Management of breast lesions detectable only on MRI

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Siegmann-Luz, K.C.; Bahrs, S.D.; Preibsch, H.; Hattermann, V.; Claussen, C.D.

2014-01-01

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline 'Diagnosis, Therapy, and Follow-Up of Breast Cancer' as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. (orig.)

Evaluation of the Significance of Incidental Breast Lesions Detected by Chest CT

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Kim, Jae Hyun; Chang, Yun Woo; Hwang, Jung Hwa; Kim, Hyung Hwan; Lee, Eun Hye; Yang, Seung Boo

2013-01-01

To evaluate the significance of incidentally detected breast lesions on a chest CT scan. Thirty-six incidental breast lesions in 26 patients were detected on a chest CT scan and were correlated with breast sonography, retrospectively. Among them, twenty-four breast lesions in 20 patients that were correlated with chest CT and sonography were available to pathology or follow up sonography. The CT findings were compared with sonographic findings according to the pathologic results. Incidentally detected breast lesions on a chest CT scan were correlated with sonography in 86% (31/36). Among 24 lesions that were available to pathology or follow up sonography, seven (29.2%) lesions were malignant and 17 (70.8%) lesions were benign. CT revealed a significant difference between benign and malignant lesions in terms of shape and margin (p = 0.007; p = 0.008, respectively). The CT findings were well correlated with sonographic findings in shape and margin (p = 0.001, respectively). Incidentally detected breast lesions on chest CT can be correlated with sonography. An irregular shape or a non-circumscribed margin of breast lesions on a CT scan can be considered as a suggestive sign of malignancy.

Benign breast lesions in Kano | Ochicha | Nigerian Journal of ...

African Journals Online (AJOL)

Results: Benign breast lesions accounted for 160 (73%) of all breast biopsies seen, and 71.9% of breast diseases in women with a benign to malignant ratio of 2.6 to 1. The mean age at presentation was 26 years. Fibrocystic disease was the commonest histological lesion comprising 55 (34.3%) of all cases, with a mean ...

Targeted Ultrasound for MR-Detected Lesions in Breast Cancer Patients

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Shin, Jung Hee; Han, Boo Kyung; Choe, Yeon Hyeon; Ko, Kyung Ran; Choi, Nami

2007-01-01

To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US. One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification. Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision. Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate

Lobular neoplasia: frequency and association with other breast lesions

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Gobbi Helenice

2011-08-01

Full Text Available Abstract Background Using new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions. Our aims were to assess the frequency of lobular neoplasia in a series of breast biopsies that were performed and examined in the same institution and to analyze the association between subtypes of lobular neoplasia and benign and malignant breast lesions. Methods Cases were selected after reviewing archived pathological reports in the Breast Pathology Laboratory, School of Medicine of Federal University of Minas Gerais (1999-2008. Cases of lobular neoplasia were reviewed and classified as atypical lobular hyperplasia, ductal involvement by cells of atypical lobular hyperplasia, lobular carcinoma in situ, and pleomorphic lobular carcinoma in situ. Coexistence of lobular neoplasia with other breast lesions, including columnar cell lesions, invasive ductal carcinoma and invasive lobular carcinoma, was evaluated. The association between lobular neoplasia and breast lesions was analyzed by Fisher's exact test and chi-square test for linear trend. Results We analyzed 5650 breast specimens, selecting 135 breast specimens (2.4% that had a diagnosis of lobular neoplasia, corresponding to 106 patients. Hematoxylin and eosin-stained slides were available for 84 cases, 5 of which were excluded because they contained only "indeterminate" in situ lesions. Of the 79 remaining cases, columnar cell lesions were present in 78.5%, primarily with columnar cell changes without atypia (67.7%. Invasive carcinoma was present in 45.6% of cases of lobular neoplasia--a similar frequency (47.2% as invasive ductal carcinoma and invasive lobular carcinoma. We noted a significant linear trend (p in situ compared with atypical lobular hyperplasia. Invasive lobular carcinomas were associated with lobular carcinoma in situ in 33% of cases, compared with 2.8% of atypical lobular

Significance of localization of nonpalpable breast lesions

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Oh, Ki Keun; Choi, Hyun Ju [Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

1990-12-15

As mammography has become more popular for the evaluation of breast symptoms and for the screening of asymptomatic women, the smaller lesions are being detected before they become palpable, therefore preoperative localization became necessary. This has led to the development of several methods for preoperative localization of nonpalpable lesions. Authors analyzed 50 cases with preoperative localization in 45 patients which had abnormal findings on film mammogram or ultrasonomammogram since October 1985 through March 1990 at Yongdong Severance Hospital, College of Medicine, Yonsei University. The results were as follows: 1. Techniques of localization were spot method in 8 cases, conventional needle localization method in 38 cases and Kopan's needle localization method in 4 cases. 2. The most common mammographic indication for localization was focal calcifications in 29 cases(58%), which was followed by a newly developed mass in 25 cases(50%). 3. Outcome of pathologically confirmed diagnosis put into benign lesions in 37 cases(74%) and malignant lesions in 13 cases(26%). 4. Among the cases with localization of lesions which has suggested as benign lesions in film and ultrasonomammogram,all cases(100%) were confirmed in benign lesions pathologically. Among the cases with localization of lesions which has suggested as malignant lesions in film and ultrasonomammogram, pathologic malignant has been proved of 44% and possible histopathologic precursor of malignant was resulted in 25% such as atypical hyperplasia and adenosis. Conclusively, authors consider that the abnormal areas should be removed in their entirety with the sacrifice of minimum volume of contiguous normal breast tissue through the preoperative localization, hence our preoperative localization has contributed favorable prognosis based on material lesions in early stage breast cancer.

Significance of localization of nonpalpable breast lesions

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Oh, Ki Keun; Choi, Hyun Ju

1990-01-01

As mammography has become more popular for the evaluation of breast symptoms and for the screening of asymptomatic women, the smaller lesions are being detected before they become palpable, therefore preoperative localization became necessary. This has led to the development of several methods for preoperative localization of nonpalpable lesions. Authors analyzed 50 cases with preoperative localization in 45 patients which had abnormal findings on film mammogram or ultrasonomammogram since October 1985 through March 1990 at Yongdong Severance Hospital, College of Medicine, Yonsei University. The results were as follows: 1. Techniques of localization were spot method in 8 cases, conventional needle localization method in 38 cases and Kopan's needle localization method in 4 cases. 2. The most common mammographic indication for localization was focal calcifications in 29 cases(58%), which was followed by a newly developed mass in 25 cases(50%). 3. Outcome of pathologically confirmed diagnosis put into benign lesions in 37 cases(74%) and malignant lesions in 13 cases(26%). 4. Among the cases with localization of lesions which has suggested as benign lesions in film and ultrasonomammogram,all cases(100%) were confirmed in benign lesions pathologically. Among the cases with localization of lesions which has suggested as malignant lesions in film and ultrasonomammogram, pathologic malignant has been proved of 44% and possible histopathologic precursor of malignant was resulted in 25% such as atypical hyperplasia and adenosis. Conclusively, authors consider that the abnormal areas should be removed in their entirety with the sacrifice of minimum volume of contiguous normal breast tissue through the preoperative localization, hence our preoperative localization has contributed favorable prognosis based on material lesions in early stage breast cancer

Breast vibro-acoustography: initial experience in benign lesions

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Alizad, Azra; Mehrmohammadi, Mohammad; Ghosh, Karthik; Glazebrook, Katrina N; Carter, Rickey E; Karaberkmez, Leman Gunbery; Whaley, Dana H; Fatemi, Mostafa

2014-01-01

Vibro-acoustography (VA) is a newly developed imaging technology that is based on low-frequency vibrations induced in the object by the radiation force of ultrasound. VA is sensitive to the dynamic characteristics of tissue. Here, we evaluate the performance of VA in identifying benign lesions and compare the results to those of mammography. An integrated mammography-VA system designed for in vivo breast imaging was tested on a group of female volunteers, age ≥ 18 years, with suspected breast lesions based on clinical examination. A set of VA scans was acquired after each corresponding mammography. Most lesions were classified as benign based on their histological results. However, in 4 cases, initial diagnosis based on clinical imaging determined that the lesions were cysts. These cysts were aspirated with needle aspiration and disappeared completely under direct ultrasound visualization. Therefore, no biopsies were performed on these cases and lesions were classified as benign based on clinical findings per clinical standards. To define the VA characteristics of benign breast masses, we adopted the features that are normally attributed to such masses in mammography. In a blinded assessment, three radiologists evaluated the VA images independently. The diagnostic accuracy of VA for detection of benign lesions was assessed by comparing the reviewers’ evaluations with clinical data. Out of a total 29 benign lesions in the group, the reviewers were able to locate all lesions on VA images and mammography, 100% with (95% confidence interval (CI): 88% to 100%). Two reviewers were also able to correctly classify 83% (95% CI: 65% to 92%), and the third reviewer 86% (95% CI: 65% to 95%) of lesions, as benign on VA images and 86% (95% CI: 69% to 95%) on mammography. The results suggest that the mammographic characteristics of benign lesion may also be used to identify such lesions in VA. Furthermore, the results show the ability of VA to detect benign breast

BI-RADS categorisation of 2708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit

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Hamy, A.S.; Giacchetti, S.; Cuvier, C.; Perret, F.; Bonfils, S.; Charveriat, P.; Hocini, H.; Espie, M.; Albiter, M.; Bazelaire, C. de; Roquancourt, A. de

2012-01-01

To determine the malignancy rate of nonpalpable breast lesions, categorised according to the Breast Imaging Reporting and Data System (BI-RADS) classification in the setting of a Breast Care Unit. All nonpalpable breast lesions from consecutive patients referred to a dedicated Breast Care Unit were prospectively reviewed and classified into 5 BI-RADS assessment categories (0, 2, 3, 4, and 5). A total of 2708 lesions were diagnosed by mammography (71.6%), ultrasound (8.7%), mammography and ultrasound (19.5%), or MRI (0.2%). The distribution of the lesions by BI-RADS category was: 152 in category 0 (5.6%), 56 in category 2 (2.1%), 742 in category 3 (27.4%), 1523 in category 4 (56.2%) and 235 in category 5 (8.7%). Histology revealed 570 malignant lesions (32.9%), 152 high-risk lesions (8.8%), and 1010 benign lesions (58.3%). Malignancy was detected in 17 (2.3%) category 3 lesions, 364 (23.9%) category 4 lesions and 185 (78.7%) category 5 lesions. Median follow-up was 36.9 months. This pragmatic study reflects the assessment and management of breast impalpable abnormalities referred for care to a specialized Breast Unit. Multidisciplinary evaluation with BI-RADS classification accurately predicts malignancy, and reflects the quality of management. This assessment should be encouraged in community practice appraisal. (orig.)

Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): A retrospective comparison in 66 breast lesions.

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Li, L; Roth, R; Germaine, P; Ren, S; Lee, M; Hunter, K; Tinney, E; Liao, L

2017-02-01

The purpose of this study was to retrospectively compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) with that of breast magnetic resonance imaging (BMRI) in breast cancer detection using parameters, including sensitivity, positive predictive value (PPV), lesion size, morphology, lesion and background enhancement, and examination time. A total of 48 women (mean age, 56years±10.6 [SD]) with breast lesions detected between October 2012 and March 2014 were included. Both CESM and BMRI were performed for each patient within 30 days. The enhancement intensity of lesions and breast background parenchyma was subjectively assessed for both modalities and was quantified for comparison. Statistical significance was analyzed using paired t-test for mean size of index lesions in all malignant breasts (an index lesion defined as the largest lesion in each breast), and a mean score of enhancement intensity for index lesions and breast background. PPV, sensitivity, and accuracy were calculated for both CESM and BMRI. The average duration time of CESM and MRI examinations was also compared. A total of 66 lesions were identified, including 62 malignant and 4 benign lesions. Both CESM and BMRI demonstrated a sensitivity of 100% for detection of breast cancer. There was no statistically significant difference between the mean size of index lesions (P=0.108). The enhancement intensity of breast background was significantly lower for CESM than for BMRI (P0.05). The average examination time for CESM was significantly shorter than that of BMRI (P<0.01). CESM has similar sensitivity than BMRI in breast cancer detection, with higher PPV and less background enhancement. CESM is associate with significantly shorter exam time thus a more accessible alternative to BMRI, and has the potential to play an important tool in breast cancer detection and staging. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights

Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography.

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Taskin, Fusun; Durum, Yasemin; Soyder, Aykut; Unsal, Alparslan

2017-12-01

Background Breast tomosynthesis is more sensitive than mammography and can detect lesions that are not always visible with conventional methods such as digital mammography (MG) and ultrasonography (US). No standardized approach is available for the management of lesions that are detectable with tomosynthesis but are not visible on MG or US. Purpose To review suspicious breast lesions detected with tomosynthesis but not visible on two-dimensional (2D) MG or US and to determine the management options for these lesions. Material and Methods Ethical committee approval was obtained. The radiological records, biopsy or surgery results, and follow-up findings of 107 patients who had a tomosynthesis-positive but MG- or US-negative breast lesion between 2011 and 2016 were retrospectively evaluated. Results Of 107 lesions visible only with tomosynthesis, 74% were architectural distortions and 26% were asymmetrical opacities. All patients underwent magnetic resonance imaging (MRI) for further evaluation. Among the 48 (45%) MRI-negative lesions, none had a suspicious alteration during the follow-up period. Among the MRI-positive lesions, 28% of the 50 architectural distortions and 11% of the nine asymmetrical opacities were malignant. Conclusion Given the inherent high false-positive rate of breast tomosynthesis, breast MRI prior to biopsy may reduce the number of unnecessary biopsies for suspicious breast lesions that are tomosynthesis-positive only.

Positive predictive value of additional synchronous breast lesions in whole-breast ultrasonography at the diagnosis of breast cancer: clinical and imaging factors

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Kim, Ah Hyun; Kim, Min Jung; Kim, Eun Kyung; Moon, Hee Jung; Park, Hee Jung

2014-01-01

To evaluate the positive predictive value (PPV) of bilateral whole-breast ultrasonography (BWBU) for detection of synchronous breast lesions on initial diagnosis of breast cancer and evaluate factors affecting the PPV of BWBU according to varying clinicoimaging factors. A total of 75 patients who had synchronous lesions with pathologic confirmation at the initial diagnosis of breast cancer during January 2007 and December 2007 were included. The clinical factors of the patients were evaluated. One observer retrospectively reviewed the imaging studies of the index breast cancer lesion and the synchronous lesion. The PPV for additional biopsy was calculated for BWBU and various clinical and imaging factors affecting the PPV for BWBU were evaluated. The overall PPV for additional biopsy was 25.7% (18 of 70). The PPV for synchronous lesions detected both on mammography and BWBU, and detected only on BWBU, was 76.9% (10 of 13) and 14.3% (7 of 49), respectively. There was no clinical factor affecting the PPV for BWBU. Among the imaging factors, ipsilateral location of the synchronous lesion to the index lesion (P=0.06) showed a marginal statistically significant correlation with malignancy in the synchronous breast lesion. A mass with calcification on mammography presentation (P<0.01), presence of calcification among the ultrasonography findings (P<0.01), and high Breast Imaging Reporting and Data System final assessment (P<0.01) were imaging factors that were associated with malignancy in the additional synchronous lesion. BWBU can detect additional synchronous malignancy at the diagnosis of breast cancer with a relatively high PPV, especially when mammography findings are correlated with ultrasonographic findings.

How accurate can we diagnose breast lesion by fine needle aspiration cytology?

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Okada, Toshihiro; Ito, Kenichi; Uehara, Tsuyoshi

2011-01-01

Fine needle aspiration cytology (FNA) is performed firstly in the diagnosis of breast lesion, as the FNA is less-invasive diagnostic procedure. Depending on the results obtained by the FNA, we subsequently perform core needle biopsy or Mammotome biopsy to determine the histological finding of the breast lesion. The purpose of the study is to evaluate the accuracy and limitation of diagnosis of breast lesion by FNA. The clinical data of 528 patients who underwent an operation for the breast lesion in the Shinshu University hospital from April 2004 to March 2009 were analyzed. Of 528 breast lesions, 488 were breast cancers, and 40 benign breast lesions. Of 528 breast lesions, 94 cases were excluded because CNB or MMT was performed firstly. In these cases, some were scheduled for the preoperative chemotherapy, and others were highly suspected to be ductal carcinoma in situ (DCIS), which was expected to be difficult to be diagnosed by FNA. Two hundreds and ninety two cases of 488 (59.8%) breast cancers and 21 of 40 (52.2%) benign lesions were diagnosed by FNA, respectively. Three of 299 cases (1%) determined to be 'malignant' by FNA were diagnosed as benign in the postoperative pathological diagnosis. 40 of 40 'suspicious for malignancy,' 40 of 46 'indeterminate,' 12 of 38 'normal or benign,' and 10 of 11 'inadequate' cases were finally diagnosed as cancer, in which scirrhous carcinoma, DCIS, small papillo-tubular carcinoma and lobular carcinoma were observed. It is speculated that enough specimens for diagnosis might not be obtained from these tumors by FNA, and that diagnosis by cytology itself might be difficult for these tumors. Although FNA is useful in the diagnosis of breast lesions, some lesions are very difficult to be diagnosed by FNA alone. We have to be careful in considering the conformity of the findings of image diagnoses with the cytological findings. Furthermore, when there is a lack of conformity between them, we should not to hesitate to perform CNB

Usefulness of serum CA-15.3 in the management of benign breast lesion.

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Mondal, Hari Pada; Roy, Himanshu; Mondal, Palash; Saha, Mita; Basu, Nandita

2012-04-01

Benign breast lesion is an important risk factor for breast cancer and elevated CA-15.3 in serum is a well established marker of breast cancer. Core-needle biopsy is now the method of choice to sample non-palpable mammographic abnormality and as well as clinically palpable lesion. To asses relationship of serum CA-15.3 with different histologic entities of benign breast lesion and usefulness of this marker in predicting breast cancer in this high risk group, a study was conducted among 140 patients who had a diagnosis of benign breast lesion and malignancy following fine needle aspiration cytology (FNAC) at department of surgery, Medical College, Kolkata between 2007 and 2009. We prospectively estimated serum CA-15.3 level in all patients. Different histologic entities of benign breast lesion, who showed serum CA-15.3 level >30U/ml underwent tru-cut biopsy to detect malignancy. Of 140 patients studied, 50 were stamped as malignancy and 90 as benign after FNAC of which 20 patients had fibroadenoma, 25 had fibro-adenoma with fibrocystic disease, 20 had fibrocystic disease with epitheliosis and 25 had fibrocystic disease with atypia. All breast cancer patients and 10 each from fibro-adenoma with fibrocystic disease, fibrocystic disease with epitheliosis and fibrocystic disease with atypia had serum CA -15.3 level>30U/ml. Thirty patients with benign breast lesion who had raised CA-15.3 underwent core-needle biopsy. Fifteen patients were detected to have intraductal carcinoma, mostly with fibrocystic disease with atypia. Clinical applicability of serum CA-15.3 to detect breast cancer should be strongly considered in management of patients with benign breast lesion and tru-cut biopsy than FNAC be done before benign breast lesion being stamped as benign. Biopsy results that are not concordant with the targeted lesion require surgical biopsy.

Clinical Significance of Focal Breast Lesions Incidentally Identified by 18F-FDG PET/CT

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Cho, Young Seok; Choi, Joon Young; Lee, Su Jin; Hyun, Seung Hyup; Lee, Ji Young; Choi, Yong; Choe, Yearn Seong; Lee, Kyung Han; Kim, Byung Tae

2008-01-01

We evaluated the incidence and malignant risk of focal breast lesions incidentally detected by 18 F-FDG PET/CT. Various PET/CT findings of the breast lesions were also analyzed to improve the differentiation between benign from malignant focal breast lesions. The subjects were 3,768 consecutive 18 F-FDG PET/CT exams performed in adult females without a history of breast cancer. A focal breast lesion was defined as a focal 18 F-FDG uptake or a focal nodular lesion on CT image irrespective of 18 F-FDG uptake in the breasts. The maximum SUV and CT pattern of focal breast lesions were evaluated, and were compared with final diagnosis. The incidence of focal breast lesions on PET/CT in adult female subjects was 1.4% (58 lesions in 53 subjects). In finally confirmed 53 lesions of 48 subjects, 11 lesions of 8 subjects (20.8%) were proven to be malignant. When the PET/CT patterns suggesting benignancy (maximum attenuation value > 75 HU or 20) were added as diagnostic criteria of PET/CT to differentiate benign from malignant breast lesions along with maximum SUV, the area under ROC curve of PET/CT was significantly increased compared with maximum SUV alone (0.680±0.093 vs. 0.786±0.076, p 18 F-FDG PET/CT is not low, deserving further diagnostic confirmation. Image interpretation considering both 18 F-FDG uptake and PET/CT pattern may be helpful to improve the differentiation from malignant and benign focal breast lesion

Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI.

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Uematsu, Takayoshi

2013-12-01

To report on our initial experiences with a new method of real-time virtual sonography (RVS)-guided 11-gauge vacuum-assisted breast biopsy for lesions that were initially detected with breast MRI. RVS-guided 11-gauge vacuum-assisted biopsy is performed when a lesion with suspicious characteristics is initially detected with breast MRI and is occult on mammography, sonography, and physical examination. Live sonographic images were co-registered to the previously loaded second-look spine contrast-enhanced breast MRI volume data to correlate the sonography and MR images. Six lesions were examined in six consecutive patients scheduled to undergo RVS-guided 11-gauge vacuum-assisted biopsy. One patient was removed from the study because of non-visualization of the lesion in the second-look spine contrast-enhanced breast MRI. Five patients with non-mass enhancement lesions were biopsied. The lesions ranged in size from 9 to 13 mm (mean 11 mm). The average procedural time, including the sonography and MR image co-registration time, was 25 min. All biopsies resulted in tissue retrieval. One was fibroadenomatous nodules, and those of four were fibrocystic changes. There were no complications during or after the procedures. RVS-guided 11-gauge vacuum-assisted breast biopsies provide a safe and effective method for the examination of suspicious lesions initially detected with MRI.

Resistive index in breast tumors; usefulness on differentiation between benign and malignant lesions

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An, Eun Joo; Choi, Hye Young; Baek, Seung Yon; Kim, Ah Young; Choe, Du Hwan

1996-01-01

We assessed the usefulness of resistive index(RI) on spectral analysis of doppler sonography for differential diagnosis of benign and malignant breast lesions. We retrospectively reviewed 29 benign and 22 malignant lesions of breast, which were examined preoperatively with color and duplex Doppler and were confirmed by histopathologically after operation. We analyzed the average and distribution of RI in benign and malignant lesions. Although, there was no difference in the average values of RI in benign and malignant breast lesions, the distribution of RI was below 0.7 in eighteen cases (62%) of benign lesions, and above 0.7 in eighteen cases (82%) of malignant lesions. Thus, RI is valuable for differentiation between benign and malignant lesions of breast. Measurement of RI in breast disease using color and duplex Doppler study is useful modality adjunct to the conventional ultrasonographic differentiation of benign and malignant lesions

Concurrent breast stroma sarcoma and breast carcinoma: a case report

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Carvalho Teresa

2010-12-01

Full Text Available Abstract Introduction Breast cancer is one of the most important health problems in the world and affects a great number of women over the entire globe. This group of tumors rarely presents as bilateral disease and, when it does happen, normally occurs within the same histological type. We report a rare case of concurrent bilateral breast cancer with two different histology types, a breast carcinoma and a breast sarcoma, in a 42-year-old woman referred to our hospital. Case presentation A 42-year-old Caucasian woman admitted to our institute in August 1999, presented with a nodule in the left breast of 3.0 × 2.5 cm, and, in the right breast, one of 1.0 cm, suspected of malignancy and with a clinically negative armpit. Biopsies had revealed invasive mammary carcinoma (right breast and sarcoma (left breast. She was submitted to bilateral modified radical mastectomy. A histological study showed an invasive mammary carcinoma degree II lobular pleomorphic type with invasion of seven of the 19 excised axillary nodes in the right breast and, in the left breast, a sarcoma of the mammary stroma, for which the immunohistochemistry study was negative for epithelial biomarkers and positive for vimentin. Later, she was submitted for chemotherapy (six cycles of 75 mg/m2 5-fluorouracil, epirubicin and cyclophosphamide followed by radiotherapy of the thoracic wall and axillary nodes on the left. Hormone receptors were positive in the tumor of the right breast, and tamoxifen, 20 mg, was prescribed on a daily basis (five years followed by letrozole, 2.5 mg, also daily (five years. She presented no sign of negative evolution in the last consultation. Conclusion The risk of development of bilateral breast cancer is about 1% each year within a similar histological type, but it is higher in tumors with lobular histology. In this case, the patient presented, simultaneously, two histologically distinct tumors, thus evidencing a rare situation.

Cytomorphology of fibrocystic change, high-risk proliferative breast disease, and premalignant breast lesions.

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Masood, Shahla

2005-12-01

In a prospective study using mammographically guided fine needle aspirates in 100 nonpalpable breast lesions, the author's group assessed the reliability of a cytological grading system to define the cytological features of proliferative and nonproliferative breast disease and to differentiate between benign, premalignant and malignant breast lesions. We developed a cytological grading system evaluating the aspirates for the cellular arrangement, the degrees of cellular pleomorphism and anisonucleosis, presence of myoepithelial cells and nucleoli and the status of the chromatin pattern. This grading system, now recognized as the Masood Cytology Index, is commonly used as a surrogate end point biomarker in chemoprevention trials.

CYTOLOGICAL EVALUATION OF MALE BREAST LESIONS IN GREATER GWALIOR : A FIVE YEAR RETROSPECTIVE STUDY

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Jagannath

2015-03-01

Full Text Available BACKGROUNDS: Fine needle aspiration cytology is an effective modality for diagnosis of breast lesions. Usually male breast lesions are benign and affect the young male. Most common lesion is gynaecomastia. Male breast cancer accounts for a small proportion of breast cancers. Male breast cancer usually presents at an advanced age. OBJECTIVE: The aim of this study was to examine the nature of male breast lesions and to determine the cytomorphologic patterns of these lesions. MET HODS: five year retrospective study was conducted in our institution and in that 112 patients underwent fine needle aspiration cytology of the palpable breast lump after thorough physical examination. The cytological diagnosis was classified as benign, inf lammatory, malignant and others. RESULTS: In 112 male patients diagnosed with breast lesions, the most common lesion was gynecomastia (103/112, 91.9%, followed by breast cancer (6/112, 5.4%, inflammatory (2/112, 1.8% and apocrine metaplasia (01/112, 0.9 %. Gynecomastia was commonly found in male patients less than 40 years of age, while breast cancer is seen in male patients over 40 years of age

Ultrasonographic findings of breast lesions

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Hwang, In Sung; Kim, Yang Soo; Suh, Hyoung Sim

1990-01-01

Authors retrospectively analyzed ultrasonographic findings of 61 cases of breast lesions which were proven pathologically at Daerim St. Mary's Hospital from May 1987 to February 1990. The results were as follows : 1. Of all 61 cases, there were 27 fibroadenomas, 13 fibrocystic diseases, 11 carcinomas, 8 abscesses, 1 sclerosing adenosis, and 1 intraductal papilloma. 2. Findings suggesting benignancy were smooth contour, round or oval shape, homogeneously echolucent internal echo, echogenic boundary echo, and posterior enhancement. In the cases of abscess, the findings were rather irregular contour, strong posterior enhancement, and dirty, inhomogeneous internal echo. While irregular and lobulated shape, inhomogeneous and mixed internal echo and pectoral muscle invasion were suggested for malignancy. 3. The sensitivity was 98% and the specificity 58% in benign mass excluding abscesses, 63% and 98% in abscesses, and 55% and 98% in carcinomas. In conclusion, ultrasonography is one of the excellent imaging modality for detecting breast lesions larger than 5 mm in size, but unfortunately some of the malignant tumors simulated benignancy, thus we considered fine needle aspiration biopsy and adjunctive imaging modalities such as film mammography must be followed for better detection of breast cancer

Ultrasonographic findings of breast lesions

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Hwang, In Sung; Kim, Yang Soo; Suh, Hyoung Sim [College of Medicine, Daerim St. Mary' s Hospital, Seoul (Korea, Republic of)

1990-07-15

Authors retrospectively analyzed ultrasonographic findings of 61 cases of breast lesions which were proven pathologically at Daerim St. Mary's Hospital from May 1987 to February 1990. The results were as follows : 1. Of all 61 cases, there were 27 fibroadenomas, 13 fibrocystic diseases, 11 carcinomas, 8 abscesses, 1 sclerosing adenosis, and 1 intraductal papilloma. 2. Findings suggesting benignancy were smooth contour, round or oval shape, homogeneously echolucent internal echo, echogenic boundary echo, and posterior enhancement. In the cases of abscess, the findings were rather irregular contour, strong posterior enhancement, and dirty, inhomogeneous internal echo. While irregular and lobulated shape, inhomogeneous and mixed internal echo and pectoral muscle invasion were suggested for malignancy. 3. The sensitivity was 98% and the specificity 58% in benign mass excluding abscesses, 63% and 98% in abscesses, and 55% and 98% in carcinomas. In conclusion, ultrasonography is one of the excellent imaging modality for detecting breast lesions larger than 5 mm in size, but unfortunately some of the malignant tumors simulated benignancy, thus we considered fine needle aspiration biopsy and adjunctive imaging modalities such as film mammography must be followed for better detection of breast cancer.

Radiological appearances of papillary breast lesions

International Nuclear Information System (INIS)

Brookes, M.J.; Bourke, A.G.

2008-01-01

This review illustrates the varied appearances of benign and malignant papillary breast tumours, as identified by a breast cancer-screening programme. The commonest mammographic appearance of a papillary tumour is as a soft-tissue mass, with calcification present in less than half of cases. When calcification is present the pattern is variable, but clusters of pleomorphic calcification can occur, sometimes resembling the mammographic appearance of invasive ductal carcinoma. Ultrasonography of papillary lesions typically shows a solid, oval, intraductal mass, often associated with duct dilatation. A cystic component is also commonly seen, and lesions may appear hypervascular on colour Doppler ultrasound. Magnetic resonance imaging (MRI) has a high sensitivity, but low specificity for detecting papillary tumours, and is useful in establishing the extent and distribution of lesions in patients with multiple papillomatosis. Despite a benign histology on core biopsy, an argument exists for complete surgical excision of all papillary tumours, as a significant proportion of papillomas will contain foci of atypia or overt malignant change

Radiological appearances of papillary breast lesions

Energy Technology Data Exchange (ETDEWEB)

Brookes, M.J. [Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia (Australia)], E-mail: mattbrookes@doctors.org.uk; Bourke, A.G. [Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia (Australia)

2008-11-15

This review illustrates the varied appearances of benign and malignant papillary breast tumours, as identified by a breast cancer-screening programme. The commonest mammographic appearance of a papillary tumour is as a soft-tissue mass, with calcification present in less than half of cases. When calcification is present the pattern is variable, but clusters of pleomorphic calcification can occur, sometimes resembling the mammographic appearance of invasive ductal carcinoma. Ultrasonography of papillary lesions typically shows a solid, oval, intraductal mass, often associated with duct dilatation. A cystic component is also commonly seen, and lesions may appear hypervascular on colour Doppler ultrasound. Magnetic resonance imaging (MRI) has a high sensitivity, but low specificity for detecting papillary tumours, and is useful in establishing the extent and distribution of lesions in patients with multiple papillomatosis. Despite a benign histology on core biopsy, an argument exists for complete surgical excision of all papillary tumours, as a significant proportion of papillomas will contain foci of atypia or overt malignant change.

Diffusion magnetic resonance imaging of breast lesions: Initial ...

African Journals Online (AJOL)

Hebatallah Hassan Mamdouh Hassan

2013-03-31

Mar 31, 2013 ... DWI was acquired during diagnostic breast MRI using b = 0, 400 and 800 ... and characterization of breast cancer.2 Additional lesions seen by MRI that are not ... mammography and ultrasonography. Conventional DCE-.

Proliferative changes in nonpalpable breast lesions detected by mammography

International Nuclear Information System (INIS)

Vega, A.; Delgado, A.; Ortega, E.; Garijo, F.; Mosquera, J.; Sogo, C.; Alvarez, A.

2000-01-01

To analyze retrospectively the radiological findings in nonpalpable breast lesions detected by mammography that lead to the performance of surgical biopsy, resulting in a histological diagnosis of proliferative breast disease with and without atypia. From two Spanish hospitals, 421 women with 429 biopsies indicative of the presence of proliferative breast disease with and without atypia were selected out of a total of 1252 surgical biopsies in nonpalpable lesions that proved to be benign. Age, personal and familial history of breast cancer, reason for requesting the mammography and radiological findings that had indicated the need for surgical biopsy were recorded for each patient. The diagnosis was proliferative breast disease (epithelial hyperplasia) in 347 women with 354 biopsies and atypical hyperplasia in the remaining 74 women with 75 biopsies, representing 28% and 6%, respectively, of the 1252 biopsies of lesions found to be benign. In 221 of the 354 cases of epithelial hyperplasia (62%) and 45 of the 75 cases of atypical hyperplasia (60%), the presence of calcifications was the most common radiological findings leading to biopsy (p<0.05). Parenchymal distortion, with or without calcifications, was the second most common radiological sign. The histological study revealed a close relationship between these proliferative events and radial scars. Calcifications are the radiological finding that most frequently indicate the need for surgical biopsy in nonpalpable lesions that results in a diagnosis of proliferative breast disease with and without atypia. (Author) 12 refs

Uncommon breast lesions. Radiologic and pathologic findings

International Nuclear Information System (INIS)

Velasco, M.; Santamaria, G.; Pages, M.; Fernandez, P.; Farrus, B.

1998-01-01

To illustrate the radiologic findings in several uncommon breast and infrequent diseases that present with unusual mammographic images. We reviewed the mammograms performed in our department between 1998 and 1995, selecting 16 patients (12 women and 4 men). Nine patients had benign breast lesions (adenomyoepithelioma, epidermal cyst, adenoid cystic carcinoma, myofibroblastoma, multiple hamartomas, intra cystic papillomas, lipoma, idiopathic granulomatous mastitis and fat necrosis) and 7 patients presented malignant breast diseases (malignant fibrous histiocytoma, intra cystic carcinoma, primary lymphoma of the breast, liposarcoma and metastasis). We present a review of the radiologic and pathologic findings in several uncommon breast diseases. (Author) 14 refs

Radiological and surgical management of nonpalpable breast lesions

International Nuclear Information System (INIS)

Leinung, S.; Wuerl, P.; Preusse, C.; Boerner, P.; Schoenfelder, M.; Schneider, J.P.; Schmidt, F.; Guetz, U.

2000-01-01

In this retrospective study the results of surgical biopsy of suspected breast cancer in 319 outpatients are reported. In 113 cases (35.4%) the lesion was palpable, in 206 cases (64.6%) it was not. Concerning the nonpalpable lesions, mammography was performed in 98 patients (47.6%) for work-up of fibrocystic changes, in 41 patients (19.9%) for initial participation in a breast cancer prevention program, and in 33 patients (16.0%) for surveillance after breast conservation therapy. Prior to operation, 84.0% (n=173) of the nonpalpable lesions were detected by mammography, 11.2% (n=23) by sonography, and 4.8% (n=10) by magnetic resonance imaging. Intra-operative specimen mammography was carried out in every case detected by mammography. In 19.4% (n=40) of 206 nonpalpable lesions a malignant tumor was found. Twenty-five percent (n=10) of all marked tumors were diagnosed and treated as in-situ stage tumors, while 65% (n=26) were diagnosed and treated as tumors in the pT1 stage. As regards the nodal stage, 85% (n=34) of the tumors were diagnosed and treated as pN0 tumors, and 100% (n=40) were found to be free from any distant metastases. Consequently, for improving prognosis and, at the same time, for reducing the rate of breast amputations as a means of curative therapy of breast cancer, regular screening in defined risk groups is necessary. Surgical treatment of patients with small and nonpalpable findings should be reserved for departments with marking and quick-freezing facilities. (orig.) [de

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).

Science.gov (United States)

Rageth, Christoph J; O'Flynn, Elizabeth Am; Comstock, Christopher; Kurtz, Claudia; Kubik, Rahel; Madjar, Helmut; Lepori, Domenico; Kampmann, Gert; Mundinger, Alexander; Baege, Astrid; Decker, Thomas; Hosch, Stefanie; Tausch, Christoph; Delaloye, Jean-François; Morris, Elisabeth; Varga, Zsuzsanna

2016-09-01

The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group-a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

Diffusion magnetic resonance imaging of breast lesions: Initial ...

African Journals Online (AJOL)

Hebatallah Hassan Mamdouh Hassan

2013-03-31

Mar 31, 2013 ... breast cancer.2 Additional lesions seen by MRI that are not visible on ... characterization of lesions as benign or malignant on the basis ... lular density associated with numerous intact cell ..... ence for ADC values between the two MRI devices, the lesions .... Magnetic resonance imaging of brain and spine.

The research on distinguishing benign from malignant breast lesions by diffusion-weighted MR imaging

International Nuclear Information System (INIS)

Zhao Bin; Peng Hongjuan; Cai Shifeng; Gao Peihong

2005-01-01

Objective: To investigate the value of apparent diffusion coefficient (ADC) of diffusion- weighted magnetic resonance imaging (DW-MRI) in distinguishing benign from malignant breast lesions. Methods: ADC in 26 normal breasts, 24 malignant breast lesions, and 30 benign breast lesions confirmed by operation and pathology were calculated, respectively, and their differentiations in statistics were compared. The differentiations of different ADCs (b=1000-0, 500-0, 1000-500 s/mm 2 ) were also compared. EPI (TR 2900 ms, TE 84 ms, thickness 5 mm) was used in order to acquire the imaging. Results: There were significant differences among the ADC values of normal breast tissue, benign, and malignant lesions. The ADC of malignant lesions was lower than those of normal breast tissue and benign lesions, and the ADC of benign lesions was lower than that of normal breast tissue. There were significant differences among the ADC value of b=1000-0, 1000-500, and 500-0 s/mm 2 . The lower the b value, the higher the ADC. The sensitivity and specificity of ADC for the diagnosis of malignant lesion were 64% and 96.7% if the upper bound of 95% confidence interval was set as a differential level. Conclusion: The differentiation of benign from malignant breast lesions by ADC is applicable, although the sensitivity is low, the specificity is high. (authors)

Triple approach for diagnosing breast lesions-experience at a Tertiary Care Hospital

Directory of Open Access Journals (Sweden)

Ritu Mehta

2017-01-01

Full Text Available Background: Breast lesions are always a diagnostic challenge and range from benign to malignant. Fine-Needle Aspiration Cytology (FNAC is done in patients with breast lesions. However, to get an accurate and diagnostic yield is difficult at times. Aims: The aim of this study is to highlight the role of triple approach in diagnosing breast lesions. Design and Setting: This is an observational prospective study carried out in the Department of Pathology at a tertiary care hospital over 2 years. Materials and Methods: One hundred and fifty cases of breast lump were studied. Clinical findings, imaging findings, and cytology along with histopathological findings were correlated. Results: Cytological findings were benign in 102 out of 107 patients, who were otherwise clinically and radiologically benign. In rest five patients, Breast Imaging Reporting and Data Systems (BIRADS BIRADS II category was given on mammography. In four of these five patients, there was cytological atypia. Biopsy in these four patients showed features of fibroadenoma with mild cytological atypia and one patient showed infiltrating duct carcinoma. Mammography was suggestive of malignant breast lump in 43 patients. In three patients, breast lump was diagnosed as benign on cytological examination. However, histopathological examination confirmed the mammography findings of malignancy. Conclusion: FNAC is a well-established procedure for diagnosing breast lesion but has got many pitfalls. Hence for diagnosis a breast lesion, the triple approach consisting of histopathological examination in addition to mammography and FNAC, should be considered.

Expression of c-kit in common benign and malignant breast lesions.

Science.gov (United States)

Kondi-Pafiti, Agatha; Arkadopoulos, Nikolaos; Gennatas, Constantinos; Michalaki, Vassiliki; Frangou-Plegmenou, Matrona; Chatzipantelis, Paschalis

2010-01-01

c-kit (CD117) is a transmembrane tyrosine kinase that acts as a type III receptor for mast cell growth factor. In recent years, the role of c-kit in the development of preinvasive and invasive breast carcinomas has been investigated. The aim of our study was to detect c-kit expression in the entire spectrum of common benign and malignant breast lesions in correlation with a well-studied myoepithelial or stem-cell like marker (p63). We evaluated 270 cases of benign and malignant breast lesions including fibrocystic disease, fibroadenoma, sclerosing adenosis, atypical ductal hyperplasia, ductal/lobular carcinoma in situ, and ductal/lobular/mixed type carcinoma. C-kit staining was evaluated in the cytoplasm/cell membrane in epithelial and myoepithelial cells and p63 in the nuclei of myoepithelial cells. c-kit was highly expressed (85.3%) in benign lesions (fibrocystic disease, sclerosing adenosis, fibroadenoma), and p63 expression was 95.5% in the aforementioned lesions. c-kit distribution in preinvasive and invasive lesions was as follows: ductal/lobular carcinoma in-situ, 43%/35%; ductal/lobular carcinoma, 36%/39%; and mixed type carcinoma, 20%. c-kit was highly expressed in myofibroblast/fibroblast cells only in grade III ductal/lobular carcinomas. c-kit was totally absent in stromal cells in benign lesions and in situ carcinomas whereas expression was weak in grade I and II carcinomas. Combined overexpression of c-kit and p63 is indicative of benign breast lesions. In contrast, there is reduced expression of c-kit in in situ and invasive breast carcinomas, with simultaneous overexpression in the stromal cells. This suggests that c-kit may play a role in breast cancer progression.

Role of multidetector computed tomography in evaluating incidentally detected breast lesions.

Science.gov (United States)

Moschetta, Marco; Scardapane, Arnaldo; Lorusso, Valentina; Rella, Leonarda; Telegrafo, Michele; Serio, Gabriella; Angelelli, Giuseppe; Ianora, Amato Antonio Stabile

2015-01-01

Computed tomography (CT) does not represent the primary method for the evaluation of breast lesions; however, it can detect breast abnormalities, even when performed for other reasons related to thoracic structures. The aim of this study is to evaluate the potential benefits of 320-row multidetector CT (MDCT) in evaluating and differentiating incidentally detected breast lesions by using vessel probe and 3D analysis software with net enhancement value. Sixty-two breast lesions in 46 patients who underwent 320-row chest CT examination were retrospectively evaluated. CT scans were assessed searching for the presence, location, number, morphological features, and density of breast nodules. Net enhancement was calculated by subtracting precontrast density from the density obtained by postcontrast values. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CT were calculated for morphological features and net enhancement. Thirty of 62 lesions were found to be malignant at histological examination and 32 were found to be benign. When morphological features were considered, the sensitivity, specificity, accuracy, PPV, and NPV of CT were 87%, 100%, 88%, 100%, and 50%, respectively. Based on net enhancement, CT reached a sensitivity, specificity, accuracy, PPV, and NPV of 100%, 94%, 97%, 94%, and 100%, respectively. MDCT allows to recognize and characterize breast lesions based on morphological features. Net enhancement can be proposed as an additional accurate feature of CT.

Usefulness of US-guided automated gun biopsy of nonpalpable breast lesions

Energy Technology Data Exchange (ETDEWEB)

Kwak, Min Sook; Kim, Hak Soo; Lee, Han Kyung; Koh, Sung Hye; O, Eun Young; Yoon, Myung Hwan; Yang, Dal Mo; Kim, Hyung Sik [Chungang Gil Hospital, Incheon (Korea, Republic of)

1997-11-01

To evaluate the clinical usefulness of ultrasonography(US)-guided automated gun biopsy of nonpalpable breast lesions. In 30 nonpalpable breast lesions over 0.6cm and detected on US, we performed US-guided biopsy using an 18-gauge automated biopsy gun. Two to four specimens were obtained from each lesion. We analyzed the site, size and depth of the lesions, and the length and histopathologic results of the specimens. In four lesions, surgical biopsy and gun biopsy results were compared. In 29 of 30 lesions(96.7%), specimens were adequate for histopathologic diagnosis, and this was as follows : one case of infiltrating ductal carcinoma, 13 of fibrocystic disease, 10 of fibrocystic disease versus fibroadenoma and one of fibrodenoma. There was also one reactive hyperplasia of LN, and one fatty one and two normal tissues, and in these four lesions, agreement between gun and surgical biopsy results was 100%. The only complication was minor bleeding, which was controlled by compression. US-guided automated gun biopsy is a clinically useful and safe procedure for evaluating nonpalpable breast lesions detected on US.

Usefulness of US-guided automated gun biopsy of nonpalpable breast lesions

International Nuclear Information System (INIS)

Kwak, Min Sook; Kim, Hak Soo; Lee, Han Kyung; Koh, Sung Hye; O, Eun Young; Yoon, Myung Hwan; Yang, Dal Mo; Kim, Hyung Sik

1997-01-01

To evaluate the clinical usefulness of ultrasonography(US)-guided automated gun biopsy of nonpalpable breast lesions. In 30 nonpalpable breast lesions over 0.6cm and detected on US, we performed US-guided biopsy using an 18-gauge automated biopsy gun. Two to four specimens were obtained from each lesion. We analyzed the site, size and depth of the lesions, and the length and histopathologic results of the specimens. In four lesions, surgical biopsy and gun biopsy results were compared. In 29 of 30 lesions(96.7%), specimens were adequate for histopathologic diagnosis, and this was as follows : one case of infiltrating ductal carcinoma, 13 of fibrocystic disease, 10 of fibrocystic disease versus fibroadenoma and one of fibrodenoma. There was also one reactive hyperplasia of LN, and one fatty one and two normal tissues, and in these four lesions, agreement between gun and surgical biopsy results was 100%. The only complication was minor bleeding, which was controlled by compression. US-guided automated gun biopsy is a clinically useful and safe procedure for evaluating nonpalpable breast lesions detected on US

Stereotaxic Fine-Needle Aspiration Cytologic Evaluation of Non-palpable Breast Lesions

Directory of Open Access Journals (Sweden)

M Haghighi

2005-07-01

Full Text Available Background: Although long-term mammography is the standard means of evaluation for the probably benign lesions of breast, some times we feel obliged to know about the benignity and the extent of lesions earlier. Therefore we evaluated the diagnostic value of stereotaxic fine-needle aspiration (SFNA in low suspicion breast lesions as an alternative to the routine modality. Methods: The study included 150 low-suspicion or probably benign breast lesions detected on mammography. All cases underwent SFNA and followed by exciosional biopsy or follow-up mammography based on SFNA findings. Results: Fibroadenoma and normal tissue lesions were diagnosed in 57% of patients, in whom no evidence of malignancy was found in the follow-up period. In 48 patients with cytologic findings suggestive of proliferative fibrocystic disease, three cases of malignancy were detected by excisional biopsy. Conclusion: A SFNA result suggesting benignity allows safe clinical follow-up, whereas a suspicious or equivocal diagnosis needs more invasive modalities for further investigations. Key words: Breast, Mammography, Stereotaxic, Fine-Needle Aspiration (FNA

Benign breast lesions in Bayelsa State, Niger Delta Nigeria: a 5 year multicentre histopathological audit.

Science.gov (United States)

Uwaezuoke, Stanley Chibuzo; Udoye, Ezenwa Patrick

2014-01-01

There has been no previous study to classify benign breast lesions in details based on histopathologically confirmed diagnosis in Bayelsa State, Nigeria. This study therefore aims to review all cases of benign breast lesions seen in all the three centres in Bayelsa State with histopathology services over a five year period for a comprehensive baseline data in our community for management, research and education. This is a multicentre retrospective descriptive study based on histopathological diagnosed benign breast lesions from January 2009 to December 2013. Archival results and slides on benign breast lesions were retrieved and analysed using simple statistical methods. A total of 228 benign breast lesions (68.3%) were seen among 334 histopathologically diagnosed breast diseases. The male to female ratio was 19.7:1. Peak age incidence was the third decade (43%) with a mean age of 29.1years. Fibroadenoma was the most common benign breast disease (BBD) accounting for 45.6% of all the cases followed by fibrocystic change (23.1%). The mean ages of fibroadenoma and fibrocystic change were 23.1years and 31.1years respectively. Inflammatory breast lesions constituted 8.3%. We recorded only 2 cases (0.9%) of atypical ductal hyperplasia (ADH) with no case of atypical lobular hyperplasia (ALH) within the study period. Gynaecomastia (4%) was the main male breast lesion in the study. Benign breast diseases are the most common breast lesions in Bayelsa State. Fibroadenoma is the most common lesion followed by fibrocystic change. The incidence of atypical hyperplasia recorded was rather low in the state.

Use of shear wave elastography to differentiate benign and malignant breast lesions.

Science.gov (United States)

Çebi Olgun, Deniz; Korkmazer, Bora; Kılıç, Fahrettin; Dikici, Atilla Süleyman; Velidedeoğlu, Mehmet; Aydoğan, Fatih; Kantarcı, Fatih; Yılmaz, Mehmet Halit

2014-01-01

We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions. A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied. Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%). SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.

CT-guided preoperative needle localization of MRI-detected breast lesions

Energy Technology Data Exchange (ETDEWEB)

Giagounidis, Elektra M. E-mail: giagounjdis@online.de; Markus, Ruwe; Josef, Luetzeler; Wemer, Audretsch; Mahdi, Rezai; Bernward, Kurtz

2001-08-01

To assess the value of accurate preoperative CT-guided needle localization of occult breast lesions, we reviewed a total of 39 needle-directed biopsies of breast tumors in 24 women. The average age was 52.9 years (range 31-67). All lesions were nonpalpable and mammographically, as well as sonographically occult. They were solely seen on MR-images. After demonstrating the suspicious region on CT scans, a hookwire was inserted. The correct position was confirmed by a control scan. The subsequent histopathological examination showed that 28 of the lesions (71.8%) were benign, among them mastopathy, fibrosis, fibroadenoma, papilloma, intramammary lymph node, liponecrosis and epitheliosis. Eleven lesions (28%) were malignant and showed either lobular, ductal or tubular cancer. Our results endorse that CT guided needle localization is a helpful method that allows a precise surgical excision of the suspect area with the removal of a minimal amount of breast tissue.

Mammographic classification of breast lesions amongst women in ...

African Journals Online (AJOL)

Objectives: The study was to classify lesions identified on mammograms using Breast Imaging Reporting and Data System (BIRADS) grading method. This was in view of ascertaining the rate of occurrence of breast malignancy of the studied population. Methods: A retrospective cohort study of 416 mammographic reports of ...

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound.

Science.gov (United States)

Luciani, M L; Pediconi, F; Telesca, M; Vasselli, F; Casali, V; Miglio, E; Passariello, R; Catalano, C

2011-09-01

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI). Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up. Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered. Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.

Computerized Analysis of MR and Ultrasound Images of Breast Lesions

National Research Council Canada - National Science Library

Giger, Maryellen Lissak

2000-01-01

...) images of breast lesions to aid radiologists in their workup of suspect lesions. We currently have retrospectively collected over 400 ultrasound cases of mass lesions, all that had gone on to either biopsy or cyst aspiration...

US-guided preoperative hook-wire localization of nonpalpable breast lesions

International Nuclear Information System (INIS)

Shin, Tae Beom; Lee, Sang Kwon; Kim, Hye Jung; Ryeom, Hun Kyu; Kim, Tae Hun; Kim, Yong Ju; Kang, Duk Sik; Lee, Young Ha; Park, Ho Yong

2000-01-01

To evaluate the feasibility and efficacy of US-guided preoperative wire localization of nonpalpable breast lesions. US-guided preoperative wire localization was performed upon 45 nonpalpable breast lesions including 14 nonpalpable masses, 11 nonpalpable masses with microcalcifications, 11 ductal lesions, 9 with microcalcifications. No local anesthesia was performed during the localization procedure. Under the US-guidance, the needle with the hook-wire was inserted into the lesion until the hook of the wire reached 1 cm beyond the posterior margin of the lesion. Precise wire positioning was confirmed by mammography. Specimen radiography or specimen ultrasonography was performed in all cases. US-guided preoperative wire localization was successfully achieved in all cases. The time required for US-guided wire localization was less than five minutes. All lesions were successfully removed by surgical excision. Successful removal was confirmed by specimen radiography or specimen ultrasonography, gross findings of the specimen and consistency between radiographic and pathologic findings. The histologic diagnosis of 45 lesions were 7 ductal carcinoma in situ, 8 invasive ductal carcinoma, 6 fibroadenoma, 8 intraductal papilloma, 2 atypical ductal hyperplasia, and 14 fibrocystic changes. No complications were occurred during and after the procedure. US-guided preoperative wire localization for excisional biopsy is simple, safe, and accurate method in the histologic diagnosis of nonpalpable breast lesions detectable with ultrasonography.

