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Liu Y, Liao X, He Y, He F, Ren J, Zhou P, Zhang X. Tumor size and stage assessment accuracy of MRI and ultrasound versus pathological measurements in early breast cancer patients. BMC Womens Health 2025; 25:159. [PMID: 40186264 PMCID: PMC11969697 DOI: 10.1186/s12905-025-03679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/19/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND Accurate size and stage estimation is important to monitor tumor response and plan further treatment in breast cancer patients undergoing neoadjuvant chemotherapy. To evaluate the accuracy of imaging findings [ultrasound (US) and magnetic resonance imaging (MRI)] for tumor size and stage estimations in early breast cancer patients and to elucidate the factors influencing tumor stage assessment. METHODS We retrospectively enrolled consecutive women having pathologically confirmed breast cancer (stage T1/T2, 199 patients and 201 lesions) and preoperative records available for both US and MRI. The concordance between imaging-determined and pathological tumor size and stage was explored. The McNemar's test was conducted to compare the concordance between imaging-determined tumor size and imaging-determined tumor stage. Multivariate logistic regression was used to analyze the factors that influenced the accuracy. RESULTS The concordance between US-determined and pathological tumor size (71.1%) was comparable to MRI-pathology concordance (72.6%). MRI-determined stage concordance (73.6%) was comparable to US-determined stage concordance (69.2%). Tumors with a larger pathological size, were more likely to be underestimated by US or MRI in terms of tumor size and stage (all P < 0.05). CONCLUSION Tumor size and tumor stage concordance did not significantly differ between US and MRI in early breast cancer patients; US could be the first choice for tumor size estimation and tumor staging.
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Affiliation(s)
- Yuanyuan Liu
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Xuerui Liao
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Yakun He
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Fawei He
- Department of Ultrasound, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Jing Ren
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Peng Zhou
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China.
| | - Xin Zhang
- Department of Breast Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55 # South Renmin Road, Chengdu, 610041, Sichuan, China.
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Ock J, Moon S, Kim M, Ko BS, Kim N. Evaluation of the accuracy of an augmented reality-based tumor-targeting guide for breast-conserving surgery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108002. [PMID: 38215659 DOI: 10.1016/j.cmpb.2023.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND OBJECTIVES Although magnetic resonance imaging (MRI) is commonly used for breast tumor detection, significant challenges remain in determining and presenting the three-dimensional (3D) morphology of tumors to guide breast-conserving surgery. To address this challenge, we have developed the augmented reality-breast surgery guide (AR-BSG) and compared its performance with that of a traditional 3D-printed breast surgical guide (3DP-BSG). METHODS Based on the MRI results of a breast cancer patient, a breast phantom made of skin, body, and tumor was fabricated through 3D printing and silicone-casting. AR-BSG and 3DP-BSG were executed using surgical plans based on the breast phantom's computed tomography scan images. Three operators independently inserted a catheter into the phantom using each guide. Their targeting accuracy was then evaluated using Bland-Altman analysis with limits of agreement (LoA). Differences between the users of each guide were evaluated using the intraclass correlation coefficient (ICC). RESULTS The entry and end point errors associated with AR-BSG were -0.34±0.68 mm (LoA: -1.71-1.01 mm) and 0.81±1.88 mm (LoA: -4.60-3.00 mm), respectively, whereas 3DP-BSG was associated with entry and end point errors of -0.28±0.70 mm (LoA: -1.69-1.11 mm) and -0.62±1.24 mm (LoA: -3.00-1.80 mm), respectively. The AR-BSG's entry and end point ICC values were 0.99 and 0.97, respectively, whereas 3DP-BSG was associated with entry and end point ICC values of 0.99 and 0.99, respectively. CONCLUSIONS AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy AR-BSG can consistently and accurately localize tumor margins for surgeons without inferior guiding accuracy compared to 3DP-BSG. Additionally, when compared with 3DP-BSG, AR-BSG can offer better spatial perception and visualization, lower costs, and a shorter setup time.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Sojin Moon
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - MinKyeong Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Beom Seok Ko
- Department of Breast Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea; Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea.
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Chamberlin MD, Islami DA, Barth RJ, Demaci S. Breast Cancer Disparities and Innovations: A Focus on Kosovo. Hematol Oncol Clin North Am 2024; 38:199-207. [PMID: 37442675 DOI: 10.1016/j.hoc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Due to the current limited capacity to provide digital mammography-based screening to all women, and the lack of modern surgical oncology methods, mastectomy is still the predominant form of surgical treatment in many parts of the world. As such there is little incentive to detect breast cancer earlier and significant fear of treatment and outcomes continues to contribute to late presentations. Neoadjuvant chemotherapy, pre-operative breast MRI and surgical mapping techniques can combine forces to allow for more women to be treated with breast conservation, decrease fear of treatment and improve outcomes.
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Affiliation(s)
- Mary D Chamberlin
- Department of Medicine /Hematology-Oncology, Dartmouth College of Medicine and Dartmouth Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Richard J Barth
- Department of Surgery, Section of General Surgery, Dartmouth College of Medicine and Dartmouth Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Shqiptar Demaci
- Department of Thoracic Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
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Kuş CC, Güldoğan N, Yılmaz E, Soyder A, Arslan A, Arıbal ME. Can Supine Breast Magnetic Resonance Imaging After a Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging Provide Information for Supine Procedures? J Comput Assist Tomogr 2023:00004728-990000000-00169. [PMID: 36944155 DOI: 10.1097/rct.0000000000001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
METHODS A retrospective analysis was conducted on 75 lesions in 50 patients with pathologically proven breast cancer who underwent MRI in prone and supine positions between December 2019 and December 2020. The transverse, anteroposterior, and craniocaudal dimensions (in millimeters) of the tumor in the x-, y-, and z-axes were measured. Distances from the center of the tumor to the chest wall and the adjacent skin were measured on transverse and reformatted sagittal images. In cases where multifocal lesions were present, the transverse, anteroposterior, and craniocaudal distances between the tumor centers in the x-, y-, and z-axes were measured. Differences between measurements in supine and prone MRI were evaluated with the Mann-Whitney U and the Wilcoxon tests. P values of less than 0.05 were considered to indicate a statistically significant difference. RESULTS The analysis revealed 31 MRIs with 1 and 20 with multifocal lesions. The x-axis dimension of the lesions in prone and supine positions did not significantly differ (P = 0.198) between the 2 positions. A significant difference in the y- and z-axes dimensions was observed between the prone and supine position (P = 0.00 for both). The distance from the tumor to the chest wall and the adjacent skin showed significant difference (P = 0.00 for both). For multifocal lesions, the distance between the lesions showed a significant difference on the y-axis (P = 0.00). CONCLUSIONS This study showed a significant difference in the tumor size, location, and tumor-to-tumor distances due to change of patient position, from the standard prone MRI to the supine position in the operating room, resulting in distortion, spatial repositioning, and convergence of the lesions. Supine MRI may be considered in providing a less extensive surgery.
