Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

Objectives

Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.

Methods

During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar’s test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities.

Results

Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p?<?0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p?<?0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed.

Conclusion

CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening.

Key Points

? CESM is feasible in the workflow of referrals from routine breast screening. ? CESM is superior to mammography, even in low disease prevalence populations. ? CESM has an extremely high negative predictive value for breast cancer. ? CESM is comparable to MRI in assessment of breast cancer extent. ? CESM is comparable to histopathology in assessment of breast cancer extent.     

Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size

Objectives

To compare mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in the detection and size estimation of histologically proven breast cancers using postoperative histology as the gold standard.

Methods

After ethical approval, 80 women with newly diagnosed breast cancer underwent MG, CESM, and MRI examinations. CESM was reviewed by an independent experienced radiologist, and the maximum dimension of suspicious lesions was measured. For MG and MRI, routine clinical reports of breast specialists, with judgment based on the BI-RADS lexicon, were used. Results of each imaging technique were correlated to define the index cancer. Fifty-nine cases could be compared to postoperative histology for size estimation.

Results

Breast cancer was visible in 66/80 MG, 80/80 CESM, and 77/79 MRI examinations. Average lesion largest dimension was 27.31 mm (SD 22.18) in MG, 31.62 mm (SD 24.41) in CESM, and 27.72 mm (SD 21.51) in MRI versus 32.51 mm (SD 29.03) in postoperative histology. No significant difference was found between lesion size measurement on MRI and CESM compared with histopathology.

Conclusion

Our initial results show a better sensitivity of CESM and MRI in breast cancer detection than MG and a good correlation with postoperative histology in size assessment.

Key points

? Contrast-enhanced spectral mammography (CESM) is slowly being introduced into clinical practice. ? Access to breast MRI is limited by availability and lack of reimbursement. ? Initial results show a better sensitivity of CESM and MRI than conventional mammography. ? CESM showed a good correlation with postoperative histology in size assessment. ? Contrast-enhanced spectral mammography offers promise, seemingly providing information comparable to MRI.     

A comparative study of breast-specific gamma imaging with the conventional imaging modality in breast cancer patients with dense breasts

Objective

The aim of this study was to evaluate the value of breast-specific gamma imaging (BSGI) as compared with mammography (MMG) and ultrasonography (US).

Methods

This study retrospectively enrolled 121 women with breast cancer (45.0?±?8.1?years) and dense breasts (breast density >50?%). All patients underwent preoperative BSGI, MMG, and US, and the results were correlated with the biopsy results.

Results

In the 121 patients, 153 breast lesions were malignant tumors and 75 lesions were diagnosed as benign tumors. The sensitivity and specificity of BSGI were 92.2 and 89.3?%, while the values of MMG and US were 53.6 and 94.7 and 91.5 and 53.3?%, respectively (p?<?0.0001 and p?<?0.0004). In breast lesions ??1?cm, the sensitivity and specificity of BSGI were 80.6 and 91.5?%, which were different from MMG and US, respectively (p?<?0.0001 and p?<?0.0003). Of 28 patients with 59 multiplicities, BSGI and US found 49 lesions and 51 lesions correctly. However, MMG detected only 26 lesions as malignancies.

Conclusion

Given the results of this study, women with dense breasts are not evaluated with MMG at all and went straight to US or MRI in order to minimize radiation exposure. Due to the high false-positive rate of these modalities, BSGI could then be utilized if the US or MRI are positive.     

A novel functional infrared imaging system coupled with multiparametric computerised analysis for risk assessment of breast cancer

Objective

We evaluated a functional three-dimensional (3D) infrared imaging system (3DIRI) coupled with multiparametric computer analysis for risk assessment of breast cancer. The technique provides objective risk assessment for the presence of a malignant tumour based on automated parameters derived from a clinically known training set.

Methods

Following institutional review board approval, we recruited 434 women for this prospective multicentre trial, including 256 healthy woman undergoing routine screening mammography with BI-RADS-1 results and 178 women with newly diagnosed breast cancer. This was a two-phase study: an initial training and calibration phase, followed by a two-armed blinded evaluation phase (52 healthy and 66 with breast cancer). 3DIRI data sets were acquired using a non-contact, no radiation system.