US-guided preoperative hook-wire localization of nonpalpable breast lesions

Energy Technology Data Exchange (ETDEWEB)

Shin, Tae Beom; Lee, Sang Kwon; Kim, Hye Jung; Ryeom, Hun Kyu; Kim, Tae Hun; Kim, Yong Ju; Kang, Duk Sik; Lee, Young Ha; Park, Ho Yong [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)

2000-12-15

To evaluate the feasibility and efficacy of US-guided preoperative wire localization of nonpalpable breast lesions. US-guided preoperative wire localization was performed upon 45 nonpalpable breast lesions including 14 nonpalpable masses, 11 nonpalpable masses with microcalcifications, 11 ductal lesions, 9 with microcalcifications. No local anesthesia was performed during the localization procedure. Under the US-guidance, the needle with the hook-wire was inserted into the lesion until the hook of the wire reached 1 cm beyond the posterior margin of the lesion. Precise wire positioning was confirmed by mammography. Specimen radiography or specimen ultrasonography was performed in all cases. US-guided preoperative wire localization was successfully achieved in all cases. The time required for US-guided wire localization was less than five minutes. All lesions were successfully removed by surgical excision. Successful removal was confirmed by specimen radiography or specimen ultrasonography, gross findings of the specimen and consistency between radiographic and pathologic findings. The histologic diagnosis of 45 lesions were 7 ductal carcinoma in situ, 8 invasive ductal carcinoma, 6 fibroadenoma, 8 intraductal papilloma, 2 atypical ductal hyperplasia, and 14 fibrocystic changes. No complications were occurred during and after the procedure. US-guided preoperative wire localization for excisional biopsy is simple, safe, and accurate method in the histologic diagnosis of nonpalpable breast lesions detectable with ultrasonography.

Adjuvant chemotherapy with sequential or concurrent anthracycline and docetaxel: Breast International Group 02-98 randomized trial

DEFF Research Database (Denmark)

Francis, P.; Crown, J.; Di, Leo A.

2008-01-01

BACKGROUND: Docetaxel is more effective than doxorubicin for patients with advanced breast cancer. The Breast International Group 02-98 randomized trial tested the effect of incorporating docetaxel into anthracycline-based adjuvant chemotherapy and compared sequential vs concurrent administration....... However, important differences may be related to doxorubicin and docetaxel scheduling, with sequential but not concurrent administration, appearing to produce better DFS than anthracycline-based chemotherapy Udgivelsesdato: 2008/1/16...

A computer simulation study comparing lesion detection accuracy with digital mammography, breast tomosynthesis, and cone-beam CT breast imaging

International Nuclear Information System (INIS)

Gong Xing; Glick, Stephen J.; Liu, Bob; Vedula, Aruna A.; Thacker, Samta

2006-01-01

Although conventional mammography is currently the best modality to detect early breast cancer, it is limited in that the recorded image represents the superposition of a three-dimensional (3D) object onto a 2D plane. Recently, two promising approaches for 3D volumetric breast imaging have been proposed, breast tomosynthesis (BT) and CT breast imaging (CTBI). To investigate possible improvements in lesion detection accuracy with either breast tomosynthesis or CT breast imaging as compared to digital mammography (DM), a computer simulation study was conducted using simulated lesions embedded into a structured 3D breast model. The computer simulation realistically modeled x-ray transport through a breast model, as well as the signal and noise propagation through a CsI based flat-panel imager. Polyenergetic x-ray spectra of Mo/Mo 28 kVp for digital mammography, Mo/Rh 28 kVp for BT, and W/Ce 50 kVp for CTBI were modeled. For the CTBI simulation, the intensity of the x-ray spectra for each projection view was determined so as to provide a total average glandular dose of 4 mGy, which is approximately equivalent to that given in conventional two-view screening mammography. The same total dose was modeled for both the DM and BT simulations. Irregular lesions were simulated by using a stochastic growth algorithm providing lesions with an effective diameter of 5 mm. Breast tissue was simulated by generating an ensemble of backgrounds with a power law spectrum, with the composition of 50% fibroglandular and 50% adipose tissue. To evaluate lesion detection accuracy, a receiver operating characteristic (ROC) study was performed with five observers reading an ensemble of images for each case. The average area under the ROC curves (A z ) was 0.76 for DM, 0.93 for BT, and 0.94 for CTBI. Results indicated that for the same dose, a 5 mm lesion embedded in a structured breast phantom was detected by the two volumetric breast imaging systems, BT and CTBI, with statistically

Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation.

Science.gov (United States)

Bayat, Mahdi; Denis, Max; Gregory, Adriana; Mehrmohammadi, Mohammad; Kumar, Viksit; Meixner, Duane; Fazzio, Robert T; Fatemi, Mostafa; Alizad, Azra

2017-01-01

Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE) performance in differentiating breast masses. With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19-85 years, mean 59.93±14.96 years) with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm) were analyzed. CUSE was performed on all patients. Three regions of interest (ROI), 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young's modulus. In correlation to pathology results, statistical analyses were performed. Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3) were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108), 89.92% specificity (107 of 119), 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P 0.21). CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their stiffness.

Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation.

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Mahdi Bayat

Full Text Available Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE performance in differentiating breast masses.With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19-85 years, mean 59.93±14.96 years with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm were analyzed. CUSE was performed on all patients. Three regions of interest (ROI, 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young's modulus. In correlation to pathology results, statistical analyses were performed.Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3 were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108, 89.92% specificity (107 of 119, 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P 0.21.CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their stiffness.

Primary lymphoma of the breast involving both axillae with bilateral breast carcinoma

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Rubin Gary

2008-05-01

Full Text Available Abstract Background Primary Non-Hodgkin's Lymphoma (PHNL of the breast is a rare entity, while secondary involvement of the breast with diffuse disease of Non-Hodgkin's lymphoma (NHL is more common. However, PNHL is the most frequent haematopoietic tumour of the breast. Diagnostic criteria for PNHL of the breast are presence of technically adequate pathologic specimens, close association of mammary tissue and lymphomatous infiltrate, no prior diagnosis of an extarammamary lymphoma, and no evidence of concurrent widespread disease, except for ipsilateral axillary lymph nodes if concomitant with the primary lesion. Case presentation A 57-year-old woman was recalled because her screening mammograms revealed three separate lesions in her right breast and one in the left. Histology of the lesions confirmed lymphoma in one breast with ductal carcinoma in the other. Conclusion Most of reported cases in literature have been involving the right breast, and almost all the patients were females. NHLs of the breast typically present as unilateral mass; the frequency of bilateral disease at first presentation ranges from 5–25%. Our objective is to report a case of primary lymphoma of the breast involving both axillae with concomitant bilateral primary breast cancer which has not been reported yet to our best of knowledge in literature.

Radioguided breast surgery for occult lesion localization – correlation between two methods

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Gutfilen Bianca

2008-08-01

Full Text Available Abstract Background The detection of sub-clinical breast lesions has increased with screening mammography. Biopsy techniques can offer precision and agility in its execution, as well as patient comfort. This trial compares radioguided occult lesion localization (ROLL and wire-guided localization (WL of breast lesions. We investigate if a procedure at the ambulatorial level (ROLL could lead to a better aesthetic result and less postoperative pain. In addition, we intend to demonstrate the efficacy of radioguided localization and removal of occult breast lesions using radiopharmaceuticals injected directly into the lesions and correlate radiological and histopathological findings. Methods One hundred and twenty patients were randomized into two groups (59 WL and 61 ROLL. The patients were requested to score the cosmetic appearance of their breast after surgery, and a numerical rating scale was used to measure pain on the first postoperative day. Clearance margins were considered at ≥ 10 mm for invasive cancer, ≥ 5 mm for ductal carcinoma in situ, and ≥ 1 mm for benign disease. Patients were subsequently treated according to the definitive histological result. When appropriate, different statistical tests were used in order to test the significance between the two groups, considering a P value Results WL and ROLL located all the occult breast lesions successfully. In the ROLL group, the specimen volume was smaller and there were more cases with clear margins (P Conclusion ROLL is an effective method for the excision of non-palpable breast lesions. It enables more careful planning of the cutaneous incision, leading to better aesthetic results, less postoperative symptoms, and smaller volumes of excised tissue.

Ultrasound-guided, vacuum-assisted biopsy in evaluation of breast lesions

International Nuclear Information System (INIS)

Luczynska, E.; Kocurek, A.; Dyczek, S.; Skotnicki, P.; Stelmach, A.; Herman, K.

2008-01-01

Aim. Evaluation of the efficacy of ultrasound-guided vacuum-assisted biopsy for the verification of breast lesions. Introduction. Ultrasound breast examination is a noninvasive method of breast imaging. It is adjunct to mammography and physical examination and, in women under 30 years of age, pregnant and lactating, it is the basic examination used for the detection and diagnosing of breast diseases. It allows also to obtain cells or tissue samples with such minimally invasive techniques as fine-needle biopsy, core needle biopsy or vacuum-assisted biopsy. Material and methods. The study group consisted of 138 women, aged from 20 to 76 years, who underwent ultrasound guided vacuum-assisted biopsy between March and December 2006. Because double lesions were diagnosed in 6 patients, this resulted in 144 performed procedures. Each patient underwent ultrasound examination, performed with a 10-12 MHz transducer. Biopsies were guided by a 12 MHz transducer and performed with the Mammotome System using an 11G or an 8G needle, depending upon the size and site of the lesion. Obtained data were compared using the Chi-square test; p values of less than 0.05 were considered indicative of a significant difference. Results. The average size of the biopted lesions was estimated as 11±3,8 mm (range: 4-30 mm). However, lesions described by radiologists as apparently suspicious were not qualified for the vacuum-assisted biopsy, in the tested material 4 lesions appeared to be carcinomas (3 were invasive breast carcinomas and 1 was ductal carcinoma in situ). When compared with other changes, these lesions were most frequently equivocal (3 vs 1 determined as benign, p=0.014). There was no statistically significant difference in echogenicity (3 hypoechoic vs 1 with mixed echogenicity) nor in the shape (1 oval change, 2 lobulated and 1 irregular). Pathological examination revealed 86 cases of fibroadenoma within the tested material. Those lesions were mostly benign (77 vs 9 equivocal

Interobserver agreement for sonograms of breast lesions obtained by an automated breast volume scanner

International Nuclear Information System (INIS)

Zhang, Jing; Lai, Xing-Jian; Zhu, Qing-Li; Wang, Hong-Yan; Jiang, Yu-Xin; Liu, He; Dai, Qing; You, Shan-Shan; Xiao, Meng-Su

2012-01-01

Objective: To evaluate the interobserver agreement of radiologists in the description and final assessment of breast sonograms obtained using an automated breast volume scanner (ABVS) using a unique descriptor of three-dimensional ultrasound (3D US) and the Breast Imaging Reporting and Data System (BI-RADS) US lexicon. Methods: From October to December 2010, 208 patients were subjected to an ABVS examination in the supine position, and data were automatically sent to the ABVS workstation. Two radiologists independently evaluated 234 breast masses (148 benign and 86 malignant masses) using a unique descriptor from the 3D US and the BI-RADS US lexicon. The reviewers were blinded to the patient's mammographic images, medical history, and pathologic findings. The interobserver agreement was measured using kappa statistics. Results: Substantial agreement was obtained for lesion shape, orientation, margin, echo pattern, posterior acoustic features, calcification and final assessment (κ = 0.79, 0.74, 0.76, 0.69, 0.68, 0.71 and 0.70, respectively). Fair agreement was obtained for retraction phenomenon and lesion boundary (κ = 0.54 and 0.42, respectively). Conclusions: The interobserver agreement for breast sonograms obtained by ABVS is good, especially for lesion shape and margin; however, the interobserver agreement for the retraction phenomenon, which is a unique descriptor of coronal-plane 3D US, needs to be improved

Digital breast tomosynthesis (DBT) to characterize MRI-detected additional lesions unidentified at targeted ultrasound in newly diagnosed breast cancer patients

International Nuclear Information System (INIS)

Mariscotti, Giovanna; Durando, Manuela; Regini, Elisa; Fornari, Alberto; Fonio, Paolo; Gandini, Giovanni; Houssami, Nehmat; Campanino, Pier Paolo; Bussone, Riccardo; Castellano, Isabella; Sapino, Anna

2015-01-01

Preoperative breast magnetic resonance (MR) often generates additional suspicious findings needing further investigations. Targeted breast ultrasound (US) is the standard tool to characterize MR additional lesions. The purpose of this study is to evaluate the potential role of digital breast tomosynthesis (DBT) to characterize MR detected additional findings, unidentified at targeted breast US. This prospective study included women who a) had biopsy-proven, newly diagnosed breast cancers detected at conventional 2D mammography and/or US, referred to breast MR for tumour staging; and b) had DBT if additional MR findings were not detected at targeted ('second look') US. In 520 patients, MR identified 164 (in 114 women, 22 %) additional enhancing lesions. Targeted US identified 114/164 (69.5 %) of these, whereas 50/164 (30.5 %) remained unidentified. DBT identified 32/50 of these cases, increasing the overall characterization of MR detected additional findings to 89.0 % (146/164). Using DBT the identified lesions were significantly more likely to be malignant than benign MR-detected additional lesions (p = 0.04). DBT improves the characterization of additional MR findings not identified at targeted breast US in preoperative breast cancer staging. (orig.)

Digital breast tomosynthesis (DBT) to characterize MRI-detected additional lesions unidentified at targeted ultrasound in newly diagnosed breast cancer patients

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Mariscotti, Giovanna; Durando, Manuela; Regini, Elisa; Fornari, Alberto; Fonio, Paolo; Gandini, Giovanni [Breast Imaging Service, Radiology - University of Turin, Department of Diagnostic Imaging and Radiotherapy, A.O.U. Citta della Salute e della Scienza, Torino (Italy); Houssami, Nehmat [University of Sydney, Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, Sydney, NSW (Australia); Campanino, Pier Paolo [Ospedale Koelliker, Breast Imaging Service, Torino (Italy); Bussone, Riccardo [A.O.U. Citta della Salute e della Scienza of Turin, SSCVD Breast Surgery. Department of Surgery, Torino (Italy); Castellano, Isabella; Sapino, Anna [University of Turin, Department of Biomedical Sciences and Human Oncology, A.O.U. Citta della Salute e della Scienza, Torino (Italy)

2015-09-15

Preoperative breast magnetic resonance (MR) often generates additional suspicious findings needing further investigations. Targeted breast ultrasound (US) is the standard tool to characterize MR additional lesions. The purpose of this study is to evaluate the potential role of digital breast tomosynthesis (DBT) to characterize MR detected additional findings, unidentified at targeted breast US. This prospective study included women who a) had biopsy-proven, newly diagnosed breast cancers detected at conventional 2D mammography and/or US, referred to breast MR for tumour staging; and b) had DBT if additional MR findings were not detected at targeted ('second look') US. In 520 patients, MR identified 164 (in 114 women, 22 %) additional enhancing lesions. Targeted US identified 114/164 (69.5 %) of these, whereas 50/164 (30.5 %) remained unidentified. DBT identified 32/50 of these cases, increasing the overall characterization of MR detected additional findings to 89.0 % (146/164). Using DBT the identified lesions were significantly more likely to be malignant than benign MR-detected additional lesions (p = 0.04). DBT improves the characterization of additional MR findings not identified at targeted breast US in preoperative breast cancer staging. (orig.)

Comparative study between breast tomosynthesis and classic digital mammography in the evaluation of different breast lesions

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Sahar Mansour

2014-09-01

Conclusion: Three-dimensional tomosynthesis significantly enhanced the detection and characterization of breast lesions on digital mammography especially in the context of dense breast parenchyma (ACR 3&4.

Categorization and evaluation of usefulness of breast lesions with using ultrasound BI-RADS (breast imaging reporting and data system)

International Nuclear Information System (INIS)

Kim, Youn Jeong; Choi, Hye Young; Moon, Byung In; Lee, Shi Nae

2006-01-01

The aim of our study was to determine the positive predictive value (PPV) and to evaluate the usefulness on ultrasound BI-RADS, as compared with the histologic results of breast lesions that were categorized and classified by the ultrasound BI-RADS lexicon. Between January and December 2004, the ultrasound features of 471 breast lesions in 368 patients were analyzed and categorized with using ultrasound BI-RADS. All of the lesions were compared with the histological results. We categorized category 2 and 3 lesions as benign lesions, and category 4 and 5 lesions as malignant lesions. We then calculated the sensitivity, specificity, positive, predictive value, negative predictive value and accuracy. The breast lesions were histologically diagnosed as 298 cases of category 2, 21 cases of category 3, 108 cases of category 4 and 44 cases of category 5. The categorical malignancy rate was 1% (3/298) in category 2 lesions, 4.7% (1/21) in category 3 lesions, 8.3% (9/108) in category 4 lesions and 90.9% (40/44) in category 5 lesions. Within category 4, the malignancy rate for category 4a lesions was 5.4% (5/92), the malignancy rate for category 4b lesions was 1.3% (1/8) and the malignancy rate for category 4c lesions was 50% (4/8). The sensitivity, specificity, positive predictive value and negative predictive value were 90.6%, 75.1%, 31.6% and 98.4%, respectively. The statistically valid ultrasound features that were correlated with malignancy were an ill defined margin, a microlobulated mass, an irregular mass, inhomogenic echogenicity, an echogenic halo and an older patient age. Ultrasound BI-RADS was useful in differentiating benign from malignant breast lesions

Concurrent fibroadenoma and intraductal papilloma - A recurring complex lesion in a premenarcheal girl.

Science.gov (United States)

Alessandrini, Lara; Gobbi, Dalia; Zanon, Giovanni Franco; Dall'Igna, Patrizia; Cecchetto, Giovanni; Alaggio, Rita

2013-02-15

Breast diseases are rare in childhood and adolescence, most lesions being fibroadenomas and papillomas. We report the case of an 11-year old girl with a complex breast lesion with hybrid features of fibroadenoma and intraductal papilloma with an early recurrence. Microscopically, the lesion was composed of dilated ducts showing intraluminal papillary projections with small to broad fibrovascular stalks. The typical leaf-like appearance of fibroadenoma was determined by the presence at the periphery of ducts compressed and distorted by the prominent stromal component. Despite its florid epithelial hyperplasia and mild cytological atypia (more evident in the relapse), immunohistochemical staining for p63 and smooth muscle actin highlighted a continuum outer myoepithelial layer, confirming the non-invasive appearance of the lesion. Two pathogenetic links have been hypothesized: one is based on the morphological continuum between these two entities, which may represent different evolutive stages in the same lesion; the other is based on epithelial/mesenchymal interactions. The possible malignant transformation of such complex lesion is also discussed, along with its differential diagnoses. The relevance of this case lies in its rarity, as well as in the therapeutic strategies related to its biological potential and to the necessity of a conservative treatment, due to the young age of the patient. Copyright © 2012. Published by Elsevier GmbH.

The diagnosis and management of pre-invasive breast disease: Promise of new technologies in understanding pre-invasive breast lesions

International Nuclear Information System (INIS)

Jeffrey, Stefanie S; Pollack, Jonathan R

2003-01-01

Array-based comparative genomic hybridization, RNA expression profiling, and proteomic analyses are new molecular technologies used to study breast cancer. Invasive breast cancers were originally evaluated because they provided ample quantities of DNA, RNA, and protein. The application of these technologies to pre-invasive breast lesions is discussed, including methods that facilitate their implementation. Data indicate that atypical ductal hyperplasia and ductal carcinoma in situ are precursor lesions molecularly similar to adjacent invasive breast cancer. It is expected that molecular technologies will identify breast tissue at risk for the development of unfavorable subtypes of invasive breast cancer and reveal strategies for targeted chemoprevention or eradication

Application of the diffusion kurtosis model for the study of breast lesions

International Nuclear Information System (INIS)

Nogueira, Luisa; Brandao, Sofia; Loureiro, Joana; Matos, Eduarda; Nunes, Rita Gouveia; Ferreira, Hugo Alexandre; Ramos, Isabel

2014-01-01

To evaluate diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in the differentiation and characterisation of breast lesions. Thirty-six women underwent breast magnetic resonance imaging (MRI) including a DWI sequence with multiple b-values (50-3,000 s/mm 2 ). Mean values for apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated by lesion type and histological subtype. Differences and correlation between parameters were determined. Forty-four lesions were found. There were significant differences between benign and malignant lesions for all parameters (ADC, p = 0.017; MD, p = 0.028; MK, p = 0.017). ADC and MD were higher for benign (1.96 ± 0.41 x 10 -3 and 2.17 ± 0.42 x 10 -3 mm 2 /s, respectively) than for malignant lesions (1.33 ± 0.18 x 10 -3 and 1.52 ± 0.50 x 10 -3 mm 2 /s). MK was higher for malignant (0.61 ± 0.27) than benign lesions (0.37 ± 0.18). We found differences between invasive ductal carcinoma (IDC) and fibroadenoma (FA) for all parameters (ADC, MD and MK): p = 0.016, 0.022 and 0.016, respectively. FA and fibrocystic change (FC) showed differences only in MK (p = 0.016). Diffusion in breast lesions follows a non-Gaussian distribution. MK enables differentiation and characterisation of breast lesions, providing new insights into microstructural complexity. To confirm these results, further investigation in a broader sample should be performed. (orig.)

Significance of β-tubulin Expression in Breast Premalignant Lesions and Carcinomas

Institute of Scientific and Technical Information of China (English)

Yuxia Gao; Yun Niu; Xiumin Ding; Yong Yu

2008-01-01

OBJECTIVE To explore the expression of β-tubulin in premalignant lesions and carcinomas of the breast, and to observe the relationship of its expression with breast cancer pathological features.METHODS The expression of β-tubulin was detected immunohistochemically in 50 specimens of premalignant lesions of the breast (ADH and Peri-PM with ADH), 50 specimens of breast in situ ductal carcinomas (DCIS), and 50 specimens of invasive ductal carcinomas (IDC). Thirty specimens of normal breast tissues served as a control group.RESULTS Immunohistochemical analysis showed that: the differences among the 4 groups (normal breast tissues, breast premalignant lesions, DCIS and IDC, P ＜ 0.05) were significant,and there were also statistically significant differences between any 2 groups (P ＜ 0.05) except for the β-tubulin positive expression comparing DCIS versus IDC (P ＞ 0.05). In addition, β-tubulin was expressed at a higher level in Peri-PM with ADH compared to ADH (P ＜ 0.05). Following the degree of breast epithelial hyperplasia involved, and its development into carcinoma, the β-tubulin positive expression displayed an elevating tendency.We also found a significant positive relationship of β-tubulin expression with lymph node metastasis (P ＜ 0.05), but no significant correlation with histological grading and nuclear grade.CONCLUSION Centrosome defects may be an early event in the development of breast cancer and they can also promote tumor progression. Studies of aberrations of centrosomal proteins provide a new way to explore the mechanism of breast tumorigenesis.

A PROSPECTIVE COHORT STUDY OF CYSTIC LESIONS OF THE BREAST, THEIR TYPES AND MANAGEMENT

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Geethakumari G. R

2017-06-01

Full Text Available BACKGROUND Mass lesions of the breast require sonological evaluation in women of any age group. It is difficult to reach a diagnosis of the cause of the mass lesion without ultrasonographic correlation. This study aims at evaluating subjects who underwent ultrasonography for evaluation of cystic mass lesion of the breast. Objective- To evaluate subjects presented with cystic lesions of the breast using ultrasonography and to understand the management of different types of cystic lesions of breast. MATERIALS AND METHODS 80 sonologically detected cystic lesions of the breast were enrolled in the study and were followed up for a minimum period of 6 months. Study was conducted after IEC approval and written informed consent was obtained from each study participant. RESULTS Majority of the study subjects (36.25% were in the age range of 41-50 years. 53.75% of the study subjects had simple cysts. 88.3% of the study subjects with simple cysts underwent needle aspiration and 5 cysts required excision. 3 subjects with simple cysts required aspiration more than once. Two of the three subjects with galactocoele underwent aspiration and one subject developed infection which required antibiotics and excision. Intracystic papillary carcinoma were detected in 21.25% and invasive ductal carcinoma were seen in 20% of the study subjects. CONCLUSION The age group of patients presented with cystic lesions of breasts indicate probable lower awareness regarding self-examination of the breasts after 30 years of age. This is a matter of concern. Breast cysts are usually benign though some radiologically complex masses may be malignant. Another differential diagnosis could be tuberculosis which has to be kept in mind.

Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience

International Nuclear Information System (INIS)

Thind, C.R.; Desmond, S.; Harris, O.; Nadeem, R.; Chagla, L.S.; Audisio, R.A.

2005-01-01

AIM: Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital. METHOD: The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs. RESULTS: All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients. CONCLUSION: Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff

Angiogenesis and dynamic contrast enhanced MRI of benign and malignant breast lesions: preliminary results

International Nuclear Information System (INIS)

Liu Peifang; Bao Runxian; Niu Yun; Yu Yong

2002-01-01

Objective: To determine whether dynamic contrast enhanced MRI features of early-phase enhancement rate, enhancement amplitude, and signal intensity (SI) time course are associated with the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of malignant and benign breast lesions. Methods: Thirty-eight patients with histopathologically verified breast lesions underwent dynamic contrast enhanced MRI. SI changes during dynamic scanning were assessed quantitatively. Early-phase enhancement rate and enhancement amplitude were calculated. Time-SI curves of the lesions were obtained and classified according to their shapes as type I (which was steady enhancement to the end of the dynamic data acquisition at 7.5 min), type II (plateau of SI after avid initial contrast enhancement), or type III (washout of SI after avid initial contrast enhancement). the mean MVD and VEGF expression of the lesions were measured with immuno-histochemical staining method in all the histologic specimens by pathologists without the knowledge of the results of the MR examination. The relationships among dynamic contrast enhanced MRI features, MVD, and VEGF expression of benign and malignant breast lesions were analyzed. Results: Histology revealed 21 malignancies and 17 benign lesions. The mean MVD and VEGF expression for 21 malignant lesions were statistically higher than the mean MVD and VEGF expression for 17 benign lesions. High VEGF expression of benign and malignant breast lesions showed an association with increased MVD. Among all 38 lesions, greater (> 60%) MR early-phase enhancement rate and time-SI curve type II and III showed an association with increased MVD and higher VEGF expression level. All the differences mentioned above showed statistical significance except that the difference between VEGF expression and the distribution of curve types had no statistical significance. No significant relationships were observed between the mean of enhancement

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions

International Nuclear Information System (INIS)

Mus, Roel D.; Borelli, Cristina; Bult, Peter; Weiland, Elisabeth; Karssemeijer, Nico; Barentsz, Jelle O.; Gubern-Mérida, Albert; Platel, Bram; Mann, Ritse M.

2017-01-01

Highlights: • New view-sharing sequences (e.g. TWIST) enable ultrafast dynamic breast MRI. • TWIST sequences accurately characterize the inflow of contrast in breast lesions. • TTE evaluation allows breast lesion classification with very high accuracy. • The use of TTE significantly increases the specificity of breast MRI. • TWIST imaging may increase the potential of breast MRI as screening tool. - Abstract: Objectives: To investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI). Methods: In this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0 × 0.9 × 2.5 mm, temporal resolution 4.32 s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied. Results: TTE had a significantly better discriminative ability than curve type (p < 0.001 and p = 0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p = 0.549 and p = 0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p < 0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ = 0.86) and substantial for conventional assessment (κ = 0.75). Conclusions: TTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions

Energy Technology Data Exchange (ETDEWEB)

Mus, Roel D., E-mail: aroel.mus@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Borelli, Cristina, E-mail: cristinaborelli@hotmail.it [Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia (Italy); Department of Radiology, Radboud University Medical Center (internal address 766), Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Bult, Peter, E-mail: peter.bult@radboudumc.nl [Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Weiland, Elisabeth, E-mail: elisabeth.weiland@siemens.com [Siemens Healthcare, Erlangen (Germany); Karssemeijer, Nico, E-mail: nico.karssemeijer@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Barentsz, Jelle O., E-mail: jelle.barentsz@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Gubern-Mérida, Albert, E-mail: albert.gubernmerida@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Platel, Bram, E-mail: bram.platel@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands); Mann, Ritse M., E-mail: ritse.mann@radboudumc.nl [Department of Radiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen (Netherlands)

2017-04-15

Highlights: • New view-sharing sequences (e.g. TWIST) enable ultrafast dynamic breast MRI. • TWIST sequences accurately characterize the inflow of contrast in breast lesions. • TTE evaluation allows breast lesion classification with very high accuracy. • The use of TTE significantly increases the specificity of breast MRI. • TWIST imaging may increase the potential of breast MRI as screening tool. - Abstract: Objectives: To investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI). Methods: In this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0 × 0.9 × 2.5 mm, temporal resolution 4.32 s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied. Results: TTE had a significantly better discriminative ability than curve type (p < 0.001 and p = 0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p = 0.549 and p = 0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p < 0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ = 0.86) and substantial for conventional assessment (κ = 0.75). Conclusions: TTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high

Digital Breast Tomosynthesis versus Supplemental Diagnostic Mammographic Views for Evaluation of Noncalcified Breast Lesions

Science.gov (United States)

Bandos, Andriy I.; Ganott, Marie A.; Sumkin, Jules H.; Kelly, Amy E.; Catullo, Victor J.; Rathfon, Grace Y.; Lu, Amy H.; Gur, David

2013-01-01

Purpose: To compare the diagnostic performance of breast tomosynthesis versus supplemental mammography views in classification of masses, distortions, and asymmetries. Materials and Methods: Eight radiologists who specialized in breast imaging retrospectively reviewed 217 consecutively accrued lesions by using protocols that were HIPAA compliant and institutional review board approved in 182 patients aged 31–60 years (mean, 50 years) who underwent diagnostic mammography and tomosynthesis. The lesions in the cohort included 33% (72 of 217) cancers and 67% (145 of 217) benign lesions. Eighty-four percent (182 of 217) of the lesions were masses, 11% (25 of 217) were asymmetries, and 5% (10 of 217) were distortions that were initially detected at clinical examination in 8% (17 of 217), at mammography in 80% (173 of 217), at ultrasonography (US) in 11% (25 of 217), or at magnetic resonance imaging in 1% (2 of 217). Histopathologic examination established truth in 191 lesions, US revealed a cyst in 12 lesions, and 14 lesions had a normal follow-up. Each lesion was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. Differences between modes were analyzed with a generalized linear mixed model for BI-RADS–based sensitivity and specificity and with modified Obuchowski-Rockette approach for probability-of-malignancy–based area under the receiver operating characteristic (ROC) curve. Results: Average probability-of-malignancy–based area under the ROC curve was 0.87 for tomosynthesis versus 0.83 for supplemental views (P tomosynthesis, the false-positive rate decreased from 85% (989 of 1160) to 74% (864 of 1160) (P tomosynthesis, more cancers were classified as BI-RADS category 5 (39% [226 of 576] vs 33% [188

Application of the diffusion kurtosis model for the study of breast lesions

Energy Technology Data Exchange (ETDEWEB)

Nogueira, Luisa [School of Health Technology of Porto/Polytechnic Institute of Porto (ESTSP/IPP), Department of Radiology, Vila Nova de Gaia (Portugal); Brandao, Sofia; Loureiro, Joana [Hospital de Sao Joao, MRI Unit, Department of Radiology, Porto (Portugal); Matos, Eduarda [University of Porto, Department of Health Community, Institute of Biomedical Sciences Abel Salazar (ICBAS), Porto (Portugal); Nunes, Rita Gouveia; Ferreira, Hugo Alexandre [University of Lisbon, Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, Lisboa (Portugal); Ramos, Isabel [Hospital de Sao Joao/Faculty of Medicine of Porto University (FMUP), Head Department of Radiology, Porto (Portugal)

2014-06-15

To evaluate diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in the differentiation and characterisation of breast lesions. Thirty-six women underwent breast magnetic resonance imaging (MRI) including a DWI sequence with multiple b-values (50-3,000 s/mm{sup 2}). Mean values for apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated by lesion type and histological subtype. Differences and correlation between parameters were determined. Forty-four lesions were found. There were significant differences between benign and malignant lesions for all parameters (ADC, p = 0.017; MD, p = 0.028; MK, p = 0.017). ADC and MD were higher for benign (1.96 ± 0.41 x 10{sup -3} and 2.17 ± 0.42 x 10{sup -3} mm{sup 2}/s, respectively) than for malignant lesions (1.33 ± 0.18 x 10{sup -3} and 1.52 ± 0.50 x 10{sup -3} mm{sup 2}/s). MK was higher for malignant (0.61 ± 0.27) than benign lesions (0.37 ± 0.18). We found differences between invasive ductal carcinoma (IDC) and fibroadenoma (FA) for all parameters (ADC, MD and MK): p = 0.016, 0.022 and 0.016, respectively. FA and fibrocystic change (FC) showed differences only in MK (p = 0.016). Diffusion in breast lesions follows a non-Gaussian distribution. MK enables differentiation and characterisation of breast lesions, providing new insights into microstructural complexity. To confirm these results, further investigation in a broader sample should be performed. (orig.)

Visualization of suspicious lesions in breast MRI based on intelligent neural systems

Science.gov (United States)

Twellmann, Thorsten; Lange, Oliver; Nattkemper, Tim Wilhelm; Meyer-Bäse, Anke

2006-05-01

Intelligent medical systems based on supervised and unsupervised artificial neural networks are applied to the automatic visualization and classification of suspicious lesions in breast MRI. These systems represent an important component of future sophisticated computer-aided diagnosis systems and enable the extraction of spatial and temporal features of dynamic MRI data stemming from patients with confirmed lesion diagnosis. By taking into account the heterogenity of the cancerous tissue, these techniques reveal the malignant, benign and normal kinetic signals and and provide a regional subclassification of pathological breast tissue. Intelligent medical systems are expected to have substantial implications in healthcare politics by contributing to the diagnosis of indeterminate breast lesions by non-invasive imaging.

Correlation between enhancement characteristics of MR mammography and capillary density of breast lesions

International Nuclear Information System (INIS)

Poellinger, Alexander; El-Ghannam, Sahra; Diekmann, Susanne; Fischer, Thomas; Kristiansen, Glen; Fritzsche, Florian; Fallenberg, Eva; Morawietz, Lars; Diekmann, Felix

2014-01-01

Highlights: • We correlate capillary density of breast lesions with MRM. • Capillary density correlates with tumor enhancement for all lesions. • However no such correlation exists for the malignant or benign groups separately. • Mean vessel number of lymphatic vessels do not correlate with tumor enhancement.These results might be of help in the workup of MR-guided breast biopsies. • These results might be of help in the workup of MR-guided breast biopsies. - Abstract: Objective: To correlate capillary density of breast lesions using the markers D2-40, CD31, and CD34 with early and late enhancement of magnetic resonance mammography (MRM). Materials and methods: The local ethics committee approved this study, and informed consent was available from all patients. The study included 64 women with 66 histologically proven breast lesions (41 malignant, 25 benign). MR-enhancement 1 min after contrast medium administration was determined in the tumor (I t1 /I t0 ratio) and in comparison to the surrounding tissue (I t1 /I t1-fat ratio). Capillary density was quantified based on immunohistological staining with D2-40, CD31, and CD34 in breast tumors and surrounding breast tissue. Mean capillary densities were correlated with contrast enhancement in the tumor and surrounding breast tissue. The Kruskal–Wallis test was used to test whether lesions with different MR enhancement patterns differed in terms of capillary density. Results: For CD34, there was statistically significant correlation between capillary density and tumor enhancement (r = 0.329, p = 0.012), however not for the malignant or benign groups separately. Mean vessel number identified by staining with D2-40 and CD31 did not correlate significantly with tumor enhancement (D2-40: r = −0.188, p = 0.130; CD31: r = 0.095, p = 0.448). There were no statistically significant differences in capillary density between breast lesions with delayed enhancement or a plateau and lesions showing washout (Kruskal�

Correlation between enhancement characteristics of MR mammography and capillary density of breast lesions

Energy Technology Data Exchange (ETDEWEB)

Poellinger, Alexander, E-mail: alexander.poellinger@charite.de [Charité, Universitätsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); El-Ghannam, Sahra; Diekmann, Susanne; Fischer, Thomas [Charité, Universitätsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Kristiansen, Glen [Universitätsklinikum Bonn, Department of Pathology, Sigmund-Freud-Str. 25, D-53127 Bonn (Germany); Fritzsche, Florian [Institut für Histologie und Zytologie, Bahnhofplatz 11, Postfach, 9101 Herisau (Switzerland); Fallenberg, Eva [Charité, Universitätsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Morawietz, Lars [Diagnostik Ernst von Bergmann GmbH, Charlottenstr. 72, 14467 Potsdam (Germany); Diekmann, Felix [Charité, Universitätsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany)

2014-12-15

Highlights: • We correlate capillary density of breast lesions with MRM. • Capillary density correlates with tumor enhancement for all lesions. • However no such correlation exists for the malignant or benign groups separately. • Mean vessel number of lymphatic vessels do not correlate with tumor enhancement.These results might be of help in the workup of MR-guided breast biopsies. • These results might be of help in the workup of MR-guided breast biopsies. - Abstract: Objective: To correlate capillary density of breast lesions using the markers D2-40, CD31, and CD34 with early and late enhancement of magnetic resonance mammography (MRM). Materials and methods: The local ethics committee approved this study, and informed consent was available from all patients. The study included 64 women with 66 histologically proven breast lesions (41 malignant, 25 benign). MR-enhancement 1 min after contrast medium administration was determined in the tumor (I{sub t1}/I{sub t0} ratio) and in comparison to the surrounding tissue (I{sub t1}/I{sub t1-fat} ratio). Capillary density was quantified based on immunohistological staining with D2-40, CD31, and CD34 in breast tumors and surrounding breast tissue. Mean capillary densities were correlated with contrast enhancement in the tumor and surrounding breast tissue. The Kruskal–Wallis test was used to test whether lesions with different MR enhancement patterns differed in terms of capillary density. Results: For CD34, there was statistically significant correlation between capillary density and tumor enhancement (r = 0.329, p = 0.012), however not for the malignant or benign groups separately. Mean vessel number identified by staining with D2-40 and CD31 did not correlate significantly with tumor enhancement (D2-40: r = −0.188, p = 0.130; CD31: r = 0.095, p = 0.448). There were no statistically significant differences in capillary density between breast lesions with delayed enhancement or a plateau and lesions showing

Application of whole-lesion histogram analysis of pharmacokinetic parameters in dynamic contrast-enhanced MRI of breast lesions with the CAIPIRINHA-Dixon-TWIST-VIBE technique.

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Li, Zhiwei; Ai, Tao; Hu, Yiqi; Yan, Xu; Nickel, Marcel Dominik; Xu, Xiao; Xia, Liming

2018-01-01

To investigate the application of whole-lesion histogram analysis of pharmacokinetic parameters for differentiating malignant from benign breast lesions on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). In all, 92 women with 97 breast lesions (26 benign and 71 malignant lesions) were enrolled in this study. Patients underwent dynamic breast MRI at 3T using a prototypical CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence and a subsequent surgery or biopsy. Inflow rate of the agent between plasma and interstitium (K trans ), outflow rate of agent between interstitium and plasma (K ep ), extravascular space volume per unit volume of tissue (v e ) including mean value, 25th/50th/75th/90th percentiles, skewness, and kurtosis were then calculated based on the whole lesion. A single-sample Kolmogorov-Smirnov test, paired t-test, and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Malignant breast lesions had significantly higher K trans , K ep , and lower v e in mean values, 25th/50th/75th/90th percentiles, and significantly higher skewness of v e than benign breast lesions (all P 0.05). The 90th percentile of K trans , the 90th percentile of K ep , and the 50th percentile of v e showed the greatest areas under the ROC curve (AUC) for each pharmacokinetic parameter derived from DCE-MRI. The 90th percentile of K ep achieved the highest AUC value (0.927) among all histogram-derived values. The whole-lesion histogram analysis of pharmacokinetic parameters can improve the diagnostic accuracy of breast DCE-MRI with the CDT-VIBE technique. The 90th percentile of K ep may be the best indicator in differentiation between malignant and benign breast lesions. 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:91-96. © 2017 International Society for Magnetic Resonance in Medicine.

Role of MRI in differentiating benign from malignant breast lesions ...

African Journals Online (AJOL)

Mohamed Ahmed Youssef

2017-02-15

Feb 15, 2017 ... detecting breast lesions than either T1- or T2-weighted imaging, but it is better to be performed in con- junction with contrast ... of MRI in several aspects of breast cancer diagnosis and management.2 ..... Hayes DF.: Normal ...

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions

International Nuclear Information System (INIS)

Mohamed Kamal, Rasha; Hussien Helal, Maha; Wessam, Rasha; Mahmoud Mansour, Sahar; Godda, Iman; Alieldin, Nelly

2015-01-01

Highlights: • We studied interpretation criteria for enhancing lesions on CESM. • We evaluated the enhancement patterns of 211 breast lesions. • Our results proved that CESM minimized positive and negative falsies in DM. • The proposed CESM lexicon helped in characterization and categorization. - Abstract: Objective: To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. Materials and method: This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. Results: The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. Conclusion: The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions

Energy Technology Data Exchange (ETDEWEB)

Mohamed Kamal, Rasha [Radiology Department (Women' s Imaging unit), Kasr ElAiny Hospital, Cairo University (Egypt); Hussien Helal, Maha [Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University (Egypt); Wessam, Rasha [Radiology Department (Women' s Imaging unit), Kasr ElAiny Hospital, Cairo University (Egypt); Mahmoud Mansour, Sahar, E-mail: sahar_mnsr@yahoo.com [Radiology Department (Breast Imaging unit), National Cancer Institute, Cairo University (Egypt); Godda, Iman [Pathology Department, National Cancer Institute, Cairo University (Egypt); Alieldin, Nelly [Statistics Department, National Cancer Institute, Cairo University (Egypt)

2015-06-15

Highlights: • We studied interpretation criteria for enhancing lesions on CESM. • We evaluated the enhancement patterns of 211 breast lesions. • Our results proved that CESM minimized positive and negative falsies in DM. • The proposed CESM lexicon helped in characterization and categorization. - Abstract: Objective: To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. Materials and method: This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. Results: The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. Conclusion: The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant

Whole-lesion histogram analysis metrics of the apparent diffusion coefficient as a marker of breast lesions characterization at 1.5 T

International Nuclear Information System (INIS)

Bougias, H.; Ghiatas, A.; Priovolos, D.; Veliou, K.; Christou, A.

2017-01-01

Introduction: To retrospectively assess the role of whole-lesion apparent diffusion coefficient (ADC) in the characterization of breast tumors by comparing different histogram metrics. Methods: 49 patients with 53 breast lesions underwent magnetic resonance imaging (MRI). ADC histogram parameters, including the mean, mode, 10th/50th/90th percentile, skewness, kurtosis, and entropy ADCs, were derived for the whole-lesion volume in each patient. Mann–Whitney U-test, area under the receiver-operating characteristic curve (AUC) were used for statistical analysis. Results: The mean, mode and 10th/50th/90th percentile ADC values were significantly lower in malignant lesions compared with benign ones (all P < 0.0001), while skewness was significantly higher in malignant lesions P = 0.02. However, no significant difference was found between entropy and kurtosis values in malignant lesions compared with benign ones (P = 0.06 and P = 1.00, respectively). Univariate logistic regression showed that 10th and 50th percentile ADC yielded the highest AUC (0.985; 95% confidence interval [CI]: 0.902, 1.000 and 0.982; 95% confidence interval [CI]: 0.896, 1.000 respectively), whereas kurtosis value yielded the lowest AUC (0.500; 95% CI: 0.355, 0.645), indicating that 10th and 50th percentile ADC values may be more accurate for lesion discrimination. Conclusion: Whole-lesion ADC histogram analysis could be a helpful index in the characterization and differentiation between benign and malignant breast lesions with the 10th and 50th percentile ADC be the most accurate discriminators. - Highlights: • DWI is a noninvasive technique that allows quantification of water diffusion in tissues. • ADC histogram analysis is a useful index in the differentiation benign and malignant breast tumors. • The 10th, 50th percentile ADC values being the best discriminators between breast lesions.

Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases.

Science.gov (United States)

Reid-Nicholson, Michelle D; Tong, Guoxia; Cangiarella, Joan F; Moreira, Andre L

2006-08-25

Breast masses occur in men far less commonly than women and are infrequently subjected to fine-needle aspiration (FNA) biopsy. Papillary lesions of the male breast are rare and are comprised of a spectrum of lesions ranging from papillary hyperplasia in gynecomastia to invasive papillary carcinoma. The following study describes the cytomorphology of papillary breast lesions in 11 men. The patients ranged in age from 23 to 78 years old and each presented with an unilateral subareolar or periareolar breast mass that varied in size from 0.5 to 3 cm. Two patients presented with bloody nipple discharge. Archival material (8-year period) from FNA biopsies of papillary lesions of the male breast was reviewed. The reviewed cases were correlated with appropriate clinicopathologic follow-up. The smears had variable cellularity but all showed papillary clusters of mammary epithelial cells with and without fibrovascular cores. Single epithelial cells with a high nuclear-to-cytoplasmic ratio and eccentric nuclei were seen in all smears; however, these were more numerous in cases of adenocarcinoma. Hemosiderin-laden macrophages were present in all cases. Nipple discharge was seen only in the 2 benign lesions. All adenocarcinomas occurred in older men. The only cytologic criteria that differentiated benign from malignant papillary lesions were marked cellularity and the presence of abundant 3-dimensional clusters. To the best of the authors' knowledge, the current series is the largest in the English literature to date that examines the cytomorphologic features of papillary breast lesions in men. Copyright 2006 American Cancer Society.

99mTc-3PRGD2 Scintimammography in Palpable and Nonpalpable Breast Lesions

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Lin Liu

2014-07-01

Full Text Available The aim of this study was to explore the diagnostic performance of 99mTc-3(poly-(ethylene glycol,PEG4-RGD2 (99mTc-3PRGD2 scintimammography (SMM in patients with either palpable or nonpalpable breast lesions and compare SMM to mammography to assess the possible incremental value of SMM in breast cancer detection. We also investigated the αvβ3 expression in malignant and benign breast lesions. Ninety-four patients with 110 lesions were included in this study. Mammograms were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS by a specialized imaging radiologist. Prone SMM was performed 1 hour after injection of 99mTc-3PRGD2. Scintigraphic images were interpreted independently by two experienced nuclear medicine physicians using a three-point system, and the kappa value was calculated to determine the interreader agreement. The McNemar test was used to compare SMM and mammography with respect to sensitivity, specificity, and accuracy. Diagnostic values for breast cancer detection were evaluated for each lesion. Immunohistochemistry was performed to evaluate integrin αvβ3 expression. Histopathology revealed 46 malignant lesions and 64 benign lesions. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SMM were 83%, 73%, 77%, 69%, and 85%, respectively. The kappa value between the two reviewers was 0.63. The diagnostic values of SMM were higher than those of mammography in evaluating overall breast lesions. A sensitivity of 91% was achieved when SMM and mammography results were combined with 60% of all false-negative mammography findings classified as true-positive results by SMM. Integrin αvβ3 expression was positively identified using SMM imaging. SMM is a promising tool to avoid unnecessary biopsies when used in addition to mammography and can be used to image αvβ3 expression in breast cancer with good image quality.

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

Science.gov (United States)

Li, Lu-Jing; Yao, Ji-Yi; Zhou, Xin-Chuan; Zhao, Xin-Bao; Zhong, Wen-Jing; Ou, Bing; Luo, Bao-Ming; Hao, Shao-Yun; Zhi, Hui

2017-05-01

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p breast papillary lesions from non-papillary benign lesions. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Exposure parameters of mammograms with and without mass lesions from a South African breast care centre

International Nuclear Information System (INIS)

Acho, Sussan N.; Boonzaier, Willem P. E.; Nel, Ina F.

2017-01-01

In South African breast care centres, full-field digital mammography units provide breast imaging services to symptomatic and asymptomatic women simultaneously. This study evaluated the technical exposure parameters of 800 mammograms of which 100 mammograms had obvious mass lesions in the fibro-glandular tissue. The average breast compression force of mammograms with mass lesions in the fibro-glandular tissue was 18.4% less than the average breast compression force of mammograms without mass lesions. The average mean glandular dose (MGD), tube potential (kV p ) and compressed breast thickness (CBT) values were 2.14 mGy, 30.5 kV p and 63.9 mm, respectively, for mammograms with mass lesions, and 1.45 mGy, 29.6 kV p and 56.9 mm, respectively, for mammograms without mass lesions. Overall, the average MGD and mean CBT of mammograms with mass lesion were significantly higher compared to those without mass lesions (p < 0.05), although there was no significant difference in their tube potentials (p > 0.05). (authors)

Metastatic Breast Cancer or Multiple Myeloma? Camouflage by Lytic Lesions

Directory of Open Access Journals (Sweden)

Bruce Hough

2010-01-01

Full Text Available We report a case of a female with stage I infiltrating ductal carcinoma who received adjuvant therapy including trastuzumab. One year later she developed lytic lesions and was retreated with trastuzumab that was held after she developed symptomatic heart failure. Lytic lesions were attributed to relapse of breast cancer, and cardiac failure attributed to prior trastuzumab therapy. After complications necessitated multiple hospitalizations, a further workup revealed that the lytic lesions were not metastatic breast cancer but multiple myeloma. Her advanced multiple myeloma was associated with systemic amyloidosis involving gut and heart, which ultimately led to her demise. This report addresses the pitfalls of overlapping symptoms and the question of which patients with suspected metastatic disease should undergo a biopsy.

Histological diagnosis of ultrasound-visible breast lesions by large core needle biopsy

International Nuclear Information System (INIS)

Sanchis-Querol, E.; Valeros, O.; Collado, A.; Gimenez, J.; Yanguas, C.

1999-01-01

We present our experience in the histological diagnosis of breast lesions using ultrasound-guided large core needle biopsy (LCNB), assessing its utility as an alternative to excisional biopsy. We have studied retrospectively a series of 146 cases involving the performance of LCNB. The results were comparable with those of FNAB in 59 cases and with those of surgical aspiration biopsy in 105. Of the 113 lesions identified as malignant by percutaneous large core needle aspiration biopsy, 96 were resected. Surgical aspiration biopsy agreed with LCNB in 100% of cases. Of the 33 lesions identified as benign by LCNB, surgical biopsy detected malignancy in 5. The results obtained establish a specificity for LCNB of 100% and a sensitivity of 96%, both of which are superior to the values for FNAB. Thus, this technique can be considered valid for preoperative diagnosis. LCNB is useful in the preoperative diagnosis of breast lesions, making FNAB and surgical biopsy unnecessary. Moreover, it constitutes a significant change in the management of patients with malignant or undetermined breast lesions. (Author) 8 refs

Evaluation of breast lesions by contrast enhanced ultrasound: Qualitative and quantitative analysis

International Nuclear Information System (INIS)

Wan Caifeng; Du Jing; Fang Hua; Li Fenghua; Wang Lin

2012-01-01

Objective: To evaluate and compare the diagnostic performance of qualitative, quantitative and combined analysis for characterization of breast lesions in contrast enhanced ultrasound (CEUS), with histological results used as the reference standard. Methods: Ninety-one patients with 91 breast lesions BI-RADS 3–5 at US or mammography underwent CEUS. All lesions underwent qualitative and quantitative enhancement evaluation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of different analytical method for discrimination between benign and malignant breast lesions. Results: Histopathologic analysis of the 91 lesions revealed 44 benign and 47 malignant. For qualitative analysis, benign and malignant lesions differ significantly in enhancement patterns (p z1 ), 0.768 (A z2 ) and 0.926(A z3 ) respectively. The values of A z1 and A z3 were significantly higher than that for A z2 (p = 0.024 and p = 0.008, respectively). But there was no significant difference between the values of A z1 and A z3 (p = 0.625). Conclusions: The diagnostic performance of qualitative and combined analysis was significantly higher than that for quantitative analysis. Although quantitative analysis has the potential to differentiate benign from malignant lesions, it has not yet improved the final diagnostic accuracy.