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Affiliation(s)
- Ceyda Civan Kuş
- From the Department of Radiology, Marmara University Research and Education Hospital
| | | | | | | | - Aydan Arslan
- Department of Radiology, Ümraniye Research and Education Hospital
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Barth RJ, Krishnaswamy V, Rooney TB, Fox MJ, Burman HE, Rosenkranz KM, Gass J, Bronfine BI, Angeles CV, Paulsen KD. A pilot multi-institutional study to evaluate the accuracy of a supine MRI based guidance system, the Breast Cancer Locator™, in patients with palpable breast cancer. Surg Oncol 2022; 44:101843. [DOI: 10.1016/j.suronc.2022.101843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
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Lai J, Lin J, Wang H, Sun Y, Li Y, Tian H, Shen S, Tan C, Liu H, Yu F. Establishment and Validation of a Preoperative MRI-based Nomogram for Predicting the Risk of Malignancy in Patients with Breast Tumor. J Cancer 2021; 12:799-806. [PMID: 33403037 PMCID: PMC7778539 DOI: 10.7150/jca.49441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/20/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: To establish a preoperative nomogram incorporating morphological and dynamic contrast-enhanced (DCE) features to individually predict the risk of malignancy in patients with breast tumor. Methods A total of 447 consecutive female patients who were divided into the primary cohort (n=326) and the validation cohort (n=121) were enrolled between March 2015 to January 2018. Univariate and multivariate logistic regression analyses were used to identify the potential independent indicators of malignancy. An MRI-based nomogram integrating morphological features and kinetic curves was developed to achieve individualized risk prediction of malignancy in patients with breast masses. The discrimination, calibration ability and clinical utility of the MRI-based model were assessed using C-index, calibration curve and decision curve analysis. Results: Age, tumor size, margin, internal enhancement characteristics, and kinetic curve were confirmed as the independent predictors of malignancy. The AUC of MRI-based nomogram was 0.940 (95% CI: 0.911-0.970) and 0.894 (95% CI: 0.816-0.974) in the primary cohort and validation cohort, respectively. 447 patients were subdivided into the low-risk group (n=107) and high-risk group (n=340) based on the optimal cut-off value of 21.704. The high-risk patients had a higher likelihood of harboring malignancy. Conclusion: The MRI-based nomogram can be used to achieve an accurate individualized risk prediction of malignancy and reduce unnecessary breast biopsy.
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Affiliation(s)
- Jianguo Lai
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Science, Guangzhou, Guangdong, China
| | - Jinjiang Lin
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongli Wang
- Diagnostic Department, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yi Sun
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yudong Li
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huan Tian
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shiyu Shen
- Diagnostic Department, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Cui Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huanhuan Liu
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fengyan Yu
- Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Şendur HN, Cerit MN, Gültekin S, Cindil E, Avdan Aslan A, Erdal ZS, Gültekin Iİ, Teke F. Accuracy in tumor size measurements: Comparison of digital mammography, digital breast tomosynthesis and synthetic mammography. Clin Imaging 2020; 69:115-119. [PMID: 32717538 DOI: 10.1016/j.clinimag.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to assess the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography (SM) in tumor size measurements compared with histological tumor sizes. MATERIALS AND METHODS 71 breast cancer patients who underwent DM and DBT acquisitions simultaneously were included in this study. One radiologist with 8 years of experience in breast imaging measured tumor sizes independently in three separate sessions which include DM, DBT and SM images, respectively. The correlations between the measured tumor sizes on each imaging technique and histological sizes were analyzed using Spearman correlation test. The patients were categorized into two subgroups according to assigned breast density categories (dense and non-dense), and histological tumor sizes (≤2 cm and > 2 cm). To assess the agreement levels between the measured tumor sizes and histological sizes Bland-Altman analyses were performed for each imaging technique. RESULTS The mean of histological size of tumors was 23.85 ± 16.57 mm (median: 20). The means of measured tumor sizes were 21.21 ± 13.59 mm (median: 19), 21.52 ± 13.42 mm (median: 19) and 18.97 ± 11.21 mm (median: 17) in DM, DBT and SM, respectively. The Spearman correlation values with histologic sizes were 0.814 (P < 0.001), 0.887 (P < 0.001), and 0.852 (P < 0.001) for DM, DBT and SM, respectively. In subgroup analyses, the correlation values showed decrement for tumors >2 cm in size compared to tumors ≤2 cm in size. CONCLUSION DBT provides the most accurate tumor size measurements among mammographic imaging techniques and if mammography will be used in tumor size measurements, DBT should be preferred.
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Affiliation(s)
- Halit Nahit Şendur
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey.
| | - Mahi Nur Cerit
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Serap Gültekin
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Emetullah Cindil
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Aydan Avdan Aslan
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Zeynep Sezgi Erdal
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Işıl İmge Gültekin
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
| | - Furkan Teke
- Gazi University Faculty of Medicine, Department of Radiology, Mevlana Bulvarı No: 29, 06560 Yenimahalle, Ankara, Turkey
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Song SE, Seo BK, Cho KR, Woo OH, Park EK, Cha J, Han S. Preoperative tumor size measurement in breast cancer patients: which threshold is appropriate on computer-aided detection for breast MRI? Cancer Imaging 2020; 20:32. [PMID: 32345364 PMCID: PMC7189711 DOI: 10.1186/s40644-020-00307-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background Computer-aided detection (CAD) can detect breast lesions by using an enhancement threshold. Threshold means the percentage of increased signal intensity in post-contrast imaging compared to precontrast imaging. If the pixel value of the enhanced tumor increases above the set threshold, CAD provides the size of the tumor, which is calculated differently depending on the set threshold. Therefore, CAD requires the accurate setting of thresholds. We aimed to compare the diagnostic accuracy of tumor size measurement using MRI and CAD with 3 most commonly used thresholds and to identify which threshold is appropriate on CAD in breast cancer patients. Methods A total of 130 patients with breast cancers (80 invasive cancers and 50 ductal carcinoma in situ [DCIS]) who underwent preoperative MRI with CAD and surgical treatment were included. Tumor size was manually measured on first contrast-enhanced MRI and acquired by CAD using 3 different thresholds (30, 50, and 100%) for each tumor. Tumor size measurements using MRI and CAD were compared with pathological sizes using Spearman correlation analysis. For comparison of size discrepancy between imaging and pathology, concordance was defined as estimation of size by imaging within 5 mm of the pathological size. Concordance rates were compared using Chi-square test. Results For both invasive cancers and DCIS, correlation coefficient rho (r) between tumor size on imaging and pathology was highest at CAD with 30% threshold, followed by MRI, CAD with 50% threshold, and CAD with 100% threshold (all p < 0.05). For invasive cancers, the concordance rate of 72.5% at CAD with 30% threshold showed no difference with that of 62.5% at MRI (p = 0.213). For DCIS, the concordance rate of 30.0% at CAD with 30% threshold showed no difference with that of 36.0% at MRI (p = 0.699). Compared to MRI, higher risk of underestimation was noted when using CAD with 50% or 100% threshold for invasive cancers and when using CAD with 100% threshold for DCIS. Conclusion For CAD analysis, 30% threshold is the most appropriate threshold whose accuracy is comparable to manual measurement on MRI for tumor size measurement. However, clinicians should be aware of the higher risk of underestimation when using CAD with 50% threshold for tumor staging in invasive cancers.