Results

The sensitivity and specificity of functional infrared imaging in providing the correct risk for the presence of breast cancer were 90.9 % and 72.5 %, respectively. The area under the ROC curve was 86 %. Forty-two of the 60 (70 %) cancers in women correctly classified by the system as suspicious were smaller than 20 mm in size.

Conclusion

The preliminary blinded results of this novel technology show sufficient performance of functional infrared imaging in providing risk assessment for breast cancer to warrant further clinical studies.

Key Points

? 3D functional infrared imaging (3DIRI) provides new metabolic signatures from breast lesions. ? 3DIRI offers high sensitivity for risk assessment of breast cancer. ? It also has reasonable specificity. ? This initial experience warrants further evaluation in larger clinical trials.     

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Objective

To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts.

Methods

Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I²). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively.

Results

A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0 % and 79.0 %, and for DM they were 89.0 % and 72.0 %, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15 % and 18 %; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively.

Conclusions

Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography.

Key Points

? Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis. ? DBT appears to have superior diagnostic accuracy relative to digital mammography. ? DBT images were captured at a lower dose than 2D images. ? DBT displays abnormal features of lesions more clearly than DM. ? Digital breast tomosynthesis could become the first choice for assessing breast lesions.     

Computer-aided detection in breast MRI: a systematic review and meta-analysis

Objectives

To evaluate the additional value of computer-aided detection (CAD) in breast MRI by assessing radiologists?? accuracy in discriminating benign from malignant breast lesions.

Methods

A literature search was performed with inclusion of relevant studies using a commercially available CAD system with automatic colour mapping. Two independent researchers assessed the quality of the studies. The accuracy of the radiologists?? performance with and without CAD was presented as pooled sensitivity and specificity.

Results

Of 587 articles, 10 met the inclusion criteria, all of good methodological quality. Experienced radiologists reached comparable pooled sensitivity and specificity before and after using CAD (sensitivity: without CAD: 89%; 95% CI: 78?C94%, with CAD: 89%; 95%CI: 81?C94%) (specificity: without CAD: 86%; 95% CI: 79?C91%, with CAD: 82%; 95% CI: 76?C87%). For residents the pooled sensitivity increased from 72% (95% CI: 62?C81%) without CAD to 89% (95% CI: 80?C94%) with CAD, however, not significantly. Concerning specificity, the results were similar (without CAD: 79%; 95% CI: 69?C86%, with CAD: 78%; 95% CI: 69?C84%).

Conclusions

CAD in breast MRI has little influence on the sensitivity and specificity of experienced radiologists and therefore their interpretation remains essential. However, residents or inexperienced radiologists seem to benefit from CAD concerning breast MRI evaluation.     

The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool

Objectives

To assess the suitability of the Breast Imaging Reporting and Data System (BI-RADS) as a quality assessment tool in the Dutch breast cancer screening programme.

Methods

The data of 93,793 screened women in the Amsterdam screening region (November 2005–July 2006) were reviewed. BI-RADS categories, work-up, age, final diagnosis and final TNM classification were available from the screening registry. Interval cancers were obtained through linkage with the cancer registry. BI-RADS was introduced as a pilot in the Amsterdam region before the nationwide introduction of digital mammography (2009–2010).

Results

A total of 1,559 women were referred to hospital (referral rate 1.7?%). Breast cancer was diagnosed in 485 women (detection rate 0.52?%); 253 interval cancers were reported, yielding a programme sensitivity of 66?% and specificity of 99?%. BI-RADS 0 had a lower positive predictive value (PPV, 14.1?%) than BI-RADS 4 (39.1?%) and BI-RADS 5 (92.9?%; P?P?Conclusion The significant differences in PPV, invasive procedures and tumour size match with stratification into BI-RADS categories. It revealed inter-observer variability between screening radiologists and can thus be used as a quality assessment tool in screening and as a stratification tool in diagnostic work-up.