Differential diagnosis of breast lesions using ultrasound elastography

Directory of Open Access Journals (Sweden)

Ioana Andreea Gheonea

2011-01-01

Full Text Available Context: The recent introduction of elastography has increased the specificity of USG and enabled early diagnosis of breast cancer. Quantitative elastography, especially with strain ratio (SR index, improves diagnostic accuracy and decreased number of biopsies. Aims: The purpose of this study was to assess the role of USG elastography in the differential diagnosis of breast lesions. Settings and Design: This prospective study was conducted in the University of Medicine and Pharmacy Research Centre of Craiova. Materials and Methods: Fifty-eight patients diagnosed with breast lesions between January 2009 and January 2010 were included in this prospective study. All the patients were examined in the supine position, and the B-mode USG image was displayed alongside the elastography strain image. For obtaining the elastography images we used a EUS Hitachi EUB 8500 ultrasound system with a 6.5-MHz linear probe. The elastography strain images were scored according to the Tsukuba elasticity score. Statistical Analysis: We performed receiver operator characteristic (ROC analysis for assessment of the role of USG elastography in the diagnosis of breast lesions. Results: We obtained a sensitivity of 86.7% and a specificity of 92.9% for elasticity score and a sensitivity of 93.3% and a specificity of 92.9% for SR (when a cutoff point of 3.67 was used. There was very good correlation between SR and elasticity score (Spearman coefficient of 0.911. Conclusions: Elastography is a fast, simple method that can complement conventional USG examination. This method has the lowest cost/efficiency ratio and it is also the most noninvasive and accessible imaging method, with an accuracy comparable to MRI.

Breast lesion characterization using whole-lesion histogram analysis with stretched-exponential diffusion model.

Science.gov (United States)

Liu, Chunling; Wang, Kun; Li, Xiaodan; Zhang, Jine; Ding, Jie; Spuhler, Karl; Duong, Timothy; Liang, Changhong; Huang, Chuan

2018-06-01

Diffusion-weighted imaging (DWI) has been studied in breast imaging and can provide more information about diffusion, perfusion and other physiological interests than standard pulse sequences. The stretched-exponential model has previously been shown to be more reliable than conventional DWI techniques, but different diagnostic sensitivities were found from study to study. This work investigated the characteristics of whole-lesion histogram parameters derived from the stretched-exponential diffusion model for benign and malignant breast lesions, compared them with conventional apparent diffusion coefficient (ADC), and further determined which histogram metrics can be best used to differentiate malignant from benign lesions. This was a prospective study. Seventy females were included in the study. Multi-b value DWI was performed on a 1.5T scanner. Histogram parameters of whole lesions for distributed diffusion coefficient (DDC), heterogeneity index (α), and ADC were calculated by two radiologists and compared among benign lesions, ductal carcinoma in situ (DCIS), and invasive carcinoma confirmed by pathology. Nonparametric tests were performed for comparisons among invasive carcinoma, DCIS, and benign lesions. Comparisons of receiver operating characteristic (ROC) curves were performed to show the ability to discriminate malignant from benign lesions. The majority of histogram parameters (mean/min/max, skewness/kurtosis, 10-90 th percentile values) from DDC, α, and ADC were significantly different among invasive carcinoma, DCIS, and benign lesions. DDC 10% (area under curve [AUC] = 0.931), ADC 10% (AUC = 0.893), and α mean (AUC = 0.787) were found to be the best metrics in differentiating benign from malignant tumors among all histogram parameters derived from ADC and α, respectively. The combination of DDC 10% and α mean , using logistic regression, yielded the highest sensitivity (90.2%) and specificity (95.5%). DDC 10% and α mean derived from

Management of breast lesions detectable only on MRI; Abklaerung ausschliesslich MRT-detektierbarer Mammalaesionen

Energy Technology Data Exchange (ETDEWEB)

Siegmann-Luz, K.C.; Bahrs, S.D.; Preibsch, H.; Hattermann, V.; Claussen, C.D. [Universitaetsklinikum Tuebingen (Germany). Abt. Diagnostische und Interventionelle Radiologie

2014-01-15

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline 'Diagnosis, Therapy, and Follow-Up of Breast Cancer' as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. (orig.)

Localization of occult breast lesions: mammographic findings in non infiltrating carcinoma; Localizacion de lesiones ocultas de mama: hallazgos mamograficos del carcinoma no infiltrante

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Paul, L; Iribar, M; Vilarrasa, A; Lopez, M A; Hernandez, R; Carrasco, A [Departamento de Radiodiagnostico, Hospital Doce de Octubre, Madrid (Spain)

1995-08-01

A review was carried out of 169 biopsies of occult breast lesions, 32 of which were malignant. The radiological findings associated with in situ carcinomas were compared with those of malignant lesions in general. The signs that permit the detection of breast carcinoma in the earliest stages are described, and the positive predictive value of signs, such as a spicular form, clusters of microcalcifications, nodules and architectural disturbances, is discussed. Given the lack of specificity of these findings, many beginning lesions should be biopsied to ensure an early diagnosis of breast cancer. (Author)

Textural kinetics: a novel dynamic contrast-enhanced (DCE)-MRI feature for breast lesion classification.

Science.gov (United States)

Agner, Shannon C; Soman, Salil; Libfeld, Edward; McDonald, Margie; Thomas, Kathleen; Englander, Sarah; Rosen, Mark A; Chin, Deanna; Nosher, John; Madabhushi, Anant

2011-06-01

Dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of the breast has emerged as an adjunct imaging tool to conventional X-ray mammography due to its high detection sensitivity. Despite the increasing use of breast DCE-MRI, specificity in distinguishing malignant from benign breast lesions is low, and interobserver variability in lesion classification is high. The novel contribution of this paper is in the definition of a new DCE-MRI descriptor that we call textural kinetics, which attempts to capture spatiotemporal changes in breast lesion texture in order to distinguish malignant from benign lesions. We qualitatively and quantitatively demonstrated on 41 breast DCE-MRI studies that textural kinetic features outperform signal intensity kinetics and lesion morphology features in distinguishing benign from malignant lesions. A probabilistic boosting tree (PBT) classifier in conjunction with textural kinetic descriptors yielded an accuracy of 90%, sensitivity of 95%, specificity of 82%, and an area under the curve (AUC) of 0.92. Graph embedding, used for qualitative visualization of a low-dimensional representation of the data, showed the best separation between benign and malignant lesions when using textural kinetic features. The PBT classifier results and trends were also corroborated via a support vector machine classifier which showed that textural kinetic features outperformed the morphological, static texture, and signal intensity kinetics descriptors. When textural kinetic attributes were combined with morphologic descriptors, the resulting PBT classifier yielded 89% accuracy, 99% sensitivity, 76% specificity, and an AUC of 0.91.

Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients

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Gweon, Hye Mi [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Cho, Nariya; Kim, Soo-Yeon [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Koo, Hye Ryoung [Hanyang University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seo, Mirinae [Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Chu, Ajung [Seoul National University College of Medicine, Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Son, Eun Ju [Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of)

2017-08-15

To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients. BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards. Of the 626 lesions, morphological features included a single focus in 26.5% (n = 166), multiple foci in 47.1% (n = 295), mass in 21.7% (n = 136) and non-mass enhancement in 4.6% (n = 29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29-66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA. Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers. (orig.)

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions.

Science.gov (United States)

Mohamed Kamal, Rasha; Hussien Helal, Maha; Wessam, Rasha; Mahmoud Mansour, Sahar; Godda, Iman; Alieldin, Nelly

2015-06-01

To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial

International Nuclear Information System (INIS)

Ocal, Koray; Dag, Ahmet; Turkmenoglu, Ozgur; Yucel, Erdem; Gunay, Emel Ceylan; Duce, Meltem Nass

2011-01-01

Aim: this prospective randomized clinical study was conducted to compare radioguided occult lesion localization (ROLL) with wire-guided localization to evaluate optimum localization techniques for non-palpable breast lesions. Methods: a total of 108 patients who were undergoing an excisional biopsy for non-palpable breast lesions requiring pathologic diagnosis were randomly assigned to the ROLL group (n 56) and wire-guided localization group (n 52). In the study, patients' characteristics, radiological abnormalities, radiological technique of localization, localization time, operation time, weight of the excised specimen, clearance margins, pathological diagnosis and perioperative complications were assessed. Results: there were no differences between the two groups in terms of age, radiological abnormalities and localization technique (p = non-significant for all). ROLL techniques resulted in 100% retrieval of the lesions; for the wire-guided localization technique, 98%. Both localization time and operation time were significantly reduced with the ROLL technique (p = significant for all). The weight of the specimen was significantly lower in the ROLL group than in the wire-guided localization group (p = significant). The overall complication rate and pathological diagnosis were similar for both groups (p = non-significant for all). Clear margins were achieved in 91% of ROLL patients and in 53% of wire-guided localization patients, and the difference was significant. Conclusions: the present study indicated that the ROLL technique is as effective as wire-guided localization for the excision of non-palpable breast lesions. In addition, ROLL improved the outcomes by reducing localization and operation time, preventing healthy tissue excision and achieving clearer margins. (author)

Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial

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Ocal, Koray; Dag, Ahmet; Turkmenoglu, Ozgur; Yucel, Erdem [Mersin University (Turkey). Medical Faculty. Dept. of General Surgery; Gunay, Emel Ceylan [Mersin University (Turkey). Medical Faculty. Dept. of Nuclear Medicine; Duce, Meltem Nass [Mersin University (Turkey). Medical Faculty. Dept. of Radiology

2011-07-01

Aim: this prospective randomized clinical study was conducted to compare radioguided occult lesion localization (ROLL) with wire-guided localization to evaluate optimum localization techniques for non-palpable breast lesions. Methods: a total of 108 patients who were undergoing an excisional biopsy for non-palpable breast lesions requiring pathologic diagnosis were randomly assigned to the ROLL group (n 56) and wire-guided localization group (n 52). In the study, patients' characteristics, radiological abnormalities, radiological technique of localization, localization time, operation time, weight of the excised specimen, clearance margins, pathological diagnosis and perioperative complications were assessed. Results: there were no differences between the two groups in terms of age, radiological abnormalities and localization technique (p = non-significant for all). ROLL techniques resulted in 100% retrieval of the lesions; for the wire-guided localization technique, 98%. Both localization time and operation time were significantly reduced with the ROLL technique (p = significant for all). The weight of the specimen was significantly lower in the ROLL group than in the wire-guided localization group (p = significant). The overall complication rate and pathological diagnosis were similar for both groups (p = non-significant for all). Clear margins were achieved in 91% of ROLL patients and in 53% of wire-guided localization patients, and the difference was significant. Conclusions: the present study indicated that the ROLL technique is as effective as wire-guided localization for the excision of non-palpable breast lesions. In addition, ROLL improved the outcomes by reducing localization and operation time, preventing healthy tissue excision and achieving clearer margins. (author)

Whole-lesion histogram analysis metrics of the apparent diffusion coefficient as a marker of breast lesions characterization at 1.5 T.

Science.gov (United States)

Bougias, H; Ghiatas, A; Priovolos, D; Veliou, K; Christou, A

2017-05-01

To retrospectively assess the role of whole-lesion apparent diffusion coefficient (ADC) in the characterization of breast tumors by comparing different histogram metrics. 49 patients with 53 breast lesions underwent magnetic resonance imaging (MRI). ADC histogram parameters, including the mean, mode, 10th/50th/90th percentile, skewness, kurtosis, and entropy ADCs, were derived for the whole-lesion volume in each patient. Mann-Whitney U-test, area under the receiver-operating characteristic curve (AUC) were used for statistical analysis. The mean, mode and 10th/50th/90th percentile ADC values were significantly lower in malignant lesions compared with benign ones (all P histogram analysis could be a helpful index in the characterization and differentiation between benign and malignant breast lesions with the 10th and 50th percentile ADC be the most accurate discriminators. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Accessory Breast Cancer Occurring Concurrently with Bilateral Primary Invasive Breast Carcinomas: A Report of Two Cases and Literature Review

International Nuclear Information System (INIS)

Hao, Jin-yan; Yang, Cui-cui; Liu, Fang-fang; Yang, Yi-ling; Li, Shuai; Li, Wei-dong; Li, Ya-qing; Lang, Rong-gang; Fan, Yu; Paulos, Estifanos; Zhang, Xin-min; Fu, Li

2012-01-01

The development of accessory breast tissue, which is found anywhere along the milk line, is attributed to the failure of milk line remnants to regress during embryogenesis. Primary tumors may arise from any ectopic breast tissue. Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare. Two such cases were reported in this article. One was a 43-year-old Chinese female who exhibited bilateral breast cancer (invasive ductal carcinoma, not otherwise specified, IDC-NOS) and an accessory breast carcinoma (IDC-NOS) incidentally identified in her left axilla. The ectopic breast tissue in her right axilla presented with adenosis. The patient was surgically treated, followed by postoperative docetaxel epirubicin (TE) chemotherapy. The second case was a 53-year-old Chinese female with bilateral breast cancer (apocrine carcinoma) accompanied by an accessory breast carcinoma (IDC-NOS) in her right axilla that was also incidentally identified. The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel (CET) neoadjuvant chemotherapy, followed by adjuvant chemotherapy of the same regimen

High-grade glioma in a patient with breast cancer

Directory of Open Access Journals (Sweden)

Che-Chao Chang

2014-07-01

Full Text Available Breast cancer is one of the most common origins of metastatic lesions in the central nervous system. Many patients with a breast cancer and concurrent brain tumor(s were diagnosed to have a metastatic lesion or lesions in the brain, based exclusively on their image findings without further pathologic verification, and received radiotherapy alone thereafter. It is, however, possible that a different pathology such as primary brain malignancy, which actually warrants a specific treatment modality, may occur in such patients with an already known malignancy. We, herein, reported a 61-year-old female patient who suffered from an anaplastic oligodendroglioma 1 year after her diagnosis of breast cancer. Demographic data, characteristic imaging findings, treatment, and outcome of the patient were discussed.

Radiologists' Performance for Detecting Lesions and the Interobserver Variability of Automated Whole Breast Ultrasound

International Nuclear Information System (INIS)

Kim, Sung Hun; Kang, Bong Joo; Choi, Byung Gil; Choi, Jae Jung; Lee, Ji Hye; Song, Byung Joo; Choe, Byung Joo; Park, Sarah; Kim, Hyunbin

2013-01-01

To compare the detection performance of the automated whole breast ultrasound (AWUS) with that of the hand-held breast ultrasound (HHUS) and to evaluate the interobserver variability in the interpretation of the AWUS. AWUS was performed in 38 breast cancer patients. A total of 66 lesions were included: 38 breast cancers, 12 additional malignancies and 16 benign lesions. Three breast radiologists independently reviewed the AWUS data and analyzed the breast lesions according to the BI-RADS classification. The detection rate of malignancies was 98.0% for HHUS and 90.0%, 88.0% and 96.0% for the three readers of the AWUS. The sensitivity and the specificity were 98.0% and 62.5% in HHUS, 90.0% and 87.5% for reader 1, 88.0% and 81.3% for reader 2, and 96.0% and 93.8% for reader 3, in AWUS. There was no significant difference in the radiologists' detection performance, sensitivity and specificity (p > 0.05) between the two modalities. The interobserver agreement was fair to good for the ultrasonographic features, categorization, size, and the location of breast masses. AWUS is thought to be useful for detecting breast lesions. In comparison with HHUS, AWUS shows no significant difference in the detection rate, sensitivity and the specificity, with high degrees of interobserver agreement

Mucocele-like lesions of the breast: a clinical outcome and histologic analysis of 102 cases.

Science.gov (United States)

Meares, Annie L; Frank, Ryan D; Degnim, Amy C; Vierkant, Robert A; Frost, Marlene H; Hartmann, Lynn C; Winham, Stacey J; Visscher, Daniel W

2016-03-01

Mucocele-like lesions (MLLs) of the breast are characterized by cystic architecture with stromal mucin and frequent atypia, but it is unknown whether they convey long-term breast cancer risk. We evaluated 102 MLLs that were derived from a single-institution benign breast disease cohort of 13412 women who underwent biopsy from 1967 to 2001. MLLs were histologically characterized by type of lining epithelium, architecture of the lesion, associated atypical hyperplasia (AH), and incidence of breast cancer (14.8-year median follow-up). A relatively large proportion of MLLs (42%) were diagnosed in women older than 55 years. AH was significantly more frequent in MLL patient compared to the cohort overall (27% versus 5%; P Breast cancer has developed in 13 patients with MLL. This frequency is only slightly higher than population expected rates overall (standardized incidence ratio, 2.28; 95% confidence interval, 1.21-3.91) and not significantly different from women in the cohort with (nonatypical) proliferative breast lesions. Younger women (breast lesion that is often associated with coexisting AH. However, in women older than 45 years, MLLs do not convey additional risk of breast cancer beyond that associated with the presence of proliferative disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Radiologists' Performance for Detecting Lesions and the Interobserver Variability of Automated Whole Breast Ultrasound

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Kim, Sung Hun; Kang, Bong Joo; Choi, Byung Gil; Choi, Jae Jung; Lee, Ji Hye [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701 (Korea, Republic of); Song, Byung Joo; Choe, Byung Joo [Department of General Surgery, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701 (Korea, Republic of); Park, Sarah [Department of Internal Medicine, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701 (Korea, Republic of); Kim, Hyunbin [CMC Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul 137-701 (Korea, Republic of)

2013-07-01

To compare the detection performance of the automated whole breast ultrasound (AWUS) with that of the hand-held breast ultrasound (HHUS) and to evaluate the interobserver variability in the interpretation of the AWUS. AWUS was performed in 38 breast cancer patients. A total of 66 lesions were included: 38 breast cancers, 12 additional malignancies and 16 benign lesions. Three breast radiologists independently reviewed the AWUS data and analyzed the breast lesions according to the BI-RADS classification. The detection rate of malignancies was 98.0% for HHUS and 90.0%, 88.0% and 96.0% for the three readers of the AWUS. The sensitivity and the specificity were 98.0% and 62.5% in HHUS, 90.0% and 87.5% for reader 1, 88.0% and 81.3% for reader 2, and 96.0% and 93.8% for reader 3, in AWUS. There was no significant difference in the radiologists' detection performance, sensitivity and specificity (p > 0.05) between the two modalities. The interobserver agreement was fair to good for the ultrasonographic features, categorization, size, and the location of breast masses. AWUS is thought to be useful for detecting breast lesions. In comparison with HHUS, AWUS shows no significant difference in the detection rate, sensitivity and the specificity, with high degrees of interobserver agreement.

Imaging findings of papillary breast lesions: A pictorial review

International Nuclear Information System (INIS)

Kestelman, F.P.; Gomes, C.F.A.; Fontes, F.B.; Marchiori, E.

2014-01-01

The aim of this review is to describe the different imaging appearances of benign and malignant papillary breast lesions on mammography, ultrasound, and magnetic resonance imaging, according to the World Health Organization histopathological classifications. The classification and morphological imaging characteristics of papillary lesions remain challenging for pathologists and radiologists. Despite the difficulty of classifying these lesions, our review and those of others suggest that morphology is associated with clinically meaningful staging and outcome implications. Imaging can help to differentiate the forms of papillary lesion, but surgical specimens are required for definitive diagnosis in the majority of cases

Benign breast lesions in an African population: A 25-year ...

African Journals Online (AJOL)

Conclusion: BBDs constituted 70% of breast lumps and were mostly fibroadenoma and fibrocystic change. BBDs occurred predominantly in young females with a peak in the third decade. Though premalignant lesions of atypical hyperplasia were less common, biopsy of all BBDs should be done to exclude these lesions ...

The Value of Ultrasound-Guided Tattooing Localization of Nonpalpable Breast Lesions

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Ko, Kyung-Ran [National Cancer Center, Goyang (Korea, Republic of); Han, Boo-Kyung; Jang, Kyung-Mi; Choe, Yeon-Hyeon; Shin, Jung-Hee [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Yang, Jung-Hyun; Nam, Suk-Jin [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2007-08-15

To investigate the value of ultrasound-guided tattooing localization (US-tattoo) using a charcoal suspension for breast lesions. One hundred sixty-four nonpalpable breast lesions in 134 patients (mean age 47 years; range 30 74 years) were marked with a charcoal suspension under US guidance. The medical records associated with the US-tattoo, the pathology results and the follow-up US results were reviewed. The average size of the localized lesions was 1.0 cm. The procedure time was < 5 minutes (range, 2 10 minutes) per lesion. The US-tattoo was well tolerated in all cases. The only technical difficulty encountered was a needle tip blockage caused by a large charcoal particle (4.9%). The surgeon easily identified the tattoo with the exception one case. In addition, surgery could be safely delayed from one to 57 days after the making US-tattoo. The pathology result was benign in 108 cases, borderline in five, and malignant in 51. The excised specimen was < 4 cm in 76.6% (82/107) of the benign cases (mean; 2.7 cm). The pathologist could identify the mass around the tattoo and was able to make a specific diagnosis in 81.3% (87/107) of benign lesions. The only complication encountered was residual charcoal marking along the incision scar (3.6%). All follow- up US documented the removal of the lesions. An US-tattoo for nonpalpable breast lesions is a very simple and accurate method that can help surgeons design and schedule an open biopsy.

The Value of Ultrasound-Guided Tattooing Localization of Nonpalpable Breast Lesions

International Nuclear Information System (INIS)

Ko, Kyung-Ran; Han, Boo-Kyung; Jang, Kyung-Mi; Choe, Yeon-Hyeon; Shin, Jung-Hee; Yang, Jung-Hyun; Nam, Suk-Jin

2007-01-01

To investigate the value of ultrasound-guided tattooing localization (US-tattoo) using a charcoal suspension for breast lesions. One hundred sixty-four nonpalpable breast lesions in 134 patients (mean age 47 years; range 30 74 years) were marked with a charcoal suspension under US guidance. The medical records associated with the US-tattoo, the pathology results and the follow-up US results were reviewed. The average size of the localized lesions was 1.0 cm. The procedure time was < 5 minutes (range, 2 10 minutes) per lesion. The US-tattoo was well tolerated in all cases. The only technical difficulty encountered was a needle tip blockage caused by a large charcoal particle (4.9%). The surgeon easily identified the tattoo with the exception one case. In addition, surgery could be safely delayed from one to 57 days after the making US-tattoo. The pathology result was benign in 108 cases, borderline in five, and malignant in 51. The excised specimen was < 4 cm in 76.6% (82/107) of the benign cases (mean; 2.7 cm). The pathologist could identify the mass around the tattoo and was able to make a specific diagnosis in 81.3% (87/107) of benign lesions. The only complication encountered was residual charcoal marking along the incision scar (3.6%). All follow- up US documented the removal of the lesions. An US-tattoo for nonpalpable breast lesions is a very simple and accurate method that can help surgeons design and schedule an open biopsy

Mammographic classification of breast lesions amongst women in ...

African Journals Online (AJOL)

These lesions' diagnosis can be accom- plished with ... estimated 246,660 new cases of the invasive breast cancer are expected to be diagnosed in women in the US. Mam- ... as ultrasound and magnetic resonance imaging (MRI)4. However ...

Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging.

Science.gov (United States)

Chen, Jeon-Hor; Nalcioglu, Orhan; Su, Min-Ying

2008-12-01

Focal fibrocystic change (FCC) of the breast is a rare form of FCC. Imaging presentations of focal FCC are not well known. This study aimed to analyze its MR imaging features. Eleven patients of pathology-proven focal FCC were retrospectively studied. Of the 11 patients, seven were mass (>or=5 mm), two showed multiple foci, and two were focus (Breast sonography suspected malignancy in seven patients (7/10, 70%). No statistically significant difference was found in the three diagnostic methods. In pathology, all 11 patients showed the typical pathological features of fibrocystic change, with mixed components of stromal fibrosis, cyst formation, apocrine metaplasia, adenosis, and/or focal sclerosing adenosis. In conclusion, MR imaging features of focal FCC usually present as a mass or focus lesion with rapid enhancement and washout kinetics that mimic a malignant breast lesion and lead to unnecessary operation, especially in patients with contralateral malignant breast cancer. (c) 2008 Wiley-Liss, Inc.

Novel Breast Imaging and Machine Learning: Predicting Breast Lesion Malignancy at Cone-Beam CT Using Machine Learning Techniques.

Science.gov (United States)

Uhlig, Johannes; Uhlig, Annemarie; Kunze, Meike; Beissbarth, Tim; Fischer, Uwe; Lotz, Joachim; Wienbeck, Susanne

2018-05-24

The purpose of this study is to evaluate the diagnostic performance of machine learning techniques for malignancy prediction at breast cone-beam CT (CBCT) and to compare them to human readers. Five machine learning techniques, including random forests, back propagation neural networks (BPN), extreme learning machines, support vector machines, and K-nearest neighbors, were used to train diagnostic models on a clinical breast CBCT dataset with internal validation by repeated 10-fold cross-validation. Two independent blinded human readers with profound experience in breast imaging and breast CBCT analyzed the same CBCT dataset. Diagnostic performance was compared using AUC, sensitivity, and specificity. The clinical dataset comprised 35 patients (American College of Radiology density type C and D breasts) with 81 suspicious breast lesions examined with contrast-enhanced breast CBCT. Forty-five lesions were histopathologically proven to be malignant. Among the machine learning techniques, BPNs provided the best diagnostic performance, with AUC of 0.91, sensitivity of 0.85, and specificity of 0.82. The diagnostic performance of the human readers was AUC of 0.84, sensitivity of 0.89, and specificity of 0.72 for reader 1 and AUC of 0.72, sensitivity of 0.71, and specificity of 0.67 for reader 2. AUC was significantly higher for BPN when compared with both reader 1 (p = 0.01) and reader 2 (p Machine learning techniques provide a high and robust diagnostic performance in the prediction of malignancy in breast lesions identified at CBCT. BPNs showed the best diagnostic performance, surpassing human readers in terms of AUC and specificity.

Proliferative changes in nonpalpable breast lesions detected by mammography; Alteraciones profiferativas de la mama en lesiones no palpables detectadas por mamografia

Energy Technology Data Exchange (ETDEWEB)

Vega, A.; Delgado, A.; Ortega, E.; Garijo, F. [Hospital Universitario Marques de Valdecilla. Santander (Spain); Mosquera, J.; Sogo, C.; Alvarez, A. [Complejo Hospitalario Juan Canalejo. La Coruna (Spain)

2000-07-01

To analyze retrospectively the radiological findings in nonpalpable breast lesions detected by mammography that lead to the performance of surgical biopsy, resulting in a histological diagnosis of proliferative breast disease with and without atypia. From two Spanish hospitals, 421 women with 429 biopsies indicative of the presence of proliferative breast disease with and without atypia were selected out of a total of 1252 surgical biopsies in nonpalpable lesions that proved to be benign. Age, personal and familial history of breast cancer, reason for requesting the mammography and radiological findings that had indicated the need for surgical biopsy were recorded for each patient. The diagnosis was proliferative breast disease (epithelial hyperplasia) in 347 women with 354 biopsies and atypical hyperplasia in the remaining 74 women with 75 biopsies, representing 28% and 6%, respectively, of the 1252 biopsies of lesions found to be benign. In 221 of the 354 cases of epithelial hyperplasia (62%) and 45 of the 75 cases of atypical hyperplasia (60%), the presence of calcifications was the most common radiological findings leading to biopsy (p<0.05). Parenchymal distortion, with or without calcifications, was the second most common radiological sign. The histological study revealed a close relationship between these proliferative events and radial scars. Calcifications are the radiological finding that most frequently indicate the need for surgical biopsy in nonpalpable lesions that results in a diagnosis of proliferative breast disease with and without atypia. (Author) 12 refs.

Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions.

Science.gov (United States)

Field, Scott S

2016-02-01

Type 1 herpes simplex virus (HSV-1) is very prevalent yet in rare circumstances can lead to fatal neonatal disease. Genital acquisition of type 2 HSV is the usual mode for neonatal herpes, but HSV-1 transmission by genital or extragenital means may result in greater mortality rates. A very rare scenario is presented in which the mode of transmission was likely through breast lesions. The lesions were seen by nurses as well as the lactation consultant and obstetrician in the hospital after delivery of the affected baby but not recognized as possibly being caused by herpes. The baby died 9 days after birth with hepatic failure and disseminated intravascular coagulation. Peripartum health care workers need to be aware of potential nongenital (including from the breast[s]) neonatal herpes acquisition, which can be lethal. © The Author(s) 2015.

Breast MRI: Are T2 IR sequences useful in the evaluation of breast lesions?

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Ballesio, Laura [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Savelli, Sara [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy)], E-mail: sarasavelli@hotmail.it; Angeletti, Marco; Porfiri, Lucio Maria; D' Ambrosio, Ilaria; Maggi, Claudia; Castro, Elisabetta Di; Bennati, Paolo; Fanelli, Gloria Pasqua [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Vestri, Anna Rita [Department of Experimental Medicine, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy); Manganaro, Lucia [Department of Radiological Sciences, Umberto I Hospital, ' Sapienza' University of Rome, Viale Del Policlinico 155, 00161 Rome (Italy)

2009-07-15

Aim: To evaluate the potential role of signal intensities calculated in T2 images as an adjunctive parameter in the analysis of mass-like enhancements classified as BIRADS (Breast Imaging Reporting and Data System) assessment categories 2, 3, 4 or 5 with the standard T1 criteria. Materials and methods: After a retrospective review of 338-breast Magnetic Resonance Imaging (MRI) performed for the evaluation of a suspicious lesion we selected a group of 65 mass-like enhancements ranging from 5 to 20 mm, classified as BIRADS assessment categories 2, 3, 4 or 5, histologically proved. In all cases we calculated the ratio between the signal intensity (SI) of the nodule and the pectoralis major muscle (LMSIR, lesion to muscle signal intensity ratio) with a multiROIs (region of interest) analysis on T2 images. A ROC analysis was performed to test the ability of the two diagnostic parameters separately considered (BIRADS and LMSIR) and combined in a new mono-dimensional variable obtained by a computerized discriminant function. Results: Histological examination assessed 34 malignant lesions (52.3%) and 31 benign lesions (47.7%). The evaluation of ROC curves gave the following results: BIRADS area under the curve (AUC) 0.913, S.E. 0.0368, LMSIR AUC 0.854, S.E. 0.0487, combined BIRADS-LMSIR AUC 0.965, S.E. 0.0191 with a definitive increase in the AUC between the overall ROC area and those of the two diagnostic modalities separately considered. Discussion: T2-weighted SI assessment with LMSIR measurement improves the diagnostic information content of standard breast MRI and can be considered a promising potential tool in the differential diagnosis of mass-like enhancements judged as borderline lesions (BIRADS 3 and 4)

Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions.

Science.gov (United States)

Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe; Moschetta, Marco

2015-10-01

To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard. Two hundred eighty consecutive patients (age range, 27-73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI. UE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found. Breast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization. Copyright © 2015 Elsevier Inc. All rights reserved.

Plasminogen and angiostatin levels in female benign breast lesions

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A. A. Tykhomyrov

2015-10-01

Full Text Available It is known that benign breast tissue exhibit relatively low angiogenic capacity. Activation of angiogenesis in mammary pre-malignant lesions could be associated with disease progression and high risk of transformation into the breast cancer. However, insight into the underlying molecular mechanisms involved in angiogenesis regulation in non-cancerous breast pathologies is still poorly defined. The purpose of the present study was to determine levels of plasminogen and its proteolytic fragments (angiostatins in mammary dysplasia (mastopathy and breast cyst and benign neoplasms (fibroadenomas. Plasminogen and angiostatins were analyzed using immunoblotting and quantified by densitometric scanning. The significant increase in plasminogen levels was found in fibrocystic, cysts, and non-proliferatious fibroadenoma masses (4.7-, 3.7-, and 3.5-fold, respectively compared to healthy breast tissues (control. In the same benign lesions, 6.7-, 4-, and 3.7-fold increase in plasminogen 50 kDa fragment (angiostatin levels as compared with control were also observed. Activation of matrix metalloproteinase-9, which was detected using gelatine zymography, could be responsible for plasminogen cleavage and abundance of angiostatin in fibrocystic and cyst masses. In contrast, dramatic decrease of both plasminogen and angiostatin levels (3.8- and 5.3-folds, respectively was shown in tissues of proliferatious form of fibroadenoma in comparison with that of the dormant type of this neoplasm. Based on the obtained results, we concluded that angiostatin, a potent vessel growth inhibitor and anti-inflammatory molecule, can play a crucial role in pathophysiology of non-cancerous breast diseases. Further studies are needed to evaluate potential diagnostic and clinical implications of these proteins for prediction and therapy of benign breast pathologies.

Clinical Usefulness of Ultrasonography-Guided Aspiration Cytology for Nonpalpable Breast Lesions

International Nuclear Information System (INIS)

Park, Jeong Mi; Kim, Jun Hyoung; Choi, Yong Baik; Gong, Gyung Yub

1996-01-01

To evaluate the clinical utility of the ultrasonography (US)-guided aspiration cytology for nonpalpable breast lesions. US-guided aspiration cytology was performed in 50 lesions in 37 patients who underwent US of the breasts and axillary area. Adequacy for the pathologic diagnosis was correlated with the size, volume, depth of the lesions and type of needles. The causes of inadequacy and complications were assessed. Available mammographic findings were correlated with US findings. Final diagnoses on surgical biopsy were correlated with the diagnoses on aspiration cytology. Thirty four of the 50 lesions were adequate for pathologic diagnosis (68%). The size and volume of the lesions were not significantly related with adequacy.Shallow depth was significantly better. Cutting needles were better than plain needles. Causes of inadequacy were low cell number and bleeding. Complications were small amount of bleeding and pain. Mammographic findings were nonspecific in 61% of the cases. Pathologic diagnoses were ductal hyperplasia and fibrocystic changes in 62%.Surgical biopsy was done in 5 cases. None of the lesions showed malignancy. US-guidance is necessary and effective for the cytologic diagnoses of the nonpalpable lesions. However, invasive procedure could be deferred for several months for these nonpalpable small lesions which are mostly benign

Clinical Usefulness of Ultrasonography-Guided Aspiration Cytology for Nonpalpable Breast Lesions

Energy Technology Data Exchange (ETDEWEB)

Park, Jeong Mi; Kim, Jun Hyoung; Choi, Yong Baik; Gong, Gyung Yub [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

1996-06-15

To evaluate the clinical utility of the ultrasonography (US)-guided aspiration cytology for nonpalpable breast lesions. US-guided aspiration cytology was performed in 50 lesions in 37 patients who underwent US of the breasts and axillary area. Adequacy for the pathologic diagnosis was correlated with the size, volume, depth of the lesions and type of needles. The causes of inadequacy and complications were assessed. Available mammographic findings were correlated with US findings. Final diagnoses on surgical biopsy were correlated with the diagnoses on aspiration cytology. Thirty four of the 50 lesions were adequate for pathologic diagnosis (68%). The size and volume of the lesions were not significantly related with adequacy.Shallow depth was significantly better. Cutting needles were better than plain needles. Causes of inadequacy were low cell number and bleeding. Complications were small amount of bleeding and pain. Mammographic findings were nonspecific in 61% of the cases. Pathologic diagnoses were ductal hyperplasia and fibrocystic changes in 62%.Surgical biopsy was done in 5 cases. None of the lesions showed malignancy. US-guidance is necessary and effective for the cytologic diagnoses of the nonpalpable lesions. However, invasive procedure could be deferred for several months for these nonpalpable small lesions which are mostly benign

Diagnostic challenges of tubercular lesions of breast

Science.gov (United States)

Jairajpuri, Zeeba Shamim; Jetley, Sujata; Rana, Safia; Khetrapal, Shaan; Khan, Sabina; Hassan, Mohammad Jaseem

2018-01-01

INTRODUCTION: Tuberculosis (TB) in the developing countries presents with both pulmonary and extrapulmonary manifestations. Breast TB, however, remains a rare presentation. Its importance lies in the fact that it may mimic malignancy or present as inflammatory lump/abscess. AIMS AND OBJECTIVE: The aim of the present study is to highlight the importance of breast TB and its diagnostic challenges. MATERIALS AND METHODS: It was a retrospective study conducted at a tertiary care hospital, over 2 years between 2013 and 2015 during which eight cases of breast lesions were diagnosed as of tubercular origin. RESULTS: Granulomas were seen in five cases while three cases revealed only few epithelioid cells, and necrosis was seen in all cases on fine-needle aspiration cytology. Histopathological evaluation was available in six out of the eight cases, while acid–fast bacilli were positive in three cases, the characteristic granulomas were seen in all the six cases evaluated. CONCLUSION: Significance of TB breast lies in the fact that it may masquerade as breast malignancy or pyogenic abscess. India is a developing country where TB is endemic, a high index of suspicion should be expressed in evaluating breast masses, and TB should be considered in the differential diagnosis. PMID:29692584

201Tl scintigraphy in the evaluation of palpable and nonpalpable breast lesions: correlation with mammography and ultrasonography

International Nuclear Information System (INIS)

Vural, G.; Atasever, T.; Oezdemir, A.; Oeznur, I.; Karabacak, N.I.; Goekcora, N.; Isik, S.; Uenlue, M.

1997-01-01

Tl-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of Tl-201. Visual and semiquantitative interpretation was performed. Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. Tl-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by Tl-201 scintigraphy. The smallest mass lesion detected by Tl-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. Tl-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed Tl-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated Tl-201. Tl-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by Tl-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58±0.38 (mean±SD) and 1.48±0.32 (p>0.05), 1.87±0.65 and 1.34±0.20 (p 0.05). (orig./MG) [de

Magnetic Resonance Spectroscopy of the Breast at 3T: Pre- and Post-Contrast Evaluation for Breast Lesion Characterization

Directory of Open Access Journals (Sweden)

E. Kousi

2012-01-01

Full Text Available Purpose. To determine whether in vivo proton magnetic resonance spectroscopy at 3T can provide accurate breast lesion characterization, and to determine the effect of gadolinium on the resonance of tCho. Methods. Twenty-four positive-mammogram patients were examined on a 3T MR scanner. 1H-MRS was performed before and after gadolinium administration. tCho peak was qualitatively evaluated before and after contrast injection. Results. Fourteen out of 27 lesions proved to be malignant after histopathological diagnosis. Using 1H-MRS, before contrast injection, 6/14 confirmed malignancies and 11/13 benign lesions were correctly classified; while, after contrast injection, 11/14 confirmed malignancies and 12/13 benign processes were correctly classified. Post gadolinium 1H-MRS proved useful in picking up tCho signal, improving the overall accuracy, sensitivity, and specificity by 35%, 83%, and 9%, respectively. Conclusion. 1H-MRS overall accuracy, sensitivity, and specificity in detecting breast lesion’s malignancy were increased after gadolinium administration. It is prudent to perform 1H-MRS before contrast injection in large breast lesions to avoid choline underestimation. In cases of small or non-mass lesions, it is recommended to perform 1H-MRS after contrast injection for better voxel prescription to enable a reliable preoperative diagnosis.

Anisotropy of Solid Breast Lesions in 2D Shear Wave Elastography is an Indicator of Malignancy.

Science.gov (United States)

Skerl, Katrin; Vinnicombe, Sarah; Thomson, Kim; McLean, Denis; Giannotti, Elisabetta; Evans, Andrew

2016-01-01

To investigate if anisotropy at two-dimensional shear wave elastography (SWE) suggests malignancy and whether it correlates with prognostic and predictive factors in breast cancer. Study group A of 244 solid breast lesions was imaged with SWE between April 2013 and May 2014. Each lesion was imaged in radial and in antiradial planes, and the maximum elasticity, mean elasticity, and standard deviation were recorded and correlated with benign/malignant status, and if malignant, correlated with conventional predictive and prognostic factors. The results were compared to a study group B of 968 solid breast lesions, which were imaged in sagittal and in axial planes between 2010 and 2013. Neither benign nor malignant lesion anisotropy is plane dependent. However, malignant lesions are more anisotropic than benign lesions (P ≤ 0.001). Anisotropy correlates with increasing elasticity parameters, breast imaging-reporting and data system categories, core biopsy result, and tumor grade. Large cancers are significantly more anisotropic than small cancers (P ≤ 0.001). The optimal anisotropy cutoff threshold for benign/malignant differentiation of 150 kPa(2) achieves the best sensitivity (74%) with a reasonable specificity (63%). Anisotropy may be useful during benign/malignant differentiation of solid breast masses using SWE. Anisotropy also correlates with some prognostic factors in breast cancer. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Quantifying heterogeneity of lesion uptake in dynamic contrast enhanced MRI for breast cancer diagnosis

International Nuclear Information System (INIS)

Karahaliou, A; Skiadopoulos, S; Yiakoumelos, A; Costaridou, L; Vassiou, K; Kanavou, T

2009-01-01

The current study investigates whether texture features extracted from lesion kinetics feature maps can be used for breast cancer diagnosis. Fifty five women with 57 breast lesions (27 benign, 30 malignant) were subjected to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on 1.5T system. A linear-slope model was fitted pixel-wise to a representative lesion slice time series and fitted parameters were used to create three kinetic maps (wash out, time to peak enhancement and peak enhancement). 28 grey level co-occurrence matrices features were extracted from each lesion kinetic map. The ability of texture features per map in discriminating malignant from benign lesions was investigated using a Probabilistic Neural Network classifier. Additional classification was performed by combining classification outputs of most discriminating feature subsets from the three maps, via majority voting. The combined scheme outperformed classification based on individual maps achieving area under Receiver Operating Characteristics curve 0.960±0.029. Results suggest that heterogeneity of breast lesion kinetics, as quantified by texture analysis, may contribute to computer assisted tissue characterization in DCE-MRI.

Diagnostic value of coustic radiation force impulse for BI-RADS category 4 breast lesions of different sizes.

Science.gov (United States)

Wu, Rong

2018-04-14

To determine the diagnostic value of combined conventional ultrasound (US) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of BI-RADS category 4 breast lesions of different sizes. From April 2013 to January 2015, 283 patients (with a total of 292 breast lesions) who underwent US and ARFI examination were included in this retrospective study. The SWV for the lesion and adjacent normal breast tissue were measured and the SWV ratio was calculated. VTI grade was also assessed. The lesions were separated into three groups on the basis of size, and two combinations of ARFI parameters (SWV + VTI and SWV ratio + VTI) were applied to reassess the BI-RADS categories. Diagnoses were confirmed by pathological examination after biopsy or surgery. ROC analysis was performed to assess the diagnostic efficiency of each method. The Z test was used to compare the difference between AUC of the two methods. Significant improvement was seen in the diagnostic performance of US with the use of the ARFI parameters SWV + VTI (77/179 [43.0%] of BI-RADS category 4A breast lesions were downgraded) and SWV ratio + VTI (64/179 [35.8%] of BI-RADS category 4A breast lesions were downgraded, including two malignant cases that were misdiagnosed as benign) (P BI-RADS category 4 breast lesions. The combination of SWV ratio + VTI can improve BI-RADS classification of small lesions (<10 mm size).

Characterization of focal breast lesions by means of elastography.

Science.gov (United States)

Fischer, T; Sack, I; Thomas, A

2013-09-01

The modern method of sonoelastography of the breast is used for differentiating focal lesions. This review gives an overview of the different techniques available and discusses their roles in the routine clinical setting. The presented techniques include compression or vibration elastography as well as shear wave elastography. Descriptions of the methods are supplemented by a discussion of the clinical role of each technique based on the most recent literature. We discuss by outlining two recent experimental approaches - MRI and tomosynthesis elastography. Currently available data suggest that elastography is an important supplementary tool for the differentiation of breast tumors under routine clinical conditions. The specificity improves with the immediate availability of additional diagnostic information using real-time techniques and/or the calculation of strain ratios (SR). Elastography is especially helpful in women with involuted breasts for differentiating BI-RADS-US 3 and 4 lesions and for evaluating very small cancers without the typical imaging features of malignancy. Here, elastography techniques are highly specific, while the sensitivity decreases compared to B-mode ultrasound. SR calculation is especially helpful in women who have a high risk of breast cancer and high pretest likelihood. B-mode ultrasound is still the first-line method for the initial evaluation of the breast. If suspicious findings are detected, elastography with or without SR calculation is the most crucial supplementary tool. © Georg Thieme Verlag KG Stuttgart · New York.

Reporting and management of breast lesions detected using MRI

International Nuclear Information System (INIS)

Dall, B.J.G.; Vinnicombe, S.; Gilbert, F.J.

2011-01-01

Magnetic resonance imaging (MRI) is the most accurate technique for diagnosing and delineating the extent of both invasive and in-situ breast cancer and is increasingly being used as part of the preoperative work-up to assess the local extent of disease. It is proving invaluable in providing information that allows successful single-stage surgery. An inevitable consequence of the high sensitivity of MRI is that it will identify additional lesions that may or may not represent significant extra disease. This may complicate and delay the preoperative process. This paper outlines a strategy for managing MRI-detected lesions to optimize the benefits of breast MRI as a local staging tool while minimizing the false-positive diagnoses. It discusses the importance of good technique to reduce the number of indeterminate lesions. Methods to refine the patient pathway to minimize delays are discussed. The format of MRI reporting is discussed in detail as is the usefulness of discussion of cases at multidisciplinary meetings. Illustrative cases are used to clarify the points made.

Role of shear wave sonoelastography in differentiation between focal breast lesions.

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Dobruch-Sobczak, Katarzyna; Nowicki, Andrzej

2015-02-01

Our goal in this study was to evaluate the relevance of shear wave sonoelastography (SWE) in the differential diagnosis of masses in the breast with respect to ultrasound (US). US and SWE were performed (Aixplorer System, SuperSonic Imagine, Aix en Provence, France) in 76 women (aged 24 to 85) with 84 lesions (43 malignant, 41 benign). The study included BI-RADS-US (Breast Imaging Reporting and Data System for Ultrsound) category 3-5 lesions. In elastograms, the following values were calculated: mean elasticity in lesions (E(av.l)) and in fat tissue (E(av.f.)) and maximal (E(max.adj.)) and mean (E(av.adj.)) elasticity in lesions and adjacent tissues. The sensitivity and specificity of the BI-RADS category 4a/4b cutoff value were 97.7% and 90.2%. For an E(av.adj.) of 68.5 kPa, the cutoff sensitivity was 86.1% and the specificity was 87.8%, and for an E(max.adj.) of 124.1 kPa, 74.4% and 92.7%, respectively. For BI-RADS-US category 3 lesions, E(av.l), E(max.adj.) and E(av.adj.) were below cutoff levels. On the basis of our findings, E(av.adj.) had lower sensitivity and specificity compared with US. Emax.adj. improved the specificity of breast US with loss of sensitivity. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

FNAC as Preoperative Diagnostic Tool for Neoplastic and Non-Neoplastic Breast Lesions: A Teaching Hospital Experience

OpenAIRE

Palak Modi; Haren Oza; Jignasa Bhalodia

2014-01-01

"Aims and objectives: Fine needle aspiration cytology is a quick, simple and accurate method for diagnosing different breast lesions. To study the role of FNAC as alternative to open surgical biopsy and accordingly to decide management of breast lump and also to study various cyto morphological patterns of breast lesions and compared them with histopathological examination, to determine the diagnostic accuracy of cytology. Materials and methods: 293 cases of palpable breast lump patie...

Improved characterization of molecular phenotypes in breast lesions using 18F-FDG PET image homogeneity

Science.gov (United States)

Cao, Kunlin; Bhagalia, Roshni; Sood, Anup; Brogi, Edi; Mellinghoff, Ingo K.; Larson, Steven M.

2015-03-01

Positron emission tomography (PET) using uorodeoxyglucose (18F-FDG) is commonly used in the assessment of breast lesions by computing voxel-wise standardized uptake value (SUV) maps. Simple metrics derived from ensemble properties of SUVs within each identified breast lesion are routinely used for disease diagnosis. The maximum SUV within the lesion (SUVmax) is the most popular of these metrics. However these simple metrics are known to be error-prone and are susceptible to image noise. Finding reliable SUV map-based features that correlate to established molecular phenotypes of breast cancer (viz. estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) expression) will enable non-invasive disease management. This study investigated 36 SUV features based on first and second order statistics, local histograms and texture of segmented lesions to predict ER and PR expression in 51 breast cancer patients. True ER and PR expression was obtained via immunohistochemistry (IHC) of tissue samples from each lesion. A supervised learning, adaptive boosting-support vector machine (AdaBoost-SVM), framework was used to select a subset of features to classify breast lesions into distinct phenotypes. Performance of the trained multi-feature classifier was compared against the baseline single-feature SUVmax classifier using receiver operating characteristic (ROC) curves. Results show that texture features encoding local lesion homogeneity extracted from gray-level co-occurrence matrices are the strongest discriminator of lesion ER expression. In particular, classifiers including these features increased prediction accuracy from 0.75 (baseline) to 0.82 and the area under the ROC curve from 0.64 (baseline) to 0.75.

Automated Breast Ultrasound Lesions Detection using Convolutional Neural Networks.

Science.gov (United States)

Yap, Moi Hoon; Pons, Gerard; Marti, Joan; Ganau, Sergi; Sentis, Melcior; Zwiggelaar, Reyer; Davison, Adrian K; Marti, Robert

2017-08-07

Breast lesion detection using ultrasound imaging is considered an important step of Computer-Aided Diagnosis systems. Over the past decade, researchers have demonstrated the possibilities to automate the initial lesion detection. However, the lack of a common dataset impedes research when comparing the performance of such algorithms. This paper proposes the use of deep learning approaches for breast ultrasound lesion detection and investigates three different methods: a Patch-based LeNet, a U-Net, and a transfer learning approach with a pretrained FCN-AlexNet. Their performance is compared against four state-of-the-art lesion detection algorithms (i.e. Radial Gradient Index, Multifractal Filtering, Rule-based Region Ranking and Deformable Part Models). In addition, this paper compares and contrasts two conventional ultrasound image datasets acquired from two different ultrasound systems. Dataset A comprises 306 (60 malignant and 246 benign) images and Dataset B comprises 163 (53 malignant and 110 benign) images. To overcome the lack of public datasets in this domain, Dataset B will be made available for research purposes. The results demonstrate an overall improvement by the deep learning approaches when assessed on both datasets in terms of True Positive Fraction, False Positives per image, and F-measure.

Pattern of Histopathological Diagnosis of Breast lesions in Gombe ...

African Journals Online (AJOL)

neoplastic proliferative and benign neoplastic disorders, while 118 (40.5%) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7%) cases. Of all the malignancies, invasive ductal carcinoma was the most ...

Imaging of precursor lesions of the female breast; Bildgebung und Vorgehen bei praeinvasiven Laesionen der Mamma

Energy Technology Data Exchange (ETDEWEB)

Weigel, Stefanie [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Universitaetsklinikum Muenster (Germany). Referenzzentrum Mammografie; Decker, Thomas [Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg (Germany). Inst. fuer Pathologie; Heindel, Walter [Universitaetsklinikum Muenster (Germany). Referenzzentrum Mammografie; Muenster Univ. (Germany). Medizinische Fakultaet

2012-06-15

Precursor lesions of the breast are biologically and clinically heterogeneous neoplastic lesions with a varying risk for progression to an invasive breast cancer. This review presents definitions, diagnostic criteria and concepts for the clinical management of the following lesions: ductal carcinoma in situ (DCIS), atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), lobular neoplasia (LN). (orig.)

Feasibility of spatial frequency-domain imaging for monitoring palpable breast lesions

Science.gov (United States)

Robbins, Constance M.; Raghavan, Guruprasad; Antaki, James F.; Kainerstorfer, Jana M.