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Affiliation(s)
- Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Eun Kyung Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Seungju Han
- Division of Clinical Bioinformatics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Khalayleh H, Khalayleh M, Diment J, Allweis TM. Breast density does not affect breast cancer tumor size assessment: A comparison of radiologic versus pathologic measurement by different imaging modalities across breast densities. Eur J Surg Oncol 2020; 46:1435-1440. [PMID: 32115332 DOI: 10.1016/j.ejso.2020.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Tumor size is an important parameter in breast cancer staging. Definitive tumor size is determined by measurement of the pathologic specimen. However, prior to surgery, size must be assessed by imaging with mammography (MMG), ultrasound (US), or magnetic resonance imaging (MRI). Discrepancies between imaging-assessed and pathologic size are not uncommon. Breast density decreases the sensitivity of MMG, and may affect image-based tumor size assessment. AIM To compare tumor size assessed by the different imaging modalities to pathologic size across breast densities. MATERIAL & METHODS This was a retrospective analysis of 183 female patients (197 breast cancers) diagnosed and operated for primary breast cancer at a single center. Tumor size measurements were collated for each available imaging modality and compared with measurements from pathologic specimens. Breast density was assessed on MMG using the Breast Imaging Reporting and Data System. RESULTS Mean pathologic tumor size was 23.0 ± 19.3 mm. Mean tumor size did not differ significantly with MMG (22.3 ± 16.6 mm; P = 0.165) or MRI (23.4 ± 19.2 mm; P = 0.620). However, US significantly underestimated mean tumor size (15.2 ± 8.6 mm; P = 0.0001 vs pathology). Breast density did not affect the accuracy of tumor size assessment by any imaging modality. CONCLUSIONS US may underestimate breast tumor size. Treatment decisions that take into account tumor size can be made equally reliably in patients with high or low breast density.
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Affiliation(s)
- Harbi Khalayleh
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel.
| | | | - Judith Diment
- Department of Pathology, Kaplan Medical Center, Rehovot, Israel
| | - Tanir M Allweis
- Department of Surgery, Kaplan Medical Center (affiliated to the School of Medicine, Hebrew University, Jerusalem), Rehovot, Israel; Hebrew University Medical School, Jerusalem, Israel
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Barth RJ, Krishnaswamy V, Paulsen KD, Rooney TB, Wells WA, Angeles CV, Zuurbier RA, Rosenkranz K, Poplack S, Tosteson TD. A Randomized Prospective Trial of Supine MRI-Guided Versus Wire-Localized Lumpectomy for Breast Cancer. Ann Surg Oncol 2019; 26:3099-3108. [PMID: 31359283 DOI: 10.1245/s10434-019-07531-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15-35% of the time. METHODS Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. RESULTS In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9 mL vs. 69.8 ± 25.1 mL; p = 0.45). The pathologic tumor diameters were underestimated by 2 cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2 cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. CONCLUSIONS A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.
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Affiliation(s)
- Richard J Barth
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Timothy B Rooney
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wendy A Wells
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christina V Angeles
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rebecca A Zuurbier
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kari Rosenkranz
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Steven Poplack
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Tor D Tosteson
- Department of Biomedical Data Science, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Barth RJ, Krishnaswamy V, Paulsen KD, Rooney TB, Wells WA, Rizzo E, Angeles CV, Marotti JD, Zuurbier RA, Black CC. A Patient-Specific 3D-Printed Form Accurately Transfers Supine MRI-Derived Tumor Localization Information to Guide Breast-Conserving Surgery. Ann Surg Oncol 2017; 24:2950-2956. [PMID: 28766199 PMCID: PMC6015768 DOI: 10.1245/s10434-017-5979-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Wire-localized excision of nonpalpable breast cancer is imprecise, resulting in positive margins 25-30% of the time. METHODS Patients underwent preoperative supine magnetic resonance imaging (MRI). A radiologist outlined the tumor edges on consecutive images, creating a three-dimensional (3D) view of its location. Using 3D printing, a bra-like plastic form (the Breast Cancer Locator [BCL]) was fabricated, with features that allowed a surgeon to (1) mark the edges of the tumor on the breast surface; (2) inject blue dye into the breast 1 cm from the tumor edges; and (3) place a wire in the tumor at the time of surgery. RESULTS Nineteen patients with palpable cancers underwent partial mastectomy after placement of surgical cues using patient-specific BCLs. The cues were in place in <5 min and no adverse events occurred. The BCL accurately localized 18/19 cancers. In the 18 accurately localized cases, all 68 blue-dye injections were outside of the tumor edges. Median distance from the blue-dye center to the pathologic tumor edge was 1.4 cm, while distance from the blue dye to the tumor edge was <5 mm in 4% of injections, 0.5-2.0 cm in 72% of injections, and >2 cm in 24% of injections. Median distance from the tumor center to the BCL-localized wire and to the clip placed at the time of diagnosis was similar (0.49 vs. 0.73 cm) on specimen mammograms. CONCLUSIONS Information on breast cancer location and shape derived from a supine MRI can be transferred safely and accurately to patients in the operating room using a 3D-printed form.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Follow-Up Studies
- Humans
- Imaging, Three-Dimensional/methods
- Magnetic Resonance Imaging/methods
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Supine Position
- Surgery, Computer-Assisted/methods
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Affiliation(s)
- Richard J Barth
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Timothy B Rooney
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wendy A Wells
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Elizabeth Rizzo
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christina V Angeles
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jonathan D Marotti
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rebecca A Zuurbier
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Candice C Black
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Daniel OK, Lim SM, Kim JH, Park HS, Park S, Kim SI. Preoperative prediction of the size of pure ductal carcinoma in situ using three imaging modalities as compared to histopathological size: does magnetic resonance imaging add value? Breast Cancer Res Treat 2017; 164:437-444. [PMID: 28439735 DOI: 10.1007/s10549-017-4252-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether magnetic resonance imaging (MRI) and ultrasonography add value to traditional mammography in an Asian population with ductal carcinoma in situ (DCIS). METHODS Data of 244 patients with pure DCIS treated at Severance Hospital between 2013 and 2015 were analyzed retrospectively. Data extracted included age, preoperative diagnosis, tumor size on preoperative imaging studies, and final histopathological tumor type and size, including hormone receptor status. The extent of correlation between imaging and histopathological tumor sizes was evaluated using a variety of methods, including Bland-Altman analysis. RESULTS The mean patient age was 52.39 years (SD = 10.31). The mean measurements of the tumor on preoperative ultrasonography, mammography, MRI, and histopathology were 1.80 (SD = 1.23) cm, 2.97 (SD = 1.92) cm, 2.53(SD = 1.84) cm, and 1.88 (SD = 1.36) cm, respectively. The mean differences in tumor size between ultrasonography, mammography, and MRI compared with histopathology were -0.09 (SD = 1.39), 1.09 (SD = 1.89), and 0.65 (SD = 1.78), respectively. The correlation between the sizes was significant with r values for ultrasonography, mammography, and MRI of 0.447 (SE = 0.061), 0.375 (SE = 0.042), and 0.409 (SE = 0.043), respectively. Mammography and MRI estimated tumor size significantly better for patients older than 50 years (p = 0.045 and <0.001, respectively). Mammography also provided good estimation for patients with a body mass index under 25 (p = 0.041). CONCLUSION MRI is better at estimation of histopathological DCIS size compared with mammography. However, ultrasonography had better estimation compared with MRI and mammography, probably owing to the high breast density in this population.
