MyT3 2 - Breast

Purpose:

Assess accuracy and additive value of breast elastography in evaluation of axillary lymph node status in patients with BIRADS 4 and 5 breast lesions, diagnosed on sono-mammography.

Methods and materials:

60 female patients with BIRADS 4 or 5 lesions were included. Conventional ultrasonography "US", strain "SE" and shear wave "SWE" elastography examinations for their lymph nodes done and their imaging findings evaluated individually and correlated with pathology. US: lymph nodes were evaluated regarding shape (ovoid or non-ovoid), cortical thickening > 3mm "according to its calculated cutoff value" (present or not, and if present "diffuse or focal or irregular mass"), Hilum (central, effaced, eccentric or not-preserved), Vascularity (hilar or non-hilar). Elastography: lymph nodes were evaluated regarding the percentage of the stiff cortex on colour-coded images with a modulated scoring system. Also cutoff values for strain ratio "SR" (in SE) and maximum elasticity "Emax", elasticity ratio "Eratio" (in SWE) calculated.

Results:

In US, Cortical thickness was the most sensitive criteria (100% sensitivity). And the vascular pattern was the second sensitive. Eratio showed the highest diagnostic indices compared to rest of SWE criteria with sensitivity, specificity, accuracy (76.9%,100%,85% respectively). SR showed higher specificity & accuracy than qualitative SE (76.2% vs 57.14% and 83.33% vs 80% respectively), with relatively lower sensitivity (87.2 % vs 92.31% respectively). US showed highest sensitivity & accuracy (100%, 88.33% respectively) among the rest of used modalities. with relatively lower specificity (66.67%).

Conclusion:

Addition of strain or shear wave elastogrphy offer no significant benefit over conventional ultrasound alone in evaluation of axillary lymph nodes in breast cancer patients.

Limitations:

Tissue compression extent influences elasticity image.

Ethics committee approval

All participated patients provided informed written consents following our institutional ethical committee approval.

Funding:

No funding was received for this work.

Purpose:

We combined the abbreviated and ultrafast MRI technique with the standard MRI protocol and compared lesion characterisation quantitatively and qualitatively to the standard MRI protocol.

Methods and materials:

Fifty-six patients with breast cancer who underwent MRI from June 2017 to May 2018 and fulfilled our inclusion criteria were included. Three radiologists measured the lesion sizes, described the MRI findings using BI-RADS lexicon and demarcated the regions of interest to extract the volumetric quantitative and semi-quantitative parameters. We used Pearson’s correlation analysis comparing the quantitative and semi-quantitative parameters. To evaluate the inter-observer variability, we calculated the intra-correlation coefficient. We also analysed the correlation in BI-RADS lexicon.

Results:

There were 45 (80.4%) luminal and 11 (19.6%) non-luminal breast cancers, and the most common tumour subtype was invasive carcinoma (n=48, 85.7%), followed by ductal carcinoma in situ (n=8, 14.3%). Regarding correlation between the quantitative and semi-quantitative parameters, K^trans significantly correlated with the wash-in factor (r, 0.862; p < 0.001) and AUC value (r, 0.951; p < 0.001). The lesion size measured by standard and combined abbreviated-ultrafast phases and that from the surgical pathological specimens showed moderate agreement (ICC range, 0.516−0.578). The ICCs among the three readers were excellent for lesion size measurement, BI-RADS lexicon regarding lesion type, mass shape, margin, internal enhancement, non-mass enhancement distribution, and internal enhancement by the standard and combined abbreviated-ultrafast protocols.

Conclusion:

The use of the modified and combined abbreviated-ultrafast MRI protocol provides a reliable measurement of the quantitative parameters and may aid in the screening of breast cancer.

Limitations:

This study was a retrospective one and conducted in a single centre. Further, this study involved a small number of cases with only breast cancer.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To evaluate if the use of 11G or 8G needle in vacuum-assisted biopsy (VAB) can predict different outcomes of breast lesions of uncertain malignant potential (B3).

Methods and materials:

We retrospectively screened 1025 women with a histological diagnosis of B3 from 2000 to 2018. All patients underwent needle core biopsy (NCB) or vacuum-assisted biopsy (VAB) at our centre. We selected patients with VAB and histological surgical specimen after open excision (OE) or vacuum-assisted excision (VAE) or proof of stability on follow-up, with a final population of 378 women. Biopsy guidance systems were stereotactic/tomosynthesis (STX/TOMO) and ultrasound (US). We evaluated positive predictive values (PPV) of the malignant outcome of the two biopsy needles in each B3 histological subtype. Chi-square test and Fisher exact test were used to compare groups.

Results:

Out of 378 VABs, 377 were STX/TOMO-guided and 1 US-guided. 86 (22.8%) were performed with 11G and 292 (77.2%) with 8G. Overall VAB PPV of malignant outcome was 16.1% (9.3% carcinoma in situ, 6.9% invasive). 11G and 8G PPV was 20.9% vs 14.7%, respectively (p-value=0.2271). No statistically significant differences in upgrade rates were found between 11G and 8G in not pure ADH (p=0.1043), pure ADH (p=0.0685), FEA (p=1), not pure LN (p=0.8595), pure LN (p=0.7973).

Conclusion:

Our results showed that 11G or 8G needle in VAB does not affect B3 outcome in any subtype. In the special case of ADH, we think that the limited group sample may have affected the statistical significance between the two groups.