2017-12-01

In breast cancer diagnosis and therapy monitoring, there is a need for frequent, noninvasive disease progression evaluation. Breast tumors differ from healthy tissue in mechanical stiffness as well as optical properties, which allows optical methods to detect and monitor breast lesions noninvasively. Spatial frequency-domain imaging (SFDI) is a reflectance-based diffuse optical method that can yield two-dimensional images of absolute optical properties of tissue with an inexpensive and portable system, although depth penetration is limited. Since the absorption coefficient of breast tissue is relatively low and the tissue is quite flexible, there is an opportunity for compression of tissue to bring stiff, palpable breast lesions within the detection range of SFDI. Sixteen breast tissue-mimicking phantoms were fabricated containing stiffer, more highly absorbing tumor-mimicking inclusions of varying absorption contrast and depth. These phantoms were imaged with an SFDI system at five levels of compression. An increase in absorption contrast was observed with compression, and reliable detection of each inclusion was achieved when compression was sufficient to bring the inclusion center within ˜12 mm of the phantom surface. At highest compression level, contrasts achieved with this system were comparable to those measured with single source-detector near-infrared spectroscopy.

Alterations in Vitamin D signalling and metabolic pathways in breast cancer progression: a study of VDR, CYP27B1 and CYP24A1 expression in benign and malignant breast lesions Vitamin D pathways unbalanced in breast lesions

International Nuclear Information System (INIS)

Lopes, Nair; Schmitt, Fernando; Sousa, Bárbara; Martins, Diana; Gomes, Madalena; Vieira, Daniella; Veronese, Luiz A; Milanezi, Fernanda; Paredes, Joana; Costa, José L

2010-01-01

Breast cancer is a heterogeneous disease associated with different patient prognosis and responses to therapy. Vitamin D has been emerging as a potential treatment for cancer, as it has been demonstrated that it modulates proliferation, apoptosis, invasion and metastasis, among others. It acts mostly through the Vitamin D receptor (VDR) and the synthesis and degradation of this hormone are regulated by the enzymes CYP27B1 and CYP24A1, respectively. We aimed to study the expression of these three proteins by immunohistochemistry in a series of breast lesions. We have used a cohort comprising normal breast, benign mammary lesions, carcinomas in situ and invasive carcinomas and assessed the expression of the VDR, CYP27B1 and CYP24A1 by immunohistochemistry. The results that we have obtained show that all proteins are expressed in the various breast tissues, although at different amounts. The VDR was frequently expressed in benign lesions (93.5%) and its levels of expression were diminished in invasive tumours (56.2%). Additionally, the VDR was strongly associated with the oestrogen receptor positivity in breast carcinomas. CYP27B1 expression is slightly lower in invasive carcinomas (44.6%) than in benign lesions (55.8%). In contrast, CYP24A1 expression was augmented in carcinomas (56.0% in in situ and 53.7% in invasive carcinomas) when compared with that in benign lesions (19.0%). From this study, we conclude that there is a deregulation of the Vitamin D signalling and metabolic pathways in breast cancer, favouring tumour progression. Thus, during mammary malignant transformation, tumour cells lose their ability to synthesize the active form of Vitamin D and respond to VDR-mediated Vitamin D effects, while increasing their ability to degrade this hormone

Preparation and administration of I-125 labeled seeds for localization of nonpalpable breast lesions

DEFF Research Database (Denmark)

Langhans, Linnea; Klausen, Thomas Levin; Tvedskov, Tove Holst Filtenborg

2016-01-01

Radioactive seed localization (RSL) is a new technique for surgical identification of nonpalpable breast lesions. We describe the preparation of the needle with I-125 seeds for ultrasound-guided deposition in breast lesions. In a feasibility study we investigated the minimum activity amount needed...... for reliable gamma probe identification of the seeds and the levels of exposure to the staff. METHODS: 11 patients received a seed, which was manually placed in an 18 gauge needle with bone wax occluding the tip, and the radiologist introduced it into the breast tissue guided by ultrasound. The seed...... identified. The surgeon removed the seeds together with the breast lesions, and they were identified by the pathologist. There were no unexpected adverse drug reactions. Water bath studies suggest that 1-3 MBq I-125 was sufficient for precise identification, regardless of the presence of conventional Tc-99m...

Diagnostic imaging strategy for MDCT- or MRI-detected breast lesions: use of targeted sonography

International Nuclear Information System (INIS)

Nakano, Satoko; Ohtsuka, Masahiko; Mibu, Akemi; Karikomi, Masato; Sakata, Hitomi; Yamamoto, Masahiro

2012-01-01

Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice. We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups. Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up. Lesion size and shape were not significantly different among the benign, malignant and follow-up groups. Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions

Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions.

Science.gov (United States)

Park, Chang Suk; Kim, Sung Hun; Jung, Na Young; Choi, Jae Jung; Kang, Bong Joo; Jung, Hyun Seouk

2015-03-01

Elastographpy is a newly developed noninvasive imaging technique that uses ultrasound (US) to evaluate tissue stiffness. The interpretation of the same elastographic images may be variable according to reviewers. Because breast lesions are usually reported according to American College of Radiology Breast Imaging and Data System (ACR BI-RADS) lexicons and final category, we tried to compare observer variability between lexicons and final categorization of US BI-RADS and the elasticity score of US elastography. From April 2009 to February 2010, 1356 breast lesions in 1330 patients underwent ultrasound-guided core biopsy. Among them, 63 breast lesions in 55 patients (mean age, 45.7 years; range, 21-79 years) underwent both conventional ultrasound and elastography and were included in this study. Two radiologists independently performed conventional ultrasound and elastography, and another three observers reviewed conventional ultrasound images and elastography videos. Observers independently recorded the elasticity score for a 5-point scoring system proposed by Itoh et al., BI-RADS lexicons and final category using ultrasound BI-RADS. The histopathologic results were obtained and used as the reference standard. Interobserver variability was evaluated. Of the 63 lesions, 42 (66.7 %) were benign, and 21 (33.3 %) were malignant. The highest value of concordance among all variables was achieved for the elasticity score (k = 0.59), followed by shape (k = 0.54), final category (k = 0.48), posterior acoustic features (k = 0.44), echogenecity and orientation (k = 0.43). The least concordances were margin (k = 0.26), lesion boundary (k = 0.29) and calcification (k = 0.3). Elasticity score showed a higher level of interobserver agreement for the diagnosis of breast lesions than BI-RADS lexicons and final category.

Changes in diagnostic methods of non-palpable breast lesions: analysis for 5 years

International Nuclear Information System (INIS)

Kim, Eun Kyung; Oh, Ki Keun; Kim, Mi Hye; You, Jai Kyung; Kwak, Jin Young; Park, Byeong Woo; Lee, Kyong Sik

2002-01-01

To describe the changes in diagnostic methods and reassess the role of core biopsy compared with needle localization biopsy (NLB) in the evaluation of non-palpable breast lesions. We retrospectively analyzed 930 non-palpable breast lesions which underwent either core biopsy or NLB between January 1996 and December 2000. NLB involved 511 lesions in 482 patients, and core 419 lesions in 365 patients. For a given lesion, NLB was guided by either mammography (n=213) or ultrasonography (US) (n=298), but only US was used to guide a core biopsy. Over the five-year period, we calculated the total number of biopsies per year relating to non-palpable breast lesions, also determining the mammographic findings in cases involving NLB and the percentage of malignancies seen at histopathology. The total number of biopsies increased with time: 1996: n=91, 1997: n=118, 1998: n=144, 1999: n=245, 2000: n=332. The implementation of core biopsy, however, led to a decrease in the proportion of NLB (1996: 97.8%, 1997:84.7%, 1998: 75.7%, 1999: 47.8%, 2000: 28.9%). Among nonpalpable lesions which underwent mammgraphy-guided MLB, 46.5% (20/43) were a mass or density in 1996, while in 2000 the proportion was 5.7% (2/35). During this period, however, the finding of calcification without a mass increased from 48.8% in 1996 to 94.3% in 2000. The proportion of cases in which NLB demonstrated malignancy increased from 13.5% in 1996 to 49% in 2000; where US-guided NLB was used, the increase was remarkable: from 15.2% in 1996 to 65.6% in 2000. In the evaluation of non-palpable breast lesions, the appropriate use of core biopsy can decrease the need for a more invasive method such as NLB. Furthermore, because most benign lesions diagnosed by core biopsy do not also undergo NLB, the use of the latter increases the yield of malignancies

Usefulness of Diffusion-Weighted MR Imaging for Breast Lesions: Comparing the Apparent Diffusion Coefficient (ADC) Values and the Pathologic Results

International Nuclear Information System (INIS)

Ahn, Hye Shin; Chang, Yun Woo; Choi, Kyung Hee; Kim, Hyun Joo; Hong, Seong Suk; Hwang, Jung Hwa; Kwon, Kui Hyang; Kim, Yong Bae

2011-01-01

We wanted to evaluate the ability of the apparent diffusion coefficient (ADC) values to differentiate between benign and malignant breast lesions and the normal breast parenchyma. We used breast MRI, including DWI, to obtain images of 167 breast lesions (18 benign lesions and 149 malignant lesions) of 152 women (mean age: 48.6 years, range: 24-80 years). The mean ADC values of the malignant lesions were compared to those of the benign lesions and the normal parenchyma. We compared the ADC values of IDC, DCIS and other types of breast cancer and we also compared the ADC values with the nuclear grade of IDC. The mean ADC values of the malignant lesions were lower than those of the benign lesions and the normal parenchyma (p -3 mm 2 /s for discriminating between malignant and benign lesion showed a specificity of 53% and a sensitivity of 100%, and the ADC threshold value of 1.33 X 10 -3 mm 2 /s showed a specificity of 93% and a sensitivity of 94% for discriminating between malignant and benign lesion.

FDG-PET/CT detection of very early breast cancer in women with breast microcalcification lesions found in mammography screening

International Nuclear Information System (INIS)

Peng, Nang-Jing; Chou, Chen-Pin; Pan, Huay-Ben; Chang, Tsung-Hsien; Hu, Chin; Chiu, Yu-Li; Fu, Ting-Ying; Chang, Hong-Tai

2015-01-01

To assess the efficacy of positron emission tomography/computed tomography with the glucose analogue 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) in Taiwanese women with early breast cancer detected by mammography screening. Dual-time-point imaging of whole-body supine and breast prone scans using FDG-PET/CT were performed sequentially in the pre-operative stage. A total of 11,849 patients underwent screening mammography, of whom 1,209 (10.2%) displayed positive results. After further investigation, 54 patients underwent FDG-PET/CT. Post-operative pathology examinations revealed malignancies in 26 lesions, including invasive breast cancer in 11 cases and non-invasive breast cancer in 15 cases, as well as benign disease in 30 lesions. The FDG-PET/CT findings from the whole-body scans were positive for 9 of 11 invasive breast cancers (81.8%) and 3 of 15 non-invasive cancers (20%), and they were negative for all benign lesions. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FDG-PET/CT with whole-body supine imaging were 46.2%, 100%, 100% and 68.2%, respectively. Breast prone imaging revealed another patient with ductal carcinoma in situ, increasing the sensitivity to 50%. Importantly, positive PET findings were significantly correlated with tumour histology (P = 0.006), tumour size (P = 0.039) and Ki-67 expression (P = 0.011). FDG-PET/CT with whole-body scanning demonstrated high sensitivity to invasive breast cancer, limited sensitivity to non-invasive breast cancer, and high specificity for breast cancer. FDG-PET/CT might be useful for differentiating tumour invasiveness. However, the good PPV but poor NPV do not allow the physician to discard the biopsy.

IS IT NECESSARY TO EXCISE ALL BREAST LESIONS? EXPERIENCE FROM A UNIVERSITY-BASED BREAST UNIT

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YIP CH

2009-01-01

Full Text Available Background: Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC, to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies. Methods: We conducted a retrospective study of all women who had excision biopsy of a breast lump in the University Malaya Medical Centre from January 2005 to December 2006. All patients with malignant preoperative biopsies were excluded. Results: Of 717 lesions in 664 patients, 459 (64% were fibroadenoma, 114 (15.9% were fibrocystic disease, 20 (2.8% were phylloides tumour, 27 (3.8% were papilloma, 59 (8.2% were malignant and 38 (5.3% were of other pathology. Of the 717 open biopsies, 449 (62.6% had fine-needle aspiration cytology (FNAC, 31 (4.3% had core needle biopsy (CNB, while 14 (2.0% had both FNAC and CNB done prior to excision biopsy. 251 (35% had neither FNAC nor CNB. The incidence of fibroadenoma decreased with increasing age and the incidence of fibrocystic changes and papilloma increased with increasing age. There was no association of age with phylloides tumour. The incidence of unexpected malignancy increased with increasing age. The incidence rates were 0.3%, 4.5%, 19.4%, 29.7% and 29.6% for the age group below 30, 30-39, 40-49, 50-59 and above 60 years of age respectively. Of the 59 malignant lesions, FNAC was performed on 47 (79.7% and CNB on 16 (27.1%. 9 had both FNAC and CNB and 3 had neither FNAC nor CNB. Out of the 56 lesions where FNAC/CNB were done, 23 (41.1% were reported as benign, 20 (35.7% as suspicious, 4 (7.1% as atypical, 5 (8.9% as inadequate, 2 (3.6% as equivocal and 2 (3.6% as lymphoid lesions. Out of the 23 prior biopsies reported as

Automatic ultrasound image enhancement for 2D semi-automatic breast-lesion segmentation

Science.gov (United States)

Lu, Kongkuo; Hall, Christopher S.

2014-03-01

Breast cancer is the fastest growing cancer, accounting for 29%, of new cases in 2012, and second leading cause of cancer death among women in the United States and worldwide. Ultrasound (US) has been used as an indispensable tool for breast cancer detection/diagnosis and treatment. In computer-aided assistance, lesion segmentation is a preliminary but vital step, but the task is quite challenging in US images, due to imaging artifacts that complicate detection and measurement of the suspect lesions. The lesions usually present with poor boundary features and vary significantly in size, shape, and intensity distribution between cases. Automatic methods are highly application dependent while manual tracing methods are extremely time consuming and have a great deal of intra- and inter- observer variability. Semi-automatic approaches are designed to counterbalance the advantage and drawbacks of the automatic and manual methods. However, considerable user interaction might be necessary to ensure reasonable segmentation for a wide range of lesions. This work proposes an automatic enhancement approach to improve the boundary searching ability of the live wire method to reduce necessary user interaction while keeping the segmentation performance. Based on the results of segmentation of 50 2D breast lesions in US images, less user interaction is required to achieve desired accuracy, i.e. < 80%, when auto-enhancement is applied for live-wire segmentation.

Contralateral lesions detected by preoperative MRI in patients with recently diagnosed breast cancer: Application of MR CAD in differentiation of benign and malignant lesions

International Nuclear Information System (INIS)

Cho, Nariya; Kim, Sun Mi; Park, Jeong Seon; Jang, Mijung; Kim, Soo-Yeon; Chang, Jung Min; Moon, Woo Kyung

2012-01-01

Objectives: To retrospectively investigate the added value of kinetic features measured by computer-aided diagnosis (CAD) for differentiating benign and malignant contralateral breast lesions detected by preoperative MRI in breast cancer patients. Methods: This study was approved by our institutional review board, and the requirement for informed consent was waived. Fifty-two breast MR images and their CAD kinetic features were obtained for 52 consecutive breast cancer patients with contralateral breast lesions detected by preoperative MRI and confirmed by excision (23 cancers and 29 benign lesions). Three experienced radiologists independently reviewed the MR images without CAD information and assessed probabilities of malignancy. Four weeks later, these probabilities were reanalyzed using stored CAD data. Diagnostic performances and detection rates of delayed washout components were compared between interpretations without and with CAD for each reader. Results: Use of MR CAD increased detection of washout component by 2.4- to 3.7-fold than visual assessment for enhancing contralateral lesions, which increased sensitivity (91% vs. 87% in reader 1; 96% vs. 74% in reader 2; 91% vs. 70% in reader 3) and decreased specificity, but statistical significance was only found for decreased specificity in one reader (52% vs. 28%, P = 0.039), and overall performance (areas under ROC curves 0.672 vs. 0.616 in reader 1; 0.624 vs. 0.603 in reader 2; 0.706 vs. 0.590 in reader 3) remained unimproved. Conclusion: Addition of MR CAD increased sensitivity and decreased specificity than radiologist's assessment alone for differentiating benign and malignant contralateral lesions in breast cancer patients and overall performance remained unimproved.

Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis

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Gennaro, Gisella; Bezzon, Elisabetta; Pescarini, Luigi; Polico, Ilaria; Proietti, Alessandro; Baldan, Enrica; Pomerri, Fabio; Muzzio, Pier Carlo [Veneto Institute of Oncology (IRCCS), Padua (Italy); Hendrick, R.E. [University of Colorado-Denver, Department of Radiology, School of Medicine, Aurora, CO (United States); Toledano, Alicia [Biostatistics Consulting, LLC, Kensington, MD (United States); Paquelet, Jean R. [Advanced Medical Imaging Consultants, Fort Collins, CO (United States); Breast Imaging, McKee Medical Center, Loveland, CO (United States); Chersevani, Roberta [Private Medical Practice, Gorizia (Italy); Di Maggio, Cosimo [Private Medical Practice, Padua (Italy); La Grassa, Manuela [Department of Radiology, Oncological Reference Center (IRCCS), Aviano (Italy)

2013-08-15

To evaluate the clinical value of combining one-view mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization. A free-response receiver operating characteristic (FROC) experiment was conducted independently by six breast radiologists, obtaining data from 463 breasts of 250 patients. Differences in mean lesion detection fraction (LDF) and mean lesion characterization fraction (LCF) were analysed by analysis of variance (ANOVA) to compare clinical performance of the combination of techniques to standard two-view digital mammography. The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT{sub (MLO)}+MX{sub (CC)}, was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT{sub (MLO)}+MX{sub (CC)} was non-inferior to two-view MX for malignant lesions. This study shows that readers' capabilities in detecting and characterizing breast lesions are improved by combining single-view digital breast tomosynthesis and single-view mammography compared to two-view digital mammography. (orig.)

Breast-Lesion Characterization using Textural Features of Quantitative Ultrasound Parametric Maps.

Science.gov (United States)

Sadeghi-Naini, Ali; Suraweera, Harini; Tran, William Tyler; Hadizad, Farnoosh; Bruni, Giancarlo; Rastegar, Rashin Fallah; Curpen, Belinda; Czarnota, Gregory J

2017-10-20

This study evaluated, for the first time, the efficacy of quantitative ultrasound (QUS) spectral parametric maps in conjunction with texture-analysis techniques to differentiate non-invasively benign versus malignant breast lesions. Ultrasound B-mode images and radiofrequency data were acquired from 78 patients with suspicious breast lesions. QUS spectral-analysis techniques were performed on radiofrequency data to generate parametric maps of mid-band fit, spectral slope, spectral intercept, spacing among scatterers, average scatterer diameter, and average acoustic concentration. Texture-analysis techniques were applied to determine imaging biomarkers consisting of mean, contrast, correlation, energy and homogeneity features of parametric maps. These biomarkers were utilized to classify benign versus malignant lesions with leave-one-patient-out cross-validation. Results were compared to histopathology findings from biopsy specimens and radiology reports on MR images to evaluate the accuracy of technique. Among the biomarkers investigated, one mean-value parameter and 14 textural features demonstrated statistically significant differences (p feature selection method could classify the legions with a sensitivity of 96%, a specificity of 84%, and an AUC of 0.97. Findings from this study pave the way towards adapting novel QUS-based frameworks for breast cancer screening and rapid diagnosis in clinic.

The added value of contrast enhanced spectral mammography in identification of multiplicity of suspicious lesions in dense breast

Directory of Open Access Journals (Sweden)

Amr Farouk Ibrahim Moustafa

2018-03-01

Full Text Available Objective: To evaluate the additive value of Contrast Enhanced Spectral Mammography (CESM in the preoperative assessment of malignant lesions in dense breast parenchyma regarding multiplicity. Material and methods: The study included 160 women having heterogeneous dense breast parenchyma (ACR c and d with suspicious lesions identified on sono mammography examination. All patients performed contrast enhanced spectral mammography to confirm or exclude lesion multiplicity. The number of lesions was calculated in the contrast high energy subtraction images with the reference standard being histopathological analysis. Results: Adding CESM to sono-mammography the accuracy in identifying multiple malignant lesion increased from 81.8% accuracy of sono-mammography up to 100% accuracy after adding CESM. Conclusion: Contrast enhanced spectral mammogram showed an added value in the preoperative assessment of breast masses increasing the accuracy of detection of lesions and multiplicity (multifocality and multi-centricity. Keywords: Breast cancer, Contrast enhanced spectral mammogram

Quality control in breast conservation

International Nuclear Information System (INIS)

Schwartz, G.F.

1992-01-01

Over the past 15 years, breast conservation has become an accepted option for treatment of Stages I and II carcinoma of the breast; in this practice in 1991, more than 80% of these patients were treated in this manner. A surgical procedure to excise the primary lesion and to dissect the axilla is generally required to prepare patients for breast conservation, concurrently maximizing esthetic appearance of the breast, minimizing the risk of local recurrence and providing appropriate information for recommendations concerning adjuvant therapy. The volume of breast tissue to be removed, significance of findings at surgical margins, and extent of the axillary dissection are all somewhat controversial subjects. Based upon a personal series of almost 800 patients undergoing breast conservation, observations that reflect the findings from this experience may be shared. (author)

Lesion type and reader experience affect the diagnostic accuracy of breast MRI: A multiple reader ROC study

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Baltzer, Pascal A.T., E-mail: patbaltzer@gmail.com [Department of Biomedical Imaging and Imge-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna (Austria); Kaiser, Werner Alois [Department of Diagnostic and Interventional Radiology, University Hospital Jena, Erlanger Allee 101, 07740 Jena (Germany); Dietzel, Matthias, E-mail: dietzelmatthias2@hotmail.com [Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen (Germany)

2015-01-15

Highlights: • The main findings of our study are, that reader experience and lesion type (i.e., mass versus non-mass enhancement) are independent predictors of the diagnostic accuracy of breast MRI. • Specifically, benign and malignant non-mass lesions cannot be differentiated with sufficient accuracy, especially if readers are not experienced. • We conclude that future research in breast MRI should focus on non-mass lesions, as these are the problem makers in modern breast MRI. - Abstract: Purpose: To evaluate the influence of lesion type (mass versus non-mass) and reader experience on the diagnostic performance of breast MRI (BMRI) in a non-screening setting. Materials and methods: Consecutive patients (mean age, 55 ± 12 years) with breast lesions that were verified by biopsy or surgery, and who had had BMRI as part of their diagnostic workup, were eligible for this retrospective single-center study. Cancers diagnosed by biopsy before BMRI were excluded to eliminate biological and interpretation bias due to biopsy or chemotherapy effects (n = 103). Six blinded readers (experience level, high (HE, n = 2); intermediate (IE, n = 2); and low (LE, n = 2)) evaluated all examinations and assigned independent MRI BI-RADS ratings. Lesion type (mass, non-mass, focal) was noted. Receiver operating characteristics (ROC) and logistic regression analysis was performed to compare diagnostic accuracies. Results: There were 259 histologically verified lesions (123 malignant, 136 benign) investigated. There were 169 mass (103 malignant, 66 benign) and 48 non-mass lesions (19 malignant, 29 benign). Another 42 lesions that met the inclusion criteria were biopsied due to conventional findings (i.e., microcalcifications, architectural distortions), but did not enhance on MRI (41 benign, one DCIS). ROC analysis revealed a total area under the curve (AUC) between 0.834 (LE) and 0.935 (HI). Logistic regression identified a significant effect of non-mass lesions (P < 0.0001) and

The use of diffusion-weighted magnetic resonance imaging in the differentiation between benign and malignant breast lesions

International Nuclear Information System (INIS)

Pereira, Fernanda Philadelpho Arantes; Martins, Gabriela; Domingues, Marisa Nassar Aidar; Domingues, Romeu Cortes; Figueiredo, Eduardo; Fonseca, Lea Mirian Barbosa da

2009-01-01

Objective: to study the utility of diffusion-weighted magnetic resonance imaging in the differentiation between benign and malignant breast lesions. Materials and methods: forty-five women (mean age, 46.1 years) with 52 focal breast lesions underwent diffusion-weighted magnetic resonance imaging. The calculation of apparent diffusion coefficient (ADC) was based on the ADC map reflecting five b values (0, 250, 500, 750, and 1000 s/mm 2 ). The mean ADC value of each lesion was correlated with imaging findings and histopathologic results. Cutoff ADC, sensitivity and specificity of diffusion-weighted imaging in the differentiation between benign and malignant lesions were calculated. P -3 mm 2 /s) as compared with benign lesions (1.50 ± 0.34 x 10 -3 mm 2 /s) (P < 0.0001). Diffusion-weighted imaging showed high sensitivity and specificity (both, 92.3%) in the differentiation between benign and malignant lesions. Conclusion: diffusion-weighted imaging is a potential resource as an adjuvant to breast magnetic resonance imaging to differentiate benign from malignant lesions. Such sequence can be easily added to the standard breast magnetic resonance imaging protocol, without implying any significant increase in examination time. (author)

Mammotome biopsy under ultrasound control in the diagnostics and treatment of nodular breast lesions - own experience.

Science.gov (United States)

Kibil, Wojciech; Hodorowicz-Zaniewska, Diana; Kulig, Jan

2012-05-01

Mammotome biopsy is an effective, minimally invasive, novel technique used in the verification of breast lesions.The aim of the study was to assess the value of ultrasound-guided vacuum-assisted core needle biopsy (mammotome biopsy) in the diagnostics and treatment of nodular breast lesions, considering own data.Material and methods. Analysis comprised 1183 mammotome biopsies under ultrasound control performed in 1177 female patients during the period between 2000 and 2010, at the Regional Clinic for Early Diagnostics and Treatment of Breast Lesions, I Chair and Department of General Surgery, Jagiellonian University, Collegium Medicum.Results. The average patient age amounted to 41.7 years. The size of the investigated lesions ranged between 4 and 65 mm (mean - 12 mm). The histopathological examination result was as follows: fibrocystic lesions (n=285), adenofibroma (n=477), adenosis sclerosans (n=188), hyperplasia without atypy (n=58), phyllode tumor (n=2), papilloma (n=14), hamartoma (n=1), atypical hyperplasia (n=25), in situ ductal carcinoma (n=4), in situ lobular carcinoma (n=5), infiltrating ductal carcinoma (n=114), infiltrating lobular carcinoma (n=4), non-diagnostic result (n=6). The histopathological diagnosis was obtained in 99.5% of cases. Patients diagnosed with atypical hyperplasia or cancer were qualified for surgery, according to accepted standards. The presence of a hematoma was the most common complication after the biopsy, observed in 16.5% of patients.Conclusions. The obtained results confirmed the high value of ultrasound-guided biopsies in the diagnostics of nodular breast lesions. The method is safe, minimally invasive, with few complications, providing a good cosmetic effect. In case of benign lesions with a diameter of less than 15 mm the mammotome biopsy enables to completely excise the lesions, being an alternative to open surgical biopsies. The mammotome biopsy should become the method of choice considering the diagnostics of nodular

A Radial Sclerosing Lesion Mimicking Breast Cancer on Mammography in a Young Woman

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Masashi Furukawa

2012-02-01

Full Text Available A spiculated mass on a mammogram is highly suggestive of malignancy. We report the case of a 32-year-old woman with a radial sclerosing lesion that mimicked breast cancer on mammography. She visited her physician after palpating a lump in her left breast. Mammography showed architectural distortion in the upper inner quadrant of the left breast. Ultrasonography showed a low echoic area with an ambiguous boundary. Core needle biopsy was performed because of the suspicion of malignancy. Histological examination did not reveal any malignant cells. After 6 months, the breast lump became larger and the patient was referred to our hospital. Mammography performed in our hospital showed a spiculated mass, and therefore mammotome biopsy was performed. Histological examination revealed dense fibroelastic stroma with a wide variety of mastopathic changes, leading to a diagnosis of a radial sclerosing lesion. One year after the biopsy, the lump on her left breast had disappeared and mammography showed no spiculated mass.

Clinical and diagnostic value of preoperative MR mammography and FDG-PET in suspicious breast lesions

International Nuclear Information System (INIS)

Walter, C.; Scheidhauer, K.; Theissen, P.; Scharl, A.; Goering, U.J.; Kugel, H.; Krahe, T.; Pietrzyk, U.

2003-01-01

Dynamic enhanced magnetic resonance (MR) mammography and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) of the breast were directly compared preoperatively in suspicious breast lesions. Forty-two breast lesions in 40 patients were examined with a three-dimensional dynamic MR imaging series and FDG-PET. The MR and PET examinations were evaluated separately and the results were compared with the histological findings. The sensitivity and specificity of each method were calculated. The diagnostic value of both modalities as single diagnostic tool and in combination was investigated. Nineteen malignant and 23 benign breast lesions were proven histologically. Magnetic resonance mammography and FDG-PET showed a sensitivity of 89 and 63%, respectively. The specificity was 74 and 91%, respectively. The combination of both imaging methods decreased the not-required biopsies from 55 to 17%. Only one false-negative finding - a patient pre-treated with chemotherapy - was observed in both methods. The combination of MR mammography and FDG-PET can help to decrease biopsies of benign breast lesions. Because of their high cost, these modalities should only be used in problematic cases to either rule out or to demonstrate malignancy. The best diagnostic strategy is achieved using MR mammography first. If the diagnosis is still questionable, FDG-PET can be performed. (orig.)

Role of quantitative pharmacokinetic parameter (transfer constant: Ktrans in the characterization of breast lesions on MRI

Directory of Open Access Journals (Sweden)

Jena Amarnath

2013-01-01

Full Text Available Background: The semi-quantitative analysis of the time-intensity curves in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI has a limited specificity due to overlapping enhancement patterns after gadolinium administration. With the advances in technology and faster sequences, imaging of the entire breast can be done in a few seconds, which allows measuring the transit of contrast (transfer constant: K trans through the vascular bed at capillary level that reflects quantitative measure of porosity/permeability of tumor vessels. Aim: Our study aims to evaluate the pharmacokinetic parameter K trans for enhancing breast lesions and correlate it with histopathology, and assess accuracy, sensitivity, and specificity of this parameter in discriminating benign and malignant breast lesions. Materials and Methods: One hundred and fifty-one women with 216 histologically proved enhancing breast lesions underwent high temporal resolution DCE-MRI for the early dynamic analysis for calculation of pharmacokinetic parameters (K trans using standard two compartment model. The calculated values of K trans were correlated with histopathology to calculate the sensitivity, specificity, and accuracy. Results: Receiver operating characteristic (ROC curve analysis revealed a mean K trans value of 0.56, which reliably distinguished benign and malignant breast lesions with a sensitivity of 91.1% and specificity of 90.3% with an overall accuracy of 89.3%. The area under curve (AUC was 0.907. Conclusion: K trans is a reliable quantitative parameter for characterizing benign and malignant lesions in routine DCE-MRI of breasts.

YKL-40 expression in benign and malignant lesions of the breast: a methodologic study

DEFF Research Database (Denmark)

Roslind, Anne; Johansen, Julia S; Junker, Nanna

2007-01-01

as well as in benign and malignant breast lesions. The presence of YKL-40 in breast tissue was verified by in situ hybridization and protein extraction procedures. An immunohistochemical method was developed and 4 different antibodies directed against YKL-40 were tested. Ten patients with normal breast...

Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients' and Doctors' Views

International Nuclear Information System (INIS)

Toledano, Alain H.; Bollet, Marc A.; Fourquet, Alain; Azria, David; Gligorov, Joseph; Garaud, Pascal; Serin, Daniel; Bosset, Jean-Francois; Miny-Buffet, Joelle; Favre, Anne; Le Foch, Olivier; Calais, Gilles

2007-01-01

Purpose: To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. Methods and Materials: From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. Results: Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (κ = 0.62). Conclusion: After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis

MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies

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Spick, Claudio; Pinker-Domenig, Katja; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), General Hospital Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

2014-06-15

To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53 ± 0.38 x 10{sup -3} mm{sup 2}/s in benign lesions and 1.06 ± 0.27 x 10{sup -3} mm{sup 2}/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58 x 10{sup -3} mm{sup 2}/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. (orig.)

A new background distribution-based active contour model for three-dimensional lesion segmentation in breast DCE-MRI

Energy Technology Data Exchange (ETDEWEB)

Liu, Hui; Liu, Yiping; Qiu, Tianshuang [Department of Biomedical Engineering, Dalian University of Technology, Dalian 116024 (China); Zhao, Zuowei, E-mail: liuhui@dlut.edu.cn [Second Affiliated Hospital, Dalian Medical University, Dalian 116027 (China); Zhang, Lina [Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian 116027 (China)

2014-08-15

Purpose: To develop and evaluate a computerized semiautomatic segmentation method for accurate extraction of three-dimensional lesions from dynamic contrast-enhanced magnetic resonance images (DCE-MRIs) of the breast. Methods: The authors propose a new background distribution-based active contour model using level set (BDACMLS) to segment lesions in breast DCE-MRIs. The method starts with manual selection of a region of interest (ROI) that contains the entire lesion in a single slice where the lesion is enhanced. Then the lesion volume from the volume data of interest, which is captured automatically, is separated. The core idea of BDACMLS is a new signed pressure function which is based solely on the intensity distribution combined with pathophysiological basis. To compare the algorithm results, two experienced radiologists delineated all lesions jointly to obtain the ground truth. In addition, results generated by other different methods based on level set (LS) are also compared with the authors’ method. Finally, the performance of the proposed method is evaluated by several region-based metrics such as the overlap ratio. Results: Forty-two studies with 46 lesions that contain 29 benign and 17 malignant lesions are evaluated. The dataset includes various typical pathologies of the breast such as invasive ductal carcinoma, ductal carcinomain situ, scar carcinoma, phyllodes tumor, breast cysts, fibroadenoma, etc. The overlap ratio for BDACMLS with respect to manual segmentation is 79.55% ± 12.60% (mean ± s.d.). Conclusions: A new active contour model method has been developed and shown to successfully segment breast DCE-MRI three-dimensional lesions. The results from this model correspond more closely to manual segmentation, solve the weak-edge-passed problem, and improve the robustness in segmenting different lesions.

Dynamics of contrast enhancement in MR imaging and power Doppler ultrasonography of solid breast lesions

International Nuclear Information System (INIS)

Reinikainen, H.; Paeaekkoe, E.; Suramo, I.; Paeivaensalo, M.; Rissanen, T.

2002-01-01

Purpose: To evaluate the dynamics of contrast enhancement in solid breast lesions at contrast-enhanced MR imaging and power Doppler ultrasonography (US) and to compare the methods to histology and to each other. Material and Methods: Forty breast lesions were prospectively examined with dynamic MR and power Doppler US. Time-signal intensity curves of enhancement were obtained for both methods. The shape of the curve was analyzed to be benign, indeterminate or malignant. The curves were also analyzed quantitatively by calculating the slope of the curve and the area under the curve (both methods), relative enhancement (MR), and time to peak (US). The lesions were divided into malignant lesions, fibroadenomas, and other benign lesions. The results were compared to histology. Results: In the subjective analysis of the MR curve in differentiating between benign and malignant lesions the accuracy was 90%. The MR curve also enabled differentiation between fibroadenomas and malignancies. The accuracy of the US curve was 38%. Quantitatively, statistically significant differences were found using all the MR variables, except between malignancies and fibroadenomas. Using the US variables, no significant difference was found between the groups. Conclusion: The dynamics of contrast-enhanced MR were reliable in the differential diagnosis of solid breast lesions, but contrast-enhanced power Doppler US was of limited value

Mammographic quantitative image analysis and biologic image composition for breast lesion characterization and classification

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Drukker, Karen, E-mail: kdrukker@uchicago.edu; Giger, Maryellen L.; Li, Hui [Department of Radiology, University of Chicago, Chicago, Illinois 60637 (United States); Duewer, Fred; Malkov, Serghei; Joe, Bonnie; Kerlikowske, Karla; Shepherd, John A. [Radiology Department, University of California, San Francisco, California 94143 (United States); Flowers, Chris I. [Department of Radiology, University of South Florida, Tampa, Florida 33612 (United States); Drukteinis, Jennifer S. [Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612 (United States)

2014-03-15

Purpose: To investigate whether biologic image composition of mammographic lesions can improve upon existing mammographic quantitative image analysis (QIA) in estimating the probability of malignancy. Methods: The study population consisted of 45 breast lesions imaged with dual-energy mammography prior to breast biopsy with final diagnosis resulting in 10 invasive ductal carcinomas, 5 ductal carcinomain situ, 11 fibroadenomas, and 19 other benign diagnoses. Analysis was threefold: (1) The raw low-energy mammographic images were analyzed with an established in-house QIA method, “QIA alone,” (2) the three-compartment breast (3CB) composition measure—derived from the dual-energy mammography—of water, lipid, and protein thickness were assessed, “3CB alone”, and (3) information from QIA and 3CB was combined, “QIA + 3CB.” Analysis was initiated from radiologist-indicated lesion centers and was otherwise fully automated. Steps of the QIA and 3CB methods were lesion segmentation, characterization, and subsequent classification for malignancy in leave-one-case-out cross-validation. Performance assessment included box plots, Bland–Altman plots, and Receiver Operating Characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) for distinguishing between benign and malignant lesions (invasive and DCIS) was 0.81 (standard error 0.07) for the “QIA alone” method, 0.72 (0.07) for “3CB alone” method, and 0.86 (0.04) for “QIA+3CB” combined. The difference in AUC was 0.043 between “QIA + 3CB” and “QIA alone” but failed to reach statistical significance (95% confidence interval [–0.17 to + 0.26]). Conclusions: In this pilot study analyzing the new 3CB imaging modality, knowledge of the composition of breast lesions and their periphery appeared additive in combination with existing mammographic QIA methods for the distinction between different benign and malignant lesion types.

Angiosonography in suspicious breast lesions with non-diagnostic FNAC: comparison with power Doppler US.

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Caumo, F; Carbognin, G; Casarin, A; Pinali, L; Vasori, S; D'Onofrio, M; Pozzi Mucelli, R

2006-02-01

The purpose of this study was to evaluate the accuracy of angiosonography in comparison with colour Doppler ultrasound (US) in the discrimination of suspicious breast lesions with nondiagnostic fine-needle aspiration cytology (FNAC). Pre-operative Power Doppler US and angiosonography were prospectively performed in 20 suspicious breast lesions with non-diagnostic FNAC. A second-generation US contrast agent was utilised with a high-frequency transducer and a contrast-specific algorithm (low acoustic pressure CnTI). The enhancement characteristics of all lesions were analysed using qualitative and quantitative parameters obtained from time-intensity curves with the different imaging modalities. The final diagnosis was confirmed at pathology in all cases. Microvessel density (MVD) was assessed in the surgical specimen using CD34. The correct assessment of biological behaviour was achieved in all cases by angiosonography (sensitivity of 100%; specificity of 91%) and colour Doppler US (45% sensitivity; 78% specificity). MVD correlated with the biological behaviour. Angiosonography is more accurate than colour Doppler US in the correct assessment of biological behaviour of suspicious breast lesions.

Contrast enhanced digital mammography: Is it useful in detecting lesions in edematous breast?

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Noha Abd ElShafy ElSaid

2015-09-01

Conclusion: Dual-energy contrast-enhanced digital mammography is a useful technique in identification of lesions in mammographically dense edematous breasts and proved to be a useful tool in the follow-up of cases presenting by edema after conservative breast surgery and chemotherapy.

The use of diffusion-weighted magnetic resonance imaging in the differentiation between benign and malignant breast lesions

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Pereira, Fernanda Philadelpho Arantes; Martins, Gabriela; Domingues, Marisa Nassar Aidar; Domingues, Romeu Cortes [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil)], e-mail: fephila@gmail.com; Figueiredo, Eduardo [GE Healthcare, Sao Paulo, SP (Brazil); Fonseca, Lea Mirian Barbosa da [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Faculdade de Medicina

2009-09-15

Objective: to study the utility of diffusion-weighted magnetic resonance imaging in the differentiation between benign and malignant breast lesions. Materials and methods: forty-five women (mean age, 46.1 years) with 52 focal breast lesions underwent diffusion-weighted magnetic resonance imaging. The calculation of apparent diffusion coefficient (ADC) was based on the ADC map reflecting five b values (0, 250, 500, 750, and 1000 s/mm{sup 2}). The mean ADC value of each lesion was correlated with imaging findings and histopathologic results. Cutoff ADC, sensitivity and specificity of diffusion-weighted imaging in the differentiation between benign and malignant lesions were calculated. P < 0.05 was considered as statistically significant. Results: the mean ADC was significantly lower for malignant lesions (0.92 {+-} 0.26 x 10{sup -3} mm{sup 2}/s) as compared with benign lesions (1.50 {+-} 0.34 x 10{sup -3} mm{sup 2}/s) (P < 0.0001). Diffusion-weighted imaging showed high sensitivity and specificity (both, 92.3%) in the differentiation between benign and malignant lesions. Conclusion: diffusion-weighted imaging is a potential resource as an adjuvant to breast magnetic resonance imaging to differentiate benign from malignant lesions. Such sequence can be easily added to the standard breast magnetic resonance imaging protocol, without implying any significant increase in examination time. (author)

Evaluation of accuracy of intra operative imprint cytology for detection of breast lesions

International Nuclear Information System (INIS)

Mahmood, Z.; Shahbaz, A.; Qureshi, A.; Aziz, N.; Niazi, S.; Qureshi, S.; Bukhari, M.H.

2010-01-01

Objective: To determine the accuracy of imprint cytology as an intraoperative diagnostic procedure for breast lesions with histopathological correlation. Materials and Methods: This was a descriptive study on 40 cases of breast lesions comprising of inflammatory, benign and malignant lesions including their margins etc. It was conducted at King Edward Medical University, Lahore in collaboration with all Surgical Departments of Mayo Hospital. Relevant clinical data was recorded in a proforma. Both touch and scrape imprints were prepared from all the lesions and stained with May-Grunwaled Giemsa and Haematoxylin and Eosin stains. The imprints were subsequently compared with histopathology sections. Results: When we used atypical cases as negative both touch and scrape imprints gave sensitivity, specificity, positive predictive value, negative predictive value and accuracy at 100%. However when we used cases with atypia as positive, sensitivity and negative predictive value were 100% with both touch and scrape imprints. Specificity, positive predictive value and accuracy were 71%, 86%, 85.5% respectively with touch imprints and 78%, 89%, 89% respectively with scrape imprints. No diagnostic difference was noted between the results of both stains. All the imprints were well correlated with histopathological diagnosis. Conclusion: Imprint cytology is an accurate and simple intraoperative method for diagnosing breast lesions. It can provide the surgeons with information regarding immediate clinical and surgical interventions. (author)

Transfer learning with convolutional neural networks for lesion classification on clinical breast tomosynthesis

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Mendel, Kayla R.; Li, Hui; Sheth, Deepa; Giger, Maryellen L.

2018-02-01

With growing adoption of digital breast tomosynthesis (DBT) in breast cancer screening protocols, it is important to compare the performance of computer-aided diagnosis (CAD) in the diagnosis of breast lesions on DBT images compared to conventional full-field digital mammography (FFDM). In this study, we retrospectively collected FFDM and DBT images of 78 lesions from 76 patients, each containing lesions that were biopsy-proven as either malignant or benign. A square region of interest (ROI) was placed to fully cover the lesion on each FFDM, DBT synthesized 2D images, and DBT key slice images in the cranial-caudal (CC) and mediolateral-oblique (MLO) views. Features were extracted on each ROI using a pre-trained convolutional neural network (CNN). These features were then input to a support vector machine (SVM) classifier, and area under the ROC curve (AUC) was used as the figure of merit. We found that in both the CC view and MLO view, the synthesized 2D image performed best (AUC = 0.814, AUC = 0.881 respectively) in the task of lesion characterization. Small database size was a key limitation in this study, and could lead to overfitting in the application of the SVM classifier. In future work, we plan to expand this dataset and to explore more robust deep learning methodology such as fine-tuning.

Impact of radioguided occult lesion localization on the correct excision of malignant breast lesions. Effect of histology and tumor size

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Woll, J.P.P.; Garcia Vicente, A.M.; Gonzalez Garcia, B.; Delgado Portela, M.; Cordero Garcia, J.M.; Pardo Garcia, R.; Molino Trinidad, C.; Soriano Castrejon, A.M.; Cortes Romera, M.

2011-01-01

The aim of this study was to evaluate the impact of radioguided occult lesion localization (ROLL) in the correct location and excision of malignant breast lesions, and analyze if these results are affected by the histology and tumor size. A total of 105 patients with occult breast lesions were studied. The mean age was 55 years. An intralesional dose of 18.5 MBq of 99mTc-labeled macroaggregated human albumin (AMA) was administered using stereotaxic mammography or ultrasound. Surgical resection was carried out with the help of a gammadetector probe. In the histological study, disease-free margin was defined by a distance between the tumor lesion and the surgical margin of more than 1 mm. The possible influence of tumor histology and lesion diameter with respect to free/affected margins was analyzed. Correct radiotracer placement was achieved in 100/105 of the cases (95.2%). In the remaining 5 cases (4.8%), radiotracer placement was incorrect, with 2 of them being malignant lesions that were found by macroscopic inspection, and the other 3 having benign pathology. Among the malignant lesions (44 cases), correct placement of the radiotracer was achieved in 42 cases (95.5%). Of these 42 malignant lesions, in which the ROLL was correctly performed, free surgical margins were obtained in 24 cases (57.1%), while the other 18 (42.9%) had infiltrated surgical margins. The most common histological type among the malignant lesions was invasive ductal carcinoma (71.4%). The histological types with an increased frequency of infiltration of surgical margins were invasive and microinvasive cancer (94.4%). All the affected margins were in lesions greater than 10 mm, and the highest incidence was in those between 20 and 30 mm (55.5%). In our experience, the advantages of the ROLL technique are a precise localization of malignant breast lesions (95.5%) and an increased probability of a complete excision with free margins in more than one half of them. Nevertheless, special

Complex cystic lesions of the breast on ultrasonography: Feature analysis and BI-RADS assessment

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Hsu, Hsian-He; Yu, Jyh-Cherng; Lee, Herng-Sheng; Lin, Wen-Chiung; Chang, Wei-Chou; Tung, Ho-Jui; Huang, Guo-Shu; Hsu, Giu-Cheng

2011-01-01

Purpose: To analyze the features of breast complex cystic lesions at ultrasonography (US) and to determine appropriate Breast Imaging Reporting and Data System (BI-RADS) categories and management recommendations for these lesions based on US findings with pathologic correlation. Materials and methods: From July 2001 to June 2007, 152 consecutive pathologically proven complex cystic lesions on US were retrospectively reviewed. All lesions at US were evaluated for size, lesion characteristics, margins, and presence of abnormal axillary nodes. US features of lesions were classified into four types, and positive predictive values (PPVs) were calculated for each type. Clinical, imaging, and histopathological findings were reviewed. Results: Of the 152 lesions based on US appearance, 36 (24%) were classified as type I, 49 (32%) as type II, 28 (18%) as type III, and 39 (26%) as type IV. The PPVs for malignancy in each type were 14% for type I, 16% for type II, 14% for type III, and 41% for type IV. There was a significantly higher frequency of malignancy among lesions of type IV compared with the other three types (16/39 = 41% vs 5/36 = 14%, p = 0.0089; 16/39 = 41% vs 8/49 = 16%, p = 0.0098; and 16/39 = 41% vs 4/28 = 14%, p = 0.018 [Chi-squared test]). Lesions with maximum diameter equal to or larger than 20 mm, not circumscribed margins, or a mammographic finding of suspected malignancy had a high probability of malignancy (p < 0.05 for each). Conclusion: US is useful in evaluating the complex cystic lesions and in clarifying the indication for biopsy of these lesions. The four types of US classifications used in our study establish accepted benchmarks for these breast abnormalities when stratified according to BI-RADS categories.

Complex cystic lesions of the breast on ultrasonography: Feature analysis and BI-RADS assessment

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Hsu, Hsian-He, E-mail: hsianhe@yahoo.com.tw [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Yu, Jyh-Cherng [Department of Surgery, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Lee, Herng-Sheng [Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Lin, Wen-Chiung; Chang, Wei-Chou [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China); Tung, Ho-Jui [Department of Healthcare Administration, Asia University, Taiwan (China); Huang, Guo-Shu; Hsu, Giu-Cheng [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan (China)

2011-07-15

Purpose: To analyze the features of breast complex cystic lesions at ultrasonography (US) and to determine appropriate Breast Imaging Reporting and Data System (BI-RADS) categories and management recommendations for these lesions based on US findings with pathologic correlation. Materials and methods: From July 2001 to June 2007, 152 consecutive pathologically proven complex cystic lesions on US were retrospectively reviewed. All lesions at US were evaluated for size, lesion characteristics, margins, and presence of abnormal axillary nodes. US features of lesions were classified into four types, and positive predictive values (PPVs) were calculated for each type. Clinical, imaging, and histopathological findings were reviewed. Results: Of the 152 lesions based on US appearance, 36 (24%) were classified as type I, 49 (32%) as type II, 28 (18%) as type III, and 39 (26%) as type IV. The PPVs for malignancy in each type were 14% for type I, 16% for type II, 14% for type III, and 41% for type IV. There was a significantly higher frequency of malignancy among lesions of type IV compared with the other three types (16/39 = 41% vs 5/36 = 14%, p = 0.0089; 16/39 = 41% vs 8/49 = 16%, p = 0.0098; and 16/39 = 41% vs 4/28 = 14%, p = 0.018 [Chi-squared test]). Lesions with maximum diameter equal to or larger than 20 mm, not circumscribed margins, or a mammographic finding of suspected malignancy had a high probability of malignancy (p < 0.05 for each). Conclusion: US is useful in evaluating the complex cystic lesions and in clarifying the indication for biopsy of these lesions. The four types of US classifications used in our study establish accepted benchmarks for these breast abnormalities when stratified according to BI-RADS categories.

Targeted Ultrasound of an Indeterminate Breast Lesion on Mammography: When Does It Influence Management?

Science.gov (United States)

Sohail, Saba; Masroor, Imrana; Afzal, Shaista

2015-08-01

To determine the change over mammographic diagnosis, BI-RADS category and management following targeted ultrasound of an indeterminate lesion seen on mammography and associated factors, if any. Descriptive, analytical study. Radiology Department, The Aga Khan University Hospital and Clifton Medical Services, Karachi, from April 2010 to May 2011. Patients referred for targeted breast ultrasound following X-ray mammography were selected regardless of age. Targeted Ultrasound (TUS) was defined as a limited ultrasound of a specific lesion or breast part as indicated by the referring source. Comparison was made between the post mammography and post TUS lesion characterization, diagnosis and BI-RADS category (0-5) which was taken as a measure of management change. Those were evaluated to determine significance of age, marital status, parity, breast parenchymal pattern ( dense, fatty, heterogeneous), referring source for the TUS (radiology resident, radiologist or surgeon), lesion characteristics (density, echogenecity, shape, location, margins, size, depth-to-width ratio, enhancement or shadowing), presenting symptoms or signs and reason for TUS. Ap-value of 0.05 or less was taken as significant. There were a total of 342 patients with mean age of 49.7 ±13.5 years. It assigned a definite category in 232 patients with an indefinite category (0) on mammography requiring further investigation. It decreased the suspicion for malignancy in 180 (77.58%) by assigning a low BI-RADS category and increased the suspicion in 52 (22.41%). The factors significantly associated with this changes included clinical indication being diagnostic (p management of an indeterminate breast lesion in a high number of patients, particularly when there was a lump as indication for imaging in the presence of risk factors in a patient with otherwise heterogeneously dense breast parenchyma.