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Affiliation(s)
| | - Sung Mook Lim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Joo Heung Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea.
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
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Proulx F, Correa JA, Ferré R, Omeroglu A, Aldis A, Meterissian S, Mesurolle B. Value of pre-operative breast MRI for the size assessment of ductal carcinoma in situ. Br J Radiol 2015; 89:20150543. [PMID: 26568438 DOI: 10.1259/bjr.20150543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the accuracy of pre-operative breast MRI and mammography in determining the size of ductal carcinoma in situ (DCIS) compared with the histopathological results. METHODS 79 patients [mean age: 56.5 (standard deviation 10.2) years] with pathologically proven DCIS (79 lesions) obtained a bilateral mammogram and a pre-operative contrast-enhanced MRI. The accuracy of MRI and mammography to detect tumour size were estimated and compared, using histopathological size as the gold standard, on the subjects with measurements with both modalities (n = 60). RESULTS MRI detected 67 (85%) lesions, mammography detected 72 (91%) and both modalities detected 60 (76%). Median DCIS size detected by mammography vs MRI was smaller (1.55 vs 1.65 cm). Out of these 60 cases, compared with the histopathological size, the accuracy of MRI and mammography was 0.66 and 0.56, respectively (p = 0.045). MRI showed better accuracy than mammography for younger patients (age ≤ 50 years, p = 0.003). For tumour nuclear grade, there was a statistically significant difference for the intermediate level, with higher accuracy for MRI (p = 0.03). CONCLUSION MRI was more accurate than mammography in DCIS size assessment when visible, particularly in lesions of intermediate grade and in patients less than 50 years of age. ADVANCES IN KNOWLEDGE Breast MRI may help in management of DCIS of intermediate grade and in females less than 50 years of age.
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Affiliation(s)
- Francesca Proulx
- 1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - José A Correa
- 2 Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Romuald Ferré
- 1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - Atilla Omeroglu
- 3 Department of Pathology, Royal Victoria Hospital, Montreal, QC, Canada
| | - Ann Aldis
- 1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - Sarkis Meterissian
- 1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - Benoît Mesurolle
- 1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
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Menezes GLG, Knuttel FM, Stehouwer BL, Pijnappel RM, van den Bosch MAAJ. Magnetic resonance imaging in breast cancer: A literature review and future perspectives. World J Clin Oncol 2014; 5:61-70. [PMID: 24829852 PMCID: PMC4014797 DOI: 10.5306/wjco.v5.i2.61] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/18/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Early detection and diagnosis of breast cancer are essential for successful treatment. Currently mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities and breast magnetic resonance imaging (MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. However, the clinical benefits of the use of pre-operative MRI in women with newly diagnosed breast cancer is still a matter of debate. The main additional diagnostic value of MRI relies on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional assessment (particularly in patients diagnosed with invasive lobular carcinoma), assessing the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer in patients presenting with cancer metastasis in axillary lymph nodes, among others. Nevertheless, the development of new MRI technologies such as diffusion-weighted imaging, proton spectroscopy and higher field strength 7.0 T imaging offer a new perspective in providing additional information in breast abnormalities. We conducted an expert literature review on the value of breast MRI in diagnosing and staging breast cancer, as well as the future potentials of new MRI technologies.
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Pallone MJ, Poplack SP, Avutu HBR, Paulsen KD, Barth RJ. Supine breast MRI and 3D optical scanning: a novel approach to improve tumor localization for breast conserving surgery. Ann Surg Oncol 2014; 21:2203-8. [PMID: 24619494 DOI: 10.1245/s10434-014-3598-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Wire localization for excision of nonpalpable breast cancer is an inefficient and inexact technique. METHODS A total of 18 women with palpable invasive breast cancers underwent preoperative prone and supine magnetic resonance imaging (MRI). Intraoperatively, the edges of the tumor were palpated and marked on the skin surface. The breast was optically scanned, and the supine MRI was adjusted to match the actual breast position at the time of surgery. Image-defined tumor edges were marked on the surface of the breast. The main outcome measure was the distance between the image-defined and palpation-defined edges of the tumor. RESULTS No significant difference was found between the mean maximal tumor diameter as measured by histopathology (29.6 ± 14.3 mm), supine MRI (25.3 ± 9.7 mm), prone MRI (27.6 ± 13 mm), or palpation (30.5 ± 9.3 mm). The distance from the tumor to the chest wall was markedly different in prone versus supine MRI (56.4 ± 38 vs 19.5 ± 20 mm, p = .002). The average distance between the palpated and supine MRI image-defined tumor edge locations was 7.2 mm (range, 0-19 mm). Accuracy improved over time; the average difference in edge locations in the last 7 patients was 4.0 mm. All 4 image-defined edge locations in the last 5 patients were ≤ 1 cm away from the palpated locations. CONCLUSIONS We have developed a method of breast tumor localization using preoperative supine MRI and intraoperative optical scanning that defines tumor size and position as accurately as palpation.
