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Breast Cancer Research and Treatment Jul 2022Mammographic Density (MD) refers to the amount of fibroglandular breast tissue present in the breast and is an established risk factor for developing breast cancer. The...
PURPOSE
Mammographic Density (MD) refers to the amount of fibroglandular breast tissue present in the breast and is an established risk factor for developing breast cancer. The ability to evaluate treatment response dynamically renders neoadjuvant chemotherapy (NACT) the preferred treatment option in many clinical scenarios. Previous studies have suggested that MD can predict patients likely to achieve a pathological complete response (pCR) to NACT. We aimed to determine whether there is a causal relationship between BI-RADS breast composition categories for breast density at diagnosis and the pCR rate and residual cancer burden score (RCB) by performing a retrospective review on consecutive breast cancer patients who received NACT in a tertiary referral centre from 2015 to 2021.
METHODS
The Mann-Whitney U Test was used to test for differences between two independent groups (i.e. those who achieved pCR and those who did not). A binary logistic regression model was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) for an association between the independent variables of molecular subtype, MD, histological grade and FNA positivity and the dependant variable of pCR. Statistical analysis was conducted with SPSS (IBM SPSS for Mac, Version 26.0; IBM Corp).
RESULTS
292 patients were included in the current study. There were 124, 155 and 13 patients in the BI-RADS MD category b, c and d, respectively. There were no patients in the BI-RADS MD category a. The patients with less dense breast composition (MD category b) were significantly older than patients with denser breast composition (MD category c, d) (p = 0.001) and patients who had a denser breast composition (MD category d) were more likely to have ER+ tumours. There was no significant difference in PgR status, HER2 status, pathological complete response (pCR), FNA positivity, or RCB class dependent upon the three MD categories. A binary logistic regression revealed that patients with HER2-enriched breast cancer and triple-negative breast cancer are more likely to achieve pCR with an OR of 3.630 (95% CI 1.360-9.691, p = 0.010) and 2.445 (95% CI 1.131-5.288, p = 0.023), respectively.
CONCLUSION
Whilst dense MD was associated with ER positivity and these women were less likely to achieve a pCR, MD did not appear to independently predict pCR post-NACT.
Topics: Breast; Breast Density; Breast Neoplasms; Female; Humans; Mammography; Neoadjuvant Therapy
PubMed: 35606616
DOI: 10.1007/s10549-022-06616-1 -
Diagnostic and Interventional Imaging Oct 2019Three-dimensional automated breast ultrasound system (3D ABUS) is an innovation in breast ultrasound that has been developed to uncouple detection from image acquisition... (Review)
Review
Three-dimensional automated breast ultrasound system (3D ABUS) is an innovation in breast ultrasound that has been developed to uncouple detection from image acquisition and to address the limitations of handheld ultrasound (HHUS). 3D ABUS provides a large field of view using high frequency transducers, producing high-resolution images and covering a large portion of the breast with one sweep. As more data become available on breast density and the impact of supplemental screening, 3D ABUS has gained wider acceptance as an adjunct tool to mammography. Computer-aided detection software significantly reduces interpretation time, improving the workflow for the utilization of 3D ABUS as a supplemental screening tool. In the diagnostic setting, 3D ABUS offers valuable impact in the detectability of breast lesions and the differentiation of malignant from benign lesions, with a high inter-observer agreement. State-of-the art technique, including uniform compression and proper positioning, tends to reduce artifactual posterior shadowing, while combined 3D ABUS-mammography interpretation improves radiologists' diagnostic performance. Promising results have supported the enhanced efficiency of 3D ABUS in detecting the extent of breast cancer and assessing response to neoadjuvant chemotherapy, whereas its correlation with molecular subtypes of breast cancer is remarkable. Future perspectives include the integration of radiomics and deep learning in the further development of 3D ABUS.
Topics: Artifacts; Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Observer Variation; Ultrasonography, Mammary
PubMed: 30962169
DOI: 10.1016/j.diii.2019.03.012 -
BMC Medical Imaging Feb 2021The background parenchymal enhancement at breast magnetic resonance imaging use to predict breast cancer attracts many searchers to draw a possible relationship.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The background parenchymal enhancement at breast magnetic resonance imaging use to predict breast cancer attracts many searchers to draw a possible relationship. However, the results of their relationships were conflicting. This meta-analysis was performed to assess breast cancer frequency associations with background parenchymal enhancement.
METHODS
A systematic literature search up to January 2020 was performed to detect studies recording associations between breast cancer frequency and background parenchymal enhancement. We found thirteen studies including 13,788 women at the start with 4046 breast cancer. We calculated the odds ratio (OR) and the 95% confidence intervals (CIs) between breast cancer frequency and background parenchymal enhancement by the dichotomous technique with a random or fixed-effect model.
RESULTS
Women with minimal or mild background parenchymal enhancement at breast magnetic resonance imaging did not have any risk of breast cancer compared to control women (OR, 1.20; 95% CI 0.54-2.67). However, high background parenchymal enhancement at breast magnetic resonance imaging (OR, 2.66; 95% CI 1.36-5.19) and moderate (OR, 2.51; 95% CI 1.49-4.21) was associated with a significantly higher rate of breast cancer frequency compared to control women.