Key Points

? The BI-RADS atlas is widely used in breast cancer screening programmes. ? There were significant differences in results amongst different BI-RADS categories. ? Those differences represented the radiologists’ degree of suspicion for malignancy, thus enabling stratification of referrals. ? BI-RADS can be used as a quality assessment tool in screening. ? Training should create more uniformity in applying the BI-RADS lexicon.     

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

Objective

To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Methods

A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.

Results

The combined technique was found to be non-inferior to standard two-view mammography (MX_(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = ?0.011), but was not statistically significant for superiority (P?=?0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P?=?0.269) and equivalent specificity (84.9 % vs. 83.0 %, P?=?0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P?=?0.002).

Conclusion

In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

? Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX). ? Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX. ? Combination DBT/MX was superior to two-view MX in recognising benign lesions. ? Combination DBT/MX reduced variability compared with two-view MX.     

Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy

Purpose

To explore the potential complementary value of PET/CT and dynamic contrast-enhanced MRI in predicting pathological response to neoadjuvant chemotherapy (NAC) of breast cancer and the dependency on breast cancer subtype.

Methods

We performed ¹⁸F-FDG PET/CT and MRI examinations before and during NAC. The imaging features evaluated on both examinations included baseline and changes in ¹⁸F-FDG maximum standardized uptake value (SUVmax) on PET/CT, and tumour morphology and contrast uptake kinetics on MRI. The outcome measure was a (near) pathological complete response ((near-)pCR) after surgery. Receiver operating characteristic curves with area under the curve (AUC) were used to evaluate the relationships between patient, tumour and imaging characteristics and tumour responses.

Results

Of 93 patients, 43 achieved a (near-)pCR. The responses varied among the different breast cancer subtypes. On univariate analysis the following variables were significantly associated with (near-)pCR: age (p?=?0.033), breast cancer subtype (p?<?0.001), relative change in SUVmax on PET/CT (p?<?0.001) and relative change in largest tumour diameter on MRI (p?<?0.001). The AUC for the relative reduction in SUVmax on PET/CT was 0.78 (95 % CI 0.68–0.88), and for the relative reduction in tumour diameter at late enhancement on MRI was 0.79 (95 % CI 0.70–0.89). The AUC increased to 0.90 (95 % CI 0.83–0.96) in the final multivariate model with PET/CT, MRI and breast cancer subtype combined (p?=?0.012).

Conclusion

PET/CT and MRI showed comparable value for monitoring response during NAC. Combined use of PET/CT and MRI had complementary potential. Research with more patients is required to further elucidate the dependency on breast cancer subtype.     

Comparison of the diagnostic performance of digital breast tomosynthesis and magnetic resonance imaging added to digital mammography in women with known breast cancers

Objectives

To compare the diagnostic performance of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to mammography in women with known breast cancers.

Methods

Three radiologists independently reviewed image sets of 172 patients with 184 cancers; mammography alone, DBT plus mammography and MRI plus mammography, and scored for cancer probability using the Breast Imaging Reporting and Data System (BI-RADS). Jack-knife alternative free-response receiver-operating characteristic (JAFROC), which allows diagnostic performance estimation using single lesion as a statistical unit in a cancer-only population, was used. Sensitivity and positive predictive value (PPV) were compared using the McNemar and Fisher-exact tests.

Results

The JAFROC figures of merit (FOMs) was lower in DBT plus mammography (0.937) than MRI plus mammography (0.978, P?=?0.0006) but higher than mammography alone (0.900, P?=?0 .0013). The sensitivity was lower in DBT plus mammography (88.2 %) than MRI plus mammography (97.8 %) but higher than mammography alone (78.3 %, both P?<?0 .0001). The PPV was significantly higher in DBT plus mammography (93.3 %) than MRI plus mammography (89.6 %, P?=?0 .0282).

Conclusions

DBT provided lower diagnostic performance than MRI as an adjunctive imaging to mammography. However, DBT had higher diagnostic performance than mammography and higher PPV than MRI.