US-guided diffuse optical tomography for breast lesions: the reliability of clinical experience

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Kim, Min Jung; Kim, Ji Youn; Youn, Jung Hyun; Kim, Myung Hyun; Koo, Hye Ryoung; Kim, Soo Jin; Sohn, Yu-Mee; Moon, Hee Jung; Kim, Eun-Kyung [Yonsei University College of Medicine, Institute of Radiological Science, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of)

2011-07-15

To prospectively assess the reliability of US-guided diffuse optical tomography (US-DOT) using interobserver agreement for the diagnosis of breast lesions with individual real-time imaging and to assess the interobserver agreement of conventional sonography (US) combined with US-DOT for differentiation between benignity and malignancy breast lesions. An Institutional Review Board approved this study, and all subjects provided written informed consent. 122 breast lesions in 111 patients evaluated with US-guided core biopsy were included. Assessments with US and US-DOT for cases subjected to biopsy were obtained by two radiologists using individual real-time imaging prior to biopsy and were prospectively recorded by each performer. With DOT, the total haemoglobin concentration (THC) for each breast lesion was measured. Histopathological results from US-guided biopsies were used as a reference standard. To assess measurement interobserver agreement, the intraclass correlation coefficient (ICC) and the Bland-Altman plot were used for THC in US-DOT and the kappa values and ROC analysis were used to evaluate the diagnostic performances of the US BI-RADS final assessment in US and combined US and US-DOT. Of 122 US-guided core biopsied lesions, 83 (68.0%) were diagnosed as benign, and 39 (32.0%) as malignant. Excellent correlation was seen in the THC in US-DOT (ICC score 0.796; 95% confidence interval, 0.708-0.857). The interobserver agreement in BI-RADS final assessment with US and US-DOT (almost perfect; {kappa} = 0.8618) was improved compared with that of US (substantial agreement, {kappa} = 0.6574). However, the overall areas under the ROC curve did not show significant differences between US and combined US and US-DOT, 0.8894 and 0.8975, respectively (P = 0.981). The reliability of THC in US-DOT showed excellent correlation in overall real-time performance. Although the inter-observer agreement for BI-RADS final assessment of US was improved by using US-DOT, the

Impact of compressed breast thickness and dose on lesion detectability in digital mammography: FROC study with simulated lesions in real mammograms

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Salvagnini, Elena, E-mail: elena.salvagnini@gmail.com [Department of Imaging and Pathology, Radiology, KUL, Herestraat 49, Leuven B-3000 (Belgium); SCK-CEN, Boeretang 200, Mol 2400 (Belgium); Bosmans, Hilde; Marshall, Nicholas W. [Department of Imaging and Pathology, Radiology, KUL, Herestraat 49, Leuven B-3000 (Belgium); Department of Radiology, Radiology, UZ Gasthuisberg, Herestraat 49, Leuven B-3000 (Belgium); Van Ongeval, Chantal; Van Steen, Andreas; Cockmartin, Lesley [Department of Radiology, Radiology, UZ Gasthuisberg, Herestraat 49, Leuven B-3000 (Belgium); Michielsen, Koen [Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KUL, Herestraat 49, Leuven B-3000 (Belgium); Struelens, Lara [SCK-CEN, Boeretang 200, Mol 2400 (Belgium)

2016-09-15

Purpose: The aim of this work was twofold: (1) to examine whether, with standard automatic exposure control (AEC) settings that maintain pixel values in the detector constant, lesion detectability in clinical images decreases as a function of breast thickness and (2) to verify whether a new AEC setup can increase lesion detectability at larger breast thicknesses. Methods: Screening patient images, acquired on two identical digital mammography systems, were collected over a period of 2 yr. Mammograms were acquired under standard AEC conditions (part 1) and subsequently with a new AEC setup (part 2), programmed to use the standard AEC settings for compressed breast thicknesses ≤49 mm, while a relative dose increase was applied above this thickness. The images were divided into four thickness groups: T1 ≤ 29 mm, T2 = 30–49 mm, T3 = 50–69 mm, and T4 ≥ 70 mm, with each thickness group containing 130 randomly selected craniocaudal lesion-free images. Two measures of density were obtained for every image: a BI-RADS score and a map of volumetric breast density created with a software application (VolparaDensity, Matakina, NZ). This information was used to select subsets of four images, containing one image from each thickness group, matched to a (global) BI-RADS score and containing a region with the same (local) VOLPARA volumetric density value. One selected lesion (a microcalcification cluster or a mass) was simulated into each of the four images. This process was repeated so that, for a given thickness group, half the images contained a single lesion and half were lesion-free. The lesion templates created and inserted in groups T3 and T4 for the first part of the study were then inserted into the images of thickness groups T3 and T4 acquired with higher dose settings. Finally, all images were visualized using the ViewDEX software and scored by four radiologists performing a free search study. A statistical jackknife-alternative free-response receiver operating

Role of 99mTc-MIBI in evaluation of palpable breast lesions

International Nuclear Information System (INIS)

Laghari, Naeem Ahmed; Anees, Mohammad

2004-01-01

Full text: Breast carcinoma is the most frequently diagnosed malignancy in women with 41% of all new cases diagnosed in developing countries. Over 323,000 women in the developing countries were detected in 1990, leading to 140,000 deaths. The annual incidence of breast carcinoma among women in Pakistan accounts for 32% of all detected carcinomas and 18% of all cancer related deaths. Three years data (2000-2002) collected from Bahawalpur Institute of Nuclear Medicine and Oncology (BINO) indicated that 16.5% of the total patients were registered with carcinoma breast. To reduce the mortality associated with this disease, screening of asymptomatic women has been advocated to diagnose problems at an early stage, particularly by X-ray mammography on annual basis after the age of 50. The available imaging modalities like mammography and ultrasound lack the desired specificity to differentiate the malignant masses from benign ones; hence there is a need to search for more specific imaging tool and to save the patients from unnecessary biopsies. Technetium-99m labeled methoxy-isobutyl-isonitrile (99mTc-MIBI) is a well-known cardiac perfusion-imaging agent. After convincing reports from various parts of the world that it specifically accumulates in malignant breast masses, we carried out a study to evaluate the diagnostic performance of 99mTc-MIBI scintimammography in palpable breast lesions. Patients with palpable breast lesions were studied after obtaining informed written consent. The study was carried out as a prospective trial. A total of 42 patients with 45 palpable breast masses were included in this study. The median age was 44 years (range 19-84 years). Tc-99m-MIBI was injected in a dose of 740 MBq in dorsal pedal vein and if unsuccessful then in medial cubital vein on the opposite side of the breast, to be imaged for the lump. Planar 10 minutes images in prone lateral and in supine position with arms raised behind the head were acquired 10 minutes and 60-90 minute

Breast imaging reports for malignant lesions: are we maintaining recommended BI-RADS® lexicon standards?

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Masroor, Imrana; Azeemuddin, Muhammad; Sakhawat, Saima; Beg, Madiha; Sohail, Saba; Ahmed, Rashid; Irfan-Ul-Haq; Mehboob, Javed

2012-01-01

The purpose of this study was to evaluate mammography reports for diagnosed breast cancer cases in major government and private centers in Karachi, Pakistan, with respect to concordance with the Breast Imaging Reports And Data System (BI-RADS ® ) lexicon. A prospective, descriptive, multicenter study was conducted in the radiology sections of the Aga Khan University Hospital, Pakistan Naval Station Shifa Hospital, Advanced Radiology Clinic, Karachi Institute of Radiotherapy and Nuclear Medicine, and Civil Hospital Karachi between May and October 2010 after approval from the ethical review committee of Aga Khan University. Mammograms reported as BI-RADS category 4 and 5 were included in the study. Mammograms reported as BI-RADS category 0, 1, 2 and 3 were excluded. Fifty reports were collected from each center. Data were collected about the clinical indication, breast density, location and description of the lesion, calcification, and comments on axillary lymph nodes. This description was compared with the BI-RADS lexicon. The mean age of the patients was 50 ± 12 years. The clinical indication, breast parenchymal density, lesion location, and presence of calcification were better described by the private centers, while description of lymph node status was better stated by the government centers. This difference was statistically significant, except for lesion description. The description of masses by the two reporting groups was comparable. Mammographic reporting of malignant breast lesions in the private sector is more in line with the BI-RADS lexicon, as compared with government sector hospitals in Karachi, Pakistan. Lymph node documentation was better in government sector reports

Fine-needle cytology of breast lesions seen on mammograms

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Schmidt, R.A.; Ridlen, M.S.; Dowlatshahi, K.; Jokich, P.M.; Bibbo, M.

1989-01-01

Stereotactic fine-needle aspiration of nonpalpable breast lesions is operator dependent. The authors have analyzed 250 biopsies at our institution (comparing aspiration cytology with surgical biopsy) for sensitivity, false-negative, and insufficient-sample rates of three different interpreters. Needle aspiration as an alternative to biopsy or a follow-up for lesions of low mammographic suspicion would have resulted in detection of most, but not all, cancers. Over 40 additional biopsies would have been needed to detect each missed cancer. Eighty percent of surgical biopsies would have been needed to detect each missed cancer. Eighty percent of surgical biopsies for low-suspicion lesions could be avoided. Aspiration cytologic series should report separately insufficient samples and LCIS, and should use a consistent threshold for interpreting cytologic results

Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision.

Science.gov (United States)

Mango, Victoria L; Wynn, Ralph T; Feldman, Sheldon; Friedlander, Lauren; Desperito, Elise; Patel, Sejal N; Gomberawalla, Ameer; Ha, Richard

2017-08-01

Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI

The diagnostic utility of CK5/6 and p63 in fine-needle aspiration of the breast lesions diagnosed as proliferative fibrocystic lesion.

Science.gov (United States)

Al-Maghraby, Hatem; Ghorab, Zeina; Khalbuss, Walid; Wong, John; Silverman, Jan F; Saad, Reda S

2012-02-01

Fine-needle aspiration (FNA) biopsy (FNAB) in the preoperative assessment of breast lesions has shown diagnostic limitations with false-positive and false-negative diagnoses. We investigated the diagnostic value of cytokeratin 5/6 (CK5/6) and p63 in a series of breast FNABs, diagnosed as proliferative breast lesions with or without atypia, to see whether these ancillary studies enhance the ability to make an accurate diagnosis by FNAB. Sixty-four breast FNABs were retrieved between January 2000 and December 2005 and included in the study as follows: 29/64 (45%) cases as proliferative with atypia and 35/64 (55%) without atypia. We also included 10 cases of fibroadenoma. All cases had histological follow-up available for correlation. Immunostaining for CK5/6 and p63 was performed on the cell block material in all cases. The percentage of staining cells in the specimen was graded as 0 (0-10%), 1 (11-25%), 2 (26-50%), and 3 (>50%). There were 9/29 (31%) cases in the atypical group that were found to be malignant on resection, compared with 6/35 (17%) in the cases without atypia. In histologically proven malignant cases, CK5/6 was negative in 11/15 (73%) or showed 1+ stain in 2/15 (13%) cases. In benign breast lesions, CK5/6 stained more than 25% of cell proliferation in 44/49 (90%). p63 showed characteristic staining for single naked bipolar nuclei in the background of the specimen (not appreciated by CK5/6) in all fibroadenoma cases. In conclusion, CK5/6 may enhance the ability to differentiate between benign and malignant epithelial proliferations in breast FNABs. In fibroepithelial lesions, p63 may be more useful than CK5/6. Copyright © 2010 Wiley Periodicals, Inc.

MR imaging of the breast. Localization of focal breast lesions with the magnetom open at 0.2 T

International Nuclear Information System (INIS)

Sittek, H.; Perlet, C.; Herrmann, K.; Linsmeier, E.; Kessler, M.; Reiser, M.; Kolem, H.; Untch, M.

1997-01-01

Purpose: To answer the following questions: Whether reliable detection of lesions is possible in low-field-MRI-system (Magnetom Open 0.2 T) equipped with currently available hard- and software components in comparison to high field system (Magnetom Impact 1.0 T). Furthermore, whether localization of lesions suspect in MR-mammography can be realized in MR system of low field (Magnetom Open 0.2 T). Patients and Methods: In 11 patients, suspect lesions were diagnosed in diagnostic MR-mammography acquired with high field system (Magnetom Impact 1.0 T) and were compared to low field MR-mammographies of 0.2 T (Magnetom Open 0.2 T). In six of the 11 patients a suspect lesion was localized using wire marking. Results: All lesions considered suspect in diagnostic MR-mammography (Magnetom Impact 1.0 T) were also clearly identified in the 0.2 T system (Magnetom Open). In six cases wire marking was performed without any complications and with an accuracy of≤0.5 cm distance to the lesion. Conclusion: Although studies in the 0.2 T system clearly showed inferior SNR (34.6 vs. 83.1) and CNR (14.6 vs. 43.5) compared to studies with the high field system, all lesions considered suspect in diagnostic MR-mammography were reliably identified also in 0.2 T studies. Due to its open construction permitting permanent access to the breast and due to sufficient image quality, the Magnetom Open is suitable for interventions on the breast. (orig.) [de

Can continuous scans in orthogonal planes improve diagnostic performance of shear wave elastography for breast lesions?

Science.gov (United States)

Yang, Pan; Peng, Yulan; Zhao, Haina; Luo, Honghao; Jin, Ya; He, Yushuang

2015-01-01

Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.

The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging

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Fiaschetti, V., E-mail: fiaschettivaleria@tin.it [Department of Imaging Diagnostic, Molecular Imaging, Interventional Radiology and Radiation Therapy University Hospital ' Tor Vergata' , 81 Oxford street, 00133 Rome (Italy); Salimbeni, C.; Gaspari, E.; Dembele, G. Kabunda; Bolacchi, F.; Cossu, E.; Pistolese, C.A.; Perretta, T.; Simonetti, G. [Department of Imaging Diagnostic, Molecular Imaging, Interventional Radiology and Radiation Therapy University Hospital ' Tor Vergata' , 81 Oxford street, 00133 Rome (Italy)

2012-11-15

Objective: To asses the value of second-look ultrasound (US) for identifying BIRADS 3 (Breast Imaging Reporting Data System) mammary lesions detected by breast Magnetic Resonance imaging (MRI). Materials and methods: From April 2008 to May 2009 330 breast MRI were performed of which 60 patients are classified as BIRADS 3. 84 lesions underwent second-look US and percutaneous vacuum biopsy Vacora system US-guided. Statistical analysis: lesions were stratified into two groups: visible on US (Group 1) and not visible on US (Group 2). The clinical impact of second-look US was studied in terms of negative predictive value (NPV). Results: The positive predictive value (PPV) of category 3 BIRADS MRI was found to be 89%. Second look-US results detected lesions in 51% of the MRI enhancing lesions. The second look-US showed a NPV of 97%. The NPV of second look-US was significantly greater than the NPV of MRI BIRADS 3 (97% vs 89%, p < 0.05). The logistic regression analysis showed a higher number of malignant lesions in group 1 than in group 2 (7vs 2, OR 3.7, p < 0.05). Conclusions: The second-look US permitted the correct management of subcentimetric MRI BIRADS 3 lesions not visible with conventional imaging tecniques.

The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging

International Nuclear Information System (INIS)

Fiaschetti, V.; Salimbeni, C.; Gaspari, E.; Dembele, G. Kabunda; Bolacchi, F.; Cossu, E.; Pistolese, C.A.; Perretta, T.; Simonetti, G.

2012-01-01

Objective: To asses the value of second-look ultrasound (US) for identifying BIRADS 3 (Breast Imaging Reporting Data System) mammary lesions detected by breast Magnetic Resonance imaging (MRI). Materials and methods: From April 2008 to May 2009 330 breast MRI were performed of which 60 patients are classified as BIRADS 3. 84 lesions underwent second-look US and percutaneous vacuum biopsy Vacora system US-guided. Statistical analysis: lesions were stratified into two groups: visible on US (Group 1) and not visible on US (Group 2). The clinical impact of second-look US was studied in terms of negative predictive value (NPV). Results: The positive predictive value (PPV) of category 3 BIRADS MRI was found to be 89%. Second look-US results detected lesions in 51% of the MRI enhancing lesions. The second look-US showed a NPV of 97%. The NPV of second look-US was significantly greater than the NPV of MRI BIRADS 3 (97% vs 89%, p < 0.05). The logistic regression analysis showed a higher number of malignant lesions in group 1 than in group 2 (7vs 2, OR 3.7, p < 0.05). Conclusions: The second-look US permitted the correct management of subcentimetric MRI BIRADS 3 lesions not visible with conventional imaging tecniques.

Guide for the realization of core needle biopsy through stereotaxy in the diagnosis of suspicious breast lesions of malignity

International Nuclear Information System (INIS)

Jimenez Zuniga, Jorge Luis

2012-01-01

Guides have been made for the realization of breast biopsies through stereotaxy in the management of breast lesions. The type of injuries that have been detected in mammography services, most have corresponded to nonpalpable lesions, that should be clarified through the take samples for an histological study with the purpose of categorize them. A bibliographic review was realized of the findings most frequent in the breast pathology. Also, before a nonpalpable breast lesion that requires a diagnosis biopsy, should be assessed the method of suitable guide for to access the same. The interventionist procedures of the breast have been developed in last years and have been guided by stereotaxy, in order to preoperative localization of these lesions or for obtaining valid cytologic-histologic material to reach a diagnosis, as it has often been difficult to differentiate, just for the image, between benign and malignant lesions. Thus, has emerged the necessity to guide the needle tip objectifying the lesion through mammography. A localization system based on triangulation is applied. The location of the lesion is calculated in the three axes of space (X, Y and Z) with a minimum error. The stereotactic devices have created to guide needles to injuries from a unique projection. This has allowed that breast and lesion are subject on a site while have taken samples several times. The complete mammography study that include the projections craniocaudal (CC) and mediolateral oblique (MLO) are analyzed to find out exactly on which quadrant has found the injury. Sometimes, the injury only has observed in a unique projection which is used for locating. The two main devices that have been used to perform stereotactic biopsy are automatic gun of biopsy and vacuum-assisted directional biopsy. Automatic gun of biopsy has used a long needle tru-cut type, with calibers between 18 and 14, although it is preferred 14-gauge needles. Multiple samples obtained from this needle have

Evaluation of solitary rib lesions in CA. breast patients for development of skeletal metastasis

International Nuclear Information System (INIS)

Fatima, A.; Fatima, S.; Khursheed, K.; Jafri, S.; Asghar, S.

2004-01-01

Determination of nature of single or double rib lesion on a bone scan is important but very difficult. In case of breast carcinoma rib lesion have particular importance, as they are one of the most common sites of metastasis. On the contrary surgical trauma and radiotherapy can induce metabolic changes, which can lead to rib lesions of benign etiology. As it is known that breast carcinoma patients having skeletal metastasis have worse prognosis so it is particularly important to differentiate between malignant and benign rib lesions. In this study etiology of rib lesions detected on bone scan was analyzed retrospectively patients. Study population consisted of breast cancer patients having solitary rib lesions on baseline or follow-up bone scan were included in the study. The etiology of solitary rib involvement was established using all the clinical, radiological and biochemical data available. The clinical and serial scintigraphic data were collected and analyzed for correlation in forty-two patients. Patients were followed up for at least two subsequent bone scans. Out of total study population nine patients (21.42%) developed skeletal metastasis on follow-up. Rest of the study population is disease free till last follow-up. All these patients developed metastasis within two years of appearance of the rib lesions. Correlation between sites of initial rib lesion, uptake pattern, size of tumor, mode of primary therapy, age of involvement, interval from initial therapy, biochemical and radiological findings was done. Correlation was seen between sites of uptake, uptake pattern, mode of primary therapy and biochemical findings with subsequent outcome of the patient. It is concluded from our study that solitary rib lesion have low incidence of malignancy if other risk factors are absent. (authors)

Interpretation Time Using a Concurrent-Read Computer-Aided Detection System for Automated Breast Ultrasound in Breast Cancer Screening of Women With Dense Breast Tissue.

Science.gov (United States)

Jiang, Yulei; Inciardi, Marc F; Edwards, Alexandra V; Papaioannou, John

2018-05-24

The purpose of this study was to compare diagnostic accuracy and interpretation time of screening automated breast ultrasound (ABUS) for women with dense breast tissue without and with use of a recently U.S. Food and Drug Administration-approved computer-aided detection (CAD) system for concurrent read. In a retrospective observer performance study, 18 radiologists interpreted a cancer-enriched set (i.e., cancer prevalence higher than in the original screening cohort) of 185 screening ABUS studies (52 with and 133 without breast cancer). These studies were from a large cohort of ABUS screened patients interpreted as BI-RADS density C or D. Each reader interpreted each case twice in a counterbalanced study, once without the CAD system and once with it, separated by 4 weeks. For each case, each reader identified abnormal findings and reported BI-RADS assessment category and level of suspicion for breast cancer. Interpretation time was recorded. Level of suspicion data were compared to evaluate diagnostic accuracy by means of the Dorfman-Berbaum-Metz method of jackknife with ANOVA ROC analysis. Interpretation times were compared by ANOVA. The ROC AUC was 0.848 with the CAD system, compared with 0.828 without it, for a difference of 0.020 (95% CI, -0.011 to 0.051) and was statistically noninferior to the AUC without the CAD system with respect to a margin of -0.05 (p = 0.000086). The mean interpretation time was 3 minutes 33 seconds per case without the CAD system and 2 minutes 24 seconds with it, for a difference of 1 minute 9 seconds saved (95% CI, 44-93 seconds; p = 0.000014), or a reduction in interpretation time to 67% of the time without the CAD system. Use of the concurrent-read CAD system for interpretation of screening ABUS studies of women with dense breast tissue who do not have symptoms is expected to make interpretation significantly faster and produce noninferior diagnostic accuracy compared with interpretation without the CAD system.

MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

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Choi, Hye Young [Department of Radiology, Gyeongsang National University Hospital, Jinju 660-702 (Korea, Republic of); Kim, Sun Mi; Jang, Mijung; Yun, Bo La [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Kim, Sung-Won; Kang, Eunyoung [Department of Surgery, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Park, So Yeon [Department of Pathology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Moon, Woo Kyung [Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of); Ko, Eun Sook [Department of Radiology, Samsung Medical Center, Seoul 135-710 (Korea, Republic of)

2013-07-01

To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.

MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

International Nuclear Information System (INIS)

Choi, Hye Young; Kim, Sun Mi; Jang, Mijung; Yun, Bo La; Kim, Sung-Won; Kang, Eunyoung; Park, So Yeon; Moon, Woo Kyung; Ko, Eun Sook

2013-01-01

To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions

Breast ultrasound elastography-Results of 193 breast lesions in a prospective study with histopathologic correlation

International Nuclear Information System (INIS)

Schaefer, F.K.W.; Heer, I.; Schaefer, P.J.; Mundhenke, C.; Osterholz, S.; Order, B.M.; Hofheinz, N.; Hedderich, J.; Heller, M.; Jonat, W.; Schreer, I.

2011-01-01

Purpose: To evaluate the diagnostic performance of ultrasound elastography in breast masses. Material and methods: 193 lesions (129 benign, 64 malignant) were analyzed with the EUB 8500 Logos-ultrasonic-unit (Hitachi Medical, Japan) and a linear-array-transducer of 7.5-13-MHz. Standard of reference was cytology (FNAfine needle aspiration) or histology (core biopsy). The elastic-score was classified according to a 6-point colour-scale (Ueno classification; 1-3 = benign, 4-5 = malignant). Conventional B-mode ultrasound (US) findings were classified according to the BI-RADS classification. Statistical analysis included sensitivity, specificity, ROC-analysis and kappa-values for intra-/interobserver reliability. Results: The mean score for elasticity was 4.1 ± 0.9 for malignant lesions, and 2.1 ± 1.0 for benign lesions (p < 0.001). With a best cut-off point between elasticity scores 3 and 4, sensitivity was 96.9%, and specificity 76%. Setting a best cut-off point for conventional US between BI-RADS 4 and 5, sensitivity was 57.8%, and specificity 96.1%. Elastography provided higher sensitivity and lower specificity than conventional US, but two lesions with elasticity score 1 were false negative, whereas no lesion scored BI-RADS 1-3 were false negative. ROC-curve was 0.884 for elastography, and 0.820 for conventional US (p < 0.001). Weighted kappa-values for intra-/interobserver reliability were 0.784/0.634 for BI-RADS classification, and 0.720/0.561 for elasticity scores. Conclusion: In our study setting, elastography does not have the potential to replace conventional B-mode US for the detection of breast cancer, but may complement conventional US to improve the diagnostic performance.

Early detection of breast cancer mass lesions by mammogram segmentation images based on texture features

International Nuclear Information System (INIS)

Mahmood, F.H.

2012-01-01

Mammography is at present one of the available method for early detection of masses or abnormalities which is related to breast cancer.The calcifications. The challenge lies in early and accurate detection to overcome the development of breast cancer that affects more and more women throughout the world. Breast cancer is diagnosed at advanced stages with the help of the digital mammogram images. Masses appear in a mammogram as fine, granular clusters, which are often difficult to identify in a raw mammogram. The incidence of breast cancer in women has increased significantly in recent years. This paper proposes a computer aided diagnostic system for the extraction of features like mass lesions in mammograms for early detection of breast cancer. The proposed technique is based on a four-step procedure: (a) the preprocessing of the image is done, (b) regions of interest (ROI) specification, (c) supervised segmentation method includes two to stages performed using the minimum distance (M D) criterion, and (d) feature extraction based on Gray level Co-occurrence matrices GLC M for the identification of mass lesions. The method suggested for the detection of mass lesions from mammogram image segmentation and analysis was tested over several images taken from A L-llwiya Hospital in Baghdad, Iraq.The proposed technique shows better results.

Diffusion-weighted imaging-guided MR spectroscopy in breast lesions using readout-segmented echo-planar imaging

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Sun, Kun; Chai, Weimin; Zhan, Ying; Luo, Xianfu; Yan, Fuhua [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ruijin Hospital, Shanghai (China); Fu, Caixia [Siemens MRI Center, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen (China); Shen, Kunwei [Shanghai Jiao Tong University School of Medicine, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai (China)

2016-06-15

To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions. A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ{sup 2}-tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis. Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23 ± 3.30 AU/mL vs. 1.26 ± 1.75 AU/mL and 3.17 ± 2.03 mmol/kg vs. 0.86 ± 0.83 mmol/kg, respectively; P < 0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of -0.54 and -0.48, respectively. DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions. (orig.)

iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?

Energy Technology Data Exchange (ETDEWEB)

Bluemel, Christina; Kajdi, Georg W.; Schmid, Jan; Buck, Andreas K.; Herrmann, Ken [University Hospital of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Cramer, Andreas; Grossmann, Christoph; Grimminger, Hanns-Joerg [Missionsaerztliches Klinikum Wuerzburg, Department of Obstetrics and Gynecology, Wuerzburg (Germany); Malzahn, Uwe [University of Wuerzburg, Institute of Clinical Epidemiology and Biometry, Wuerzburg (Germany); Lamp, Nora [University of Wuerzburg, Institute of Pathology, Wuerzburg (Germany); Langen, Heinz-Jakob [Missionsaerztliches Klinikum Wuerzburg, Department of Radiology, Wuerzburg (Germany)

2015-10-15

To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB). WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology. iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97 % of patients. In a single patient (3 %), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81 % of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p < 0.01) lower than the score for iROLL. iROLL is a well-tolerated and feasible technique for localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection. (orig.)

iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?

Science.gov (United States)

Bluemel, Christina; Cramer, Andreas; Grossmann, Christoph; Kajdi, Georg W; Malzahn, Uwe; Lamp, Nora; Langen, Heinz-Jakob; Schmid, Jan; Buck, Andreas K; Grimminger, Hanns-Jörg; Herrmann, Ken

2015-10-01

To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB). WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology. iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97% of patients. In a single patient (3%), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81% of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection.

In-plane visibility of lesions using breast tomosynthesis and digital mammography

International Nuclear Information System (INIS)

Timberg, P.; Baath, M.; Andersson, I.; Mattsson, S.; Tingberg, A.; Ruschin, M.

2010-01-01

Purpose: The purpose of this work was to evaluate the visibility of simulated lesions in 2D digital mammography (DM) and breast tomosynthesis (BT) images of patients. Methods: Images of the same women were acquired on both a DM system (Mammomat Novation, Siemens Healthcare, Erlangen, Germany) and a BT prototype system adapted from the same type of DM system. Using the geometrical properties of the two systems, simulated lesions were projected and added to each DM image as well as to each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose to the glandular tissue were used for each breast image acquisition on the two systems. A series of four-alternative forced choice human observer experiments was conducted for each of five simulated lesion diameters: 0.2, 1, 3, 8, and 25 mm. An additional experiment was conducted for the 0.2 mm lesion in BT only at twice the dose level (BT 2x ). Threshold signal was defined as the lesion signal intensity required for a detectability index (d ' ) of 2.5. Four medical physicists participated in all experiments. One experiment, consisting of 60 cases, was conducted per test condition (i.e., lesion size and signal combination). Results: For the smallest lesions (0.2 mm), the threshold signal for DM was 21% lower than for BT at equivalent dose levels, and BT 2x was 26% lower than DM. For the lesions larger than 1 mm, the threshold signal increased linearly (in log space) with the lesion diameter for both DM and BT, with DM requiring around twice the signal as BT. The difference in the threshold signal between BT and DM at each lesion size was statistically significant, except for the 0.2 mm lesion between BT 2x and DM. Conclusions: The results of this study indicate that low-signal lesions larger than 1.0 mm may be more visible in BT compared to DM, whereas 0.2 mm lesions may be better visualized with DM compared to BT, when compared at equal dose.

Computer-aided diagnosis with morphological features for breast lesion on sonograms

International Nuclear Information System (INIS)

Huang Yu-Len; Jiang Yu-Ru; Shiu Jia-Jia; Chen Dar-Ren; Moon Woo Kyung

2007-01-01

Information about shape, provided by a breast tumor contour is important to physicians in making diagnostic decisions. To avoid needless biopsy and enhance the diagnostic accuracy, a computer-aided diagnosis (CAD) system can provide a second beneficial support reference. This paper aimed to evaluate the potential role of the CAD with automatic contouring and morphologic analysis in the differential of breast tumors for ultrasound (US) images. This study evaluated 118 breast lesions. The suspicious tumor contour in the digitized US image was automatically extracted by the proposed contouring algorithm. Then 20 practical morphologic features from the extracted contour were calculated and a support vector machine (SVM) classifier identified the breast tumor as benign or malignant. The area (Az) under the receiver operating characteristic (ROC) curve for the proposed CAD system was 0.91 ± 0.03. This system differentiates benign from malignant breast tumors with relative high accuracy and is therefore clinically useful to reduce patients needed for dispensable breast biopsy. (orig.)

Intravoxel incoherent motion MR imaging for breast lesions: comparison and correlation with pharmacokinetic evaluation from dynamic contrast-enhanced MR imaging

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Liu, Chunling; Liu, Zaiyi; Zhang, Jine; He, Hui; Zhang, Shuixing; Liang, Changhong [Guangdong General Hospital/Guangdong Academy of Medical Sciences, Department of Radiology, GuangZhou (China); Wang, Kun [Guangdong General Hospital/Guangdong Academy of Medical Sciences, Department of Breast Cancer, Cancer Center, GuangZhou (China); Chan, Queenie [Philips Healthcare, 6/F, Core Building 1, 1 Science Park East Avenue, Hong Kong Science Park, Shatin, New Territories, Hong Kong (China)

2016-11-15

To compare diagnostic performance for breast lesions by quantitative parameters derived from intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and to explore whether correlations exist between these parameters. IVIM and DCE MRI were performed on a 1.5-T MRI scanner in patients with suspicious breast lesions. Thirty-six breast cancers and 23 benign lesions were included in the study. Quantitative parameters from IVIM (D, f and D*) and DCE MRI (K{sup trans}, K{sub ep}, V{sub e} and V{sub p}) were calculated and compared between malignant and benign lesions. Spearman correlation test was used to evaluate correlations between them. D, f, D* from IVIM and K{sup trans}, K{sub ep}, V{sub p} from DCE MRI were statistically different between breast cancers and benign lesions (p < 0.05, respectively) and D demonstrated the largest area under the receiver-operating characteristic curve (AUC = 0.917) and had the highest specificity (83 %). The f value was moderately statistically correlated with V{sub p} (r = 0.692) and had a poor correlation with K{sup trans} (r = 0.456). IVIM MRI is useful in the differentiation of breast lesions. Significant correlations were found between perfusion-related parameters from IVIM and DCE MRI. IVIM may be a useful adjunctive tool to standard MRI in diagnosing breast cancer. (orig.)

Liquid biopsy in the diagnosis of HPV DNA in breast lesions.

Science.gov (United States)

Carolis, Sabrina De; Pellegrini, Alice; Santini, Donatella; Ceccarelli, Claudio; De Leo, Antonio; Alessandrini, Federica; Arienti, Chiara; Pignatta, Sara; Tesei, Anna; Mantovani, Vilma; Zamagni, Claudio; Taffurelli, Mario; Sansone, Pasquale; Bonafé, Massimiliano; Cricca, Monica

2018-02-01

HPV DNA has never been investigated in nipple discharges (ND) and serum-derived extracellular vesicles, although its presence has been reported in ductal lavage fluids and blood specimens. We analyzed 50 ND, 22 serum-derived extracellular vesicles as well as 51 pathologic breast tissues for the presence of 16 HPV DNA types. We show that the presence of HPV DNA in the ND is predictive of HPV DNA-positive breast lesions and that HPV DNA is more represented in intraductal papillomas. We also show the presence of HPV DNA in the serum-derived extracellular vesicles. Our data supports the use of liquid biopsy to detect HPV DNA in breast pathology.

Time-resolved optical mammography between 637 and 985 nm: clinical study on the detection and identification of breast lesions

International Nuclear Information System (INIS)

Taroni, Paola; Torricelli, Alessandro; Spinelli, Lorenzo; Pifferi, Antonio; Arpaia, Francesco; Danesini, Gianmaria; Cubeddu, Rinaldo

2005-01-01

The first time-resolved optical mammograph operating beyond 900 nm was tested in a retrospective clinical study involving 194 patients with malignant and benign lesions, to investigate the diagnostic potential for the detection and characterization of breast lesions. For the first part of the study (101 patients with 114 lesions), the system was operated at 683, 785, 913 and 975 nm. Subsequently, to improve the spectral content of optical images, the number of wavelengths was increased (up to 7) and the spectral range was extended (637-985 nm). Late gated intensity and scattering images provide sensitivity to tissue composition (oxy- and deoxyhaemoglobin, water and lipids) and physiology (total haemoglobin content and oxygen saturation), as well as to structural changes. Tumours are typically identified because of the strong blood absorption at short wavelengths (637-685 nm), while cysts are characterized by low scattering, leading to a detection rate of approximately 80% for both lesion types, when detection is required in both cranio-caudal and oblique views. The detection rate for other benign lesions, such as fibroadenomas, is presently much lower (<40%). The effectiveness of the technique in localizing and identifying different lesion types was analysed as a function of various parameters (lesion size, compressed breast thickness, age, body mass index, breast parenchymal pattern). The possibility that physiologic changes due to the development of a malignant lesion could affect the entire breast was investigated. The capacity to assess the density of breast based on the average scattering properties was also tested

[Diagnostic value of quantitative pharmacokinetic parameters and relative quantitative pharmacokinetic parameters in breast lesions with dynamic contrast-enhanced MRI].

Science.gov (United States)

Sun, T T; Liu, W H; Zhang, Y Q; Li, L H; Wang, R; Ye, Y Y

2017-08-01

Objective: To explore the differential between the value of dynamic contrast-enhanced MRI quantitative pharmacokinetic parameters and relative pharmacokinetic quantitative parameters in breast lesions. Methods: Retrospective analysis of 255 patients(262 breast lesions) who was obtained by clinical palpation , ultrasound or full-field digital mammography , and then all lessions were pathologically confirmed in Zhongda Hospital, Southeast University from May 2012 to May 2016. A 3.0 T MRI scanner was used to obtain the quantitative MR pharmacokinetic parameters: volume transfer constant (K(trans)), exchange rate constant (k(ep))and extravascular extracellular volume fraction (V(e)). And measured the quantitative pharmacokinetic parameters of normal glands tissues which on the same side of the same level of the lesions; and then calculated the value of relative pharmacokinetic parameters: rK(rans)、rk(ep) and rV(e).To explore the diagnostic value of two pharmacokinetic parameters in differential diagnosis of benign and malignant breast lesions using receiver operating curves and model of logistic regression. Results: (1)There were significant differences between benign lesions and malignant lesions in K(trans) and k(ep) ( t =15.489, 15.022, respectively, P 0.05). The areas under the ROC curve(AUC)of K(trans), k(ep) and V(e) between malignant and benign lesions were 0.933, 0.948 and 0.387, the sensitivity of K(trans), k(ep) and V(e) were 77.1%, 85.0%, 51.0% , and the specificity of K(trans), k(ep) and V(e) were 96.3%, 93.6%, 60.8% for the differential diagnosis of breast lesions if taken the maximum Youden's index as cut-off. (2)There were significant differences between benign lesions and malignant lesions in rK(trans), rk(ep) and rV(e) ( t =14.177, 11.726, 2.477, respectively, P quantitative pharmacokinetic parameters and the prediction probability of relative quantitative pharmacokinetic parameters( Z =0.867, P =0.195). Conclusion: There was no significant

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer.

Science.gov (United States)

Liu, Qian; Liu, Yinhua; Xu, Ling; Duan, Xuening; Li, Ting; Qin, Naishan; Kang, Hua; Jiang, Hongchuan; Yang, Deqi; Qu, Xiang; Jiang, Zefei; Yu, Chengze

2014-01-01

This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer. The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group. The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P surgery were 100% and 88.54%, respectively. There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.

Overall survival benefit for sequential doxorubicin-docetaxel compared with concurrent doxorubicin and docetaxel in node-positive breast cancer--8-year results of the Breast International Group 02-98 phase III trial

DEFF Research Database (Denmark)

Oakman, C; Francis, P A; Crown, J

2013-01-01

Background In women with node-positive breast cancer, the Breast International Group (BIG) 02-98 tested the incorporation of docetaxel (Taxotere) into doxorubicin (Adriamycin)-based chemotherapy, and compared sequential and concurrent docetaxel. At 5 years, there was a trend for improved disease...

The assessment of angiogenesis and fibroblastic stromagenesis in hyperplastic and pre-invasive breast lesions

Directory of Open Access Journals (Sweden)

Louvrou Niki

2008-04-01

Full Text Available Abstract Background To investigate the changes of the neoplastic microenvironment during the different morphological alterations of hyperplastic and pre-invasive breast lesions. Methods 78 in situ ductal carcinomas of all degrees of differentiation, 22 atypical ductal hyperplasias, 25 in situ lobular carcinomas, 18 atypical lobular hyperplasias, 32 ductal epithelial hyperplasias of usual type and 8 flat atypias were immunohistochemically investigated for the expression of vascular endothelial growth factor (VEGF, smooth muscle actin (SMA and CD34, while microvessel density (MVD was counted using the anti-CD31 antibody. Results VEGF expression was strongly correlated with MVD in all hyperplastic and pre-invasive breast lesions (p Conclusion Angiogenesis is observed before any significant fibroblastic stromagenesis in pre-invasive breast lesions. A composite phenotype characterized by VEGF positive epithelial cells and SMA positive/CD34 negative stromal cells, is identified mostly in intermediate and high grade DCIS. These findings might imply for new therapeutic strategies using both anti-angiogenic factors and factors selectively targeting tumor stroma in order to prevent the progression of DCIS to invasive carcinoma.

Detection and excision of non-palpable breast lesions by radio guided surgery and air injection for radiological control

International Nuclear Information System (INIS)

Machado, Rafael Henrique Szymanski; Gutfilen, Bianca; Fonseca, Lea Mirian Barbosa da

2005-01-01

Purpose: to asses the efficiency of the radioguided localization and removal of occult breast lesions using radiopharmaceuticals injected directly into the lesions or close to them with posterior air injection as a radiological control. Methods: twenty-nine consecutive patients with thirty-two occult breast lesions detected mammographically or by ultrasound, and categorized 3, 4 and 5 BI-RADS, were included in this observational study with results expressed in percentages. The radiopharmaceutical used was human serum albumin labeled with 99m Tc-HSA injected inside or close to the lesion using mammographic or ultrasonographic guidance. The injection of the radiopharmaceutical was followed immediately by air injection through the needle used for stereotaxis as a radiological control of the radiopharmaceutical placement. The excision biopsy was carried out with the aid of a hand-held gamma-detecting probe and the entire removal of the lesion was verified by X-ray of the surgical specimens or by intraoperative frozen section examination. Results: breast cancer was found in 10.0% (1/10) of the 3 BI-RADS lesions, in 31.5% (6/19) of the 4 BI-RADS and in 66.6% (2/3) of the 5 BI-RADS. The radiotracer was correctly positioned in 96.8% of the specimens (31/32) allowing the removal of also 96.8% of the studied non-palpable breast lesions. To show the entire removal, X-ray was used in 23 cases (71.8%), intraoperative frozen section study in 21.8% (7/32) and both methods in 6.2% (2/32). Conclusions: radioguided surgery showed to be an important tool in the removal of non-palpable breast lesions, as a simple, fast and feasible method that can be implemented in the clinical routine of these patients. (author)

Evaluation of incidence and histolopathological findings of breast lesions in reduction mammoplasty specimens: Uludag University experience

International Nuclear Information System (INIS)

Aytac, B.; Tolunay, S.; Erturk, F.Y.; Kahveci, R.

2013-01-01

To report the incidence of benign, pre-cancerous and malignant lesions in reduction mammoplasty specimens. Methods: The retrospective study was conducted at the Uludag University, Bursa, Turkey and comprised data of 264 patients who underwent bilateral breast reduction between 2004 and 2009. Operative reports and pathological findings of all patients were reviewed. Patients were divided into three age groups with reference to the hormonal characteristics: girls and women between 13 and 35 years constituted group 1; women older than 35 and younger than 50 years old were clustered in group 2; and women over 50 years formed group 3. Descriptive statistics were applied. Results: Fibrocystic disease was the most common (n=402; 76.13%) lesion in all groups. Proliferative lesions such as intraductal epithelial hyperplasia and atypical ductal hyperplasia were each found in 0.4% (n=2) cases. There were 2(0.4%) cases with invasive ductal carcinoma, and 1 (0.2%) case with ductal carcinoma in situ. All malignant tumours were found in patients over 50 years of age. Conclusion: Microscopic examination of macroscopically normal breast tissue from breast reduction specimens may provide noteworthy pathological findings. Histological sampling of reduction mammoplasty specimens gave rise to the early detection of occult neoplastic breast lesions. (author)

Computer-Aided Diagnosis of Solid Breast Lesions Using an Ultrasonic Multi-Feature Analysis Procedure

Science.gov (United States)

2011-01-01

ultrasound. 1. BACKGROUND AND INTRODUCTION Breast cancer affects one of every eight women, it kills one of 29 women in the United States, and is the leading...feature analysis procedure for computer-aided diagnosis of solid breast lesions,” Ultrason Imag, 2010 (In Press). 22. C. B. Shakespeare , personal

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions.

Science.gov (United States)

Ianculescu, Victor; Ciolovan, Laura Maria; Dunant, Ariane; Vielh, Philippe; Mazouni, Chafika; Delaloge, Suzette; Dromain, Clarisse; Blidaru, Alexandru; Balleyguier, Corinne

2014-05-01

To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann-Whitney U test, pmasses, we reached overall levels of 92% sensitivity and 72.9% specificity. VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

COMPARISON OF CR MAMMOGRAPHY, SONOMAMMOGRAPHY AND REAL-TIME ELASTOGRAPHY IN EVALUATING BREAST LESIONS

Directory of Open Access Journals (Sweden)

Onteddu Joji Reddy

2016-11-01

Full Text Available BACKGROUND Breast cancer is the most common cause of cancer deaths in women worldwide. As early detection can decrease the deaths due to breast cancer, high sensitive and specific tests are necessary to evaluate breast lesions. MATERIALS AND METHODS 80 patients with complaint of pain or lump in the breast or nipple discharge were evaluated by mammography, sonomammography and real-time elastography. Imaging studies were compared with the FNAC/biopsy of lesions. RESULTS Mammography has sensitivity, specificity, PPV, NPV as 80%, 95.5%, 93.3%, 86%, respectively. Sonomammography has sensitivity, specificity, PPV, NPV as 74.2%, 91%, 86%, 82%, respectively. Real-time elastography has sensitivity, specificity, PPV, NPV as 91.4%, 94.4%, 94.1%, 91.8%, respectively. Combined mammography and sonomammography has sensitivity, specificity, PPV, NPV as 82.8%, 93.3%, 90.6%, 87.5%, respectively. Combined sonomammography and elastography has sensitivity, specificity, PPV, NPV as 91.4%, 97.2%, 96.96%, 92.1%, respectively. CONCLUSIONS Combination of CR mammography, sonomammography and real-time elastography has high diagnostic sensitivity and specificity in the diagnosis of benign and malignant breast masses obviating the use of higher modalities like MRI, CAD and digital tomosynthesis, which is very useful in resource poor countries like India.

A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

Energy Technology Data Exchange (ETDEWEB)

Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

2017-09-15

To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

Effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up

International Nuclear Information System (INIS)

Masroor, I.

2008-01-01

To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up. Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased in number/size and/or on physician or patient preference. The effectiveness of this approach was analyzed by determining the sensitivity, specificity, positive and negative predictive value for BI-RADS category-3. Of the 65 lesions, 55 remained stable. Of the remaining 10 lesions, two showed increase in number of microcalcification prompting biopsy. Both turned out to be ductal carcinoma in situ. Eight biopsies were performed on clinician or patient preference which turned out to be benign. The sensitivity, specificity, positive and negative predictive values were 100%, 87%, 20% and 100% respectively. Assessment with short-interval mammographic follow-up is useful to confirm the nature of most non-palpable breast lesions considered probably benign and permits detection of a small number of breast cancers at an early stage. The local setup, patient compliance is a major limitation for performing a follow-up study, as the available numbers can have a profound effect on the determined accuracy value. (author)

Fine needle aspiration cytology of radiation-induced changes in nonneoplastic breast lesions. Possible pitfalls in cytodiagnosis

International Nuclear Information System (INIS)

Peterse, J.L.; Thunnissen, F.B.; van Heerde, P.

1989-01-01

The range of radiation-induced changes in fine needle aspiration (FNA) smears of the breast is described. In 41 of more than 800 patients who underwent breast-conserving treatment, a palpable breast lesion developed, and FNA was performed. In six cases, a recurrent carcinoma was present. In the remaining cases, three patterns of nonneoplastic lesions could be discerned: epithelial atypia (14 cases), fat necrosis (10 cases) and poorly cellular smears without epithelial atypia or fat necrosis (13 cases). It is important to be familiar with the patterns of radiation-induced epithelial atypia, since such atypia may lead to a misdiagnosis of recurrent carcinoma. These atypical cells may show impressive anisocytosis and anisonucleosis; however, the nuclear/cytoplasmic ratio remains normal and an admixture of bipolar cells is present. Cell dissociation and necrotic cell debris, as often seen in breast cancer smears, were never encountered in FNA smears from radiated nonneoplastic breasts

Vacuum-assisted biopsy - new trend in the histologization of non-palpable breast lesions

International Nuclear Information System (INIS)

Lehotska, V.; Rauova, K.

2012-01-01

The article discusses the principle of vacuum-assisted biopsy, which now represents a trend in the histologization of non-palpable breast lesions. At the same time it informs about indications and methods of navigation under imaging-related guidance. The authors of the paper present two case reports, which demonstrate the benefit of the method in the early diagnosis of minimal breast cancer. (author)

Role of MRI in differentiating benign from malignant breast lesions ...

African Journals Online (AJOL)

Mohamed Ahmed Youssef

2017-02-15

Feb 15, 2017 ... renal dysfunction or previous reactions to contrast agents and will relieve the cost of examination.4,5. The aim of the study was to evaluate the role of the magnetic resonance imaging in differentiation of benign from malignant breast lesions using dynamic contrast enhanced MRI (DCE-MRI) and diffusion ...

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions

Energy Technology Data Exchange (ETDEWEB)

Ianculescu, Victor; Ciolovan, Laura Maria [Radiology Department, Gustave Roussy, Villejuif (France); Dunant, Ariane [Department of Statistics, Gustave Roussy, Villejuif (France); Vielh, Philippe [Department of Biopathology, Gustave Roussy, Villejuif (France); Mazouni, Chafika [Department of Surgery, Gustave Roussy, Villejuif (France); Delaloge, Suzette [Department of Oncology, Gustave Roussy, Villejuif (France); Dromain, Clarisse [Radiology Department, Gustave Roussy, Villejuif (France); Blidaru, Alexandru [Department of Surgery, Bucharest Institute of Oncology, Bucharest (Romania); Balleyguier, Corinne, E-mail: corinne.balleyguier@gustaveroussy.fr [Radiology Department, Gustave Roussy, Villejuif (France); UMR 8081, IR4M, Paris-Sud University, 91405 Orsay (France)

2014-05-15

Purpose: To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Materials and methods: Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. Results: BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann–Whitney U test, p < 0.0001). By selecting a lesion cut-off value of 3.31 m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity. Conclusion: VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies.

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions

International Nuclear Information System (INIS)

Ianculescu, Victor; Ciolovan, Laura Maria; Dunant, Ariane; Vielh, Philippe; Mazouni, Chafika; Delaloge, Suzette; Dromain, Clarisse; Blidaru, Alexandru; Balleyguier, Corinne

2014-01-01

Purpose: To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Materials and methods: Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. Results: BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann–Whitney U test, p < 0.0001). By selecting a lesion cut-off value of 3.31 m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity. Conclusion: VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies

Discrimination between benign and malignant breast lesions using volumetric quantitative dynamic contrast-enhanced MR imaging

International Nuclear Information System (INIS)

Cheng, Ziliang; Wu, Zhuo; Shen, Jun; Shi, Guangzi; Yi, Zhilong; Xie, Mingwei; Zeng, Weike; Song, Chao; Zheng, Chushan

2018-01-01

To determine the diagnostic performance of volumetric quantitative dynamic contrast-enhanced MRI (qDCE-MRI) in differentiation between malignant and benign breast lesions. DCE-MRI was performed in 124 patients with 136 breast lesions. Quantitative pharmacokinetic parameters K trans , K ep , V e , V p and semi-quantitative parameters TTP, MaxCon, MaxSlope, AUC were obtained by using a two-compartment extended Tofts model and three-dimensional volume of interest. Morphologic features (lesion size, margin, internal enhancement pattern) and time-signal intensity curve (TIC) type were also assessed. Logistic regression analysis was used to determine predictors of malignancy, followed by receiver operating characteristics (ROC) analysis to evaluate the diagnostic performance. qDCE parameters (K trans , K ep , V p , TTP, MaxCon, MaxSlope and AUC), morphological parameters and TIC type were significantly different between malignant and benign lesions (P≤0.001). Multivariate logistic regression analyses showed that K trans , K ep , MaxSlope, size, margin and TIC type were independent predictors of malignancy. The diagnostic accuracy of logistic models based on qDCE parameters alone, morphological features plus TIC type, and all parameters combined was 94.9%, 89.0%, and 95.6% respectively. qDCE-MRI can be used to improve diagnostic differentiation between benign and malignant breast lesions in relation to morphology and kinetic analysis. (orig.)

Discrimination between benign and malignant breast lesions using volumetric quantitative dynamic contrast-enhanced MR imaging

Energy Technology Data Exchange (ETDEWEB)

Cheng, Ziliang; Wu, Zhuo; Shen, Jun [Sun Yat-Sen University, Department of Radiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong (China); Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Medical Research Centre, Sun Yat-Sen Memorial Hospital, Guangzhou (China); Shi, Guangzi; Yi, Zhilong; Xie, Mingwei; Zeng, Weike; Song, Chao; Zheng, Chushan [Sun Yat-Sen University, Department of Radiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong (China)

2018-03-15

To determine the diagnostic performance of volumetric quantitative dynamic contrast-enhanced MRI (qDCE-MRI) in differentiation between malignant and benign breast lesions. DCE-MRI was performed in 124 patients with 136 breast lesions. Quantitative pharmacokinetic parameters K{sup trans}, K{sub ep}, V{sub e}, V{sub p} and semi-quantitative parameters TTP, MaxCon, MaxSlope, AUC were obtained by using a two-compartment extended Tofts model and three-dimensional volume of interest. Morphologic features (lesion size, margin, internal enhancement pattern) and time-signal intensity curve (TIC) type were also assessed. Logistic regression analysis was used to determine predictors of malignancy, followed by receiver operating characteristics (ROC) analysis to evaluate the diagnostic performance. qDCE parameters (K{sup trans}, K{sub ep}, V{sub p}, TTP, MaxCon, MaxSlope and AUC), morphological parameters and TIC type were significantly different between malignant and benign lesions (P≤0.001). Multivariate logistic regression analyses showed that K{sup trans}, K{sub ep}, MaxSlope, size, margin and TIC type were independent predictors of malignancy. The diagnostic accuracy of logistic models based on qDCE parameters alone, morphological features plus TIC type, and all parameters combined was 94.9%, 89.0%, and 95.6% respectively. qDCE-MRI can be used to improve diagnostic differentiation between benign and malignant breast lesions in relation to morphology and kinetic analysis. (orig.)