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Nagarajan MB, Huber MB, Schlossbauer T, Leinsinger G, Krol A, Wismüller A. Classification of Small Lesions in Breast MRI: Evaluating The Role of Dynamically Extracted Texture Features Through Feature Selection. J Med Biol Eng 2013; 33. [PMID: 24223533 DOI: 10.5405/jmbe.1183] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dynamic texture quantification, i.e., extracting texture features from the lesion enhancement pattern in all available post-contrast images, has not been evaluated in terms of its ability to classify small lesions. This study investigates the classification performance achieved with texture features extracted from all five post-contrast images of lesions (mean lesion diameter of 1.1 cm) annotated in dynamic breast magnetic resonance imaging exams. Sixty lesions are characterized dynamically using Haralick texture features. The texture features are then used in a classification task with support vector regression and a fuzzy k-nearest neighbor classifier; free parameters of these classifiers are optimized using random sub-sampling cross-validation. Classifier performance is determined through receiver-operator characteristic (ROC) analysis, specifically through computation of the area under the ROC curve (AUC). Mutual information is used to evaluate the contribution of texture features extracted from different post-contrast stages to classifier performance. Significant improvements (p < 0.05) are observed for six of the thirteen texture features when the lesion enhancement pattern is quantified using the proposed approach of dynamic texture quantification. The highest AUC value observed (0.82) is achieved with texture features responsible for capturing aspects of lesion heterogeneity. Mutual information analysis reveals that texture features extracted from the third and fourth post-contrast images contributed most to the observed improvement in classifier performance. These results show that the performance of automated character classification with small lesions can be significantly improved through dynamic texture quantification of the lesion enhancement pattern.
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Affiliation(s)
- Mahesh B Nagarajan
- Departments of Imaging Sciences and Biomedical Engineering, University of Rochester, Rochester NY 14627, USA
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Tadrous PJ. On the concept of objectivity in digital image analysis in pathology. Pathology 2010; 42:207-11. [PMID: 20350211 DOI: 10.3109/00313021003641758] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The term 'objective' connotes a method that is based on facts and not influenced by personal opinions, perception or emotion. One often reads in the biomedical literature claims of objectivity for methods that use digital image analysis applied to histology. Since objective assessment of histology would represent a huge leap forward in scientific measurement and clinical diagnosis, such claims should be substantiated by strong evidence. This paper takes a selective look at the literature on image analysis to assess the definition of objectivity in image analysis and asks whether such a claim is ever justified. METHODS First, a brief background on the basic science of image analysis in histology details some of the controversies and opinions in the field. Then, a literature review of a subset of papers pertaining to image analysis in histology (with claims of objectivity) is conducted to determine what evidence exists for objectivity in these methods. RESULTS It was found that image analysis may have many benefits (speed, indefatigability, standardisation, etc.). However, algorithms are devised and implemented by human beings who make subjective decisions at each stage of the algorithm design and implementation process. Thus, image analysis methods can be seen as deterministic processes which 'objectively' implement the subjective decisions of the programmer. This indicates that 'inter-observer' variation in image analysis is equivalent to 'inter-algorithm' variation (which is rarely studied) and that a single computer algorithm's repeatability is of lesser importance than the repeatability of the image analysis method as a whole (including the block, slide and field selection and the method of tissue processing). CONCLUSION Repeatability and automaticity must not be confused with objectivity, but a lack of objectivity does not imply a lack of utility. Unless specific evidence of objectivity is provided, editors should insist that claims of objectivity in image analysis papers be either removed or justified prior to publication.
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Affiliation(s)
- Paul J Tadrous
- Department of Cellular Pathology, Northwick Park Hospital, London, United Kingdom.
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20
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Potente G, Messineo D, Maggi C, Savelli S. Practical application of contrast-enhanced magnetic resonance mammography [CE-MRM] by an algorithm combining morphological and enhancement patterns. Comput Med Imaging Graph 2008; 33:83-90. [PMID: 19095407 DOI: 10.1016/j.compmedimag.2008.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 03/22/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this article is to report our practical utilization of dynamic contrast-enhanced magnetic resonance mammography [DCE-MRM] in the diagnosis of breast lesions. In many European centers, was preferred a high-temporal acquisition of both breasts simultaneously in a large FOV. We preferred to scan single breasts, with the aim to combine the analysis of the contrast intake and washout with the morphological evaluation of breast lesions. We followed an interpretation model, based upon a diagnostic algorithm, which combined contrast enhancement with morphological evaluation, in order to increase our confidence in diagnosis. DCE-MRM with our diagnostic algorithm has identified 179 malignant and 41 benign lesions; final outcome has identified 178 malignant and 42 benign lesions, 3 false positives and 2 false negatives. Sensitivity of CE-MRM was 98.3%; specificity, 95.1%; positive predictive value, 98.9%; negative predictive value, 92.8% and accuracy, 97.7%.
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Affiliation(s)
- Giuseppe Potente
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, 00161 Rome, Italy.
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Ceugnart L, Taieb S, Vennin P, Giard S, Chauvet MP, Chaveron C, Bachelle F, Faivre-Pierret M, Rocourt N, Bercez H, Fauquet I. [Role of MRI in the presurgical work-up of breast cancer: appropriate utilization of MRI as a complement to mammography and ultrasound]. JOURNAL DE RADIOLOGIE 2008; 89:1774-1779. [PMID: 19106838 DOI: 10.1016/s0221-0363(08)74486-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The role of MRI for presurgical local staging of breast cancers amenable to conservative treatment has been the subject of multiple publications and tends to become a "validated" indication in routine practice. The purpose of the paper is to review the advantages and limitations of this imaging modality that is part of a comprehensive management that must be validated by clinical data especially with regards to local recurrence and survival. Knowledge of these elements combined with more precise indications should result in improved patient management while avoiding overtreatment or unnecessary anxiety-producing examinations.
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Affiliation(s)
- L Ceugnart
- Département d'imagerie, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3, rue Frédéric Combemale, 59000 Lille.