Key Points

? Digital breast tomosynthesis (DBT) plus mammography was compared with MRI plus mammography. ? DBT had lower sensitivity and higher PPV than MRI. ? DBT had higher diagnostic performance than mammography.

     

Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer

Purpose

This study was done to verify the usefulness of preoperative breast magnetic resonance (MR) imaging in patients with newly diagnosed breast cancer.

Materials and methods

A retrospective analysis of 291 patients with invasive breast cancer newly diagnosed with conventional breast imaging (mammography and ultrasound) was performed. All patients underwent MR imaging prior to surgery. The MR imaging detection rate of additional malignant cancers occult to mammography and ultrasound was calculated. Data were analysed with Fisher??s exact test (p<0.05) according to the following parameters: histopathological features of the index tumour (histological type and size) and mammographic density [according to the Breast Imaging Reporting and Data System (BI-RADS) classification from 1 fatty to 4 dense). The gold standard was the histological examination on the surgical specimen.

Results

MR imaging identified 40 mammographically and sonographically occult malignant lesions other than the index cancer in 27/291 patients (9%). These additional cancers were located in the same quadrant as the index cancer in 13 women (4%), in a different quadrant in 12 (4%) and in the contralateral breast in the remaining two (1%). The cancer detection rate in the subgroup of index cancers with lobular histological type was 25%, significantly higher (p=0.03) than the detection rate of 11% recorded in the subgroup of ductal cancers. The cancer detection rate in the subgroup of index cancers >2 cm was 27%, significantly higher (p=0.001) than the rate of 8% found in the subgroup of index cancers <2 cm. Mammographic density was not correlated (p=0.48) with MR detection of additional cancer, with 14% of additional malignancies being detected in both dense and fatty breasts.

Conclusions

In patients with newly diagnosed invasive breast cancer, preoperative MR imaging is useful for detecting additional synchronous malignancies that are not detected on conventional breast imaging. The cancer detection rate is 9%. The use of preoperative MR imaging as an adjunct to conventional breast imaging in women with an infiltrating lobular index cancer and an index cancer >2 cm is especially beneficial.     

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI

Purpose

Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size.

Materials and methods

We retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality.

Results

The median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77).

Conclusions

DBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.     

In vivo imaging of human breast cancer mouse model with high level expression of calcium sensing receptor at 3T

Objectives

To demonstrate that manganese can visualise calcium sensing receptor (CaSR)-expressing cells in a human breast cancer murine model, as assessed by clinical 3T magnetic resonance (MR).

Methods

Human MDA-MB-231-Luc or MCF7-Luc breast cancer cells were orthotopically grown in NOD/SCID mice to a minimum mass of 5?mm. Mice were evaluated on T1-weighted sequences before and after intravenous injection of MnCl₂. To block the CaSR-activated Ca²⁺ channels, verapamil was injected at the tumour site 5?min before Mn²⁺ administration. CaSR expression in vivo was studied by immunohistochemistry.

Results

Contrast enhancement was observed at the tumour periphery 10?min after Mn²⁺ administration, and further increased up to 40?min. In verapamil-treated mice, no contrast enhancement was observed. CaSR was strongly expressed at the tumour periphery.

Conclusion

Manganese enhanced magnetic resonance imaging can visualise CaSR-expressing breast cancer cells in vivo, opening up possibilities for a new MR contrast agent.

Key Points

? Manganese contrast agents helped demonstrate breast cancer cells in an animal model. ? Enhancement was most marked in cells with high calcium sensing receptor expression. ? Manganese uptake was related to the distribution of CaSR within the tumour. ? Manganese MRI may become useful to investigate human breast cancer.     

3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography

Objective

To investigate the diagnostic value of 3-Tesla (T) breast MRI in patients presenting with microcalcifications on mammography.

Methods

Between January 2006 and May 2009, 123 patients with mammographically detected BI-RADS 3–5 microcalcifications underwent 3-T breast MRI before undergoing breast biopsy. All MRIs of the histopathologically confirmed index lesions were reviewed by two breast radiologists. The detection rate of invasive carcinoma and ductal carcinoma in situ (DCIS) was evaluated, as well as the added diagnostic value of MRI over mammography and breast ultrasound.