MRI-Guided Diffuse Optical Spectroscopy of Malignant and Benign Breast Lesions

Directory of Open Access Journals (Sweden)

Vasilis Ntziachristos

2002-01-01

Full Text Available We present the clinical implementation of a novel hybrid system that combines magnetic resonance imaging (MRI and near-infrared (NIR optical measurements for the noninvasive study of breast cancer in vivo. Fourteen patients were studied with a MR-NIR prototype imager and spectrometer. A diffuse optical tomographic scheme employed the MR images as a priori information to implement an image-guided NIR localized spectroscopic scheme. All patients who entered the study also underwent gadolinium-enhanced MRI and biopsy so that the optical findings were crossvalidated with MR readings and histopathology. The technique quantified the oxy-and deoxyhemoglobin of five malignant and nine benign breast lesions in vivo. Breast cancers were found with decreased oxygen saturation and higher blood concentration than most benign lesions. The average hemoglobin concentration ([H] of cancers was 0.130±0.100 mM, and the average hemoglobin saturation (Y was 60±9% compared to [H]=0.018±0.005 mM and Y=69±6% of background tissue. Fibroadenomas exhibited high hemoglobin concentration [H]=0.060±0.010 mM and mild decrease in oxygen saturation Y=67±2%. Cysts and other normal lesions were easily differentiated based on intrinsic contrast information. This novel optical technology can be a significant add-on in MR examinations and can be used to characterize functional parameters of cancers with diagnostic and treatment prognosis potential. It is foreseen that the technique can play a major role in functional activation studies of brain and muscle as well.

Comparison of the cytology technique and the frozen section results in intraoperative consultation of the breast lesions

Directory of Open Access Journals (Sweden)

"Haeri H

2002-07-01

Full Text Available The cytology study is effective and reliable technique in intraoperative consultation. This study was performed to evaluate the accuracy of the cytology study in intraoperative consultation of the breast lesions. 125 specimens of the breast lesions were examined and studied in Imam Khomeini Hospital during the years 1998-99. The sensitivity, specificity and accuracy for cytological method were 87.5% , 95%, 90.5% and for the frozen section 92.4%, 100% and 95.4% respectively. The false positive reports were 2% in the cytology technique and the most important source of error and false postivie reports was fibroadenoma in this method. By reviewing the results. It could be concluded that combination of these two techniques is beneficial and more reliable in intraoperative consultation resports of the breast lesions

Improving digital breast tomosynthesis reading time: A pilot multi-reader, multi-case study using concurrent Computer-Aided Detection (CAD).

Science.gov (United States)

Balleyguier, Corinne; Arfi-Rouche, Julia; Levy, Laurent; Toubiana, Patrick R; Cohen-Scali, Franck; Toledano, Alicia Y; Boyer, Bruno

2017-12-01

Evaluate concurrent Computer-Aided Detection (CAD) with Digital Breast Tomosynthesis (DBT) to determine impact on radiologist performance and reading time. The CAD system detects and extracts suspicious masses, architectural distortions and asymmetries from DBT planes that are blended into corresponding synthetic images to form CAD-enhanced synthetic images. Review of CAD-enhanced images and navigation to corresponding planes to confirm or dismiss potential lesions allows radiologists to more quickly review DBT planes. A retrospective, crossover study with and without CAD was conducted with six radiologists who read an enriched sample of 80 DBT cases including 23 malignant lesions in 21 women. Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) compared the readings with and without CAD to determine the effect of CAD on overall interpretation performance. Sensitivity, specificity, recall rate and reading time were also assessed. Multi-reader, multi-case (MRMC) methods accounting for correlation and requiring correct lesion localization were used to analyze all endpoints. AUCs were based on a 0-100% probability of malignancy (POM) score. Sensitivity and specificity were based on BI-RADS scores, where 3 or higher was positive. Average AUC across readers without CAD was 0.854 (range: 0.785-0.891, 95% confidence interval (CI): 0.769,0.939) and 0.850 (range: 0.746-0.905, 95% CI: 0.751,0.949) with CAD (95% CI for difference: -0.046,0.039), demonstrating non-inferiority of AUC. Average reduction in reading time with CAD was 23.5% (95% CI: 7.0-37.0% improvement), from an average 48.2 (95% CI: 39.1,59.6) seconds without CAD to 39.1 (95% CI: 26.2,54.5) seconds with CAD. Per-patient sensitivity was the same with and without CAD (0.865; 95% CI for difference: -0.070,0.070), and there was a small 0.022 improvement (95% CI for difference: -0.046,0.089) in per-lesion sensitivity from 0.790 without CAD to 0.812 with CAD. A slight reduction in specificity with a -0

Correlation of contrast agent kinetics between iodinated contrast-enhanced spectral tomosynthesis and gadolinium-enhanced MRI of breast lesions

International Nuclear Information System (INIS)

Froeling, Vera; Diekmann, Felix; Renz, Diane M.; Fallenberg, Eva M.; Steffen, Ingo G.; Diekmann, Susanne; Schmitzberger, Florian F.; Lawaczeck, Ruediger

2013-01-01

Assessment of contrast agent kinetics in contrast-enhanced MRI (CE-MRI) with gadolinium-containing contrast agents offers the opportunity to predict breast lesion malignancy. The goal of our study was to determine if similar patterns exist for spectral contrast-enhanced digital breast tomosynthesis (CE-DBT) using an iodinated contrast agent. The protocol of our prospective study was approved by the relevant institutional review board and the German Federal Office for Radiation Protection. All patients provided written informed consent. We included 21 women with a mean age of 62.4 years. All underwent ultrasound-guided biopsy of a suspect breast lesion, spectral CE-DBT and CE-MRI. For every breast lesion, contrast agent kinetics was assessed by signal intensity-time curves for spectral CE-DBT and CE-MRI. Statistical comparison used Cohen's kappa and Spearman's rho test. Spearman's rho of 0.49 showed significant (P = 0.036) correlation regarding the contrast agent kinetics in signal intensity-time curves for spectral CE-DBT and CE-MRI. Cohen's kappa indicated moderate agreement (kappa = 0.438). There is a statistically significant correlation between contrast agent kinetics in the signal intensity-time curves for spectral CE-DBT and CE-MRI. Observing intralesional contrast agent kinetics in spectral CE-DBT may aid evaluation of malignant breast lesions. (orig.)

Delineating an Epigenetic Continuum for Initiation, Transformation and Progression to Breast Cancer

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Chen, Kang Mei; Stephen, Josena K. [Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, 1 Ford Place, 1D, Detroit, MI 48202 (United States); Raju, Usha [Department of Pathology, Henry Ford Hospital, Detroit, 1 Ford Place, 1D, Detroit, MI 48202 (United States); Worsham, Maria J., E-mail: mworsha1@hfhs.org [Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, 1 Ford Place, 1D, Detroit, MI 48202 (United States)

2011-03-29

Aberrant methylation of promoter CpG islands is a hallmark of human cancers and is an early event in carcinogenesis. We examined whether promoter hypermethylation contributes to the pathogenesis of benign breast lesions along a progression continuum to invasive breast cancer. The exploratory study cohort comprised 17 breast cancer patients with multiple benign and/or in situ lesions concurrently present with invasive carcinoma within a tumor biopsy. DNA from tumor tissue, normal breast epithelium when present, benign lesions (fibroadenoma, hyperplasia, papilloma, sclerosing adenosis, apocrine metaplasia, atypical lobular hyperplasia or atypical ductal hyperplasia), and in situ lesions of lobular carcinoma and ductal carcinoma were interrogated for promoter methylation status in 22 tumor suppressor genes using the multiplex ligation-dependent probe amplification assay (MS-MLPA). Methylation specific PCR was performed to confirm hypermethylation detected by MS-MLPA. Promoter methylation was detected in 11/22 tumor suppressor genes in 16/17 cases. Hypermethylation of RASSF1 was most frequent, present in 14/17 cases, followed by APC in 12/17, and GSTP1 in 9/17 cases with establishment of an epigenetic monocloncal progression continuum to invasive breast cancer. Hypermethylated promoter regions in normal breast epithelium, benign, and premalignant lesions within the same tumor biopsy implicate RASSF1, APC, GSTP1, TIMP3, CDKN2B, CDKN2A, ESR1, CDH13, RARB, CASP8, and TP73 as early events. DNA hypermethylation underlies the pathogenesis of step-wise transformation along a monoclonal continuum from normal to preneoplasia to invasive breast cancer.

Delineating an Epigenetic Continuum for Initiation, Transformation and Progression to Breast Cancer

International Nuclear Information System (INIS)

Chen, Kang Mei; Stephen, Josena K.; Raju, Usha; Worsham, Maria J.

2011-01-01

Aberrant methylation of promoter CpG islands is a hallmark of human cancers and is an early event in carcinogenesis. We examined whether promoter hypermethylation contributes to the pathogenesis of benign breast lesions along a progression continuum to invasive breast cancer. The exploratory study cohort comprised 17 breast cancer patients with multiple benign and/or in situ lesions concurrently present with invasive carcinoma within a tumor biopsy. DNA from tumor tissue, normal breast epithelium when present, benign lesions (fibroadenoma, hyperplasia, papilloma, sclerosing adenosis, apocrine metaplasia, atypical lobular hyperplasia or atypical ductal hyperplasia), and in situ lesions of lobular carcinoma and ductal carcinoma were interrogated for promoter methylation status in 22 tumor suppressor genes using the multiplex ligation-dependent probe amplification assay (MS-MLPA). Methylation specific PCR was performed to confirm hypermethylation detected by MS-MLPA. Promoter methylation was detected in 11/22 tumor suppressor genes in 16/17 cases. Hypermethylation of RASSF1 was most frequent, present in 14/17 cases, followed by APC in 12/17, and GSTP1 in 9/17 cases with establishment of an epigenetic monocloncal progression continuum to invasive breast cancer. Hypermethylated promoter regions in normal breast epithelium, benign, and premalignant lesions within the same tumor biopsy implicate RASSF1, APC, GSTP1, TIMP3, CDKN2B, CDKN2A, ESR1, CDH13, RARB, CASP8, and TP73 as early events. DNA hypermethylation underlies the pathogenesis of step-wise transformation along a monoclonal continuum from normal to preneoplasia to invasive breast cancer

Clinical experiences with photoacoustic breast imaging: the appearance of suspicious lesions

NARCIS (Netherlands)

Heijblom, M.

2014-01-01

This thesis describes photoacoustic (PA) imaging of suspicious breast lesions. In PA imaging, the tissue of interest is illuminated by short pulses of laser light, usually in the near infrared (NIR) regime. Upon absorption by primarily the tumor vasculature, the light causes a small temperature

Radiographic-guided fine-needle aspiration of nonpalpable breast lesions

International Nuclear Information System (INIS)

Helvie, M.A.; Baker, D.E.; Adler, D.D.; Andersson, I.; Naylor, B.; Buckwalter, K.

1989-01-01

The authors have performed radiographically guided fine-needle aspirations (FNA) on 215 nonpalpable mammographically detected breast lesions, using a coordinate grid localization system. Aspirates were classified into five cytologic groups. With the most stringent cytologic criteria, the sensitivity was 98% and the specificity 95% for the detection of carcinoma. However, according to these strict cytologic criteria, only 46% of aspirates contained representative material. Forty-two of 74 lesions undergoing biopsy proved malignant. Sixteen percent of patients did not compete adequate mammographic follow-up. High sensitivity and specificity can be achieved with radiographically guided FNA. However, management decisions ultimately require integration of mammographic findings with cytologic results. Close cooperation between mammographer, surgeon, cytopathologist, and patients is mandatory for successful operation

Caveolin-1 expression in benign and malignant lesions of the breast

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Kiesel Ludwig

2007-10-01

Full Text Available Abstract Background Caveolin-1 is thought to have an important impact on both signal transduction and mediation of intracellular processes. Furthermore, it has been suggested that Caveolin-1 may contribute to certain steps of carcinogenesis in various types of cancer. We examined the potential clinical relevance of Caveolin-1 in normal, benign and malignant breast tissue specimens. Methods Using tissue microarray (TMA technology cases of invasive breast cancer, DCIS, benign breast disease (i.e. fibroadenoma, sclerosing adenosis, ductal hyperplasia and radial scar and normal breast tissue were evaluated for Caveolin-1 expression. Immunohistochemical staining with an anti-Caveolin-1-antibody was performed. Staining intensity was quantified semiquantitatively. In invasive lesions staining results were correlated with clinical and pathological data. Results No Caveolin-1 expression was observed in epithelial cells of normal breast tissue (n = 5, benign breast disease (n = 295 and DCIS (n = 108. However, Caveolin-1 expression was found in 32 of 109 cases of invasive breast carcinomas (29.4%. Caveolin-1 expression in invasive breast cancer could neither be correlated with survival parameters such as overall or disease-free survival nor with established clinical and pathological markers. Conclusion In this study we demonstrated expression of Caveolin-1 in one third of invasive breast cancers. A significant increase in Caveolin-1 expression was observed comparing invasive breast cancer to both benign breast tissue and non-invasive breast cancer. Since inhibitors of Caveolin-1 signalling are available, targeting Caveolin-1 in breast cancer may represent a potential option for future breast cancer treatment.

Concurrent chemo-radiation in the conservative management of breast cancer

International Nuclear Information System (INIS)

Haffty, Bruce G.; Kim, Janet H.; Yang Qifeng; Higgins, Susan A.

2006-01-01

Purpose: Sequencing of chemotherapy (CTX) with radiation (RT) in the conservative management of breast cancer (CS+RT) remains controversial. We report here the results of a retrospective analysis of all patients treated with CTX and RT, with specific focus on outcome as a function of sequencing of CTX with RT. Methods and Materials: A total of 535 patients treated with CS+RT received CTX as a component of therapy. RT was administered concurrently with CTX in 109 (CONCTX). CTX was administered before RT in 276 patients, after RT in 106 patients, and in 'sandwich' fashion in 44 patients. These three groups comprise the sequential chemotherapy group (SEQCTX). Results: With follow-up of 8.8 years, the 10-year survival rate was 78% and the distant metastasis-free rate was 75%. Despite more adverse factors for local control, patients in the CONCTX group had superior local control rate of 92% at 10 years compared with 83% in the SEQCTX group (p < 0.001). In multivariate analysis, CONCTX was associated with a significant improvement in local control (HR = 0.338, 95% CI = 0.141-0.809, p = 0.015). Cosmetic results, toxicities, and long-term complications were acceptable using this CONCTX regimen. Conclusions: CONCTX was associated with a reduction in local relapse rates, acceptable cosmesis, and toxicities. These data support the use of concurrent RT and CTX in selected patients at high risk for local failure. Future prospective trials should explore the use of concurrent CTX and RT in high-risk patients using currently employed agents

Diagnostic value of virtual touch tissue imaging quantification for benign and malignant breast lesions with different sizes

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Liu, Hui; Zhao, Li-Xia; Xu, Guang; Yao, Ming-Hua; Zhang, Ai-Hong; Xu, Hui-Xiong; Wu, Rong

2015-01-01

The study was to explore diagnostic value of the virtual touch tissue imaging quantification (VTIQ) in distinguishing benign and malignant breast lesions of variable sizes. We performed conventional ultrasound and VTIQ in 139 breast lesions. The lesions were categorized into three groups according to size (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm), and their mean, min, and max shear wave velocities (SWVs) were measured. Diagnoses were confirmed by pathological examination after surgery or needle biopsy. Receiver-operating characteristic curves (ROC) were constructed to determine the optimum cut-off values, calculate the area under curve (AUC), the sensitivity, specificity and accuracy for each velocity. For all groups, the mean, min, and max SWVs of malignant lesions were significantly higher than those of benign lesions (P < 0.05). The cut-off values of mean, min, and max SWVs were not significantly different among the three groups. In addition, the diagnostic performance of mean, min, and max SWV values is analogous, regardless of lesion size. In conclusion, VTIQ is a strong complement to conventional ultrasound, which is a promising method in the differential diagnosis of the breast lesions with different sizes. Further studies validate our results as well as reduce the number of unnecessary biopsies, regardless of size is warranted. PMID:26550234

Diagnostic value of breast ultrasound in mammography BI-RADS 0 and clinically indeterminate or suspicious of malignancy breast lesions

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Dobrosavljević Aleksandar

2016-01-01

Full Text Available Background/Aim. Not only that ultrasound makes the difference between cystic and solid changes in breast tissue, as it was the case at the beginning of its use, but it also makes the differential diagnosis in terms of benign-malignant. The aim of this study was to assess the role of sonography in the diagnosis of palpable breast masses according to the American College of Radiology Ultrasonographic Breast Imaging Reporting and Data System (BI-RADS and to correlate the BI-RADS 4 and BI-RADS 5 category with pathohistological findings. Methods. A retrospective study was conducted with the breast sonograms of 30 women presented with palpable breast masses found to be mammography category BI-RADS 0 and ultrasonographic BI-RADS categories 4 and 5. The sonographic categories were correlated with pathohistological findings. Results. Surgical biopsy in 30 masses revealed: malignancy (56.7%, fibroadenoma (26.7%, fibrocystic dysplasia with/without atypia (10%, lipoma (3.3% and intramammary lymph node (3.3%. Correlation between BI-RADS categories and pathohistological findings was found (p < 0.05. All BI-RADS 5 masses were malignant, while in BI-RADS 4A category fibroadenomas dominated. A total of 53.8% of all benign lesions were found in women 49 years of age or younger as compared with 35.3% of all malignancies in this group (p < 0.05. Conclusion. Ultrasonography BI-RADS improved classification of breast masses. The ultrasound BI-RADS 4 (A, B, C and BI-RADS 5 lesions should be worked-up with biopsy.

Correlative study of the parameters of dynamic contrast-enhanced MRI and angiogenesis in breast lesions

International Nuclear Information System (INIS)

Tang Guangyu; Xiao Xiangsheng; Liu Yong; Yao Yiping; Li Wei; Zhao Wenrong; Li Peng

2007-01-01

Objective: To evaluate the relationship between dynamic contrast-enhanced MRI (DCE-MRI)-derived parameters and tumor angiogenesis in malignant and benign breast lesions. Methods: Fifty-one patients with malignant and benign breast lesions underwent DCE-MRI using a Philips Intera 1.5 T MR System and dedicated breast coil prospectively before operation. DCE-MRI derived parameters such as steepest slope (S max )), peak height (PH), time-to-peak (T peak ) were calculated based on time-signal intensity curve. The micro-vessel density (MVD) was counted and vascular endothelial growth factor (VEGF) expression was assessed in these patients after operation with immunohistochemical staining method. The parameters were correlated statistically with MVD counts and VEGF expression in breast cancer. The MVD counts and VEGF expression were also compared among the patients with breast cancer (29 cases), with fibroadenoma (12 cases), mastopathy (10 cases) and the normal tissue (10 cases). Results: The enhancement parameters S max (r=0.807, P peak (69 ± 38) correlated negatively with MVD counts (r=-0.425, P< 0.05). The mean value of MVD (65.09±15.81/200 times field) in patients with breast cancer were significantly higher than those with fibroadenoma, mastopathy or normal tissue (P=0.043, 0.018, 0.002 respectively). 69% (20/29 cases) of breast cancers demonstrated positive VEGF expression, which were significantly more than that of fibroadenoma, mastopathy or normal tissue (P=0.035, 0.007, 0.001 respectively). Moreover, the MVD counts (60.38±24.14) in the peripheral region of breast cancer were more than those in central region (37.64±16.52; t=2.635, P=0.016). There was a significant difference in MVD counts between breast cancers with metastasis to axillary lymph nodes (73.23±23.02) and those without metastasis (59.34±18.03), (t=2.303, P=0.031). Conclusions: Some parameters derived from DCE-MRI correlated positively with MVD counts and VEGF expression in patients with breast

Association between power law coefficients of the anatomical noise power spectrum and lesion detectability in breast imaging modalities

Science.gov (United States)

Chen, Lin; Abbey, Craig K.; Boone, John M.

2013-03-01

Previous research has demonstrated that a parameter extracted from a power function fit to the anatomical noise power spectrum, β, may be predictive of breast mass lesion detectability in x-ray based medical images of the breast. In this investigation, the value of β was compared with a number of other more widely used parameters, in order to determine the relationship between β and these other parameters. This study made use of breast CT data sets, acquired on two breast CT systems developed in our laboratory. A total of 185 breast data sets in 183 women were used, and only the unaffected breast was used (where no lesion was suspected). The anatomical noise power spectrum computed from two-dimensional region of interests (ROIs), was fit to a power function (NPS(f) = α f-β), and the exponent parameter (β) was determined using log/log linear regression. Breast density for each of the volume data sets was characterized in previous work. The breast CT data sets analyzed in this study were part of a previous study which evaluated the receiver operating characteristic (ROC) curve performance using simulated spherical lesions and a pre-whitened matched filter computer observer. This ROC information was used to compute the detectability index as well as the sensitivity at 95% specificity. The fractal dimension was computed from the same ROIs which were used for the assessment of β. The value of β was compared to breast density, detectability index, sensitivity, and fractal dimension, and the slope of these relationships was investigated to assess statistical significance from zero slope. A statistically significant non-zero slope was considered to be a positive association in this investigation. All comparisons between β and breast density, detectability index, sensitivity at 95% specificity, and fractal dimension demonstrated statistically significant association with p performance. Specifically, lower values of β were associated with lower breast density

Cluster analysis of signal-intensity time course in dynamic breast MRI: does unsupervised vector quantization help to evaluate small mammographic lesions?

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Leinsinger, Gerda; Schlossbauer, Thomas; Scherr, Michael; Lange, Oliver; Reiser, Maximilian; Wismueller, Axel [Institute for Clinical Radiology University of Munich, Munich (Germany)

2006-05-15

We examined whether neural network clustering could support the characterization of diagnostically challenging breast lesions in dynamic magnetic resonance imaging (MRI). We examined 88 patients with 92 breast lesions (51 malignant, 41 benign). Lesions were detected by mammography and classified Breast Imaging and Reporting Data System (BIRADS) III (median diameter 14 mm). MRI was performed with a dynamic T1-weighted gradient echo sequence (one precontrast and five postcontrast series). Lesions with an initial contrast enhancement {>=}50% were selected with semiautomatic segmentation. For conventional analysis, we calculated the mean initial signal increase and postinitial course of all voxels included in a lesion. Secondly, all voxels within the lesions were divided into four clusters using minimal-free-energy vector quantization (VQ). With conventional analysis, maximum accuracy in detecting breast cancer was 71%. With VQ, a maximum accuracy of 75% was observed. The slight improvement using VQ was mainly achieved by an increase of sensitivity, especially in invasive lobular carcinoma and ductal carcinoma in situ (DCIS). For lesion size, a high correlation between different observers was found (R{sup 2} = 0.98). VQ slightly improved the discrimination between malignant and benign indeterminate lesions (BIRADS III) in comparison with a standard evaluation method. (orig.)

Recurrent neural networks for breast lesion classification based on DCE-MRIs

Science.gov (United States)

Antropova, Natasha; Huynh, Benjamin; Giger, Maryellen

2018-02-01

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) plays a significant role in breast cancer screening, cancer staging, and monitoring response to therapy. Recently, deep learning methods are being rapidly incorporated in image-based breast cancer diagnosis and prognosis. However, most of the current deep learning methods make clinical decisions based on 2-dimentional (2D) or 3D images and are not well suited for temporal image data. In this study, we develop a deep learning methodology that enables integration of clinically valuable temporal components of DCE-MRIs into deep learning-based lesion classification. Our work is performed on a database of 703 DCE-MRI cases for the task of distinguishing benign and malignant lesions, and uses the area under the ROC curve (AUC) as the performance metric in conducting that task. We train a recurrent neural network, specifically a long short-term memory network (LSTM), on sequences of image features extracted from the dynamic MRI sequences. These features are extracted with VGGNet, a convolutional neural network pre-trained on a large dataset of natural images ImageNet. The features are obtained from various levels of the network, to capture low-, mid-, and high-level information about the lesion. Compared to a classification method that takes as input only images at a single time-point (yielding an AUC = 0.81 (se = 0.04)), our LSTM method improves lesion classification with an AUC of 0.85 (se = 0.03).

Differentiation between benign and malignant breast lesions using quantitative diffusion-weighted sequence on 3 T MRI

International Nuclear Information System (INIS)

Tan, S.L.L.; Rahmat, K.; Rozalli, F.I.; Mohd-Shah, M.N.; Aziz, Y.F.A.; Yip, C.H.; Vijayananthan, A.; Ng, K.H.

2014-01-01

Aim: To investigate the capability and diagnostic accuracy of diffusion-weighted imaging (DWI) in differentiating benign from malignant breast lesions using 3 T magnetic resonance imaging (MRI). Materials and methods: Women with suspicious or indeterminate breast lesions detected at MRI, mammogram and/or ultrasound were recruited for dynamic contrast-enhanced (DCE)-MRI and DWI prior to their biopsy. Image fusion of DCE-MRI with apparent diffusion coefficient (ADC) map was utilized to select the region of interest (ROI) for ADC calculation in the area that showed the most avid enhancement. DWI was performed using two sets of b-values at 500 and 1000 s/mm 2 , respectively. Results: Fifty women were recruited and the final analysis comprised 44 breast lesions, 31 of which were malignant and 13 were benign. Significant results were obtained between ADC values of benign and malignant lesions (p −3 mm 2 /s for b = 500 s/mm 2 and 1.22 × 10 −3 mm 2 /s for b = 1000 s/mm 2 , respectively. The sensitivity of DCE-MRI alone was 100% with a specificity of 66.7%. When DCE-MRI was combined with b = 1000 s/mm 2 , the specificity rose to 100%, while only mildly affecting sensitivity (90.6%). No significant correlation was found between ADC values and prognostic factors, such as lymph node metastasis, tumour size, oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status, and tumour grades. Conclusion: The present study provides consistent evidence to support DWI as a diagnostic tool for breast lesion characterization. A combination of DCE-MRI with DWI is suggested to improve the sensitivity and specificity of lesion characterization

Pattern of palpable breast lesions on fine needle aspiration: A retrospective analysis of 902 cases

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Shirish S Chandanwale

2014-01-01

Conclusion : With experienced hands, FNA is safe, cost effective and a reliable technique for preoperative evaluation of palpable breast lumps. FNA features are more informative when combined with physical and radiology findings (Triple test. Fibroadenoma, fibrocystic change and mastitis form the major bulk of benign breast lesions. Epithelioid cells when seen in inflammatory breast FNA smears, tuberculosis must be ruled out. In India, breast carcinoma arises in younger patients as compared to western countries. Grading of breast carcinomas must be done on FNA smears for selecting neoadjuvent therapy. Clinical breast examination and mammography screening in females should be encouraged in developing countries from the third decade onwards for early detection of breast carcinoma.

Non-invasive optical estimate of tissue composition to differentiate malignant from benign breast lesions: A pilot study

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Taroni, Paola; Paganoni, Anna Maria; Ieva, Francesca; Pifferi, Antonio; Quarto, Giovanna; Abbate, Francesca; Cassano, Enrico; Cubeddu, Rinaldo

2017-01-01

Several techniques are being investigated as a complement to screening mammography, to reduce its false-positive rate, but results are still insufficient to draw conclusions. This initial study explores time domain diffuse optical imaging as an adjunct method to classify non-invasively malignant vs benign breast lesions. We estimated differences in tissue composition (oxy- and deoxyhemoglobin, lipid, water, collagen) and absorption properties between lesion and average healthy tissue in the same breast applying a perturbative approach to optical images collected at 7 red-near infrared wavelengths (635-1060 nm) from subjects bearing breast lesions. The Discrete AdaBoost procedure, a machine-learning algorithm, was then exploited to classify lesions based on optically derived information (either tissue composition or absorption) and risk factors obtained from patient’s anamnesis (age, body mass index, familiarity, parity, use of oral contraceptives, and use of Tamoxifen). Collagen content, in particular, turned out to be the most important parameter for discrimination. Based on the initial results of this study the proposed method deserves further investigation.

[Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines].

Science.gov (United States)

Bendifallah, S; Canlorbe, G

2015-12-01

To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning common benign breast tumors: fibroadenoma (FA), phyllodes breast tumors (PBT), and papillary lesions (BPL). Bibliographical search in French and English languages by consultation of PubMed, Cochrane and international databases. In case of percutaneous biopsy diagnosis of FA, clinico-radiologic and pathologic discordance or complex FA or proliferative lesions or atypia with FA, a family history of cancer, it seems legitimate to discuss management in a multidisciplinary meeting. When surgery is proposed for FA, periareolar compared to direct incision is associated with more insensitive nipple but better aesthetic results (LE4). When surgery is proposed for FA, indirect incision is preferable for better cosmetic results (Grade C). Techniques of percutaneous destruction or resection can be used (Grade C). The WHO classification distinguishes three categories of phyllodes tumors (PBT): benign (grade 1), borderline (grade 2) and malignant (grade 3). For grade 1 PBT, the risk of local recurrence after surgical excision increases when PBT lesion is in contact with surgical limits (not in sano). After in sano resection, there is no correlation between margin size and the risk of recurrence (LE4). For grade 2 PBT, local recurrence after surgical excision increases for margins under 10mm margins (LE4). For grade 1-2 PBT, in sano excision is recommended. For grade 2 PBT, 10-mm margins are recommended (Grade C). No lymph node evaluation or neither systematic mastectomy is recommended (Grade C). Breast papillary lesion (BPL) without atypia, complete resection of radiologic signal is recommended (Grade C). For BPL with atypia, complete excisional surgery is recommended (Grade C). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Study of nuclear morphometry on cytology specimens of benign and malignant breast lesions: A study of 122 cases.

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Kashyap, Anamika; Jain, Manjula; Shukla, Shailaja; Andley, Manoj

2017-01-01

Breast cancer has emerged as a leading site of cancer among women in India. Fine needle aspiration cytology (FNAC) has been routinely applied in assessment of breast lesions. Cytological evaluation in breast lesions is subjective with a "gray zone" of 6.9-20%. Quantitative evaluation of nuclear size, shape, texture, and density parameters by morphometry can be of diagnostic help in breast tumor. To apply nuclear morphometry on cytological breast aspirates and assess its role in differentiating between benign and malignant breast lesions with derivation of suitable cut-off values between the two groups. The present study was a descriptive cross-sectional hospital-based study of nuclear morphometric parameters of benign and malignant cases. The study included 50 benign breast disease (BBD), 8 atypical ductal hyperplasia (ADH), and 64 carcinoma cases. Image analysis was performed on Papanicolaou-stained FNAC slides by Nikon Imaging Software (NIS)-Elements Advanced Research software (Version 4.00). Nuclear morphometric parameters analyzed included 5 nuclear size, 2 shape, 4 texture, and 2 density parameters. Nuclear morphometry could differentiate between benign and malignant aspirates with a gradually increasing nuclear size parameters from BBD to ADH to carcinoma. Cut-off values of 31.93 μm 2 , 6.325 μm, 5.865 μm, 7.855 μm, and 21.55 μm for mean nuclear area, equivalent diameter, minimum feret, maximum ferret, and perimeter, respectively, were derived between benign and malignant cases, which could correctly classify 7 out of 8 ADH cases. Nuclear morphometry is a highly objective tool that could be used to supplement FNAC in differentiating benign from malignant lesions, with an important role in cases with diagnostic dilemma.

Diagnostic value of 99mTc-bombesin scintigraphy for differentiation of malignant from benign breast lesions.

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Shariati, Farzaneh; Aryana, Kamran; Fattahi, Asiehsadat; Forghani, Mohammad N; Azarian, Azita; Zakavi, Seyed R; Sadeghi, Ramin; Ayati, Narjes; Sadri, Keyvan

2014-06-01

In this study, we evaluated the diagnostic accuracy of (99m)Tc-bombesin scintigraphy for differentiation of benign from malignant palpable breast lesions. (99m)Tc-Bombesin is a tracer with high affinity for gastrin-releasing peptide receptor, which is overexpressed on a variety of human tumors including breast carcinoma. We examined 33 consecutive women who were referred to our center with suspicious palpable breast lesions but had no definitive diagnosis in other imaging procedures. A volume of 370-444 MBq of (99m)Tc-bombesin was injected and dynamic 1-min images were taken for 20 min immediately after injection in anterior view. Thereafter, two static images in anterior and prone-lateral views were taken for 5 min. Finally, single-photon emission computed tomography images were taken for each patient. Definitive diagnosis was based on biopsy and histopathological evaluation. The scan findings were positive in 19 patients and negative in 11 on visual assessment of the planar and single-photon emission computed tomography images. Pathologic examination confirmed breast carcinoma in 12 patients with positive scans and benign pathology for 18 patients. The overall sensitivity, specificity, negative and positive predictive values, and accuracy of this radiotracer for diagnosis of breast cancer were 100, 66.1, 100, 63, and 76%, respectively. Semiquantitative analysis improved the specificity of the visual assessment from 66 to 84%. Our study showed that (99m)Tc-bombesin scintigraphy has a high sensitivity and negative predictive value for detecting malignant breast lesions, but the specificity and positive predictive value of this radiotracer for differentiation of malignant breast abnormalities from benign ones are relatively low.

Automatic detection of breast lesions with MIBI-Tc99m scintimammography using a novelty filter

International Nuclear Information System (INIS)

Costa, M.; Moura, L.

1996-01-01

An automatic method for detecting breast lesion in scintimammography is described. It is reported that the proposed method not only detects lesions but also classifies them as benign or malignant. The detection method makes use of Kohonen's novelty filter and the classification method is obtained by the analysis of an identified lesion mean profile. The method was able to detect all lesions presented in the scintimammogram and to correctly classify 16 out of 17 malignant lesions and 15 out of 17 benign lesions. The sensitivity of the method was 94,12% and specificity was 88,24%

Breast Cancer Suspicion in a Transgender Male-to-Female Patient on Hormone Replacement Therapy Presenting with Right Breast Mass: Breast Cancer Risk Assessment and Presentation of a Rare Lesion

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Krystina Tongson

2017-01-01

Full Text Available There has been an increasing use of hormonal therapy among male-to-female (MtF transgender individuals. This long-term hormone replacement therapy (HRT renders MtF individuals a unique patient subgroup in terms of breast cancer risk. This case describes a MtF transgender who presented with a breast lesion concerning for malignancy following hormonal replacement therapy. The patient additionally had a strong family history of breast cancer. Final pathology revealed lobular hyperplasia in the setting of gynecomastia and pseudoangiomatous stromal hyperplasia (PASH. Both pathology findings are rare in biological females, let alone in the setting of hormone replacement therapy in a MtF individual. While the number of reported cases of suspicious breast lesions in this population remains scarce, it presents both a diagnostic and therapeutic challenge due to the nature of the treatment course and the lack of research in this recently growing subgroup of patients.

Epidemiology of breast lesions in eastern Nigeria. A 10- year ...

African Journals Online (AJOL)

Results: The most common breast lesion is fibroadenoma with n = 674 (30.5%). Its mean age of presentation is 23.8 years Standard Deviation (SD) 7.4 years. All were diagnosed as palpable lumps, the average sizes of these lumps at presentation were 3.2cm x 2.3cm x 1.4cm. Next was fibrocystic change with n = 343 ...

Optimization of Region of Interest Drawing for Quantitative Analysis: Differentiation Between Benign and Malignant Breast Lesions on Contrast-Enhanced Sonography.

Science.gov (United States)

Nakata, Norio; Ohta, Tomoyuki; Nishioka, Makiko; Takeyama, Hiroshi; Toriumi, Yasuo; Kato, Kumiko; Nogi, Hiroko; Kamio, Makiko; Fukuda, Kunihiko

2015-11-01

This study was performed to evaluate the diagnostic utility of quantitative analysis of benign and malignant breast lesions using contrast-enhanced sonography. Contrast-enhanced sonography using the perflubutane-based contrast agent Sonazoid (Daiichi Sankyo, Tokyo, Japan) was performed in 94 pathologically proven palpable breast mass lesions, which could be depicted with B-mode sonography. Quantitative analyses using the time-intensity curve on contrast-enhanced sonography were performed in 5 region of interest (ROI) types (manually traced ROI and circular ROIs of 5, 10, 15, and 20 mm in diameter). The peak signal intensity, initial slope, time to peak, positive enhancement integral, and wash-out ratio were investigated in each ROI. There were significant differences between benign and malignant lesions in the time to peak (P benign and malignant lesions in the time to peak (P benign and malignant breast lesions. © 2015 by the American Institute of Ultrasound in Medicine.

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

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Crystal, Pavel [Mount Sinai Hospital, University Health Network, Division of Breast Imaging, Toronto, ON (Canada); Mount Sinai Hospital, Toronto, ON (Canada); Sadaf, Arifa; Bukhanov, Karina; Helbich, Thomas H. [Mount Sinai Hospital, University Health Network, Division of Breast Imaging, Toronto, ON (Canada); McCready, David [Princess Margaret Hospital, Department of Surgical Oncology, Toronto, ON (Canada); O' Malley, Frances [Mount Sinai Hospital, Department of Pathology, Laboratory Medicine, Toronto, ON (Canada)

2011-03-15

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision. (orig.)

Pathological criteria and practical issues in papillary lesions of the breast - a review.

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Ni, Yun-Bi; Tse, Gary M

2016-01-01

Papillary lesions of the breast include a broad spectrum of lesions, ranging from benign papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) to papillary carcinoma. The accurate diagnosis of mammary papillary lesions is a challenge for pathologists, owing to the overlapping features among these lesions. In this review, some of the diagnostic criteria of papillary lesions are discussed, with special emphasis on some key morphological features, namely fibrovascular cores, epithelial proliferation in a solid pattern, intraductal papilloma complicated by ADH or DCIS, and invasion and its mimics. The roles of immunohistochemistry, and the interpretation of myoepithelial cell markers, hormone receptors, and high molecular weight cytokeratin, are addressed. Finally, novel biomarkers and genetic aberrations in papillary lesions are summarized. © 2015 John Wiley & Sons Ltd.

Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions

International Nuclear Information System (INIS)

Cakir, Ozgur; Arslan, Arzu; Inan, Nagihan; Anık, Yonca; Sarısoy, Tahsin; Gumustas, Sevtap; Akansel, Gur

2013-01-01

Purpose: To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast. Materials and methods: The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm 2 for DWI and b 0 and 1000 s/mm 2 for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses. Results: Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p = 0.001). The FA showed no statistical significance. With the cut-off values of ≤1.23 × 10 −3 mm 2 /s (b 0–1000 s/mm 2 ) and ≤1.12 × 10 −3 mm 2 /s (b 0–1500 s/mm 2 ), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cut-off value of ≤1.27 × 10 −3 mm 2 /s (b 1000 s/mm 2 ), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm 2 and MD with a b value of 0, 1000 s/mm 2 (AUC = 0.82 ± 0.07). Conclusion: ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant contribution to the final radiologic decision

Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions

Energy Technology Data Exchange (ETDEWEB)

Cakir, Ozgur, E-mail: cakirozgur@hotmail.com; Arslan, Arzu, E-mail: arzu.s.arslan@gmail.com; Inan, Nagihan, E-mail: nagihaninan@yahoo.com.tr; Anık, Yonca, E-mail: yoncaanik@yahoo.com; Sarısoy, Tahsin, E-mail: htsarisoy@yahoo.com; Gumustas, Sevtap, E-mail: svtgumustas@yahoo.com; Akansel, Gur, E-mail: gakansel@gmail.com

2013-12-01

Purpose: To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast. Materials and methods: The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm{sup 2} for DWI and b 0 and 1000 s/mm{sup 2} for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses. Results: Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p = 0.001). The FA showed no statistical significance. With the cut-off values of ≤1.23 × 10{sup −3} mm{sup 2}/s (b 0–1000 s/mm{sup 2}) and ≤1.12 × 10{sup −3} mm{sup 2}/s (b 0–1500 s/mm{sup 2}), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cut-off value of ≤1.27 × 10{sup −3} mm{sup 2}/s (b 1000 s/mm{sup 2}), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm{sup 2} and MD with a b value of 0, 1000 s/mm{sup 2} (AUC = 0.82 ± 0.07). Conclusion: ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant

Histopathologic Patterns of Breast Lesions in Northern Saudi Arabia

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Hussain Gadelkarim Ahmed

2017-10-01

Full Text Available Objective: The aim of this study was to find out the prevalence rates of common types of breast cancer in Northern Saudi Arabia. Methodology: A retrospective cohort study was carried out over a five-year period in two referral hospitals. In this study 257 files were retrieved from departments of Surgery from different hospitals in Hail region, Kingdom of Saudi Arabia (KSA. Results: Of the 257 samples diagnosed using Fine Needle Aspiration Cytology (FNAC, histopathological diagnosis was confirmed for 158 patients. Of the 158 diagnosed samples, 46/158 (23.2% were ductal carcinoma, 7/158 (4.4% were lobular carcinoma, 3/158 (1.9% were mixed tumours, and 102/158 (64.6 were fibroadenoma. Conclusion: Fibroadenoma and ductal carcinoma are the prevalent breast lesions in Hail Region of Saudi Arabia.

A deep learning framework for supporting the classification of breast lesions in ultrasound images

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Han, Seokmin; Kang, Ho-Kyung; Jeong, Ja-Yeon; Park, Moon-Ho; Kim, Wonsik; Bang, Won-Chul; Seong, Yeong-Kyeong

2017-10-01

In this research, we exploited the deep learning framework to differentiate the distinctive types of lesions and nodules in breast acquired with ultrasound imaging. A biopsy-proven benchmarking dataset was built from 5151 patients cases containing a total of 7408 ultrasound breast images, representative of semi-automatically segmented lesions associated with masses. The dataset comprised 4254 benign and 3154 malignant lesions. The developed method includes histogram equalization, image cropping and margin augmentation. The GoogLeNet convolutionary neural network was trained to the database to differentiate benign and malignant tumors. The networks were trained on the data with augmentation and the data without augmentation. Both of them showed an area under the curve of over 0.9. The networks showed an accuracy of about 0.9 (90%), a sensitivity of 0.86 and a specificity of 0.96. Although target regions of interest (ROIs) were selected by radiologists, meaning that radiologists still have to point out the location of the ROI, the classification of malignant lesions showed promising results. If this method is used by radiologists in clinical situations it can classify malignant lesions in a short time and support the diagnosis of radiologists in discriminating malignant lesions. Therefore, the proposed method can work in tandem with human radiologists to improve performance, which is a fundamental purpose of computer-aided diagnosis.

Surgical approach for minimal breast lesions in the material of the center, using preoperative insertion of metal identification wire

International Nuclear Information System (INIS)

Waltzer, I; Kroupa, K.; Cierny, R.; Palacka, P.; Puskarova, E.; Torok, A.; Osifova, O.; Laukova, T.; Bella, V.; Simova, A.

2006-01-01

In the pursuit of the detection of early subclinical forms of breast cancer, and with regard to the advancement in screening programs, the wire-guided excision is irreplaceable in the diagnostic and therapy of benign and malignant breast lesions. In the 15-year period (1. 1. 1991 - 31. 12. 2005) we have performed surgery on 21 826 patients. 7 845 (35,9 %) of them were surgically treated for breast disease, including patients (311 cases) with other operation (secondary suture, surgery for infection, debridement...). 3 383 patients were treated for benign, 4 151 for malignant lesions. Out of the total of 7 534 patients, 6 332 (84,0 %) were treated for palpable lesions, 1 202 (16,0 %) for non-palpable lesions, with the localization needle. In this article we present the analysis of clinical material of the Clinic of surgery of the National Oncological Institute (NOU). (author)

Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: comparison of three devices.

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Wang, Zhi Li; Liu, Gang; Huang, Yan; Wan, Wen Bo; Li, Jun Lai

2012-04-01

The aim of this study was to compare three devices in percutaneous excisional biopsy of clinically benign breast lesions in terms of complete excision rate, duration of procedure and complications. In a retrospective study from March 2005 to May 2009, 983 lesions underwent ultrasound-guided excisional biopsy with three vacuum-assisted systems, respectively. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n=951) or had been confirmed as benign by a previous core needle biopsy (n=32). The completely excision rate, duration of procedure and complications (hematoma, pain and ecchymosis) were recorded. 99.7% (980/983) lesions were demonstrated to be benign by pathology after percutaneous excisional biopsy. The overall complete excision rate was 94.8% (932/983). In lesions whose largest diameter equal to or larger than 1.5cm, the complete excision rates of EnCor(®) group (97.8%, 348/356) and Mammotome(®) group (97.2%, 139/143) were significantly higher than that of Vacora(®) group (91.9%, 445/484) (P<0.05). The EnCor(®) group (6.6±6.5min) had a significant less duration than Mammotome(®) (10.6±9.3min) and Vacora(®) group (25.6±23.3min) (P<0.05). Hematoma occurred more in EnCor(®) group and Mammotome(®) group than in Vacora(®) group (P<0.05). All these three vacuum-assisted systems are highly successful for excisional biopsy of benign breast lesions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Polydimethylsiloxane: a new contrast material for localization of occult breast lesions

International Nuclear Information System (INIS)

Vitral, Geraldo Sérgio Farinazzo; Raposo, Nádia Rezende Barbosa

2011-01-01

The radioguided localization of occult breast lesions (ROLL) technique often utilizes iodinated radiographic contrast to assure that the local injection of 99m Tc-MAA corresponds to the location of the lesion under investigation. However, for this application, this contrast has several shortcomings. The objective of this study was to evaluate the safety, effectiveness and technical feasibility of the use of polydimethylsiloxane (PDMS) as radiological contrast and tissue marker in ROLL. The safety assessment was performed by the acute toxicity study in Wistar rats (n = 50). The radiological analysis of breast tissue (n = 32) from patients undergoing reductive mammoplasty was used to verify the effectiveness of PDMS as contrast media. The technical feasibility was evaluated through the scintigraphic and histologic analysis. We found no toxic effects of PDMS for this use during the observational period. It has been demonstrated in human breast tissue that the average diameter of the tissue marked by PDMS was lower than when marked by the contrast medium (p <0.001). PDMS did not interfere with the scintigraphic uptake (p = 0.528) and there was no injury in histological processing of samples. This study demonstrated not only the superiority of PDMS as radiological contrast in relation to the iodinated contrast, but also the technical feasibility for the same applicability in the ROLL

Lesions of uncertain malignant potential in the breast (B3): what do we know?

International Nuclear Information System (INIS)

Purushothaman, H.N.; Lekanidi, K.; Shousha, S.; Wilson, R.

2016-01-01

Breast lesions classified as of uncertain malignant potential (B3) on biopsy form a diverse group of abnormalities, which pose a diagnostic and management challenge. In this paper, we discuss the imaging and pathology features as well as the management of the most controversial B3 lesions, consisting of papillary lesions, complex sclerosing lesions/radial scars, lobular intraepithelial neoplasia, and atypical epithelial proliferation of ductal type. As there is an association with malignancy at the time of diagnosis, as well as an increase in the risk of subsequent development of cancer, a multidisciplinary discussion is almost always required to tailor treatment.

Radioguided Surgery for Localization of Nonpalpable Breast Lesions A Mini-Review

DEFF Research Database (Denmark)

Langhans, Linnea; Klausen, Thomas Levin; Tvedskov, Tove Filtenborg

2016-01-01

by ultrasound a small titanium seed containing typically 1-10 MBq of radioactive iodine-125 is placed in the centre of the nonpalpable breast lesion. During the operation the seed is located with a hand-held gamma probe. To date, only few cohort studies exist on the feasibility of RSL, and the method has only...... of patients with insufficient resection margin. These patients require a reoperation. New methods in the field of radioguided surgery (RGS) have been developed including radioguided occult lesion localization (ROLL) and radioactive seed localization (RSL). Especially RSL is a very promising technique. Guided...

Precursors and preinvasive lesions of the breast: the role of molecular prognostic markers in the diagnostic and therapeutic dilemma

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Zografos George C

2007-05-01

Full Text Available Abstract Precursors and preinvasive lesions of the breast include atypical ductal hyperplasia (ADH, ductal carcinoma in situ (DCIS, and lobular neoplasia (LN. There is a significant debate regarding the classification, diagnosis, prognosis and management of these lesions. This review article describes the current theories regarding the pathogenesis and molecular evolution of these lesions. It reviews the implication of a variety of molecules in the continuum of breast lesions: estrogen receptors (ER-alpha and ER-beta, c-erb-B2 (Her2/neu, p53, Ki-67, bcl-2, E-cadherin, transforming growth factor-beta (TGF-beta, p27 (Kip1, p16 (INK4a, p21 (Waf1, vascular endothelial growth factor (VEGF. With respect to the aforementioned molecules, this article reviews their pathophysiological importance, and puts the stress on whether they confer additional risk for invasive breast cancer or not. This knowledge has the potential to be of importance in the therapeutic decisions presenting in the common clinical practice.

Computer-assisted assessment of ultrasound real-time elastography: initial experience in 145 breast lesions.

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Zhang, Xue; Xiao, Yang; Zeng, Jie; Qiu, Weibao; Qian, Ming; Wang, Congzhi; Zheng, Rongqin; Zheng, Hairong

2014-01-01

To develop and evaluate a computer-assisted method of quantifying five-point elasticity scoring system based on ultrasound real-time elastography (RTE), for classifying benign and malignant breast lesions, with pathologic results as the reference standard. Conventional ultrasonography (US) and RTE images of 145 breast lesions (67 malignant, 78 benign) were performed in this study. Each lesion was automatically contoured on the B-mode image by the level set method and mapped on the RTE image. The relative elasticity value of each pixel was reconstructed and classified into hard or soft by the fuzzy c-means clustering method. According to the hardness degree inside lesion and its surrounding tissue, the elasticity score of the RTE image was computed in an automatic way. Visual assessments of the radiologists were used for comparing the diagnostic performance. Histopathologic examination was used as the reference standard. The Student's t test and receiver operating characteristic (ROC) curve analysis were performed for statistical analysis. Considering score 4 or higher as test positive for malignancy, the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8% (136/145), 92.5% (62/67), 94.9% (74/78), 93.9% (62/66), and 93.7% (74/79) for the computer-assisted scheme, and 89.7% (130/145), 85.1% (57/67), 93.6% (73/78), 92.0% (57/62), and 88.0% (73/83) for manual assessment. Area under ROC curve (Az value) for the proposed method was higher than the Az value for visual assessment (0.96 vs. 0.93). Computer-assisted quantification of classical five-point scoring system can significantly eliminate the interobserver variability and thereby improve the diagnostic confidence of classifying the breast lesions to avoid unnecessary biopsy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Computer-assisted assessment of ultrasound real-time elastography: Initial experience in 145 breast lesions

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Zhang, Xue; Xiao, Yang [Shenzhen Key Lab for Molecular Imaging, Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen (China); Zeng, Jie [Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou (China); Qiu, Weibao; Qian, Ming; Wang, Congzhi [Shenzhen Key Lab for Molecular Imaging, Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen (China); Zheng, Rongqin, E-mail: zhengronggin@hotmail.com [Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou (China); Zheng, Hairong, E-mail: hr.zheng@siat.ac.cn [Shenzhen Key Lab for Molecular Imaging, Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen (China)

2014-01-15

Purpose: To develop and evaluate a computer-assisted method of quantifying five-point elasticity scoring system based on ultrasound real-time elastography (RTE), for classifying benign and malignant breast lesions, with pathologic results as the reference standard. Materials and methods: Conventional ultrasonography (US) and RTE images of 145 breast lesions (67 malignant, 78 benign) were performed in this study. Each lesion was automatically contoured on the B-mode image by the level set method and mapped on the RTE image. The relative elasticity value of each pixel was reconstructed and classified into hard or soft by the fuzzy c-means clustering method. According to the hardness degree inside lesion and its surrounding tissue, the elasticity score of the RTE image was computed in an automatic way. Visual assessments of the radiologists were used for comparing the diagnostic performance. Histopathologic examination was used as the reference standard. The Student's t test and receiver operating characteristic (ROC) curve analysis were performed for statistical analysis. Results: Considering score 4 or higher as test positive for malignancy, the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8% (136/145), 92.5% (62/67), 94.9% (74/78), 93.9% (62/66), and 93.7% (74/79) for the computer-assisted scheme, and 89.7% (130/145), 85.1% (57/67), 93.6% (73/78), 92.0% (57/62), and 88.0% (73/83) for manual assessment. Area under ROC curve (A{sub z} value) for the proposed method was higher than the A{sub z} value for visual assessment (0.96 vs. 0.93). Conclusion: Computer-assisted quantification of classical five-point scoring system can significantly eliminate the interobserver variability and thereby improve the diagnostic confidence of classifying the breast lesions to avoid unnecessary biopsy.