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Peters NHGM, Borel Rinkes IHM, Mali WPTM, van den Bosch MAAJ, Storm RK, Plaisier PW, de Boer E, van Overbeeke AJ, Peeters PHM. Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome - MONET - study. Trials 2007; 8:40. [PMID: 18045470 PMCID: PMC2222222 DOI: 10.1186/1745-6215-8-40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 11/28/2007] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In recent years there has been an increasing interest in MRI as a non-invasive diagnostic modality for the work-up of suspicious breast lesions. The additional value of Breast MRI lies mainly in its capacity to detect multicentric and multifocal disease, to detect invasive components in ductal carcinoma in situ lesions and to depict the tumor in a 3-dimensional image. Breast MRI therefore has the potential to improve the diagnosis and provide better preoperative staging and possibly surgical care in patients with breast cancer. The aim of our study is to assess whether performing contrast enhanced Breast MRI can reduce the number of surgical procedures due to better preoperative staging and whether a subgroup of women with suspicious nonpalpable breast lesions can be identified in which the combination of mammography, ultrasound and state-of-the-art contrast-enhanced Breast MRI can provide a definite diagnosis. METHODS/DESIGN The MONET - study (MR mammography Of Nonpalpable BrEast Tumors) is a randomized controlled trial with diagnostic and therapeutic endpoints. We aim to include 500 patients with nonpalpable suspicious breast lesions who are referred for biopsy. With this number of patients, the expected 12% reduction in surgical procedures due to more accurate preoperative staging with Breast MRI can be detected with a high power (90%). The secondary outcome is the positive and negative predictive value of contrast enhanced Breast MRI. If the predictive values are deemed sufficiently close to those for large core biopsy then the latter, invasive, procedure could possibly be avoided in some women. The rationale, study design and the baseline characteristics of the first 100 included patients are described. TRIAL REGISTRATION Study protocol number NCT00302120.
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Affiliation(s)
- Nicky HGM Peters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Inne HM Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, G04.228 3584 CX Utrecht, The Netherlands
| | - Willem PTM Mali
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Maurice AAJ van den Bosch
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Remmert K Storm
- Department of Radiology, Albert Schweitzer Ziekenhuis, van der Steenhovenplein 1 3300 AK Dordrecht, The Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Ziekenhuis, van der Steenhovenplein 1 3300 AK Dordrecht, The Netherlands
| | - Erwin de Boer
- Department of Radiology, Meander Medisch Centrum, lokatie Lichtenberg, Utrechtseweg 1603813 ES Amersfoort, The Netherlands
| | - Adriaan J van Overbeeke
- Department of Surgery, Meander Medisch Centrum, lokatie Lichtenberg, Utrechtseweg 1603813 ES Amersfoort, The Netherlands
| | - Petra HM Peeters
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, STR 6.131 3584 CX Utrecht, The Netherlands
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Peters NHGM, Borel Rinkes IHM, Zuithoff NPA, Mali WPTM, Moons KGM, Peeters PHM. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 2007; 246:116-24. [PMID: 18024435 DOI: 10.1148/radiol.2461061298] [Citation(s) in RCA: 394] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine, in a meta-analysis, the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging in patients with breast lesions. MATERIALS AND METHODS Studies to assess the diagnostic performance of MR imaging in patients suspected of having breast cancer who underwent MR imaging and biopsy from January 1985 through March 2005 were reviewed for inclusion. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated by using the recently developed bivariate approach for diagnostic meta-analysis. RESULTS Of 251 eligible studies, 44 were included in the meta-analysis (sample size range, 14-821; cancer prevalence, 23%-84%). Pooled weighted estimates of sensitivity and specificity were 0.90 (95% confidence interval: 0.88, 0.92) and 0.72 (95% confidence interval: 0.67, 0.77), respectively. The performance of breast MR imaging was influenced by the prevalence of cancer in the studied population (P = .05) and by whether two criteria (ie, morphology, enhancement, and kinetic enhancement pattern)--versus one or three criteria--were used to differentiate benign from malignant lesions (P = .02). CONCLUSION MR imaging of the breast has high sensitivity and lower specificity in the evaluation of breast lesions. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2461061298/DC1.
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Affiliation(s)
- Nicky H G M Peters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, 3584 CX Utrecht, The Netherlands
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Duarte GM, Cabello C, Torresan RZ, Alvarenga M, Telles GHQ, Bianchessi ST, Caserta N, Segala SR, de Lima MDCL, Etchebehere ECSDC, Camargo EE, Tinois E. Fusion of Magnetic Resonance and Scintimammography Images for Breast Cancer Evaluation: A Pilot Study. Ann Surg Oncol 2007; 14:2903-10. [PMID: 17632758 DOI: 10.1245/s10434-007-9476-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 05/04/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND To achieve a more specific method to estimate the real size of breast cancer, we have developed a method to fuse magnetic resonance imaging (MRI) and scintimammography (SM) images. The aim of this study was to assess the feasibility of this method and to evaluate its accuracy to measure the size of breast cancer compared with MRI alone, mammography, and clinical examination, employing pathologic size as the gold standard. METHODS Twenty consecutive breast cancer women at stages IIA-IIIA, scheduled for mastectomies, underwent SM with (99m)Tc-sestamibi and MRI with gadolinium 2-10 days before surgery. All patients had had recent mammographies and were examined clinically. Software was developed in visual language to perform the fusion between MRI and SM images and tumor measurements (MRI/SM). The tumor size, in 3 diameters (anteroposterior, longitudinal, and transverse), for each examination was correlated with pathological measurements using linear regression. RESULTS The MRI/SM technique was successfully performed in all patients, and the principal tumor was measured by this method. The MRI/SM cancer measurements correlated better with pathology than MRI, mammography, and clinical exam in all diameters analyzed (r = 0.88, 0.81, 0.81; SE = 0.11, 0.14, 0.11 in anteroposterior, longitudinal, and transverse diameters, respectively). CONCLUSIONS The MRI/SM is a feasible technique and appears to be more accurate than other examinations (MRI alone, mammography, and clinical exam) to measure breast cancer size.
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Affiliation(s)
- Giuliano Mendes Duarte
- Division of Oncology and Senology, Department of Obstetrics and Gynecology School of Medicine, Universidade Estadual de Campinas (Unicamp), Campinas, Brazil.