CONCLUSIONS
Our meta-analysis showed that the women with high and moderate background parenchymal enhancement at breast magnetic resonance imaging have higher risks, up to 2.66 fold, of breast cancer. We suggest that women with high or moderate background parenchymal enhancement at breast magnetic resonance imaging to be scheduled for more frequent follow-up and screening for breast cancer to avoid any complications.
Topics: Breast; Breast Neoplasms; Contrast Media; Female; Humans; Image Enhancement; Magnetic Resonance Imaging
PubMed: 33607959
DOI: 10.1186/s12880-021-00566-8 -
European Journal of Radiology Oct 2022In X-ray breast imaging, Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT), are the standard and largely used techniques, both for diagnostic and screening... (Review)
Review
In X-ray breast imaging, Digital Mammography (DM) and Digital Breast Tomosynthesis (DBT), are the standard and largely used techniques, both for diagnostic and screening purposes. Other techniques, such as dedicated Breast Computed Tomography (BCT) and Contrast Enhanced Mammography (CEM) have been developed as an alternative or a complementary technique to the established ones. The performance of these imaging techniques is being continuously assessed to improve the image quality and to reduce the radiation dose. These imaging modalities are predominantly used in the diagnostic setting to resolve incomplete or indeterminate findings detected with conventional screening examinations and could potentially be used either as an adjunct or as a primary screening tool in select populations, such as for women with dense breasts. The aim of this review is to describe the radiation dosimetry for these imaging techniques, and to compare the mean glandular dose with standard breast imaging modalities, such as DM and DBT.
Topics: Breast; Breast Density; Breast Neoplasms; Female; Humans; Mammography; Radiometry; X-Rays
PubMed: 36087425
DOI: 10.1016/j.ejrad.2022.110509 -
Korean Journal of Radiology Jul 2021Breast augmentation is becoming more common, be it for cosmetic reasons or post-mastectomy. Multiple articles in the literature describe the imaging findings of various... (Review)
Review
Breast augmentation is becoming more common, be it for cosmetic reasons or post-mastectomy. Multiple articles in the literature describe the imaging findings of various types of cosmetic breast augmentation. Some articles describe imaging findings for different types of post-mastectomy reconstructions. This essay aims to serve as a comprehensive reference for the multimodality imaging of various types of breast augmentations in native breast and post-mastectomy reconstructions. Familiarity with these findings will facilitate the detection of complications and new or recurrent breast malignancies in patients. With the extensive illustrations provided in this essay on normal and abnormal imaging findings of augmented breasts, readers will receive exposure that will facilitate effective practice.
Topics: Breast; Breast Implants; Breast Neoplasms; Female; Humans; Mastectomy; Neoplasm Recurrence, Local; Postoperative Complications
PubMed: 33938642
DOI: 10.3348/kjr.2020.0779 -
Diagnostic and Interventional Imaging Oct 2019Although mammography is currently the imaging technique of choice for screening and diagnosis, it has some limitations, especially in patients with high-density breasts.... (Review)
Review
Although mammography is currently the imaging technique of choice for screening and diagnosis, it has some limitations, especially in patients with high-density breasts. The evolution from film screen to full-field digital mammography has recently led to the development of new imaging techniques, which are less expensive and widely available. Contrast-enhanced spectral mammography (CESM) is one of them, coupling X-ray breast imaging to the intravenous administration of an iodinated contrast material. CESM provides both morphological information, similar to mammography, and functional information of tumor perfusion. In this review, the imaging technique, the specificity of interpretation of CESM compared to MRI and the currently available data are presented. The clinical performances of CESM versus those of mammography and MRI and its additional value in preoperative local assessment and screening is discussed. The potential advantages and disadvantages are mentioned and we also discuss how CESM contributes to the detection of lesions and how it can be used in daily clinical workflow.
Topics: Antineoplastic Agents; Breast; Breast Neoplasms; Contraindications, Procedure; Contrast Media; Drug Monitoring; Early Detection of Cancer; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Mammography; Neoadjuvant Therapy; Patient Preference; Problem Solving; Radiation Dosage; Sensitivity and Specificity
PubMed: 30962168
DOI: 10.1016/j.diii.2019.01.011 -
European Radiology Experimental Jul 2022We retrospectively evaluated safety and performance of magnetic seed localisation of nonpalpable breast lesions. (Review)
Review
BACKGROUND
We retrospectively evaluated safety and performance of magnetic seed localisation of nonpalpable breast lesions.
METHODS
We reviewed records of patients with nonpalpable breast lesions preoperative localised by placing magnetic Magseed® marker between February 2019 and December 2020. During surgery, Sentimag® magnetic probe was used to localise the marker and guide surgery. Safety, lesion identification and excision with tumour with free margins and re-excision rate were assessed.