MR evaluation of breast lesions obtained by diffusion-weighted imaging with background body signal suppression (DWIBS) and correlations with histological findings.

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Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Capolongo, Arcangela; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-07-01

Diffusion imaging represents a new imaging tool for the diagnosis of breast cancer. This study aims to investigate the role of diffusion-weighted MRI with background body signal suppression (DWIBS) for evaluating breast lesions. 90 patients were prospectively evaluated by MRI with STIR, TSE-T2, contrast enhanced THRIVE-T1 and DWIBS sequences. DWIBS were analyzed searching for the presence of breast lesions and calculating the ADC value. ADC values of ≤1.44×10(-3)mm(2)/s were considered suspicious for malignancy. This analysis was then compared with the histological findings. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated. In 53/90 (59%) patients, DWIBS indicated the presence of breast lesions, 16 (30%) with ADC values of >1.44 and 37 (70%) with ADC≤1.44. The comparison with histology showed 25 malignant and 28 benign lesions. DWIBS sequences obtained sensitivity, specificity, DA, PPV and NPV values of 100, 82, 87, 68 and 100%, respectively. DWIBS can be proposed in the MRI breast protocol representing an accurate diagnostic complement. Copyright © 2014 Elsevier Inc. All rights reserved.

Towards an in-plane methodology to track breast lesions using mammograms and patient-specific finite-element simulations

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Lapuebla-Ferri, Andrés; Cegoñino-Banzo, José; Jiménez-Mocholí, Antonio-José; Pérez del Palomar, Amaya

2017-11-01

In breast cancer screening or diagnosis, it is usual to combine different images in order to locate a lesion as accurately as possible. These images are generated using a single or several imaging techniques. As x-ray-based mammography is widely used, a breast lesion is located in the same plane of the image (mammogram), but tracking it across mammograms corresponding to different views is a challenging task for medical physicians. Accordingly, simulation tools and methodologies that use patient-specific numerical models can facilitate the task of fusing information from different images. Additionally, these tools need to be as straightforward as possible to facilitate their translation to the clinical area. This paper presents a patient-specific, finite-element-based and semi-automated simulation methodology to track breast lesions across mammograms. A realistic three-dimensional computer model of a patient’s breast was generated from magnetic resonance imaging to simulate mammographic compressions in cranio-caudal (CC, head-to-toe) and medio-lateral oblique (MLO, shoulder-to-opposite hip) directions. For each compression being simulated, a virtual mammogram was obtained and posteriorly superimposed to the corresponding real mammogram, by sharing the nipple as a common feature. Two-dimensional rigid-body transformations were applied, and the error distance measured between the centroids of the tumors previously located on each image was 3.84 mm and 2.41 mm for CC and MLO compression, respectively. Considering that the scope of this work is to conceive a methodology translatable to clinical practice, the results indicate that it could be helpful in supporting the tracking of breast lesions.

Revaluation of breast cytology with pathologist on-site of lesions with suspicious sonographic features

Energy Technology Data Exchange (ETDEWEB)

Capalbo, Emanuela, E-mail: emanuelacapalbo@tiscalinet.it [Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano Via Di Rudinì, Milano, 20142 Italy (Italy); Sajadidehkordi, Farideh, E-mail: faridehit@yahoo.it [Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano Via Di Rudinì, Milano, 20142 Italy (Italy); Colombi, Claudio; Ticha, Vladimira; Moretti, Angela, E-mail: info.radiologia@sancarlo.mi.it [Dipartimento di Scienze Diagnostiche, UOC di Radiologia Diagnostica ed Interventistica, A.O San Carlo Borromeo. Via Pio II, 3, 20153 Milano (Italy); Peli, Michela, E-mail: peli.michela@gmail.com [Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano Via Di Rudinì, Milano, 20142 Italy (Italy); Cosentino, Maria, E-mail: maria-cosentino@tiscali.it [Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano Via Di Rudinì, Milano, 20142 Italy (Italy); Lovisatti, Maria, E-mail: marialovisatti@hotmail.com [Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano Via Di Rudinì, Milano, 20142 Italy (Italy); Berti, Elisabetta, E-mail: eliberti@hotmail.it [Dipartimento di Scienze Diagnostiche, UOC di Anatomia Patologica, A.O San Carlo Borromeo. Via Pio II, 3, Milano 20153 (Italy); Cariati, Maurizio, E-mail: info.radiologia@sancarlo.mi.it [Dipartimento di Scienze Diagnostiche, UOC di Radiologia Diagnostica ed Interventistica, A.O San Carlo Borromeo. Via Pio II, 3, 20153 Milano (Italy)

2013-09-15

Objective: Evaluating correlation estimation between diagnostic ultrasound (U.S.) of breast lesions and fine needle aspiration cytology (FNAC), and the correlation between cytology and histology (I) of these lesions undergo surgery. Materials and methods: In 2010 we performed 1589 ultrasound breast. We identified 210 suspicious lesions to be subjected to FNAC, which was performed with pathologist on site, and extemporaneous analysis of the sample to assess their appropriateness. We classified the lesions in 5 ultrasound (U) classes according to the criteria defined by Echographic BIRADS Lexicon. The results of cytology were classified in 5 classes (C) according to the guidelines of F.O.N.Ca.M. Then we evaluated the diagnostic correlation between U.S. and FNAC, and between FNAC and Histology. Results: The distribution of lesions in U classes was: 57U2, 55U3, 36U4 and 62U5. The diagnostic concordance between U and FNAC was 96.7%, with a sensitivity of 98%, specificity 93%, negative and positive predictive value respectively of 94.9% and 97.3%, and diagnostic accuracy of 96.6%. The 98 patients with C4-C5 lesions were subjected to surgery and the histology confirmed high-grade malignancy of lesions with a concordance of 99.7%. Conclusions: Having achieved high diagnostic concordance between U and FNAC, and then between FNAC and histology, we may say that the FNAC, less invasive and traumatic for the patient than needle biopsy (CB), may be still a valid method when performed with pathologist on-site to assess the adequacy of the sample taken.

Preliminary evaluation of data mining on non-masslike enhancement of breast lesions on MRI

International Nuclear Information System (INIS)

Tan Hongna; Li Ruimin; Wang Peihua; Tang Feng; Mao Jian; Shen Xigang; Qian Min; Gu Yajia; Su Yi; Chen Ying

2009-01-01

Objective: To evaluate the diagnostic values of the breast imaging reporting and data system-MRI (BI-RADS-MRI)description about non-masslike enhancement by data mining. Methods: Fifty- five patients with non-masslike enhancement lesions showed on breast contrast-enhanced MRI were evaluated using two data mining algorithms (Logistic regression and decision tree) and 10-fold cross-validation methods. Results: There were 28 malignant and 27 benign lesions. The most frequent findings of the malignant lesions were clustered ring enhancement and clumped enhancement [12 and 4 lesions, respectively; 84.2% (16/19) in decision trees, partial regression coefficients in Logistic model were 2.128 and 1.723, respectively], whereas homogenous, stippled, reticular internal and linear ductal enhancement were the most frequent findings in benign lesions [4,9,1 and 7 lesions, respectively; 72.4% (21/29) in decision tree, partial regression coefficients in Logistic model were 0.357 (homogenous), 1.861 (stippled) and 18.870(reticular), respectively]. 10-fold cross-validation indicated that decision tree (C5.0) achieved an accuracy of 69.3% with a sensitivity of 66.7% and a specificity of 71.7% in comparison to the Logistic regression model with an accuracy of 57.0%, a sensitivity of 43.3% and a specificity of 71.7%. Conclusions: The diagnosis efficacy of non-masslike enhancement interpretation according to BI-RADS-MRI is not high. It is very important to find more potential features of non-masslike enhancement to improve the diagnosis accuracy. (authors)

Value of the hypointensive internal septation on MR for the differentiation between benign and malignant breast lesions

International Nuclear Information System (INIS)

Gao Peihong; Cai Shifeng; Zhao Bin; Wang Guangbin; Peng Hongjuan; Liu Shaoling

2007-01-01

Objective: To investigate the diagnostic value of internal septation for differentiating benign from malignant breast lesions. Methods: A total of 26 patients were included in the study, in which 12 patients had 20 lesions of breast carcinoma and 14 patients had 25 lesions of fibroadenoma diagnosed either pathologically or clinically. The differential diagnoistic value of the hypointensive internal septation was analyzed. Results: The signal intensity of fibroadenomas and malignant lesions on T 2 -weighted fat-suppressed images could be classified as iso- to hyper- intensity, hypointensity and mixed intensity. According to the signal intensity classification, there were 5, 11 and 4 cases in patients with breast carcinoma respectively, while 11, 10, 4 cases in patients with fibroadenoma respectively. There was no statistical difference in the distribution between the two patient groups (χ 2 =1.764, P=0.414). The shape of fibroadenomas and malignant lesions could be classified as irregular, roundish or lobulated. According to the morphological classification, there were 12, 7 and 1 case in patients with breast carcinoma respectively, while 1, 7, 17 cases in patients with fibroadenoma respectively. There was statistical difference in the distribution between the two patient groups (χ 2 =23.262, P=0.000). The typical features of fibroadenomas were as follows: lobulated shape, hypointensive internal septations on T 2 -weighted or postcontrast images. The diagnostic sensitivity of the three imaging features for fibroadenoma was 68%(17/25), 52%(13/25), and 72%(18/25) respectively; and the diagnostic specificity was 95%(19/20), 90%(18/20), 95% (19/20) respectively. Conclusion: The internal septation is a rather specific sign for diagnosis of fibroadenomas. (authors)

A modified Seeded Region Growing algorithm for vessel segmentation in breast MRI images for investigating the nature of potential lesions

Science.gov (United States)

Glotsos, D.; Vassiou, K.; Kostopoulos, S.; Lavdas, El; Kalatzis, I.; Asvestas, P.; Arvanitis, D. L.; Fezoulidis, I. V.; Cavouras, D.

2014-03-01

The role of Magnetic Resonance Imaging (MRI) as an alternative protocol for screening of breast cancer has been intensively investigated during the past decade. Preliminary research results have indicated that gadolinium-agent administrative MRI scans may reveal the nature of breast lesions by analyzing the contrast-agent's uptake time. In this study, we attempt to deduce the same conclusion, however, from a different perspective by investigating, using image processing, the vascular network of the breast at two different time intervals following the administration of gadolinium. Twenty cases obtained from a 3.0-T MRI system (SIGNA HDx; GE Healthcare) were included in the study. A new modification of the Seeded Region Growing (SRG) algorithm was used to segment vessels from surrounding background. Delineated vessels were investigated by means of their topology, morphology and texture. Results have shown that it is possible to estimate the nature of the lesions with approximately 94.4% accuracy, thus, it may be claimed that the breast vascular network does encodes useful, patterned, information, which can be used for characterizing breast lesions.

Analysis of false results in a series of 835 fine needle aspirates of breast lesions.

Science.gov (United States)

Willis, S L; Ramzy, I

1995-01-01

To analyze cases of false diagnoses from a large series to help increase the accuracy of fine needle aspiration of palpable breast lesions. The results of FNA of 835 palpable breast lesions were analyzed to determine the reasons for false positive, false negative and false suspicious diagnoses. Of the 835 aspirates, 174 were reported as positive, 549 as negative and 66 as suspicious or atypical but not diagnostic of malignancy. Forty-six cases were considered unsatisfactory. Tissue was available for comparison in 286 cases. The cytologic diagnoses in these cases were reported as follows: positive, 125 (43.7%); suspicious, 33 (11.5%); atypical, 18 (6.2%); negative, 92 (32%); and unsatisfactory, 18 (6.2%). There was one false positive diagnosis, yielding a false positive rate of 0.8%. This lesion was a case of fibrocystic change with hyperplasia, focal fat necrosis and reparative atypia. There were 14 false negative cases, resulting in a false negative rate of 13.2%. Nearly all these cases were sampling errors and included infiltrating ductal carcinomas (9), ductal carcinomas in situ (2), infiltrating lobular carcinomas (2) and tubular carcinoma (1). Most of the suspicious and atypical lesions proved to be carcinomas (35/50). The remainder were fibroadenomas (6), fibrocystic change (4), gynecomastia (2), adenosis (2) and granulomatous mastitis (1). A positive diagnosis of malignancy by FNA is reliable in establishing the diagnosis and planning the treatment of breast cancer. The false-positive rate is very low, with only a single case reported in 835 aspirates. Most false negatives are due to sampling and not to interpretive difficulties. The category "suspicious but not diagnostic of malignancy" serves a useful purpose in management of patients with breast lumps.

A review of columnar cell lesions of the breast in a Lagos Tertiary ...

African Journals Online (AJOL)

CCLs) in Nigerian women using Fibrocystic changes (FCC) of the breast as a surrogate lesion as well as to determine the variants of CCLs found using the standard histologic criteria.The materials for this study consisted of all consecutive ...

Focal breast lesions in clinical CT examinations of the chest. A retrospective analysis

International Nuclear Information System (INIS)

Krug, Kathrin Barbara; Houbois, Christian; Grinstein, Olga; Borggrefe, Jan; Puesken, Michael; Maintz, David; Hanstein, Bettina; Malter, Wolfram; Hellmich, Martin

2017-01-01

Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤2%. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings. All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses. The range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N = 701, 59.9 %) and vascular (190, 16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 - 5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant. The relative frequency of BI-RADS 3 - 5 findings was 5.8 %. It reflects the situation

PET-CT detection rate of primary breast cancer lesions. Correlation with the clinicopathological factors

International Nuclear Information System (INIS)

Ogawa, Tomoko; Tozaki, Mitsuhiro; Fukuma, Eisuke

2008-01-01

One hundred and forty lesions of primary breast cancer underwent positron emission tomography (PET)-CT between June 2006 and May 2007. The PET-CT detection rate of primary breast cancer lesions was 72.1%. The detection rate was 52.1% for invasive cancer ≤20 mm, 92.8% for invasive breast cancers >20 mm, and these results were significant. In the present study, no significant relationship was observed between tumor types, however, invasive lobular carcinoma showed a lower detection rate, 58.3%. The PET-CT results were not significantly affected by either estrogen and progesterone receptors or distant metastasis. A significant correlation regarding the detection rate of PET-CT was found with HER2 status, tumor grade, and axillary lymph node status. The detection rate was 100% for invasive cancer ≤20 mm when the interval between prior diagnostic Mammotome biopsies and PET-CT was less than 3 weeks, 18.8% for invasive cancer ≤20 mm when the interval was more than 3 weeks, and these results were significant. Mammotome biopsies may therefore affect the detection rate of PET-CT. Invasive cancers ≤20 mm showed a low detection rate, therefore, it is considered to be insufficient to use PET-CT for the detection of early breast cancer. (author)

Oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant chemotherapy in breast cancer patients

DEFF Research Database (Denmark)

Jensen, Siri Beier; Mouridsen, Henning T.; Bergmann, Olav Jonas

2008-01-01

OBJECTIVE: The aim of the study was to examine oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant chemotherapy (CT) in breast cancer patients during and 1 year after treatment. STUDY DESIGN: Forty-five consecutive breast cancer patients, eligible for adjuvant CT...... with cyclophosphamide, epirubicin or methotrexate, and 5-fluorouracil were followed before, during, 6 months and 1 year after CT and were compared to a control group of 31 breast cancer patients not receiving adjuvant CT. RESULTS: During CT, oral mucosal lesions developed including erythema (n = 10, 22%) and ulceration...... (n = 7, 16%). Five patients (11%) were diagnosed with oral candidosis. Scores of dental bacterial plaque and gingival inflammation increased during CT and the oral microbial composition changed towards a more acidophilic flora. Taste disturbances were experienced by 84% (n = 38) of the patients...

[Tumor and tumor-like benign mesenchymal lesions of the breast].

Science.gov (United States)

Bisceglia, M; Nirchio, V; Carosi, I; Cappucci, U; Decata, A; Paragone, T; Di Mattia, A L

1995-02-01

All the spectrum is encompassed of those miscellaneous pathologic entities occurring in the mammary stroma which are on record up to date other than "mixed fibroepithelial" tumors (fibroadenomas and phyllodes tumors) and tumors both "pure" and "mixed" originating from myoepithelium (adenomyoepitheliomas and pleomorphic adenomas). Also they were excluded those dysreactive-autoimmune diseases (sarcoidosis, sclerosing lymphocytic lobulitis, lobular granulomatous mastitis) and those inflammatory-infectious conditions (tuberculosis, actinomycosis, foreign body reactions, Mondor's disease) which can mimick breast tumors clinically or on image analysis, but on the contrary not evoking the idea of a tumor on histology. Specifically, inflammatory pseudotumor, myofibroblastoma, leiomyoma, neurinoma/neurofibroma, benign fibrous histiocytoma, hemangiopericytoma, fibromatosis, nodular fascitis, variants of lipoma, mesenchymoma, amartoma and its variants, hemangiomas, pseudoangiomatous hyperplasia of stroma, amyloid tumor, granular cell tumor, are consecutively described and discussed, with a large list of references enclosed to each rubric. Most of the pictures are taken from personally observed lesions of the breast. Only few pictures referred to are from their analogue lesions which occurred in soft parts of other locations, with specific mention of that when it was the case. Of note after reviewing the literature the fact that no glomus tumor, nor Kaposi's sarcoma either sporadic or in the context of any immunodeficiency, nor myelolipoma has been recorded yet.

TU-CD-207-02: Quantification of Breast Lesion Compositions Using Low-Dose Spectral Mammography: A Feasibility Study

Energy Technology Data Exchange (ETDEWEB)

Cho, H; Ding, H; Sennung, D; Kumar, N; Molloi, S [Department of Radiological Sciences, University of California, Irvine, CA (United States)

2015-06-15

Purpose: To investigate the feasibility of measuring breast lesion composition with spectral mammography using physical phantoms and bovine tissue. Methods: Phantom images were acquired with a spectral mammography system with a silicon-strip based photon-counting detector. Plastic water and adipose-equivalent phantoms were used to calibrate the system for dual-energy material decomposition. The calibration phantom was constructed in range of 2–8 cm thickness and water densities in the range of 0% to 100%. A non-linear rational fitting function was used to calibrate the imaging system. The phantom studies were performed with uniform background phantom and non-uniform background phantom. The breast lesion phantoms (2 cm in diameter and 0.5 cm in thickness) were made with water densities ranging from 0 to 100%. The lesion phantoms were placed in different positions and depths on the phantoms to investigate the accuracy of the measurement under various conditions. The plastic water content of the lesion was measured by subtracting the total decomposed plastic water signal from a surrounding 2.5 mm thick border outside the lesion. In addition, bovine tissue samples composed of 80 % lean were imaged as background for the simulated lesion phantoms. Results: The thickness of measured and known water contents was compared. The rootmean-square (RMS) errors in water thickness measurements were 0.01 cm for the uniform background phantom, 0.04 cm for non-uniform background phantom, and 0.03 cm for 80% lean bovine tissue background. Conclusion: The results indicate that the proposed technique using spectral mammography can be used to accurately characterize breast lesion compositions.

Is 99mTc-MDP mammoscintigraphy useful in patients with breast mass lesions?

International Nuclear Information System (INIS)

Park, S. K.; Lee, Y. H.; Rhyu, J. W.; Yoo, S. M.

1998-01-01

Piccolo et al. advocated the usefulness of 99m Tc-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied 99m Tc-MDP uptake pattern and lesion/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of 99m Tc-MDP scan. Total 34 patients were studied with physical examination, mammogram and 99m Tc-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq 99m Tc-MDP. Breast uptake pattern of 99m Tc-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammogram. Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of 99m Tc-MDP uptake was noted in 4/7 carcinomas, 3/5 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 2/7, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. 99m Tc-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned

Dietary and other risk factors in women having fibrocystic breast conditions with and without concurrent breast cancer: a nested case-control study in Shanghai, China.

Science.gov (United States)

Li, Wenjin; Ray, Roberta M; Lampe, Johanna W; Lin, Ming-Gang; Gao, Dao Li; Wu, Chunyuan; Nelson, Zakia C; Fitzgibbons, E Dawn; Horner, Neilann; Hu, Yong Wei; Shannon, Jackilen; Satia, Jessie A; Patterson, Ruth E; Stalsberg, Helge; Thomas, David B

2005-07-20

Risk of breast cancer is increased in women with proliferative benign breast conditions. Most of these conditions, however, do not progress to breast cancer. The purpose of our study was to identify factors possibly associated with this progression. Women with proliferative fibrocystic breast conditions alone (214), and women with proliferative fibrocystic breast conditions and concurrent breast cancer (130), were compared to each other, and each of these groups of women were also compared to 1,070 controls; and 176 women with non-proliferative benign breast conditions alone, and 155 also with breast cancer, were similarly compared. All study subjects were selected from a cohort of women enrolled in a trial of breast self-examination in Shanghai. Women were interviewed to ascertain information on suspected risk factors for breast cancer and dietary habits. Conditional logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Increased risks of both proliferative fibrocystic breast conditions alone, and with breast cancer, were associated with low parity, a prior benign breast lump and breast cancer in a first-degree relative. Decreasing trends in the risk of both conditions with increasing intake of fruits and vegetables were observed. No factors were significantly associated with risk of breast cancer relative to risk of proliferative changes. Similar, but in some instances weaker, associations were observed for non-proliferative fibrocystic conditions with and without breast cancer. The possible risk or protective factors that were observed in our study most likely alter the risk of breast cancer at an early stage in the carcinogenic process, and probably do not alter risk of progression from proliferative fibrocystic breast conditions to breast cancer. Copyright 2005 Wiley-Liss, Inc.

Potential Use of American College of Radiology BI-RADS Mammography Atlas for Reporting and Assessing Lesions Detected on Dedicated Breast CT Imaging: Preliminary Study.

Science.gov (United States)

Jung, Hae Kyoung; Kuzmiak, Cherie M; Kim, Keum Won; Choi, Na Mi; Kim, Hye Jeong; Langman, Eun Lee; Yoon, Sora; Steen, Doreen; Zeng, Donglin; Gao, Fei

2017-11-01

Dedicated breast computed tomography (DBCT) is an emerging and promising modality for breast lesions. The objective of this study was to evaluate the potential use of applying the BI-RADS Mammography Atlas 5th Edition for reporting and assessing breast lesions on DBCT. Currently, no atlas exists for DBCT. Four radiologists trained in breast imaging were recruited in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. The enrolled radiologists, who were blinded to mammographic and histopathologic findings, individually reviewed 30 randomized DBCT cases that contained marked lesions. Thirty-four lesions were included in this study: 24 (70.6%) masses, 7 (20.6%) calcifications, and 3 (8.8%) architectural distortions. Eight (23.5%) lesions were malignant and 26 (76.5%) were benign. The reader was asked to specify according to the BI-RADS Mammography Atlas for each marked DBCT lesion: primary findings, features, breast density, and final assessment. We calculated readers' diagnostic performances for differentiating between benign and malignant lesions and interobserver variability for reporting and assessing lesions using a generalized estimating equation and the Fleiss kappa (κ) statistic. The estimated overall sensitivity of the readers was 0.969, and the specificity was 0.529. There were no significant differences in the sensitivity and the specificity between lesion types. For reporting the presence of a primary finding, the overall substantial agreement (κ = 0.70) was seen. In assigning the breast density and the final assessment, the overall agreement was moderate (κ = 0.53) and fair (κ = 0.30). The use of the BI-RADS Mammography Atlas 5th Edition for DBCT showed high performance and good agreement among readers. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

The assessment of angiogenesis and fibroblastic stromagenesis in hyperplastic and pre-invasive breast lesions

International Nuclear Information System (INIS)

Pavlakis, Kitty; Messini, Irene; Vrekoussis, Thomas; Yiannou, Petros; Keramopoullos, Dimitrios; Louvrou, Niki; Liakakos, Theodoros; Stathopoulos, Efstathios N

2008-01-01

To investigate the changes of the neoplastic microenvironment during the different morphological alterations of hyperplastic and pre-invasive breast lesions. 78 in situ ductal carcinomas of all degrees of differentiation, 22 atypical ductal hyperplasias, 25 in situ lobular carcinomas, 18 atypical lobular hyperplasias, 32 ductal epithelial hyperplasias of usual type and 8 flat atypias were immunohistochemically investigated for the expression of vascular endothelial growth factor (VEGF), smooth muscle actin (SMA) and CD34, while microvessel density (MVD) was counted using the anti-CD31 antibody. VEGF expression was strongly correlated with MVD in all hyperplastic and pre-invasive breast lesions (p < 0.05). Stromagenesis, as characterized by an increase in SMA and a decrease in CD34 positive myofibroblasts was observed mostly around ducts harboring high grade in situ carcinoma and to a lesser extent around moderately differentiated DCIS. In these two groups of in situ carcinomas, a positive correlation between MVD and SMA (p < 0.05) was observed. On the contrary, CD34 was found to be inversely related to MVD (p < 0.05). No statistically significant changes of the stromal fibroblasts were observed in low grade DCIS neither in any of the other lesions under investigation as compared to normal mammary intra- and interlobular stroma. Angiogenesis is observed before any significant fibroblastic stromagenesis in pre-invasive breast lesions. A composite phenotype characterized by VEGF positive epithelial cells and SMA positive/CD34 negative stromal cells, is identified mostly in intermediate and high grade DCIS. These findings might imply for new therapeutic strategies using both anti-angiogenic factors and factors selectively targeting tumor stroma in order to prevent the progression of DCIS to invasive carcinoma

Comparison of synthetic mammography, reconstructed from digital breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories.

Science.gov (United States)

Mariscotti, Giovanna; Durando, Manuela; Houssami, Nehmat; Fasciano, Mirella; Tagliafico, Alberto; Bosco, Davide; Casella, Cristina; Bogetti, Camilla; Bergamasco, Laura; Fonio, Paolo; Gandini, Giovanni

2017-12-01

To compare the interpretive performance of synthetic mammography (SM), reconstructed from digital breast tomosynthesis (DBT), and full-field digital mammography (FFDM) in a diagnostic setting, covering different conditions of breast density and mammographic signs. A retrospective analysis was conducted on 231 patients, who underwent FFDM and DBT (from which SM images were reconstructed) between September 2014-September 2015. The study included 250 suspicious breast lesions, all biopsy proven: 148 (59.2%) malignant and 13 (5.2%) high-risk lesions were confirmed by surgery, 89 (35.6%) benign lesions had radiological follow-up. Two breast radiologists, blinded to histology, independently reviewed all cases. Readings were performed with SM alone, then with FFDM, collecting data on: probability of malignancy for each finding, lesion conspicuity, mammographic features and dimensions of detected lesions. Agreement between readers was good for BI-RADS classification (Cohen's k-coefficient = 0.93 ± 0.02) and for lesion dimension (Wilcoxon's p = 0.76). Visibility scores assigned to SM and FFDM for each lesion were similar for non-dense and dense breasts, however, there were significant differences (p = 0.0009) in distribution of mammographic features subgroups. SM and FFDM had similar sensitivities in non-dense (respectively 94 vs. 91%) and dense breasts (88 vs. 80%) and for all mammographic signs (93 vs. 87% for asymmetric densities, 96 vs. 75% for distortion, 92 vs. 85% for microcalcifications, and both 94% for masses). Based on all data, there was a significant difference in sensitivity for SM (92%) vs. FFDM (87%), p = 0.02, whereas the two modalities yielded similar results for specificity (SM: 60%, FFDM: 62%, p = 0.21). SM alone showed similar interpretive performance to FFDM, confirming its potential role as an alternative to FFDM in women having tomosynthesis, with the added advantage of halving the patient's dose exposure.

Model observer for assessing digital breast tomosynthesis for multi-lesion detection in the presence of anatomical noise

Science.gov (United States)

Wen, Gezheng; Markey, Mia K.; Miner Haygood, Tamara; Park, Subok

2018-02-01

Model observers are widely used in task-based assessments of medical image quality. The presence of multiple abnormalities in a single set of images, such as in multifocal multicentric breast cancer (MFMC), has an immense clinical impact on treatment planning and survival outcomes. Detecting multiple breast tumors is challenging as MFMC is relatively uncommon, and human observers do not know the number or locations of tumors a priori. Digital breast tomosynthesis (DBT), in which an x-ray beam sweeps over a limited angular range across the breast, has the potential to improve the detection of multiple tumors. However, prior studies of DBT image quality all focus on unifocal breast cancers. In this study, we extended our 2D multi-lesion (ML) channelized Hotelling observer (CHO) into a 3D ML-CHO that detects multiple lesions from volumetric imaging data. Then we employed the 3D ML-CHO to identify optimal DBT acquisition geometries for detection of MFMC. Digital breast phantoms with multiple embedded synthetic lesions were scanned by simulated DBT scanners of different geometries (wide/narrow angular span, different number of projections per scan) to simulate MFMC cases. With new implementations of 3D partial least squares (PLS) and modified Laguerre-Gauss (LG) channels, the 3D ML-CHO made detection decisions based upon the overall information from individual DBT slices and their correlations. Our evaluation results show that: (1) the 3D ML-CHO could achieve good detection performance with a small number of channels, and 3D PLS channels on average outperform the counterpart LG channels; (2) incorporating locally varying anatomical backgrounds and their correlations as in the 3D ML-CHO is essential for multi-lesion detection; (3) the most effective DBT geometry for detection of MFMC may vary when the task of clinical interest changes, and a given DBT geometry may not yield images that are equally informative for detecting MF, MC, and unifocal cancers.

The Rare Benign Lesion That Mimics a Malignant Tumor in Breast Parenchyma: Nodular Fasciitis of the Breast

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Hilal Erinanc

2018-01-01

Full Text Available We herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may show clinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm.

En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

International Nuclear Information System (INIS)

Lifrange, E.; Colin, C.; Dondelinger, R.F.; Fridman, V.

2001-01-01

This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40 %) patients underwent needle-guided surgery. Finally, 96/186 (51 %) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38 %) excisions were obtained with the ABBI system; 17/43 (40 %) benign lesions and 11/53 (21 %) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55 %) had tumor-free margins and in 8/9 (89 %) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery. (orig.)

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

Directory of Open Access Journals (Sweden)

Maha Helal

2017-09-01

Full Text Available Aim: Assess accuracy of contrast enhanced spectral mammography (CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation. Patients and methods: Thirty female patients with 35 breast lesions diagnosed by conventional imaging as BI-RADS 3 and 4, presented to Women’s Imaging Unit of Radiology Department between January and December 2015, age ranged from 23 to 70 years. All patients underwent conventional mammography and ultrasound then CESM. Results: Patients divided into two groups, benign and malignant lesions group according to histological analysis. Mammography results that malignant lesions detected in 18/35 (51.4% while benign lesions 17/35 (48.6%. Ultrasound revealed 27/35 (77.1% lesions were malignant and 8/35 (22.9% lesions benign. But CESM, revealed 25/35 (71.4% lesions were malignant & 10/35 (28.6% lesions benign. Among 7 patients with multifocal/ multi-centric histologically proven malignant lesions, all detected by CESM 7/7 cases (100% versus 2/7 cases (28.6% and 6/7 cases (85.7% detected by mammography and ultrasound respectively. Based on, CESM had 95.2% sensitivity and 82.9% diagnostic accuracy. Conclusion: CESM has better diagnostic accuracy than mammography alone and mammography plus ultrasound. CESM has 82.9% diagnostic accuracy in comparison to 51.4% for mammography and 77.1% for ultrasound. Keywords: Breast lesions, CESM, BI-RADS lexicon

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions

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Ilaria Testa

2018-05-01

Full Text Available Introduction: Phylloides tumours (PTs are rare fibroepithelial neoplasms that account for 0.3–0.9% of all breast tumours. These tumours typically occur in women aged 30–70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation: A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion: This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions.

Science.gov (United States)

Testa, Ilaria; Salvatori, Cristina; Prestipino, Marco; Laurenti, Maria Elena; Gerli, Paolo; Di Cara, Giuseppe; Principi, Nicola; Esposito, Susanna; Bertozzi, Mirko

2018-05-11

Introduction : Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3⁻0.9% of all breast tumours. These tumours typically occur in women aged 30⁻70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation : A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US) revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion : This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be considered to confirm

Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

Directory of Open Access Journals (Sweden)

Richard Ha

2015-01-01

Full Text Available Purpose: The purpose of this study was to describe the breast ultrasonography (US features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses. Methods: A total of 76 solid palpable masses in 68 consecutive women (≤25 years old underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology. Results: All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%, margin as circumscribed (68.4% and 77.6% and orientation as parallel (85.5% and 90.8%; the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%, non-circumscribed margin (31.6% and 22.4% and non-parallel orientation (14.5% and 9.2%; the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively. Conclusion: Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

Energy Technology Data Exchange (ETDEWEB)

Ha, Richard; Kim, Hyon Ah; Mango, Victoria; Wynn, Ralph [Dept. of Radiology, Columbia University Medical Center, New York (United States); Comstock, Christopher [Dept. of Radiology, Memorial Sloan Kettering Cancer Center, New York (United States)

2015-01-15

The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses. A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology. All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively. Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Ultrasonographic features and clinical implications of benign palpable breast lesions in young women

International Nuclear Information System (INIS)

Ha, Richard; Kim, Hyon Ah; Mango, Victoria; Wynn, Ralph; Comstock, Christopher

2015-01-01

The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses. A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology. All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively. Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Localization techniques for guided surgical excision of non-palpable breast lesions.

Science.gov (United States)

Chan, Benjamin K Y; Wiseberg-Firtell, Jill A; Jois, Ramesh H S; Jensen, Katrin; Audisio, Riccardo A

2015-12-31

Breast cancer is the most common form of cancer and the second leading cause of death amongst women in Europe. Amongst five invasive cancers per 1000 women detected in screening, 2.7 were localization (WGL). With the clinical setting shifting towards earlier non-palpable breast lesions being detected through screening, we investigated whether the current standard in assisting surgical excision of these lesions, WGL, yields the best therapeutic outcome for women with breast cancer. To assess the therapeutic outcomes of any new form of guided surgical intervention for non-palpable breast lesions against wire-guided localization, the current gold standard. We searched the Cochrane Breast Cancer Group's (CBCG) Specialized Register, MEDLINE (via PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal from the earliest available date up to 30 March 2015. We also handsearched recent conference proceedings and sought information from experts in the field. Two review authors, BC and RJ, independently screened by title and abstract the studies we had identified through the search strategy; when this was inconclusive, they examined the full-text article for inclusion. We resolved any discrepancies regarding eligibility by discussion with a third review author, RA. Three review authors, BC, JW, and RJ, independently extracted data using a standardized data sheet. We performed all analyses using Review Manager (RevMan) or the R meta package, and in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We reported results via a graphical assessment using forest plots showing the study estimates. We considered and discussed additional subgroup and sensitivity analyses. We identified 11 randomized controlled trials (RCTs) that met the inclusion criteria of this Cochrane review and included eight trials in the meta-analyses. Six RCTs

Radio-guided occult lesion localisation using iodine-125 seeds ('ROLLIS') for removal of impalpable breast lesions: first Australian experience

International Nuclear Information System (INIS)

Taylor, Donna B.; Bourke, Anita G.; Westcott, Eliza

2015-01-01

Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia. In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radio guided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed. All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff. ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.

Monomorphic Epithelial Proliferations of the Breast: A Possible Precursor Lesion Associated With Ipsilateral Breast Failure After Breast Conserving Therapy in Patients With Negative Lumpectomy Margins

International Nuclear Information System (INIS)

Goldstein, Neal S.; Kestin, Larry L.; Vicini, Frank A.

2011-01-01

Background: It is generally believed that ipsilateral breast failures (IBFs) after breast-conserving therapy (BCT) develop from incompletely eradicated carcinoma. We previously suggested that monomorphic epithelial proliferations (MEPs) in the breast may be a pool of partially transformed clones from which breast carcinomas can arise and that radiation therapy (RT) may also reduce the risk of IBF by eradicating MEPs. We examined salvage mastectomy specimens in patients experiencing an IBF to define the relationship between MEPs and IBFs and an additional potential mechanism for IBF risk reduction by RT. Methods and Materials: The location, number, and distribution of radiation changes and MEPs relative to 51 IBFs were mapped in salvage mastectomy specimens from BCT patients with adequately excised, initial carcinomas (negative lumpectomy margins). Results: All 51 salvage mastectomies had diffuse, late radiation changes. None had active fibrocystic lesions. MEPs were predominantly located in the immediate vicinity of the IBFs. A mean of 39% of MEP cases were located within the IBF, 46% were located within 2 cm of the IBF, and 14% were 2-3 cm from the IBF. Conclusions: MEPs appear to be a pool of partially transformed precursor lesions that can give rise to ductal carcinoma in situ and invasive carcinomas (CAs). Many IBFs may arise from MEPs that reemerge after RT. Radiation may also reduce IBF risk after BCT (including in patients with negative margins) by primarily eradicating MEPs.

Correlation of needle core biopsy with excision histology in screen-detected B3 lesions: the Merrion Breast Screening Unit experience.

LENUS (Irish Health Repository)

Hayes, B D

2012-02-01

AIMS: Needle core biopsy (NCB) is a widely-used technique for non-operative evaluation of screen-detected breast lesions. Although most NCBs are B2 (benign) or B5 (malignant), some fall into the B3 category of "uncertain malignant potential". This study aims to categorise the lesions prompting a B3 NCB in the Merrion Breast Screening Unit, and establish the incidence of malignancy on subsequent excision biopsy. METHODS: Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2008 who had a B3 NCB were identified. The NCB pathology reports were reviewed and the diagnosis correlated with excision histology; the latter was classified as benign, atypical or malignant. Lesion-specific positive predictive values (PPVs) for malignancy were derived. RESULTS: 141 patients with a B3 NCB were identified. The most frequent lesions on NCB were radial scar (RS; n = 57), atypical intraductal epithelial proliferation (AIDEP; n = 25) and papillary lesion (n = 24). The final diagnosis was malignant in 22 patients (16%), atypical in 40 (28%) and benign in 79 (56%). Two of the patients with a malignant diagnosis had invasive carcinoma. The lesion-specific PPVs were: lobular neoplasia 50%, AIDEP 32%, columnar cell lesion with atypia 12.5%, RS 12.3%, papillary lesion 8.3%, suspected phyllodes tumour 7.7%, and spindle cell lesion 0%. Atypia on RS NCB predicted an atypical or malignant excision diagnosis, but atypia on papillary lesion NCB did not. CONCLUSIONS: One-sixth of B3 NCBs in this series proved to be malignant on excision. The PPV for malignancy varied according to lesion type.

Differentiating benign and malignant breast lesions with T2*-weighted first pass perfusion imaging

International Nuclear Information System (INIS)

Kvistad, K.A.; Smenes, E.; Haraldseth, O.; Lundgren, S.; Fjoesne, H.E.; Smethurst, H.B.

1999-01-01

Purpose: Invasive breast carcinomas and fibroadenomas are often difficult to differentiate in dynamic contrast-enhanced T1-weighted MR imaging of the breast, because both tumors can enhance strongly after contrast injection. The purpose of this study was to evaluate whether the addition of T2*-weighted first pass perfusion imaging can increase the differentiation of malignant from benign lesions. Material and Methods: Nine patients with invasive carcinomas and 10 patients with contrast enhancing fibroadenomas were examined by a dynamic contrast-enhanced T1-weighted 3D sequence immediately followed by a single slice T2*-weighted first pass perfusion sequence positioned in the contrast-enhancing lesion. Results: The carcinomas and the fibroadenomas were impossible to differentiate based on the contrast enhancement characteristics in the T1-weighted sequence. The signal loss in the T2*-weighted perfusion sequence was significantly stronger in the carcinomas than in the fibroadenomas (p=0.0004). Conclusion: Addition of a T2*-weighted first pass perfusion sequence with a high temporal resolution can probably increase the differentiation of fibroadenomas from invasive carcinomas in contrast-enhanced MR imaging of the breast. (orig.)

Can We Predict Phyllodes Tumor among Fibroepithelial Lesions with Cellular Stroma Diagnosed at Breast Core Needle Biopsy?

Energy Technology Data Exchange (ETDEWEB)

Jung, Hae Kyoung; Ko, Kyung Hee; Rho, Ji Young [Dept. of Radiology, CHA University College of Medicine, Seoul (Korea, Republic of); Moon, Hee Jung; Kim, Eun Kyung; Kim, Min Jung; Park, Byeong Woo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of)

2011-06-15

To evaluate the surgical outcomes of fibroepithelial lesion with cellular stroma (FELCS) diagnosed at sonography guided core needle biopsy of breast masses, and to determine whether the clinical and imaging features of this lesion could predict the presence of a phyllodes tumor. We retrospectively reviewed the pathologic results of sonography guided core needle biopsy of solid breast masses. A total of 55 FELCS diagnosed with this procedure that underwent subsequent surgical excision were included in this study; their medical records and radiologic images were retrospectively reviewed. The results of the surgical excision revealed 22 (40%) phyllodes tumors and 33 (60%) non-phyllodes tumors: 30 (54.6%) fibroadenomas, 1 (1.8%) adenosis, 1 (1.8%) fibrocystic changes and 1 (1.8%) fibroadenomatous hyperplasia. Lesion size and patient age were significantly different between phyllodes tumors and nonphyllodes tumors groups (32.2 {+-} 14.07 mm/22.4 {+-} 13.64 mm, p=0.0078, 43.5 {+-} 11.60 years/36.5 {+-} 10.25 years, p=0.0207). Among the sonographic features, only cleft was significantly more visible in phyllodes tumors than in non-phyllodes tumors (n=14 (70%)/n=6 (30%), p=0.0016). The size of the lesions, the age of the patients, and the sonographic features of cleft were the significant helpful variables to predict phyllodes tumors among FELCS diagnosed at breast core biopsy.

Can We Predict Phyllodes Tumor among Fibroepithelial Lesions with Cellular Stroma Diagnosed at Breast Core Needle Biopsy?

International Nuclear Information System (INIS)

Jung, Hae Kyoung; Ko, Kyung Hee; Rho, Ji Young; Moon, Hee Jung; Kim, Eun Kyung; Kim, Min Jung; Park, Byeong Woo

2011-01-01

To evaluate the surgical outcomes of fibroepithelial lesion with cellular stroma (FELCS) diagnosed at sonography guided core needle biopsy of breast masses, and to determine whether the clinical and imaging features of this lesion could predict the presence of a phyllodes tumor. We retrospectively reviewed the pathologic results of sonography guided core needle biopsy of solid breast masses. A total of 55 FELCS diagnosed with this procedure that underwent subsequent surgical excision were included in this study; their medical records and radiologic images were retrospectively reviewed. The results of the surgical excision revealed 22 (40%) phyllodes tumors and 33 (60%) non-phyllodes tumors: 30 (54.6%) fibroadenomas, 1 (1.8%) adenosis, 1 (1.8%) fibrocystic changes and 1 (1.8%) fibroadenomatous hyperplasia. Lesion size and patient age were significantly different between phyllodes tumors and nonphyllodes tumors groups (32.2 ± 14.07 mm/22.4 ± 13.64 mm, p=0.0078, 43.5 ± 11.60 years/36.5 ± 10.25 years, p=0.0207). Among the sonographic features, only cleft was significantly more visible in phyllodes tumors than in non-phyllodes tumors (n=14 (70%)/n=6 (30%), p=0.0016). The size of the lesions, the age of the patients, and the sonographic features of cleft were the significant helpful variables to predict phyllodes tumors among FELCS diagnosed at breast core biopsy.

A contrast enhancement method for improving the segmentation of breast lesions on ultrasonography.

Science.gov (United States)

Flores, Wilfrido Gómez; Pereira, Wagner Coelho de Albuquerque

2017-01-01

This paper presents an adaptive contrast enhancement method based on sigmoidal mapping function (SACE) used for improving the computerized segmentation of breast lesions on ultrasound. First, from the original ultrasound image an intensity variation map is obtained, which is used to generate local sigmoidal mapping functions related to distinct contextual regions. Then, a bilinear interpolation scheme is used to transform every original pixel to a new gray level value. Also, four contrast enhancement techniques widely used in breast ultrasound enhancement are implemented: histogram equalization (HEQ), contrast limited adaptive histogram equalization (CLAHE), fuzzy enhancement (FEN), and sigmoid based enhancement (SEN). In addition, these contrast enhancement techniques are considered in a computerized lesion segmentation scheme based on watershed transformation. The performance comparison among techniques is assessed in terms of both the quality of contrast enhancement and the segmentation accuracy. The former is quantified by the measure, where the greater the value, the better the contrast enhancement, whereas the latter is calculated by the Jaccard index, which should tend towards unity to indicate adequate segmentation. The experiments consider a data set with 500 breast ultrasound images. The results show that SACE outperforms its counterparts, where the median values for the measure are: SACE: 139.4, SEN: 68.2, HEQ: 64.1, CLAHE: 62.8, and FEN: 7.9. Considering the segmentation performance results, the SACE method presents the largest accuracy, where the median values for the Jaccard index are: SACE: 0.81, FEN: 0.80, CLAHE: 0.79, HEQ: 77, and SEN: 0.63. The SACE method performs well due to the combination of three elements: (1) the intensity variation map reduces intensity variations that could distort the real response of the mapping function, (2) the sigmoidal mapping function enhances the gray level range where the transition between lesion and background

Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: Long-term results of the ARCOSEIN multicenter randomized study

International Nuclear Information System (INIS)

Toledano, Alain; Garaud, Pascal; Serin, Daniel; Fourquet, Alain; Bosset, Jean-Francois; Breteau, Noel; Body, Gilles; Azria, David; Le Floch, Olivier; Calais, Gilles

2006-01-01

Purpose: In 1996, a multicenter randomized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) after breast-conserving surgery (ARCOSEIN study). After a median follow-up of 6.7 years (range, 4.3-9 years), we decided to prospectively evaluate the late effects of these 2 strategies. Methods and Materials: A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination. Seventy-two percent (214 patients) were eligible for evaluation of late toxicity. After breast-conserving surgery, patients were treated either with sequential treatment with CT first followed by RT (Arm A) or CT administered concurrently with RT (Arm B). In all patients, CT regimen consisted of mitoxantrone (12 mg/m 2 ), 5-FU (500 mg/m 2 ), and cyclophosphamide (500 mg/m 2 ), 6 cycles (Day 1 to Day 21). Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy (± boost to the primary tumor bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist, according to the LENT/SOMA scale. Skin pigmentation was also evaluated according to a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results: Among the 214 evaluable patients, 107 were treated in each arm. The 2 populations were homogeneous for patient, tumor, and treatment characteristics. Subcutaneous fibrosis (SF), telangectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain, breast edema, or lymphedema. No deaths were caused by late toxicity. Conclusion: After breast-conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects

{sup 201}Tl scintigraphy in the evaluation of palpable and nonpalpable breast lesions: correlation with mammography and ultrasonography

Energy Technology Data Exchange (ETDEWEB)

Vural, G.; Atasever, T.; Oezdemir, A.; Oeznur, I.; Karabacak, N.I.; Goekcora, N.; Isik, S. [Gazi Univ., Dept. of Nuclear Medicine, Ankara (Turkey)]|[Gazi Univ., Dept. of Radiology, Ankara (Turkey); Uenlue, M. [Gazi Univ., Dept. of Nuclear Medicine, Ankara (Turkey)

1997-12-01

Tl-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of Tl-201. Visual and semiquantitative interpretation was performed. Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. Tl-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by Tl-201 scintigraphy. The smallest mass lesion detected by Tl-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. Tl-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed Tl-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated Tl-201. Tl-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by Tl-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58{+-}0.38 (mean{+-}SD) and 1.48{+-}0.32 (p>0.05), 1.87{+-}0.65 and 1.34{+-}0.20 (p<0.5) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). (orig./MG) [Deutsch] 68 Patientinnen mit insgesamt 70 Laesionen (davon 51 palpable Tumoren) wurden untersucht: 15 Min. und 3 Std. nach Injektion von 111 MBq (3 mCi) {sup 201}Tl-Cl wurden planare Aufnahmen von ventral, lateral und schraeg-lateral durchgefuehrt. Die Auswertung erfolgte sowohl visuel-qualitativ als auch semiquantitativ. Von 52 Karzinomen wurden durch die {sup 201}Tl-Szintigraphie 47 (90%) richtig erkannt

MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy.

Science.gov (United States)

Li, Jie; Dershaw, D David; Lee, Carol H; Kaplan, Jennifer; Morris, Elizabeth A

2009-09-01

Follow-up MRI can be useful to confirm a benign diagnosis after MRI-guided breast biopsy. This retrospective study was undertaken to evaluate appropriate timing and imaging interpretation for the initial follow-up MRI when a benign, concordant histology is obtained using MRI-guided breast biopsy. Retrospective review was performed of 177 lesions visualized only by MRI in 172 women who underwent 9-gauge, vacuum-assisted core biopsy and marker placement with imaging-concordant benign histology. All underwent follow-up MRI within 12 months. Timing of the follow-up study, change in size, results of second biopsy if performed, and distance of localizing marker to the lesion on the follow-up study were recorded. At initial follow-up, 155 lesions were decreased or gone, 14 lesions were stable, and eight were enlarged. Seventeen (9.6%, 17/177) lesions underwent a second biopsy, including six enlarging, 10 stable, and one decreasing. Of these, four were malignant. Enlargement was seen in two carcinomas at 6 and 12 months. Two carcinomas, one stable at 2 months and another stable at 3 and 11 months, were rebiopsied because of suspicion of a missed lesion in the former and worrisome mammographic and sonographic changes in the latter. The distance of the marker from the lesion on follow-up did not correlate with biopsy accuracy. Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling.

Comparison between fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in the diagnosis of breast lesions.

Science.gov (United States)

Moschetta, M; Telegrafo, M; Carluccio, D A; Jablonska, J P; Rella, L; Serio, Gabriella; Carrozzo, M; Stabile Ianora, A A; Angelelli, G

2014-01-01

To compare the diagnostic accuracy of fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in patients with USdetected breast lesions. Between September 2011 and May 2013, 3469 consecutive breast US examinations were performed. 400 breast nodules were detected in 398 patients. 210 FNACs and 190 CNBs were performed. 183 out of 400 (46%) lesions were surgically removed within 30 days form diagnosis; in the remaining cases, a six month follow up US examination was performed. Sensitivity, specificity, diagnostic accuracy, positive predictive (PPV) and negative predictive (NPV) values were calculated for FNAC and CNB. 174 out of 400 (43%) malignant lesions were found while the remaining 226 resulted to be benign lesions. 166 out of 210 (79%) FNACs and 154 out of 190 (81%) CNBs provided diagnostic specimens. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 94%, 95%, 91% and 98% were found for FNAC, and values of 92%, 82%, 89%, 92% and 82% were obtained for CNB. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 96%, 96%, 97% and 96% were found for FNAC, and values of 97%, 96%, 96%, 97% and 96% were obtained for CNB. FNAC and CNB provide similar values of diagnostic accuracy.