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Kim DY, Moon WK, Cho N, Ko ES, Yang SK, Park JS, Kim SM, Park IA, Cha JH, Lee EH. MRI of the breast for the detection and assessment of the size of ductal carcinoma in situ. Korean J Radiol 2007; 8:32-9. [PMID: 17277561 PMCID: PMC2626696 DOI: 10.3348/kjr.2007.8.1.32] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare the accuracy of magnetic resonance imaging (MRI) and mammography for the detection and assessment of the size of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS The preoperative contrast-enhanced MRI and mammography were analyzed in respect of the detection and assessment of the size of DCIS in 72 patients (age range: 30-67 years, mean age: 47 years). The MRI and mammographic measurements were compared with the histopathologic size with using the Pearson's correlation coefficients and the Mann-Whitney u test. We evaluated whether the breast density, the tumor nuclear grade, the presence of comedo necrosis and microinvasion influenced the MRI and mammographic size estimates by using the chi-square test. RESULTS Of the 72 DCIS lesions, 68 (94%) were detected by MRI and 62 (86%) were detected by mammography. Overall, the Pearson's correlation of the size between MRI and histopathology was 0.786 versus 0.633 between mammography and histopathology (p < 0.001). MRI underestimated the size by more than 1 cm (including false negative examination) in 12 patients (17%), was accurate in 52 patients (72%) and overestimated the size by more than 1 cm in eight patients (11%) whereas mammography underestimated the size in 25 patients (35%), was accurate in 31 patients (43%) and overestimated the size in 16 patients (22%). The MRI, but not the mammography, showed significant correlation for the assessment of the size of tumor in noncomedo DCIS (p < 0.001 vs p = 0.060). The assessment of tumor size by MRI was affected by the nuclear grade (p = 0.008) and the presence of comedo necrosis (p = 0.029), but not by the breast density (p = 0.747) or microinvasion (p = 0.093). CONCLUSION MRI was more accurate for the detection and assessment of the size of DCIS than mammography.
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Affiliation(s)
- Do Youn Kim
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Woo Kyung Moon
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Nariya Cho
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Eun Sook Ko
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Sang Kyu Yang
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Sun Mi Kim
- Department of Radiology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - In-Ae Park
- Department of Pathology, College of Medicine Seoul National University and The Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea
| | - Joo Hee Cha
- Department of Radiology, Boramae Municipal Hospital, Seoul 156-707, Korea
| | - Eun Hye Lee
- Department of Radiology, Boramae Municipal Hospital, Seoul 156-707, Korea
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Deutscher A, Niessen HG, Angenstein F, Goldschmidt J, Scheich H, Schulze H. Comparison of estimates for volumes of brain ablations derived from structural MRI and classical histology. J Neurosci Methods 2006; 156:136-9. [PMID: 16554094 DOI: 10.1016/j.jneumeth.2006.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 02/09/2006] [Accepted: 02/13/2006] [Indexed: 11/16/2022]
Abstract
Estimates of auditory cortex ablation sizes in a rodent model as derived from classical histology (volume reconstructions from Nissl-stained brain sections) and structural magnetic resonance imaging (MRI) (T1-weighted whole-brain scans from a 4.7 T animal scanner) were compared in the same specimens (Mongolian gerbils). Estimates of lesion volumes obtained with the two methods were very similar, robust, highly correlated and not significantly different from each other. Hence, the general usefulness of structural MRI for the determination of brain lesion size in small animal models is demonstrated. MRI therefore seems to be well suited to determine proper size and location of an experimental brain ablation prior to (potentially extensive) behavioral testing.
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Affiliation(s)
- Anke Deutscher
- Leibniz Institute for Neurobiology, Department Auditory Learning & Speech, 39118 Magdeburg, Germany
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Schouten van der Velden AP, Boetes C, Bult P, Wobbes T. The value of magnetic resonance imaging in diagnosis and size assessment of in situ and small invasive breast carcinoma. Am J Surg 2006; 192:172-8. [PMID: 16860625 DOI: 10.1016/j.amjsurg.2006.02.026] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Revised: 02/05/2006] [Accepted: 02/05/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The value of magnetic resonance imaging (MRI) in diagnosis and size assessment of ductal carcinoma-in-situ (DCIS) and DCIS with small (<10 mm) invasive carcinoma was evaluated. METHODS Fifty-four patients with DCIS and 12 patients with DCIS and small invasive carcinoma were included. Mammographic (N = 64) and MRI (N = 22) images were retrospectively reviewed. Correlation coefficients were calculated to assess differences in size between imaging and histopathologic examination. RESULTS Mammographic rate of detection for DCIS was 48/52 (92%) and for DCIS with small invasive carcinoma, 10/12 (83%). MRI revealed 1 false negative case and the rate of detection for DCIS was 16/17 (94%). Correlation of mammographic size with histopathologic size was r = .44 (P < .01) and r = 0.49 (P = .03) for MRI. Mammography underestimated lesion size by 5 mm or more in 47%, whereas with MRI size was adequately assessed in 43% and overestimated in 38%. CONCLUSIONS DCIS can be visualised on MRI with high sensitivity, although tumor size can be overestimated.
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Akazawa K, Tamaki Y, Taguchi T, Tanji Y, Miyoshi Y, Kim SJ, Ueda S, Yanagisawa T, Sato Y, Tamura S, Noguchi S. Preoperative Evaluation of Residual Tumor Extent by Three-Dimensional Magnetic Resonance Imaging in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Breast J 2006; 12:130-7. [PMID: 16509837 DOI: 10.1111/j.1075-122x.2006.00220.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the usefulness of three-dimensional magnetic resonance imaging (3D MRI) for the preoperative assessment of residual tumor extent in breast cancer patients treated with neoadjuvant chemotherapy (NAC). Thirty-eight breast cancer patients treated with NAC containing taxane and/or anthracycline for 3-6 months were enrolled in this study. Tumor size was measured by means of calipers, ultrasonography, and dynamic MRI before and after NAC. Three-dimensional maximum intensity projection MRIs to measure the tumor size were created for every case. The tumor size determined by calipers, ultrasonography, and 3D MRI after NAC was compared with that determined by pathologic examination. The tumor size determined by 3D MRI showed a strong correlation with that determined by pathologic examination (r = 0.896). Moderate, but significant correlations were found between measurements obtained with calipers and pathology (r = 0.554), and between ultrasonography and pathology (r = 0.484). The response rates to NAC were estimated at 84.2% with calipers, 58.0% with ultrasonography, and 44.7% with 3D MRI. Calipers and ultrasonography thus tended to overestimate the response to NAC compared to 3D MRI (p < 0.001 and 0.240, respectively). Three-dimensional MRI can visualize residual tumor extent after NAC more accurately than calipers and ultrasonography, and seems to be more reliable than other modalities for estimating response to NAC. It should also help surgeons with decision making for breast-conserving surgery after NAC.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Cyclophosphamide/administration & dosage
- Decision Making
- Docetaxel
- Epirubicin/administration & dosage
- Female
- Humans
- Imaging, Three-Dimensional
- Magnetic Resonance Imaging/methods
- Mastectomy
- Mastectomy, Segmental
- Neoadjuvant Therapy
- Neoplasm Staging/methods
- Neoplasm, Residual
- Paclitaxel/administration & dosage
- Patient Care Planning
- Preoperative Care
- Taxoids/administration & dosage
- Ultrasonography
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Affiliation(s)
- Kenji Akazawa
- Department of Surgical Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
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29
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Chen W, Giger ML, Bick U. A fuzzy c-means (FCM)-based approach for computerized segmentation of breast lesions in dynamic contrast-enhanced MR images. Acad Radiol 2006; 13:63-72. [PMID: 16399033 DOI: 10.1016/j.acra.2005.08.035] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 08/25/2005] [Accepted: 08/27/2005] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Accurate quantification of the shape and extent of breast tumors has a vital role in nearly all applications of breast magnetic resonance (MR) imaging (MRI). Specifically, tumor segmentation is a key component in the computerized assessment of likelihood of malignancy. However, manual delineation of lesions in four-dimensional MR images is labor intensive and subject to interobserver and intraobserver variations. We developed a computerized lesion segmentation method that has the advantage of being automatic, efficient, and objective. MATERIALS AND METHODS We present a fuzzy c-means (FCM) clustering-based method for the segmentation of breast lesions in three dimensions from contrast-enhanced MR images. The proposed lesion segmentation algorithm consists of six consecutive stages: region of interest (ROI) selection by a human operator, lesion enhancement within the selected ROI, application of FCM on the enhanced ROI, binarization of the lesion membership map, connected-component labeling and object selection, and hole-filling on the selected object. We applied the algorithm to a clinical MR database consisting of 121 primary mass lesions. Manual segmentation of the lesions by an expert MR radiologist served as a reference in the evaluation of the computerized segmentation method. We also compared the proposed algorithm with a previously developed volume-growing (VG) method. RESULTS For the 121 mass lesions in our database, 97% of lesions were segmented correctly by means of the proposed FCM-based method at an overlap threshold of 0.4, whereas 84% of lesions were correctly segmented by means of the VG method. CONCLUSION Our proposed algorithm for breast-lesion segmentation in dynamic contrast-enhanced MRI was shown to be effective and efficient.