Results

At pathology, 40/123 (33 %) lesions proved malignant; 28 (70 %) DCIS and 12 (30 %) invasive carcinoma. Both observers detected all invasive malignancies at MRI, as well as 79 % (observer 1) and 86 % (observer 2) of in situ lesions. MRI in addition to conventional imaging led to a significant increase in area under the receiver operating characteristic (ROC) curve from 0.67 (95 % CI 0.56–0.79) to 0.79 (95 % CI 0.70–0.88, observer 1) and to 0.80 (95 % CI 0.71–0.89, observer 2), respectively.

Conclusions

3-T breast MRI was shown to add significant value to conventional imaging in patients presenting with suspicious microcalcifications on mammography.

Key points

? 3-T MRI is increasingly used for breast imaging in clinical practice. ? On 3-T breast MRI up to 86 % of DCIS lesions are detected. ? 3-T MRI increases the diagnostic value in patients with mammographically detected microcalcifications.     

Imaging features of sporadic breast cancer in women under 40 years old: 97 cases

Objectives

To evaluate characteristic features of mammography, ultrasound and magnetic resonance imaging (MRI) of sporadic breast cancer in women <40 years and to determine correlations with pathological and biological factors.

Methods

A retrospective review of radiological, clinicopathological and biological features of sporadic breast cancers for women under 40 years at our institution between 2007-2012 covering 91 patients. Mammography was available for 97 lesions, ultrasound for 94 and MRI for 38.

Results

The most common imaging features were masses, nearly all classified BI-RADS 4 or 5. On mammography microcalcifications alone accounted for 31 %, all suspicious. There were 42.6 % luminal B, 24.5 % luminal A, 19.1 % HER2-enriched and 10.6 % triple-negative (TN) tumours by immunohistochemistry. HER2 overexpression was correlated with the presence of calcifications at mammography (P?=?0.03). TN cancers more often had an oval shape and abrupt interface at ultrasound and rim enhancement on MRI. MRI features were suspicious for all cancers and rim enhancement of a mass was a significant predictor of triple-negative tumours (P?=?0.01).

Conclusions

The imaging characteristics of cancers in patients under 40 years without proven gene mutations do not differ from their older counterparts, but appear correlated to phenotypic profiles, which have a different distribution in young women compared to the general population.

Key Points

? Young women have more luminal B/HER2+ phenotypes than older women. ? The appearance of cancers is correlated with their biological profiles. ? Sporadic breast cancer imaging in young women is generally classified BI-RADS 4/5. ? Triple-negative cancers can be misinterpreted as benign, requiring thorough imaging analysis.     

Comparison of automated breast volume scanning to hand-held ultrasound and mammography

Purpose

Our aim was to investigate the diagnostic potential of automated breast volume scanning (ABVS) and compare it with manual ultrasound (US) and mammography.

Patients and methods

One hundred and fifty-five patients with a total of 165 breast lesions had mammograms, manual US and an ABVS. Multiplanar reconstructions in coronal, transverse and sagittal views were reconstructed from the automated data set. After biopsy or surgery, all lesions were confirmed histologically. Data were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) classification. Detection rate, diagnostic accuracy, sensitivity, specificity and positive (PPV) and negative (NPV) predictive value of each method were analysed.

Results

Detection rate, diagnostic accuracy and mammography sensitivity were significantly lower than those of each US method (p<0.05). There were no significant differences between manual US and ABVS. When combining ABVS, US and mammography, diagnostic accuracy, sensitivity and specificity reached 96.4%, 97.1% and 95.2%, respectively. A spiculated and stellate margin in the coronal plane has a high specificity in diagnosing malignant lesions.

Conclusions

ABVS can provide additional information in the differential diagnosis of a lesion. It has significantly higher sensitivity than mammography, but it is similar to manual US and cannot be preferred to a manual US examination.     