Analysis of diffusion-weighted MR in the differential diagnosis of benign and malignant breast lesions with Meta-analysis

International Nuclear Information System (INIS)

Chen Xin; Zhang Qiujuan; Zhao Xian; Bai Zhilan; Zhang Yili; Guo Youmin

2008-01-01

Objective: To evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of benign and malignant breast lesions with Meta-analysis. Methods: English and Chinese articles published from 1997 to 2007 were searched in Cochrane library, Pubmed, Ovid, Elsevier, Springer databases and Chinese National Knowledge Infrastructure (CNKI), and selected according to the criteria for diagnostic research recommended by Cochrane Method Group. The characteristics of selected articles including the study background, design, results and diagnostic indicators were analyzed. Statistical analysis was performed with Meta-test version 0.9. Results: Six articles were included with a total of 479 lesions. The sensitivity and specificity of DWI for breast lesions ranged from 64.0% to 92.8% and from 45.8% to 96.7% respectively. All groups had homogeneity, and a fixation effects regression was developed. The pooled weighted sensitivity and specificity with 95% CI and Az was 86% (76%-92%), 80% (61%-91%) and 92.19% respectively. Sensitivity analysis demonstrated no remarkable change on heterogeneity. Conclusion: The value of ADC in DWI can help to differentiate the benign breast lesions from the malignant with good sensitivity and specificity. The further study is needed to assess the clinical application of the b-value and diagnostic threshold. (authors)

Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US

Energy Technology Data Exchange (ETDEWEB)

Pons, Elena Pastor, E-mail: elenapastorpons@gmail.com; Azcón, Francisco Miras, E-mail: frmiaz00@gmail.com; Casas, María Culiañez, E-mail: mariacc1980@gmail.com; Meca, Salvador Martínez, E-mail: isalvaa@hotmail.com; Espona, José Luis García, E-mail: gespona@hotmail.com

2014-06-15

Objectives: To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated. Results: Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p < 0.001). Agreement between both techniques was low (k = 0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes. Conclusions: Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.

Computerized detection of breast lesions in multi-centre and multi-instrument DCE-MR data using 3D principal component maps and template matching

Science.gov (United States)

Ertas, Gokhan; Doran, Simon; Leach, Martin O.

2011-12-01

In this study, we introduce a novel, robust and accurate computerized algorithm based on volumetric principal component maps and template matching that facilitates lesion detection on dynamic contrast-enhanced MR. The study dataset comprises 24 204 contrast-enhanced breast MR images corresponding to 4034 axial slices from 47 women in the UK multi-centre study of MRI screening for breast cancer and categorized as high risk. The scans analysed here were performed on six different models of scanner from three commercial vendors, sited in 13 clinics around the UK. 1952 slices from this dataset, containing 15 benign and 13 malignant lesions, were used for training. The remaining 2082 slices, with 14 benign and 12 malignant lesions, were used for test purposes. To prevent false positives being detected from other tissues and regions of the body, breast volumes are segmented from pre-contrast images using a fast semi-automated algorithm. Principal component analysis is applied to the centred intensity vectors formed from the dynamic contrast-enhanced T1-weighted images of the segmented breasts, followed by automatic thresholding to eliminate fatty tissues and slowly enhancing normal parenchyma and a convolution and filtering process to minimize artefacts from moderately enhanced normal parenchyma and blood vessels. Finally, suspicious lesions are identified through a volumetric sixfold neighbourhood connectivity search and calculation of two morphological features: volume and volumetric eccentricity, to exclude highly enhanced blood vessels, nipples and normal parenchyma and to localize lesions. This provides satisfactory lesion localization. For a detection sensitivity of 100%, the overall false-positive detection rate of the system is 1.02/lesion, 1.17/case and 0.08/slice, comparing favourably with previous studies. This approach may facilitate detection of lesions in multi-centre and multi-instrument dynamic contrast-enhanced breast MR data.

Is {sup 99m}Tc-MDP mammoscintigraphy useful in patients with breast mass lesions?

Energy Technology Data Exchange (ETDEWEB)

Park, S. K.; Lee, Y. H.; Rhyu, J. W.; Yoo, S. M. [College of Medicine, Dankook Univ., Cheonan (Korea, Republic of)

1998-06-01

Piccolo et al. advocated the usefulness of {sup 99m}Tc-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied {sup 99m}Tc-MDP uptake pattern and lesion/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of {sup 99m}Tc-MDP scan. Total 34 patients were studied with physical examination, mammogram and {sup 99m}Tc-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq {sup 99m}Tc-MDP. Breast uptake pattern of {sup 99m}Tc-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammogram. Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of {sup 99m}Tc-MDP uptake was noted in 4/7 carcinomas, 3/5 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 2/7, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. {sup 99m}Tc-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned.

Elastosonography in the diagnosis of the nodular breast lesions: preliminary report

International Nuclear Information System (INIS)

Giuseppetti, Gian Marco; Di Cioccio, Barbara; Baldassarre, Silvia; Martegani, Alberto

2005-01-01

Purpose. To assess the diagnostic accuracy of elastography in characterising nodular breast lesions. Materials and methods. A total of 82 patients who received mammographic, ultrasonographic and elastographic evaluation in a single session at two Italian centres (Dept of Radiology, Az. Ospedali Riuniti, Ancona, and Ospedale Valduce, Corno, Italy) between January and August 2004 according to identical protocols exhibited 91 nodules that were subjected to cytological/histological examination. Lesions were classified and scored and the sensitivity of elastography calculated. Results. Overall sensitivity and specificity were 79% and 89%, respectively. However, sensitivity was 86% and 65% and specificity 100% and 62% for lesions 2 cm in diameter, respectively. Despite the small sample and the fact that it does not include the full range of cell types, tumour cell composition seemed to affect accuracy. Conclusions. Elastography is easy and rapid to perform. Larger studies are needed to establish semiological patterns; despite the small patient sample, these data provide an interesting contribution [it

Ultrasound screening of contralateral breast after surgery for breast cancer

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Kim, Seung Ja [Department of Radiology, Seoul Metropolitan Government Seoul National University, Boramae Medical Center (Korea, Republic of); Chung, Se-Yeong; Chang, Jung Min; Cho, Nariya [Department of Radiology, Seoul National University Hospital (Korea, Republic of); Han, Wonshik [Department of Surgery, Seoul National University Hospital (Korea, Republic of); Moon, Woo Kyung, E-mail: moonwk@snu.ac.kr [Department of Radiology, Seoul National University Hospital (Korea, Republic of)

2015-01-15

Highlights: • The addition of supplemental US to mammography depicted additional 5.0 cancers per 1000 postoperative women. • Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15). • US can be helpful to detect mammographically occult breast cancer in the contralateral breast in women with previous history of cancer and dense breast. - Abstract: Objective: To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts. Materials and methods: During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed. Results: Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by

Ultrasound screening of contralateral breast after surgery for breast cancer

International Nuclear Information System (INIS)

Kim, Seung Ja; Chung, Se-Yeong; Chang, Jung Min; Cho, Nariya; Han, Wonshik; Moon, Woo Kyung

2015-01-01

Highlights: • The addition of supplemental US to mammography depicted additional 5.0 cancers per 1000 postoperative women. • Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15). • US can be helpful to detect mammographically occult breast cancer in the contralateral breast in women with previous history of cancer and dense breast. - Abstract: Objective: To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts. Materials and methods: During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed. Results: Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by

Manufacture and characterization of breast tissue phantoms for emulating benign lesions

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Villamarín, J. A.; Rojas, M. A.; Potosi, O. M.; Narváez-Semanate, J. L.; Gaviria, C.

2017-11-01

Phantoms elaboration has turned a very important field of study during the last decades due to its applications in medicine. These objects are capable of emulating or mimicking acoustically biological tissues in which parameters like speed of sound (SOS) and attenuation are successfully attained. However, these materials are expensive depending on their characteristics (USD 460.00 - 6000.00) and is difficult to have precise measurements because of their composition. This paper presents the elaboration and characterization of low cost ( USD $25.00) breast phantoms which emulate histological normality and pathological conditions in order to support algorithm calibration procedures in imaging diagnosis. Quantitative ultrasound (QUS) was applied to estimate SOS and attenuation values for breast tissue (background) and benign lesions (fibroadenoma and cysts). Results showed values of the SOS and attenuation for the background between 1410 - 1450 m/s and 0.40 - 0.55 dB/cm at 1 MHz sampling frequency, respectively. On the other hand, the SOS obtained for the lesions ranges from 1350 to 1700 m/s and attenuation values between 0.50 - 1.80 dB/cm at 1 MHz. Finally, the fabricated phantoms allowed for obtaining ultrasonograms comparable with real ones whose acoustic parameters are in agree with those reported in the literature.

Quantitative differentiation of breast lesions at 3T diffusion-weighted imaging (DWI) using the ratio of distributed diffusion coefficient (DDC).

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Ertas, Gokhan; Onaygil, Can; Akin, Yasin; Kaya, Handan; Aribal, Erkin

2016-12-01

To investigate the accuracy of diffusion coefficients and diffusion coefficient ratios of breast lesions and of glandular breast tissue from mono- and stretched-exponential models for quantitative diagnosis in diffusion-weighted magnetic resonance imaging (MRI). We analyzed pathologically confirmed 170 lesions (85 benign and 85 malignant) imaged using a 3.0T MR scanner. Small regions of interest (ROIs) focusing on the highest signal intensity for lesions and also for glandular tissue of contralateral breast were obtained. Apparent diffusion coefficient (ADC) and distributed diffusion coefficient (DDC) were estimated by performing nonlinear fittings using mono- and stretched-exponential models, respectively. Coefficient ratios were calculated by dividing the lesion coefficient by the glandular tissue coefficient. A stretched exponential model provides significantly better fits then the monoexponential model (P DDC ratio (area under the curve [AUC] = 0.93) when compared with lesion DDC, ADC ratio, and lesion ADC (AUC = 0.91, 0.90, 0.90) but with no statistically significant difference (P > 0.05). At optimal thresholds, the DDC ratio achieves 93% sensitivity, 80% specificity, and 87% overall diagnostic accuracy, while ADC ratio leads to 89% sensitivity, 78% specificity, and 83% overall diagnostic accuracy. The stretched exponential model fits better with signal intensity measurements from both lesion and glandular tissue ROIs. Although the DDC ratio estimated by using the model shows a higher diagnostic accuracy than the ADC ratio, lesion DDC, and ADC, it is not statistically significant. J. Magn. Reson. Imaging 2016;44:1633-1641. © 2016 International Society for Magnetic Resonance in Medicine.

Pilot Study of a New Nonradioactive Surgical Guidance Technology for Locating Nonpalpable Breast Lesions.

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Cox, Charles E; Garcia-Henriquez, Norbert; Glancy, M Jordan; Whitworth, Pat; Cox, John M; Themar-Geck, Melissa; Prati, Ronald; Jung, Michelle; Russell, Scott; Appleton, Kristie; King, Jeff; Shivers, Steven C

2016-06-01

The current technique for locating nonpalpable breast lesions is wire localization (WL). Radioactive seed localization and intraoperative ultrasound were developed to improve difficulties with WL. The SAVI SCOUT surgical guidance system was developed to improve these methods. The SCOUT system is a non-radioactive, FDA-cleared medical device that uses electromagnetic wave technology to provide real-time guidance during excisional breast procedures. Consenting patients underwent localization and excision using an implantable electromagnetic wave reflective device (reflector) and a detector handpiece with a console. Using image guidance, the reflector was placed up to 7 days before the surgical procedure. The primary end points of the study were successful reflector placement, localization, and retrieval. The secondary end points were percentage of clear margins, reexcision rates, days of placement before excision, and physician comparison with WL. This study analyzed 50 patients. The reflectors were placed under mammographic guidance (n = 18, 36 %) or ultrasound guidance (n = 32, 64 %). Of the 50 patients, 10 (20 %) underwent excisional biopsy and 40 (80 %) had a lumpectomy. The lesion and reflector were successfully removed in all 50 patients, and no adverse events occurred. Of the 41 patients who had in situ and/or invasive carcinoma identified, 38 (93 %) had clear margins and 3 (7 %) were recommended for reexcision. These data suggest that the SCOUT system is safe and effective for guiding the excision of nonpalpable breast lesions and a viable alternative to standard localization options. A larger prospective, multi-institution trial of SCOUT currently is underway to validate these findings.

Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

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Jung, Hyun Kyung; Moon, Hee Jung; Kim, Min Jung; Kim, Eun Kyung

2014-01-01

To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology.

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Dauphine, Christine; Reicher, Joshua J; Reicher, Murray A; Gondusky, Christina; Khalkhali, Iraj; Kim, Michelle

2015-06-01

The purpose of this study was to evaluate the safety and performance of localizing nonpalpable breast lesions using radiofrequency identification technology. Twenty consecutive women requiring preoperative localization of a breast lesion were recruited. Subjects underwent placement of both a hook wire and a radiofrequency identification tag immediately before surgery. The radiofrequency identification tag was the primary method used by the operating surgeon to localize each lesion during excision, with the hook wire serving as backup in case of tag migration or failed localization. Successful localization with removal of the intended lesion was the primary outcome measured. Tag migration and postoperative infection were also noted to assess safety. Twenty patients underwent placement of a radiofrequency identification tag, 12 under ultrasound guidance and eight with stereotactic guidance. In all cases, the radiofrequency identification tag was successfully localized by the reader at the level of the skin before incision, and the intended lesion was removed along with the radiofrequency identification tag. There were no localization failures and no postoperative infections. Tag migration did not occur before incision, but in three cases, occurred as the lesion was being retracted with fingers to make the final cut along the deep surface of the specimen. In this initial clinical study, radiofrequency tags were safe and able to successfully localize nonpalpable breast lesions. Radiofrequency identification technology may represent an alternative method to hook wire localization.

Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology.

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Dessauvagie, Benjamin F; Lee, Andrew H S; Meehan, Katie; Nijhawan, Anju; Tan, Puay Hoon; Thomas, Jeremy; Tie, Bibiana; Treanor, Darren; Umar, Seemeen; Hanby, Andrew M; Millican-Slater, Rebecca

2018-02-13

Fibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses. Scanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved. Interobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a 'weak' mean kappa agreement between pathologists (k=0.36). 'Moderate' agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs. Accurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

1H-MRS evaluation of breast lesions by using total choline signal-to-noise ratio as an indicator of malignancy: a meta-analysis.

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Wang, Xin; Wang, Xiang Jiang; Song, Hui Sheng; Chen, Long Hua

2015-05-01

The aim of this study was to evaluate the diagnostic performance of the use of total choline signal-to-noise ratio (tCho SNR) criteria in MRS studies for benign/malignant discrimination of focal breast lesions. We conducted (1) a meta-analysis based on 10 studies including 480 malignant breast lesions and 312 benign breast lesions and (2) a subgroup meta-analysis of tCho SNR ≥ 2 as cutoff for malignancy based on 7 studies including 371 malignant breast lesions and 239 benign breast lesions. (1) The pooled sensitivity and specificity of proton MRS with tCho SNR were 0.74 (95 % CI 0.69-0.77) and 0.76 (95 % CI 0.71-0.81), respectively. The PLR and NLR were 3.67 (95 % CI 2.30-5.83) and 0.25 (95 % CI 0.14-0.42), respectively. From the fitted SROC, the AUC and Q* index were 0.89 and 0.82. Publication bias was present (t = 2.46, P = 0.039). (2) Meta-regression analysis suggested that neither threshold effect nor evaluated covariates including strength of field, pulse sequence, TR and TE were sources of heterogeneity (all P value >0.05). (3) Subgroup meta-analysis: The pooled sensitivity and specificity were 0.79 and 0.72, respectively. The PLR and NLR were 3.49 and 0.20, respectively. The AUC and Q* index were 0.92 and 0.85. The use of tCho SNR criteria in MRS studies was helpful for differentiation between malignant and benign breast lesions. However, pooled diagnostic measures might be overestimated due to publication bias. A tCho SNR ≥ 2 as cutoff for malignancy resulted in higher diagnostic accuracy.

Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions.

Science.gov (United States)

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2016-06-01

The use of an abbreviated magnetic resonance (MR) protocol has been recently proposed for cancer screening. The aim of our study is to evaluate the diagnostic accuracy of an abbreviated MR protocol combining short TI inversion recovery (STIR), turbo-spin-echo (TSE)-T2 sequences, a pre-contrast T1, and a single intermediate (3 minutes after contrast injection) post-contrast T1 sequence for characterizing breast lesions. A total of 470 patients underwent breast MR examination for screening, problem solving, or preoperative staging. Two experienced radiologists evaluated both standard and abbreviated protocols in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both protocols were calculated (with the histological findings and 6-month ultrasound follow-up as the reference standard) and compared with the McNemar test. The post-processing and interpretation times for the MR images were compared with the paired t test. In 177 of 470 (38%) patients, the MR sequences detected 185 breast lesions. Standard and abbreviated protocols obtained sensitivity, specificity, diagnostic accuracy, PPV, and NPV values respectively of 92%, 92%, 92%, 68%, and 98% and of 89%, 91%, 91%, 64%, and 98% with no statistically significant difference (P < .0001). The mean post-processing and interpretation time were, respectively, 7 ± 1 minutes and 6 ± 3.2 minutes for the standard protocol and 1 ± 1.2 minutes and 2 ± 1.2 minutes for the abbreviated protocol, with a statistically significant difference (P < .01). An abbreviated combined MR protocol represents a time-saving tool for radiologists and patients with the same diagnostic potential as the standard protocol in patients undergoing breast MRI for screening, problem solving, or preoperative staging. Copyright © 2016 Elsevier Inc. All rights reserved.

Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy.

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Park, Ah Young; Son, Eun Ju; Kim, Jeong-Ah; Han, Kyunghwa; Youk, Ji Hyun

2015-12-01

To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (PBreast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Magnetic resonance imaging-radioguided occult lesion localization (ROLL) in breast cancer using Tc-99m macro-aggregated albumin and distilled water control.

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Philadelpho Arantes Pereira, Fernanda; Martins, Gabriela; Gregorio Calas, Maria Julia; Fonseca Torres de Oliveira, Maria Veronica; Gasparetto, Emerson Leandro; Barbosa da Fonseca, Lea Mirian

2013-09-18

Magnetic resonance imaging (MRI) guided wire localization presents several challenges apart from the technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided occult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The purpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion localization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast lesions only observed on MRI. Sixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization in a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the procedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was performed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a gamma detector probe. The lesion histopathology and imaging concordance; the procedure's positive predictive value (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI six months after the surgery were assessed. One lesion in one patient had to be excluded because the radioactive substance came back after the injection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign lesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all benign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was active breast cancer. The median procedure duration time was 26 minutes, and all included procedures were defined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent six-month postoperative MRI (50%). MRI-ROLL offers a

Magnetic resonance imaging-radioguided occult lesion localization (ROLL) in breast cancer using Tc-99m macro-aggregated albumin and distilled water control

International Nuclear Information System (INIS)

Philadelpho Arantes Pereira, Fernanda; Martins, Gabriela; Gregorio Calas, Maria Julia; Fonseca Torres de Oliveira, Maria Veronica; Gasparetto, Emerson Leandro; Barbosa da Fonseca, Lea Mirian

2013-01-01

Magnetic resonance imaging (MRI) guided wire localization presents several challenges apart from the technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided occult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The purpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion localization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast lesions only observed on MRI. Sixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization in a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the procedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was performed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a gamma detector probe. The lesion histopathology and imaging concordance; the procedure’s positive predictive value (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI six months after the surgery were assessed. One lesion in one patient had to be excluded because the radioactive substance came back after the injection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign lesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all benign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was active breast cancer. The median procedure duration time was 26 minutes, and all included procedures were defined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent six-month postoperative MRI (50%). MRI-ROLL offers a

Breast metastasis from cutaneous malignant melanoma mimicking a breast cancer.

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Maniglio, Marina; Capalbo, Emanuela; Viganò, Sara; Trecate, Giovanna; Scaperrotta, Gianfranco Paride; Panizza, Pietro

2015-06-25

Breast metastases are very uncommon, either from solid tumors or malignant melanoma. We present the case of a 42-year-old woman with a history of cutaneous melanoma of the shoulder excised 21 years ago. She presented with a palpable lump in the upper outer quadrant of the right breast. Ultrasound demonstrated a solid mass within a cystic lesion. A core biopsy was taken and first histology reported a poorly differentiated primary breast cancer suspected to be triple negative. MRI detected a satellite lesion in the same breast, a focus of suspected enhancement in the other breast, and the extramammary finding of an enhancing pulmonary lesion. Staging computed tomography detected widespread metastases to the lungs, brain, subcutaneous left shoulder, liver, pancreas, and hepatorenal recess. A core biopsy was taken from the left breast lesion and the previous slides were reviewed; histopathology and immunohistochemistry were in keeping with metastasis from melanoma. The possibility of a metastatic lesion to the breast should be taken into account in any patient presenting with a breast lump and a previous history of melanoma. Breast involvement cannot be considered an isolated finding, as it might be the first manifestation of widespread disease.

A STUDY OF SILVER STAINING NUCLEOLAR ORGANISING REGIONS AGNOR SCORE AS PROGNOSTIC MARKER IN BREAST LESIONS IN A TERTIARY CARE HOSPITAL IN HYDERABAD

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Bhavani Shankar Nithyananda

2017-10-01

Full Text Available BACKGROUND Nucleolar Organising Regions (NORS are segments of DNA closely associated with nucleolus, which code for ribosomal DNA consisting of non-histone proteins, which are argyrophilic. They are demonstrated as black, brown spots on staining with silver colloidal staining technique. Hence, they are called AgNORs. The assessment of AgNORs correlates with rate of proliferation, cell cycle time, since shorter the cell cycle, greater the ribosomal activity and protein synthesis higher AgNOR count. 1 AgNORs have been studied on NHL, GIT neoplasms, skin, gynaecological neoplasms, pulmonary neoplasms, prostate, bladder and breast cancer. In breast cancer, AgNOR can be used for early detection, grading and staging of disease. In this study, we have tried to correlate AgNOR character to morphological prognostic markers. MATERIALS AND METHODS A total of 159 cases presenting with lump in the breast were included in the study. Specimens were subjected to histopathological examination. Sections cut three micron thickness were stained for AgNOR with silver colloidal AgNOR staining technique. AgNOR count was done on both benign and malignant lesions. RESULTS Benign breast lesions were more common compared to malignant lesions. The age of the patients ranged from 15-79 yrs. The mean age for benign lesions was 31 yrs. and for malignant lesions 43 yrs. The most common benign lesion was fibroadenoma and most common malignant lesion was infiltrating ductal carcinoma. AgNOR spots were seen as black/brown spots. AgNOR score was higher in malignant lesions when compared to benign lesions. Among malignant lesions, AgNOR score was found to be higher in high grade, metastatic tumours. CONCLUSION AgNOR count is a useful technique, which can supplement other prognostic markers like Ki-67, mitotic index. A long follow up study is required to confirm the prognostic utility of AgNOR count done in this study

Comparison of Diagnostic Performance of US Elastography and Conventional B-mode US in Differentiation of Breast Lesions

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Kang, Ji Young; Lee, Jin Hwa; Cho, Jin Han; Ha, Dong Ho; Park, Byeong Ho; Choi, Sun Seob [Dept. of Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, Eun Kyung [Dept. of Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Shin, Su Young [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Byeong Ho [Dept. of Preventive Medicine, Dong-A University College of Medicine, Busan (Korea, Republic of)

2012-08-15

The purpose of this study was to compare the diagnostic performance of ultrasound (US) elastography and conventional B-mode US for discrimination between benign and malignant breast lesions. During a 13-month period, 277 women with 335 sonographically visible breast lesions who were scheduled to undergo biopsy were examined with US elastography. Elastographic findings were classified as benign or malignant based on the area ratio, with 1.00 as the threshold. Findings on conventional B mode US were classified according to the BI-RADS category, as follows: lesions of BIRADS categories 2 and 3 were considered benign, while those in categories 4 and 5 were considered malignant. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC curve analysis for comparison of the diagnostic performance of US elastography and conventional B-mode US. Of the 335 breast lesions, 85 (25.4%) showed malignancy on pathology. Findings on B-mode US showed malignancy in 264 (78.8%) and elastographic findings showed malignancy in 102 (30.4%). The sensitivity, specificity, PPV, NPV, and accuracy of B-mode US and elastography were 98.8%, 28.0%, 31.8%, 98.6%, and 79.4% and 69.4%, 81.2%, 57.8%, 88.8%, and 79.4%, respectively. Elastography showed significantly higher specificity and PPV and lower sensitivity and NPV, compared with B-mode US (p < 0.001). The area under the ROC curve (AUC value) was 0.761 for elastography, and 0.634 for B-mode US (p < 0.001). US elastography can improve specificity and PPV of B-mode US, but with significant sacrifice of sensitivity and NPV. Therefore, US elastography may complement B-mode US for differentiation of breast masses.

Typing and grading of cytological category C5 breast lesions

International Nuclear Information System (INIS)

Zafar, N.; Jamal, S.; Mamoon, N.; Luqman, M.; Anwar, M.

2005-01-01

Objective: To determine the tumour type, cytological grade and nuclear grade on fine-needle aspiration smears in cytological category C5 breast lesions and compare them with histopathological findings. Subjects and Methods: Out of all patients referred to AFIP, Rawalpindi for fine-needle aspiration of breast masses, those adjudged C5 (malignant) were chosen for this study. History, clinical details and mammographic findings were noted. Aspirated smears were examined and an attempt was made to ascertain tumour type, cytological grade and nuclear grade. On excision of these lesions, the cytological findings were compared with those on paraffin-embedded histological sections. Results: A total of 71 patients were included in this study. Of these, 64 (90.14%) were cytologically diagnosed as ductal carcinoma, 4 (5.63%) lobular carcinoma, 2 (2.82%) mucinous carcinoma and 1 (1.41%) as medullary carcinoma. Seventy (98.60%) tumours were correctly typed on aspiration smears. Sixty-eight (95.77%) cases were cytologically graded with accuracy. Nuclear grading was even better on cytology and, excluding one malignant lymphoma, all 70 (100%) smears were assessed correctly. Conclusion: Overall efficiency of the tumour typing, cytological grading and nuclear grading on aspirated material turned out to be quite accurate. In expert hands, cytological examination can be of great help in pre-operative planning and in cases where tumour morphology in paraffin-embedded material has been distorted by neo-adjuvant therapy prior to excision. (author)

The diagnostic value of diffusion-weighted imaging and the apparent diffusion coefficient values in the differentiation of benign and malignant breast lesions.

Science.gov (United States)

Çabuk, Gonca; Nass Duce, Meltem; Özgür, Anıl; Apaydın, Feramuz Demir; Polat, Ayşe; Orekici, Gülhan

2015-04-01

The goal of our study was to evaluate the diagnostic efficacy of diffusion-weighted imaging (DWI) in the differentiation of benign and malignant breast lesions. Between June 2012 and March 2013, 60 patients with 63 lesions (age range 29-70 years, mean age 48.6 years) were included in our study. All lesions, except complicated cysts and intra-mammary lymph nodes, were confirmed histopathologically. The patients were evaluated with a 1.5 Tesla MR scanner using dedicated bilateral breast coil. DWI images were obtained by echo planar imaging sequence and 'b' values were selected as 200, 600 and 1000 s/mm(2). Apparent diffusion coefficient (ADC) values of both breast lesions and the normal fibroglandular tissue of the contralateral breast were calculated and statistically compared using Shapiro-Wilk test, Student's t-test, Mann-Whitney U test, chi-square test and the receiver operating curve. Of 63 lesions, 22 were malignant and 41 were benign. In malignant lesions, the mean ADC values were 1.40 ± 0.41 × 10(-3) mm(2)/s for b = 200, 1.05 ± 0.28 × 10(-3) mm(2)/s for b = 600 and 0.91 ± 0.20 × 10(-3) mm(2)/s for b = 1000 and in benign lesions, the mean ADC values were 2.13 ± 0.85 × 10(-3) mm(2)/s for b = 200, 1.64 ± 0.47 × 10(-3) mm(2)/s for b = 600 and 1.40 ± 0.43 × 10(-3) mm(2)/s for b = 1000. The success of ADC values in differentiation of benign and malignant lesions was statistically significant (P = 0.0001). The threshold values were determined to be 1.50 × 10(-3) mm(2)/s for b = 200, 1.22 × 10(-3) mm(2)/s for b = 600 and 0.98 × 10(-3) mm(2)/s for b = 1000 (P benign and malignant breast lesions. © 2015 The Royal Australian and New Zealand College of Radiologists.

Spontaneous infarction of benign breast lesion during pregnancy: Ultrasonographic and pathologic findings

Energy Technology Data Exchange (ETDEWEB)

Kim, Jin Young; Kim, Kyu Soon; Kim, Ju Hun [Eulji University Hospital, Daejeon (Korea, Republic of); Lee, Yun Hak [Dept. of Radiology, Health Care Center, Pohang (Korea, Republic of)

2015-10-15

The spontaneous infarction of benign breast lesions is a rare entity and hence is not usually considered in the differential diagnosis during radiologic or clinical examination. There have been a few published cases of infarction during pregnancy and lactation. In this study we report the ultrasonographic and pathologic features of a spontaneous infarction of a lactating adenoma with acute mastitis and abscess and a spontaneously infarcted fibroadenoma.

Spontaneous infarction of benign breast lesion during pregnancy: Ultrasonographic and pathologic findings

International Nuclear Information System (INIS)

Kim, Jin Young; Kim, Kyu Soon; Kim, Ju Hun; Lee, Yun Hak

2015-01-01

The spontaneous infarction of benign breast lesions is a rare entity and hence is not usually considered in the differential diagnosis during radiologic or clinical examination. There have been a few published cases of infarction during pregnancy and lactation. In this study we report the ultrasonographic and pathologic features of a spontaneous infarction of a lactating adenoma with acute mastitis and abscess and a spontaneously infarcted fibroadenoma

Retrospective analysis of the utility of multiparametric MRI for differentiating between benign and malignant breast lesions in women in China.

Science.gov (United States)

Fan, Wei Xiong; Chen, Xiao Feng; Cheng, Feng Yan; Cheng, Ya Bao; Xu, Tai; Zhu, Wen Biao; Zhu, Xiao Lei; Li, Gui Jin; Li, Shuai

2018-01-01

We explored the utility of time-resolved angiography with interleaved stochastic trajectories dynamic contrast-enhanced magnetic resonance imaging (TWIST DCE-MRI), readout segmentation of long variable echo-trains diffusion-weighted magnetic resonance imaging- diffusion-weighted magnetic resonance imaging (RESOLVE-DWI), and echo-planar imaging- diffusion-weighted magnetic resonance imaging (EPI-DWI) for distinguishing between malignant and benign breast lesions.This retrospective analysis included female patients with breast lesions seen at a single center in China between January 2016 and April 2016. Patients were allocated to a benign or malignant group based on pathologic diagnosis. All patients received routine MRI, RESOLVE-DWI, EPI-DWI, and TWIST DCE-T1WI. Variables measured included quantitative parameters (K, Kep, and Ve), semiquantitative parameters (rate of contrast enhancement for contrast agent inflow [W-in], rate of contrast decay for contrast agent outflow [W-out], and time-to-peak enhancement after contrast agent injection [TTP]) and apparent diffusion coefficient (ADC) values for RESOLVE-DWI (ADCr) and EPI-DWI (ADCe). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the diagnostic utility of each parameter for differentiating malignant from benign breast lesions.A total of 87 patients were included (benign, n = 20; malignant, n = 67). Compared with the benign group, the malignant group had significantly higher K, Kep and W-in and significantly lower W-out, TTP, ADCe, and ADCr (all P benign and malignant lesions. Combining 3 parameters (Kep, W-out, and ADCr) had a higher diagnostic efficiency (AUC, 0.965) than any individual parameter and distinguished between benign and malignant lesions with high sensitivity (91.0%), specificity (95.0%), and accuracy (91.9%).An index combining Kep, W-out, and ADCr could potentially be used for the differential diagnosis of breast lesions.

{sup 99m}Tc-(V)DMSA scintimammography in the assessment of breast lesions: comparative study with {sup 99m}Tc-MIBI

Energy Technology Data Exchange (ETDEWEB)

Papantoniou, V.; Papadaki, E.; Valotassiou, V.; Stipsanelli, A.; Zerva, C. [Dept. of Nuclear Medicine, Alexandra University Hospital, Athens (Greece); Christodoulidou, J.; Pampouras, G. [Dept. of Radiology, Alexandra University Hospital, Athens (Greece); Louvrou, A.; Lazaris, D.; Keramopoulos, A.; Michalas, S. [Dept. of Obstetrics and Gynaecology, Alexandra University Hospital, Athens (Greece); Sotiropoulou, M. [Dept. of Pathology, Alexandra University Hospital, Athens (Greece)

2001-07-01

The purpose of this study was to evaluate and compare the diagnostic accuracy of pentavalent technetium-99m dimercaptosuccinic acid [{sup 99m}Tc-(V)DMSA] and {sup 99m}Tc-methoxyisobutylisonitrile (MIBI) in the detection of primary breast cancer and metastatic lymph node involvement, and in the clarification of cases with indeterminate mammograms. Forty-one women (mean age{+-}SD 55{+-}7 years) referred for a suspicious breast lesion on physical examination and/or an abnormal mammogram underwent MIBI and (V)DMSA scintimammography (SMM) at separate sessions (48-h interval). Lateral prone and anterior supine images were obtained at 10 and 60 min after administration of 740-925 MBq of each tracer, in the arm contralateral to the breast lesion. The ipsilateral axillary region was also included in the field of view. The results of SMM and mammography were compared with histological findings. Breast cancer was histologically confirmed in 26 patients (mean diameter{+-}SD 2.87{+-}1.5 cm). Benign lesions were found in 15 patients (mean diameter{+-}SD 2.04{+-}2.7 cm). Mammography was definitely positive in 23/26 patients with breast cancer and indeterminate in 3/26 (sensitivity 88.4%). In benign lesions, mammography was true negative in 5/15 cases and indeterminate in 10/15 (specificity 33.3%). Both MIBI and (V)DMSA SMM detected 23/26 breast cancers (sensitivity 88.4%) and were true negative in 14/15 (specificity 93.3%). T/B ratios for breast cancer in MIBI and (V)DMSA scans were similar, and significantly higher than for benign lesions. MIBI correctly diagnosed 12/13 and (V)DMSA 11/13 cases in which the findings of mammography were indeterminate. In addition, (V)DMSA detected seven of eight cases of in situ ductal carcinoma (DCIS) associated with infiltrating carcinomas, while MIBI detected only two of these eight cases. (V)DSMA was also diffusely concentrated in benign lesions complicated by epithelial hyperplasia. Metastatic lymph node involvement was successfully imaged in

Comparison of conventional DCE-MRI and a novel golden-angle radial multicoil compressed sensing method for the evaluation of breast lesion conspicuity.

Science.gov (United States)

Heacock, Laura; Gao, Yiming; Heller, Samantha L; Melsaether, Amy N; Babb, James S; Block, Tobias K; Otazo, Ricardo; Kim, Sungheon G; Moy, Linda

2017-06-01

To compare a novel multicoil compressed sensing technique with flexible temporal resolution, golden-angle radial sparse parallel (GRASP), to conventional fat-suppressed spoiled three-dimensional (3D) gradient-echo (volumetric interpolated breath-hold examination, VIBE) MRI in evaluating the conspicuity of benign and malignant breast lesions. Between March and August 2015, 121 women (24-84 years; mean, 49.7 years) with 180 biopsy-proven benign and malignant lesions were imaged consecutively at 3.0 Tesla in a dynamic contrast-enhanced (DCE) MRI exam using sagittal T1-weighted fat-suppressed 3D VIBE in this Health Insurance Portability and Accountability Act-compliant, retrospective study. Subjects underwent MRI-guided breast biopsy (mean, 13 days [1-95 days]) using GRASP DCE-MRI, a fat-suppressed radial "stack-of-stars" 3D FLASH sequence with golden-angle ordering. Three readers independently evaluated breast lesions on both sequences. Statistical analysis included mixed models with generalized estimating equations, kappa-weighted coefficients and Fisher's exact test. All lesions demonstrated good conspicuity on VIBE and GRASP sequences (4.28 ± 0.81 versus 3.65 ± 1.22), with no significant difference in lesion detection (P = 0.248). VIBE had slightly higher lesion conspicuity than GRASP for all lesions, with VIBE 12.6% (0.63/5.0) more conspicuous (P < 0.001). Masses and nonmass enhancement (NME) were more conspicuous on VIBE (P < 0.001), with a larger difference for NME (14.2% versus 9.4% more conspicuous). Malignant lesions were more conspicuous than benign lesions (P < 0.001) on both sequences. GRASP DCE-MRI, a multicoil compressed sensing technique with high spatial resolution and flexible temporal resolution, has near-comparable performance to conventional VIBE imaging for breast lesion evaluation. 3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;45:1746-1752. © 2016 International Society for Magnetic Resonance in Medicine.

Characterization of breast precancerous lesions and myoepithelial hyperplasia in sclerosing adenosis with apocrine metaplasia

DEFF Research Database (Denmark)

Celis, J.E.; Gromova, I.; Cabezón, T.

2007-01-01

) with apocrine metaplasia. The latter is a benign proliferative lesion of the breast that exhibits an increase in the size of the TDLUs and characterized by retained two-cell lining, and myoepithelial (ME) and stromal hyperplasia. SA with apocrine metaplasia, i.e. apocrine adenosis (AA), presents with a higher...

[One day diagnosis for breast lesions: Medical and psychological assessment--EVADIASEIN study].

Science.gov (United States)

Berman, A; Teig, B; Duracinsky, M; Gayet, M; Bellin, M-F; Guettier, C; Fernandez, H; Nazac, A

2016-01-01

Breast cancer is the most frequent feminine cancer in France and its incidence increases steadily. The time of access to medical care is an indicator of the quality of the treatments recommended by the Plan Cancer 2009-2013, as it influences the diagnosis and reduces psychological morbidity during the pre-diagnosis phase. The one-day diagnosis is a recently initiated concept, which offers to get the results of the biopsy on the day it is performed and facilitates the setting-up of therapeutic care with the surgeon met during the one-day medical consultations. The aim of this study is to evaluate the satisfaction of patients who benefited from a one-day breast lesion diagnosis, as well as confirm the decrease of time of access to medical treatment. This is an observational, non-interventional and single-centre study based on 27 patients who benefited from one-day breast lesions diagnosis over two years. The patients were only included who had a classified lesion ACR 4 or 5 and visible in the ultrasound. We analyzed the histological concordance between the biopsy and the definitive histology, the time of access to medical care, and the therapeutic treatments We analyzed the psychological impact of such an organization by sending to the patients a questionnaire including the Psychological Consequence Questionnaire (PCQ) and the Breast Cancer Anxiety Indicator (BCA) allowing to estimate the anxiety generated by the pre-diagnostic phase, the DC-Sat allowing to estimate the satisfaction of the consultation of announcement, as well as the same day diagnosis benefit. The patients were 59.8 years old in average [33-87]. The average time between the date of the mammography and the one-day diagnosis consultation (including the biopsy) was 15.0 days [0-60]. Fifty-seven percent of the patients considered this time as short. The average time between the biopsy date and the start of the treatment was 15.9 days [4-30]. The one-day diagnosis took an average of 1.6 days [1-5]. The

An evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool): Concurrent, face and content validity.

Science.gov (United States)

De Groef, An; Van Kampen, Marijke; Moortgat, Peter; Anthonissen, Mieke; Van den Kerckhove, Eric; Christiaens, Marie-Rose; Neven, Patrick; Geraerts, Inge; Devoogdt, Nele

2018-01-01

To investigate the concurrent, face and content validity of an evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool). 1) Concurrent validity of the MAP-BC evaluation tool was investigated by exploring correlations (Spearman's rank Correlation Coefficient) between the subjective scores (0 -no adhesions to 3 -very strong adhesions) of the skin level using the MAP-BC evaluation tool and objective elasticity parameters (maximal skin extension and gross elasticity) generated by the Cutometer Dual MPA 580. Nine different examination points on and around the mastectomy scar were evaluated. 2) Face and content validity were explored by questioning therapists experienced with myofascial therapy in breast cancer patients about the comprehensibility and comprehensiveness of the MAP-BC evaluation tool. 1) Only three meaningful correlations were found on the mastectomy scar. For the most lateral examination point on the mastectomy scar a moderate negative correlation (-0.44, p = 0.01) with the maximal skin extension and a moderate positive correlation with the resistance versus ability of returning or 'gross elasticity' (0.42, p = 0.02) were found. For the middle point on the mastectomy scar an almost moderate positive correlation with gross elasticity was found as well (0.38, p = 0.04) 2) Content and face validity have been found to be good. Eighty-nine percent of the respondent found the instructions understandable and 98% found the scoring system obvious. Thirty-seven percent of the therapists suggested to add the possibility to evaluate additional anatomical locations in case of reconstructive and/or bilateral surgery. The MAP-BC evaluation tool for myofascial adhesions in breast cancer patients has good face and content validity. Evidence for good concurrent validity of the skin level was found only on the mastectomy scar itself.

Mammographic evaluation of suspicious malignant lesions based on ACR(American College of Radiology) breast imaging reporting and data system(BI-RADS)

International Nuclear Information System (INIS)

Lee, Jei Hee; Oh, Ki Keun; Chang, So Yong; Kim, Eun Kyung; Kim, Mi Hye

1999-01-01

The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as '4' ('suspicious abnormality') and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. The pathologic outcome of these 113 lesions was as follows:infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0%(9/113); ADH(atypical ductal hyperplasia), 5.3%(6/113); DEH(ductal epithelial hyperplasia), 1.8%(2/113); ductectasia, 0.9%(1/113), FCD(fibrocystic change), 27.4%(31/113); firoadenoma, 7.1%(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1%(8/113); other pathology, 15.0%(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2%), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1%). Because category 4 lesions account for about 25.7% of all breast malignancies, mammographic lesions in this category ('suspicious abnormality') should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part II: Diagnostic value of BIRADS-US classification, Tsukuba score and FLR ratio

OpenAIRE

Dobruch-Sobczak, Katarzyna

2013-01-01

Sonoelastography is a dynamically developing method of ultrasound examination used to differentiate the character of focal lesions in the breasts. The aim of the Part II of the study is to determine the usefulness of sonoelastography in the differentiation diagnosis of focal breast lesions including the evaluation of the diagnostic value of Tsukuba score and FLR ratio in characterizing solid lesions in the breasts. Furthermore, the paper provides a comparison of classic B-mode imaging and son...

Evaluation of shear wave elastography for differential diagnosis of breast lesions: A new qualitative analysis versus conventional quantitative analysis.

Science.gov (United States)

Ren, Wei-Wei; Li, Xiao-Long; Wang, Dan; Liu, Bo-Ji; Zhao, Chong-Ke; Xu, Hui-Xiong

2018-04-13

To evaluate a special kind of ultrasound (US) shear wave elastography for differential diagnosis of breast lesions, using a new qualitative analysis (i.e. the elasticity score in the travel time map) compared with conventional quantitative analysis. From June 2014 to July 2015, 266 pathologically proven breast lesions were enrolled in this study. The maximum, mean, median, minimum, and standard deviation of shear wave speed (SWS) values (m/s) were assessed. The elasticity score, a new qualitative feature, was evaluated in the travel time map. The area under the receiver operating characteristic (AUROC) curves were plotted to evaluate the diagnostic performance of both qualitative and quantitative analyses for differentiation of breast lesions. Among all quantitative parameters, SWS-max showed the highest AUROC (0.805; 95% CI: 0.752, 0.851) compared with SWS-mean (0.786; 95% CI:0.732, 0.834; P = 0.094), SWS-median (0.775; 95% CI:0.720, 0.824; P = 0.046), SWS-min (0.675; 95% CI:0.615, 0.731; P = 0.000), and SWS-SD (0.768; 95% CI:0.712, 0.817; P = 0.074). The AUROC of qualitative analysis in this study obtained the best diagnostic performance (0.871; 95% CI: 0.825, 0.909, compared with the best parameter of SWS-max in quantitative analysis, P = 0.011). The new qualitative analysis of shear wave travel time showed the superior diagnostic performance in the differentiation of breast lesions in comparison with conventional quantitative analysis.

Fusion of classifiers for REIS-based detection of suspicious breast lesions

Science.gov (United States)

Lederman, Dror; Wang, Xingwei; Zheng, Bin; Sumkin, Jules H.; Tublin, Mitchell; Gur, David

2011-03-01

After developing a multi-probe resonance-frequency electrical impedance spectroscopy (REIS) system aimed at detecting women with breast abnormalities that may indicate a developing breast cancer, we have been conducting a prospective clinical study to explore the feasibility of applying this REIS system to classify younger women (breast cancer. The system comprises one central probe placed in contact with the nipple, and six additional probes uniformly distributed along an outside circle to be placed in contact with six points on the outer breast skin surface. In this preliminary study, we selected an initial set of 174 examinations on participants that have completed REIS examinations and have clinical status verification. Among these, 66 examinations were recommended for biopsy due to findings of a highly suspicious breast lesion ("positives"), and 108 were determined as negative during imaging based procedures ("negatives"). A set of REIS-based features, extracted using a mirror-matched approach, was computed and fed into five machine learning classifiers. A genetic algorithm was used to select an optimal subset of features for each of the five classifiers. Three fusion rules, namely sum rule, weighted sum rule and weighted median rule, were used to combine the results of the classifiers. Performance evaluation was performed using a leave-one-case-out cross-validation method. The results indicated that REIS may provide a new technology to identify younger women with higher than average risk of having or developing breast cancer. Furthermore, it was shown that fusion rule, such as a weighted median fusion rule and a weighted sum fusion rule may improve performance as compared with the highest performing single classifier.

Intraoperative digital specimen radiography in the treatment of nonpalpable breast lesions

Directory of Open Access Journals (Sweden)

Vicko Ferenc

2017-01-01

Full Text Available Introduction/Objective. About a third of the breast lesions on mammography are clinically occult. The goals of surgical treatment are to locate, remove, and verify their presence in the removed breast tissue. Standard specimen mammography (SSM has been an official procedure for the latter, while intraoperative digital specimen radiography (IDSR was introduced recently. The aim of this study was to evaluate the use of IDSR versus SSM and possible benefits regarding the duration of the procedures (operating room occupancy, availability of digital mammography for additional number of patients, surgeon productivity, and the quality of performed services. Methods. A retrospective chart review of 109 patients who underwent IDSR for nonpalpable breast lesions was performed between January 2014 and June 2016. We compared the difference in the duration of IDSR versus SSM procedure. We also observed the number of re-excisions and evaluated time-saving in the operating room workflow. Results. The average duration of surgery in the IDSR group of patients was 51 minutes, compared to 64 minutes in the SSM group. Every IDSR procedure saved 13 minutes over the standard SSM. That would allow another 28 procedures in the same time frame, with the same quality of service compared with SSM. In that way we increased productivity by 27.5%. Additional operation/surgery was needed for histologically involved surgical margins in three cases (2.75%. Conclusion. The use of new technology resulted in the rationalization of the operative room workflow and gave better productivity. More savings were obtained through the increase of digital mammography capacity for diagnostics, decrease of anesthesia duration, and better management of human resources. The number of “true” re-excisions, involving additional surgery, remained similar after introducing IDSR.

Breast cancer detection using sonography in women with mammographically dense breasts

International Nuclear Information System (INIS)

Okello, Jimmy; Kisembo, Harriet; Bugeza, Sam; Galukande, Moses

2014-01-01

Mammography, the gold standard for breast cancer screening misses some cancers, especially in women with dense breasts. Breast ultrasonography as a supplementary imaging tool for further evaluation of symptomatic women with mammographically dense breasts may improve the detection of mass lesions otherwise missed at mammography. The purpose of this study was to determine the incremental breast cancer detection rate using US scanning in symptomatic women with mammographically dense breasts in a resource poor environment. A cross sectional descriptive study. Women referred for mammography underwent bilateral breast ultrasound, and mammography for symptom evaluation. The lesions seen by both modalities were described using sonographic BI-RADS lexicon and categorized. Ultrasound guided core biopsies were performed. IRB approval was obtained and all participants provided informed written consent. In total 148 women with mammographically dense breasts were recruited over six months. The prevalence of breast cancer in symptomatic women with mammographically dense breasts was 22/148 (15%). Mammography detected 16/22 (73%) of these cases and missed 6/22 (27%). The six breast cancer cases missed were correctly diagnosed on breast ultrasonography. Sonographic features typical of breast malignancy were irregular shape, non-parallel orientation, non circumscribed margin, echogenic halo, and increased lesion vascularity (p values < 0.005). Typical sonofeatures of benign mass lesions were: oval shape, parallel orientation and circumscribed margin (p values <0.005). Breast ultrasound scan as a supplementary imaging tool detected 27% more malignant mass lesions otherwise missed by mammography among these symptomatic women with mammographically dense breasts. We recommend that ultra sound scanning in routine evaluation of symptomatic women with mammographically dense breasts

Detection of breast abnormalities on enhanced chest CT: Correlation with breast composition on mammography

Energy Technology Data Exchange (ETDEWEB)

Cho, Eun Mi; Kang, Hee; Shin, Young Gyung; Yun, Jong Hyouk; Oh, Kyung Seung [Dept. of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan (Korea, Republic of)

2017-02-15

To investigate the capability of enhanced chest computed tomography (CT) for detecting breast abnormalities and to assess the influence of breast composition on this detectability. From 2000 to 2013, 75 patients who underwent mammography, breast sonography, and enhanced chest CT within one month and had abnormalities on sonography were included. Detection rate of breast abnormality on enhanced chest CT was compared among 4 types of breast composition by the Breast Imaging Reporting and Data System. Contribution of breast composition, size and enhancement of target lesions to detectability of enhanced chest CT was assessed using logistic regression and chi-square test. Of the 75 target lesions, 34 (45.3%) were detected on enhanced chest CT, corresponding with those on breast sonography; there were no significantly different detection rates among the 4 types of breast composition (p = 0.078). Breast composition [odds ratio (OR) = 1.07, p = 0.206] and enhancement (OR = 21.49, p = 0.998) had no significant effect, but size (OR = 1.23, p = 0.004) was a significant contributing factor influencing the detectability of enhanced chest CT for breast lesions. About half of the cases (45.3%) demonstrated breast lesions on chest CT corresponding with target lesions on sonography. Breast composition defined on mammography did not affect the detectability of enhanced chest CT for breast lesions.

Effect of gadolinium injection on diffusion-weighted imaging with background body signal suppression (DWIBS) imaging of breast lesions.

Science.gov (United States)

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-12-01

Diffusion-weighted imaging with background body signal suppression (DWIBS) provides both qualitative and quantitative imaging of breast lesions and are usually performed before contrast material injection (CMI). This study aims to assess whether the administration of gadolinium significantly affects DWIBS imaging. 200 patients were prospectively evaluated by MRI with STIR, TSE-T2, pre-CMI DWIBS, contrast enhanced THRIVE-T1 and post-CMI DWIBS sequences. Pre and post-CMI DWIBS were analyzed searching for the presence of breast lesions and calculating the ADC value. ADC values of ≤1.44×10(-3) mm(2)/s were considered suspicious for malignancy. This analysis was then compared with the histological findings. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated for both sequences and represented by ROC analysis. Pre and post-CMI ADC values were compared by using the paired t test. In 150/200 (59%) patients, pre and post-CMI DWIBS indicated the presence of breast lesions, 53 (35%) with ADC values of >1.44×10(-3) mm(2)/s and 97 (65%) with ADC≤1.44×10(-3) mm(2)/s. Pre-CMI and post-DWIBS sequences obtained the same sensitivity, specificity, DA, PPV and NPV values of 97%, 83%, 89%, 79% and 98%. The mean ADC value of benign lesions was 1.831±0.18×10(-3) mm(2)/s before and 1.828±0.18×10(-3) mm(2)/s after CMI. The mean ADC value of the malignant lesions was 1.146±0.16×10(-3) mm(2)/s before and 1.144±0.16×10(-3) mm(2)/s after CMI. No significant difference was found between pre and post CMI ADC values (p>0.05). DWIBS imaging is not influenced by CMI. Breast MR protocol could be modified by placing DWIBS after dynamic contrast enhanced sequences in order to maximize patient cooperation. Copyright © 2014 Elsevier Inc. All rights reserved.