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Affiliation(s)
- Weijie Chen
- University of Chicago, Radiology, 584 South Maryland, MC Chicago, IL , USA.
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30
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Shah N, Gibbs J, Wolverton D, Cerussi A, Hylton N, Tromberg BJ. Combined diffuse optical spectroscopy and contrast-enhanced magnetic resonance imaging for monitoring breast cancer neoadjuvant chemotherapy: a case study. JOURNAL OF BIOMEDICAL OPTICS 2005; 10:051503. [PMID: 16292947 DOI: 10.1117/1.2070147] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Monitoring tumor response to therapy can enable assessment of treatment efficacy, maximizing patient outcome and survival. We employ a noninvasive, handheld laser breast scanner (LBS) based on broadband diffuse optical spectroscopy (DOS) in conjunction with contrast-enhanced magnetic resonance imaging (cMRI) to assess tumor response to presurgical neoadjuvant chemotherapy. DOS and cMRI scans are performed after the first and fourth cycles of a doxorubicin/cyclophosphamide regimen in a patient with invasive ductal carcinoma. DOS measurements are used to quantify bulk tissue optical and physiological parameters, which are mapped to T2- and T1-weighted cMRI images. Initial DOS measurements show high tumor/normal contrast in total hemoglobin concentration (THC, 56+/-7 versus 27+/-4 microM) and water fraction (81.4+/-1% versus 24+/-3%) colocalized with regions of strongly enhancing T2-weighted and cMRI signals. After the fourth cycle of chemotherapy, we observe decreases in peak MRI contrast-enhancement values (37.6%) and apparent lesion volume (21.9 versus 13.7 cm3), which corresponds to physiological changes measured by DOS, including a 20 to 25% reduction in the spatial extent of the tumor and a 38.7% drop in mean total hemoglobin content (THC, 41.6 versus 23.4 microM). These data provide in vivo validation of the accuracy of broadband DOS and the sensitivity of optical methods to changes in tumor physiology.
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Affiliation(s)
- Natasha Shah
- University of California-Irvine, Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, Irvine, California 92162-1475, USA
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Morakkabati-Spitz N, Leutner C, Schild H, Traeber F, Kuhl C. Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol 2005; 15:2010-7. [PMID: 15841382 DOI: 10.1007/s00330-005-2755-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 03/02/2005] [Accepted: 03/24/2005] [Indexed: 11/29/2022]
Abstract
The aim of this study was the evaluation of the diagnostic usefulness of ductal or segmental enhancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging finding is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unselected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients undergoing bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients' final diagnoses were established by imaging guided excisional or core biopsy or by clinical plus conventional imaging follow-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for patients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mammogram. The overall prevalence of a ductal or a segmental enhancement pattern on breast MRI is low. But this finding has a high specificity and a moderate positive predictive value for intraductal neoplastic changes. We conclude that if segmental or linear enhancement is identified on breast MRI further work-up is necessary. We recommend either direct MR-guided vacuum-assisted core biopsy or short-term follow-up breast MRI within 3 months. If ductal enhancement then persists, MR-guided biopsy should be recommended even in the absence of mammographically visible signs of DCIS.
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Affiliation(s)
- N Morakkabati-Spitz
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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Montemurro F, Martincich L, De Rosa G, Cirillo S, Marra V, Biglia N, Gatti M, Sismondi P, Aglietta M, Regge D. Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer. Eur Radiol 2005; 15:1224-33. [PMID: 15906034 DOI: 10.1007/s00330-005-2656-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022]
Abstract
We compared dynamic contrast-enhanced MRI (DCE-MRI) and sonography (US) for monitoring tumour size in 21 patients with breast cancer undergoing primary chemotherapy (PCT) followed by surgery. The correlation between DCE-MRI and US measurements of tumour size, defined as the product of the two major diameters, was 0.555 (P=0.009), 0.782 (P<0.001), and 0.793 (P<0.001) at baseline, and after two and four cycles of PCT, respectively. The median tumour size was significantly larger when measured by DCE-MRI than by US at baseline (1472 vs 900 mm(2), P<0.001) and after two cycles of PCT (600 vs 400 mm(2), P=0.009). After PCT, the median tumour size measured by the two techniques was similar (256 vs 289 mm(2) for DCE-MRI and US, respectively, P=0.859). The correlation with the histopathological major tumour diameter was 0.824 (P<0.001) and 0.705 (P<0.001) for post-treatment DCE-MRI and US, respectively. Measurements of the final major tumour diameter by DCE-MRI tended to be more precise, including cases achieving a pathological complete response. Randomized trials are warranted to establish the clinical impact of the initial discrepancy in tumour size estimates between DCE-MRI and US, and the trend towards a better definition of the final tumour size provided by DCE-MRI in this clinical setting.
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Affiliation(s)
- Filippo Montemurro
- Unit of Medical Oncology, Institute for Cancer Research and Treatment (IRCC), Strada Provinciale 142, Candiolo, Torino, Italy
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