer independent of patient age in all subgroups. The recommended total dose is 50 Gy administered as whole breast irradiation (WBI) in single fractions of 1.8 or 2.0 Gy given on 5 days weekly. Retrospective data indicate a possible beneficial effect of an additional tumor bed boost for younger patients. Prospective clinical trials of different dose–volume concepts (hypofractionation, accelerated partial breast irradiation, boost radiotherapy) are still ongoing.

Conclusion

Postoperative radiotherapy permits breast conservation for the majority of women by halving local recurrence as well as reducing progression rates into invasive cancer. New data confirmed this effect in all patient subsets—even in low risk subgroups (LoE 1a).     

Does renal transplantation increase the risk of breast diseases?

PURPOSE: To evaluate the risk of breast pathology occurrence in a group of kidney transplanted patients. MATERIAL: and methods. In the last five years, 30 kidney-transplanted women underwent systematic breast evaluation in our institution and were included in this retrospective study (exposed-group). To compare with this exposed-group, 90 non transplanted women undergoing breast evaluation in the same period at our institution (non-exposed group), were retrospectively randomized. In both groups, results of breast evaluation were classified in two categories (normal and abnormal) and distribution of benign and malignant breast pathologies were evaluated. The mean exposition-time was determined in months in the exposed-group. Comparative analysis of both groups included a comparison of mean patients age and evaluation of the relative risk (RR) of breast pathology occurrence. RESULTS: Mean exposition time was 72.7+/-66.6 months. The percentages of benign breast pathology were 93.7% in the exposed-group and 83.3% in the non-exposed group. Percentages of cancer were respectively 6.3 and 16.7%. Mean patient age was quite similar in the exposed-group (50.7+/-10 years) and in the non-exposed group (50.6+/-10.5 years). The relative risk of breast pathology occurrence was 1.70 (0.99相似文献   

DEGRO practical guidelines: radiotherapy of breast cancer I

Background and purpose

The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft für Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012.

Methods

A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms “breast cancer”, “radiotherapy”, and “breast conserving therapy”. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer.

Results

Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48–0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75–0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast irradiation strategies as well as WBI hypofractionation schedules. The potential of both in replacing normofractionated WBI has not yet been finally clarified.

Conclusion

After breast conserving surgery, no subgroup even in low risk patients has yet been identified for whom radiotherapy can be safely omitted without compromising local control and, hence, cancer-specific survival. In most patients, this translates into an overall survival benefit.     

How does semi-automated computer-derived CT measure of breast density compare with subjective assessments to assess mean glandular breast density,in patients with breast cancer?

Objectives:

(a) To compare radiologists'' breast mammographic density readings with CT subjective measures. (b) To correlate computer-derived measurement of CT density with subjective assessments. (c) To evaluate density distributions in this cohort of patients with breast cancer.

Methods:

A retrospective review of mammograms and CT scans in 77 patients with breast cancer obtained within 1 year of each other was performed. Two radiologists independently reviewed both CT and mammograms and classified each case into four categories as defined by the breast imaging-reporting and data system of the American College of Radiology. Inter-reader agreements were obtained for both mammographic and CT density subjective evaluations by using the Cohen-weighted kappa statistic and Spearman correlation. The semi-automated computer-derived measurement of breast density was correlated with visual measurements.

Results:

Inter-reader agreements were lower for subjective CT density grades than those for mammographic readings 0.428 [confidence interval (CI), 0.24–0.89] vs 0.571 (CI, 0.35–0.76). There was moderately good correlation between subjective CT density grades and the mammographic density grades for both readers (0.760 for Reader 1 and 0.913 for Reader 2). The semi-automated CT density measurement correlated well with the subjective assessments, with complete agreement of the density grades in 84.9% of patients and only one level difference in the rest.

Conclusions:

Semi-automated CT density measurements in the evaluation of breast density correlated well with subjective mammographic density measurement.

Advances in knowledge:

There is good correlation between CT and mammographic density, but further studies are needed on how to incorporate semi-automated CT breast density measurement in the risk stratification of patients.High glandular density on mammograms has been identified as a risk factor for development of breast cancer.^1–3 Moreover, mammograms of breasts with high glandular density have low sensitivity for diagnosing breast cancer. There has been an impetus to use methods other than traditional mammograms to evaluate breasts with high density such as ultrasound and MRI.^4,5On the other hand, CT scans are increasingly performed in a variety of age groups for reasons other than breast symptoms. Following recent recommendations of low-dose chest CT screening for lung cancer in high-risk patients,⁶ many females have had CT of the chest performed but not mammograms. We believe that CT provides a valuable resource to get reliable information with respect to breast density. If breast density can be determined accurately and is deemed to be high on CT scan, there is a case to suggest supplemental screening with other modalities in addition to mammography.The aim of this study is to evaluate (1) if semi-automated CT measurement of density is a reliable method to measure breast density by comparing computer-generated values with visual mammographic density values and subjective CT measurements and (2) to evaluate the density distribution in this cohort of breast cancers.     

Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact(®) breast lesion excision system

Objective

Image-guided percutaneous biopsy is the recommended initial diagnostic procedure for suspicious mammographic lesions. This study was conducted to determine the accuracy of the Intact^® breast lesion excision system (BLES) and to identify predictive factors for complete excision and underestimation.

Material and methods

A prospective study was conducted between January 28, 2008 and April 30, 2009 on 166 biopsy procedures using Intact^® biopsy device. Diagnoses obtained from biopsy specimen were compared with to final diagnosis on surgical excision specimen.

Results

Of the 166 patients, 15 (9%) displayed lesions with cell atypia, 28 (17%) had an intra ductal carcinoma (IDC) and 9 (5%) had an invasive carcinoma. Eight of 15 patients with cell atypia had open surgical excision, and none showed underestimation. All patients with IDC underwent surgical excision: we found an invasive carcinoma in 6 cases (21.4% underestimation) and a complete removal of the lesion by the Intact^® BLES in 11 cases (39%). All 9 patients with invasive carcinoma had a surgical excision, with 1 complete removal of the lesion by Intact^® BLES. Multivariate analyses did not identify predictive factors for underestimation; clear margins ≥1 mm on biopsy specimen was the only independent predictive factor of complete excision (OR = 8.51, p = 0.02).

Conclusions

Intact^® BLES provides a safe alternative to vacuum assisted core needle biopsy (VACNB) with an underestimation rate comparable to those previously reported for VACNB. The high rate of complete removal of the lesions, particularly ISC, offers an interesting perspective of avoiding subsequent excisional surgery for small lesions and thus requires further confirmational study.