女性乳腺体积密度及分布的影像学初步研究

目的 利用乳腺X射线摄影检查资料,描述和评估受检者女性不同年龄段乳腺体积密度(VBD)的分布规律。方法 基于北京市某三甲医院2010年1月—2016年12月期间1 140人次乳腺X射线摄影图像,使用Volpara 1.5.1评估女性的VBD。根据美国乳腺影像报告和数据系统对VBD进行分级,将样本群体年龄根据中位数分成两组,两组间均数比较采用两独立样本t检验。为进一步分析年龄因素的影响,将年龄细化分为4组(< 40 岁、40~49 岁、50~59 岁、≥60 岁),多组间均数比较采用单因素方差分析评估,分别评估不同年龄组受检者的乳房压迫厚度(CBT)、乳房体积(BV)、腺体体积(GV)和VBD。结果 年龄中位数为50岁,50岁及以上受检者的CBT和BV明显>50以下受检者(t=-8.99、-7.92,P<0.001),而GV和VBD明显<50以下受检者(t=8.11、18.49,P<0.001)。CBT、BV、GV和 VBD各指标在4个年龄组间的差异具有统计学意义(F=27.10、22.34、25.70、122.03,P<0.001)。年龄在60岁及以上的受检者的VBD最低(t=-12.56、-15.27、-4.57,P<0.001),VBD与年龄呈负相关(r=0.47,P<0.001)。结论 受检者CBT和BV与年龄呈正相关,GV和VBD与年龄呈负相关。     

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

ObjectiveTo 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.Materials and MethodsThis 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.ResultsOf 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.ConclusionDBT 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.     

Between-Race Differences in Supplemental Breast Cancer Screening Before and After Breast Density Notification Law

Guidelines recommend supplemental breast cancer screening for women at increased breast cancer risk; however, the passage of breast density notification laws may lead to supplemental screening that is incongruent with women’s risk. We examined supplemental screening (ie, MRI, ultrasound, or tomosynthesis within 6 months of screening mammogram) among a sample of 2,764 African American (AA) and 691 European American (EA) women with negative or benign screening mammograms for whom we had data from both before and after implementation of breast density notification laws in the state of Michigan. Results indicated a 5-fold increase (from 0.14% to 0.7% of women) in supplemental screening among screen-negative women after passage of the law, driven in large part by an increase in supplemental screening among AA women. Breast density was more predictive of supplemental screening and had a marginally greater explanatory role in between-race differences in supplemental screening after passage of the law. Subgroup analyses (n = 250) indicated that whereas 5-year breast cancer risk was positively associated with supplemental screening before the law and negatively associated after the law for EA women, 5-year risk was not associated with supplemental screening either before or after passage of the law for AA women. Our findings suggest that whereas passage of the breast density notification laws may have motivated supplemental screening among AA women in particular, it lessened the consideration of breast cancer risk in supplemental screening decision making.     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions

Aim of the work

To study the diagnostic performance of combined single voxel 1H-MRS and DW-MRI with ADC values as a non-contrast diagnostic tool, compared to the DCE-MRI, in suspicious breast lesions.

Peritumoral Fat Content Correlates with Histological Prognostic Factors in Breast Carcinoma: A Study Using Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-squares Estimation (IDEAL)

Purpose:To correlate peritumoral fat content using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with histologic prognostic factors in breast carcinoma.Methods:This study consisted of 100 patients who were diagnosed with invasive carcinoma of breast and underwent breast MRI including IDEAL before surgery. The scan time of IDEAL fat fraction (FF) map imaging was 33 s. Four regions of interests (ROIs), which are a distance of 5 mm from the tumor edge, and one ROI in the mammary fat of the healthy side were set on the FF map. Then average peritumoral FF values (FFt), average FF values in the healthy side (FFh), and peritumoral fat ratio (pTFR: defined as FFt/FFh) were calculated. Histologically, the presence of lymph node metastasis and the MIB-1 index were evaluated.Results:FFt and pTFR for breast carcinoma with lymph node metastasis (79.27 ± 10.36 and 0.897 ± 0.078) were significantly lower than those without (86.23 ± 4.53 and 0.945 ± 0.032) (P < 0.001 and P = 0.005). Spearman rank correlation suggested that the FFt correlated with the MIB-1 index (r = −340, P = 0.001).Conclusion:Quantification of peritumoral fat using IDEAL-iron quantification is associated with the histologic prognostic factors, and may be a practical tool for therapeutic strategy of breast carcinoma.     

Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease

Purpose

Can focal laser ablation (FLA) of low to intermediate risk prostate cancer preserve sexual and urinary function with low morbidity while providing adequate oncologic outcomes.

Tumoral pseudoangiomatous stromal hyperplasia: Radiological and pathological correlation with review of literature

Tumoral pseudoangiomatous stromal hyperplasia (PASH) is rare and presents more often as a clinically apparent, well-circumscribed, solid mass. It may clinically and radiologically mimic fibroadenoma or Phyllodes tumor. In this article, our objective was to describe the clinical presentations, ultrasound and histopathological appearances of tumoral PASH in three patients. Among the three PASH tumors, all except one were palpable breast masses; and the non-palpable mass was detected on ultrasound. All patients underwent core biopsy followed by wide local excision of the mass which were histopathologically proven to be PASH.