RESULTS
A total of 77 Magseed® devices were placed into the breasts of 73 patients, 44 under ultrasound and 33 under stereotactic guidance (4 bilateral). All devices were retrieved as were the target lesions. Magnetic marker placement was successful in all cases without any adverse event. Intraoperative identification and excision of the localised lesion were successful in 77 of 77 of cases (100%). In three cases (all of them calcifications with the seed placed under stereotactic guidance), the seed did not reach the exact target position of the biopsy clip; thus, larger excision was needed, with localisation failure attributed to incorrect clip insertion (n = 1) or to clip dislocation (n = 2). Migration of the marker was negligible in all patients. Complete excision after the initial procedure with at least 1-mm disease-free margins was obtained in 74 out of 77 (96.1%) lesions. The re-excision rate was 3 out of 77 (4%).
CONCLUSIONS
Magnetic marker localisation for nonpalpable breast lesions was safe, reliable, and effective in terms of lesion identification, excision with tumour-free margins and re-excision rate.
Topics: Breast; Humans; Imaging, Three-Dimensional; Magnetic Phenomena; Neoplasms; Retrospective Studies; Ultrasonography
PubMed: 35790602
DOI: 10.1186/s41747-022-00280-2 -
Women's Health (London, England) 2021Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny... (Review)
Review
BACKGROUND
Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications.
AIM
This study reviews existing research into the relationship between and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of in the human milk microbiome.
METHOD
The author conducted three searches to investigate (a) breastfeeding-related pain and ; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review.
RESULTS
There is little evidence to support the hypothesis that spp, including , in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. spp including are commonly identified in healthy human milk and nipple-areolar complex mycobiomes.
DISCUSSION
Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance.
CONCLUSION
Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
Topics: Breast Diseases; Breast Feeding; Candida albicans; Candidiasis; Ecosystem; Female; Humans; Infant; Medical Overuse; Nipples
PubMed: 34269140
DOI: 10.1177/17455065211031480 -
RoFo : Fortschritte Auf Dem Gebiete Der... Aug 2021Considering radiological examinations not as mere images, but as a source of data, has become the key paradigm in the diagnostic imaging field. This change of... (Review)
Review
BACKGROUND
Considering radiological examinations not as mere images, but as a source of data, has become the key paradigm in the diagnostic imaging field. This change of perspective is particularly popular in breast imaging. It allows breast radiologists to apply algorithms derived from computer science, to realize innovative clinical applications, and to refine already established methods. In this context, the terminology "imaging biomarker", "radiomics", and "artificial intelligence" are of pivotal importance. These methods promise noninvasive, low-cost (e. g., in comparison to multigene arrays), and workflow-friendly (automated, only one examination, instantaneous results, etc.) delivery of clinically relevant information.
METHODS AND RESULTS
This paper is designed as a narrative review on the previously mentioned paradigm. The focus is on key concepts in breast imaging and important buzzwords are explained. For all areas of breast imaging, exemplary studies and potential clinical use cases are discussed.
CONCLUSION
Considering radiological examination as a source of data may optimize patient management by guiding individualized breast cancer diagnosis and oncologic treatment in the age of precision medicine.
KEY POINTS
· In conventional breast imaging, examinations are interpreted based on patterns perceivable by visual inspection.. · The radiomics paradigm treats breast images as a source of data, containing information beyond what is visible to our eyes.. · This results in radiomic signatures that may be considered as imaging biomarkers, as they provide diagnostic, predictive, and prognostic information.. · Radiomics derived imaging biomarkers may be used to individualize breast cancer treatment in the era of precision medicine.. · The concept and key research of radiomics in the field of breast imaging will be discussed in this narrative review..
CITATION FORMAT
· Dietzel M, Clauser P, Kapetas P et al. Images Are Data: A Breast Imaging Perspective on a Contemporary Paradigm. Fortschr Röntgenstr 2021; 193: 898 - 908.
Topics: Algorithms; Artificial Intelligence; Breast; Humans; Magnetic Resonance Imaging; Precision Medicine
PubMed: 33535260
DOI: 10.1055/a-1346-0095 -
Clinical Imaging Oct 2020Breast malignancy is the second most common cause of cancer death in women. However, less common breast masses can mimic carcinoma and can pose diagnostic challenges.... (Review)
Review
Breast malignancy is the second most common cause of cancer death in women. However, less common breast masses can mimic carcinoma and can pose diagnostic challenges. This case-based review describes a spectrum of rare breast neoplastic and non-neoplastic masses ranging from malignant to benign entities. Malignant masses in this review include adenoid cystic carcinoma, spindle cell lipoma, granular cell tumor, angiosarcoma, glomus tumor, adenosquamous carcinoma, and myofibroblastoma. Benign masses include sarcoidosis, diabetic mastopathy, and cat scratch disease. Demographics and, when relevant, clinical presentation are summarized. Breast imaging appearance on mammography and ultrasound are highlighted along with radiology-pathology correlation with the appearance and characteristics of the histopathological specimen of these rare masses.
Topics: Adult; Breast; Breast Neoplasms; Diagnosis, Differential; Female; Glomus Tumor; Humans; Lipoma; Mammography; Mastitis; Middle Aged; Ultrasonography; Ultrasonography, Mammary
PubMed: 32470708
DOI: 10.1016/j.clinimag.2020.04.039