Diagnostic and prognostic correlates of preoperative FDG PET for breast cancer

Purpose

To explore the preoperative utility of FDG PET for the diagnosis and prognosis in a retrospective breast cancer case series.

Methods

In this retrospective study, 104 patients who had undergone a preoperative FDG PET scan for primary breast cancer at the UZ Brussel during the period 2002–2008 were identified. Selection criteria were: histological confirmation, FDG PET performed prior to therapy, and breast surgery integrated into the primary therapy plan. Patterns of increased metabolism were recorded according to the involved locations: breast, ipsilateral axillary region, internal mammary chain, or distant organs. The end-point for the survival analysis using Cox proportional hazards was disease-free survival. The contribution of prognostic factors was evaluated using the Akaike information criterion and the Nagelkerke index.

Results

PET positivity was associated with age, gender, tumour location, tumour size >2 cm, lymphovascular invasion, oestrogen and progesterone receptor status. Among 63 patients with a negative axillary PET status, 56 (88.9?%) had three or fewer involved nodes, whereas among 41 patients with a positive axillary PET status, 25 (61.0?%) had more than three positive nodes (P?Conclusion Preoperative PET axillary node positivity identified patients with a higher burden of nodal involvement, which might be important for treatment decisions in breast cancer patients.     

Sonoelastography versus dynamic magnetic resonance imaging in evaluating BI-RADS III and IV breast masses

Background

Several clinical studies showed that sonoelastography was useful for the differentiation of benign and malignant breast lesions. Contrast-enhanced MRI has emerged as a promising tool in the detection, diagnosis, and staging of breast cancer.

Aim of work

To study the role of sonoelastography versus dynamic MRI in evaluating BI-RADS III, IV breast masses and detect which modality is of better sensitivity and specificity trying to guide the patient either to follow-up the lesion or proceed to lesion excision.

Subjects and methods

The study included 50 Egyptian patients (age ranged from 32 to 58 years) who presented by breast masses and categorized as BI-RADS III, IV by mammography and ultrasound. Sonoelastography and dynamic MRI were done for all the patients.

Results

Differentiation between BI-RADS III and IV by US elastography had 84% sensitivity and 84% specificity and by MRI had 88% sensitivity and 80% specificity.

Conclusion

Regarding the sonoelastography, it is an easy and cheap modality. The elasticity score is an important parameter for lesion characterization. Combination of morphologic and dynamic MRI studies is very important for the breast lesion evaluation. MRI is more sensitive but less specific than sonoelastography. Finally if we find any suspicious character elicited by either sonoelastography or MRI (BI-RADS IV), lesion excision is recommended.     

Adjunctive diagnostic value of MRI in the breast radial scar

Purpose

We sought to identify breast magnetic resonance imaging (MRI) criteria capable of influencing the differential diagnosis between radial scars related to benign proliferative disease and those associated with breast cancer with a view to proposing breast MRI as a promising and cost-effective modality to be carried out between mammography and surgical biopsy.

Materials and methods

From 1998 to June 2006, we studied 20 patients with a focal architectural distortion on mammography. All patients underwent contrast-enhanced breast MRI with a T1 Philips Gyroscan scanner and the acquisition of T1-weighted fast field echo, echo planar imaging (FFE EPI) axial dynamic sequences with a slice thickness of 3 mm. During postprocessing, subtracted images were assessed for morphological features, pattern of contrast enhancement, time-intensity curve and lesion enhancement rate.

Results

Breast MRI depicted 27 lesions between 7 mm and 30 mm in size. Fifteen of the 27 breast lesions showed benign features, eight showed malignant features and four were classified as suspicious. Pathological examination confirmed the benignity of all 15 lesions showing benign MRI features and revealed the benign nature of the four lesions classified as suspicious.

Conclusions

Evaluation of breast MRI showed that enhancement rate and time-intensity curve were useful only in the differential diagnosis between benign and malignant breast lesions. Our experience confirmed that breast MRI has very high sensitivity and, in particular, a negative predictive value of 100%. Breast MRI could thus be considered a useful diagnostic tool that can guide the choice between follow-up or surgical excision of radial scars.