Limitations:

The retrospective nature of the study and different numeric sample between 11G and 8G.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Breast density affects mammographic sensitivity by a masking phenomenon; as the dense tissue may obscure an underlying malignancy. Breast density has been reported to be a strong independent risk factor for breast cancer. Purpose of this work is to study the impact of breast ultrasound vs contrast-enhanced spectral mammography in the detection and diagnosis of lesions in the mammography dense breasts.

Methods and materials:

This study was done on 50 cases with mammography dense breast classified as (C) or (D). All patients underwent digital mammography, breast ultrasound and contrast-enhanced spectral mammography.

Results:

By comparing both modalities, they both revealed the same specificity 65%, with higher sensitivity in CESM 97% compared to 88% in ultrasound and thus total accuracy was higher in CESM 85% compared to 79% in ultrasound.

Conclusion:

CESM revealed superior diagnostic accuracy and higher sensitivity than ultrasound and hence, permitted better detection of malignant lesions. CESM can be performed in routine practice changing the diagnostic, and further, the treatment strategy. Bilateral CESM is feasible, easily accomplished and well-tolerated. CESM is cost-effective, easily feasible and radiation dose is a minor drawback as it is only slightly higher than for conventional mammography. Future studies should investigate the performance of CESM in larger population groups to evaluate the diagnostic accuracy of this promising imaging method particularly in women at high risk and women with dense breasts.

Limitations:

Our study is limited by small sample size and the fact that was performed in a single institution. Multi-centre with multi-reader studies are needed. Also the increased number of malignant lesions 33/53 lesions (62.3 %), this could be attributed to the work nature of the institute and the targeted study population.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To evaluate the outcome of histological subtypes of breast lesions of uncertain malignant potential (B3), using 14G needle core biopsy.

Methods and materials:

We retrospectively screened 1025 women with a histological diagnosis of B3 from 2000 to 2018. All patients underwent needle core biopsy (NCB) or vacuum-assisted biopsy (VAB) at our centre. We selected patients with 14G NCB and histological surgical specimen after open excision (OE) or vacuum-assisted excision (VAE) or proof of stability on follow-up, with a final population of 400 women. Biopsy guidance systems were ultrasound (US) and clinical (freehand). We evaluated positive predictive values (PPV) of malignant outcome in each B3 histological subtype. Chi-square and t student tests were used to assess statistically significant differences between groups.

Results:

Out of 400 NCBs, 394 (98.5%) were US-guided and 6 (1.5%) freehand. Overall NCB PPV of malignant outcome was 27.3% (13% carcinoma in situ, 14.3% invasive). Out of 44 carcinomas in situ, 14 (32%) were G1, 25 (57%) G2 and 5 (11%) G3, while out of 45 invasive, 21 (47%) were G1, 20 (44%) G2 and 4 (9%) G3. Mean size of carcinomas in situ and invasive was 18.43±10.32 mm (range: 4.00-80.00) vs 41.88±65.63 mm (range: 4.00-200.00), respectively (p= 0.0215). The histological subtypes with the highest association with malignancy were pure atypical ductal hyperplasia-ADH (68.3%), not pure ADH (64.3%), flat epithelial atipia-FEA (26.9%), pure lobular neoplasia-LN (20%) and not pure LN (21.7%). No statistically significant difference was found between pure ADH and not pure ADH (p=0.725) and between pure LN and not pure LN (p =1).

Conclusion:

Our results using 14G NCB showed the highest malignancy outcome rates for ADH (64.3%), FEA (26.9%) and LN (21.7%).

Limitations:

This study is a retrospective study.

Ethics committee approval

n/a

Funding:

No funding received for this work.

Purpose:

Neoadjuvant chemotherapy (NAC) has an essential role in the treatment of patients with breast cancer. A subgroup of these patients achieves a pathologic complete response (pCR) after NAC, defined as the absence of invasive cancer in breast surgery. pCR is related to higher long-term survival, especially in aggressive phenotypes. MRI is able to predict non-invasively and accurately the presence of pCR by rCR, defined as the absence of enhancement at tumour bed after NAC. The main purpose of our study is to assess rCR as a surrogate outcome of survival in breast cancer patients treated with NAC.

Methods and materials:

We retrospectively reviewed contrast-enhanced and diffusion-weighted MRI studies of breast cancer patients treated with NAC at the diagnosis, during (early response) and after NAC (late response) and determined if they presented a complete, partial or not radiological response. We reviewed survival outcomes (overall survival and disease-free survival) and assessed its realationship to rCR.

Results:

Preliminary data: We included >200 patients. The hypothesis is that the presence of rCR was related to a higher short and long-term survival, with differences according to the tumour fenotype. The combined use of CE and DW-MRI rCR had good correlation when predicting pCR.

Conclusion:

rCR seems to be a prognostic survival outcome in breast cancer patients treated with NAC. The combined use of CE and DW-MRI is accurate in predicting pCR.

Limitations:

The main limitation is the change of diagnostic methods and criteria in evaluating radiological response. To try to compensate it, a review of all MRI studies was done by two radiologists with exclusive dedication to breast radiology (JdR and LT).

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To compare the performance of prone DBT–guided VAB with prone S-guided VAB, focusing on time of procedure, number of expositions, average glandular dose and complications.

Methods and materials:

The institutional review board approved this retrospective study and informed consent was waived. From July 2015 to January 2017, 306 patients with 306 suspicious mammographic findings (BI-RADS ≥4) underwent to a mammography-guided biopsy, prone S-guided or prone DBT-guided VAB. T student Test, Chi-squared and multivariate regression statistics were used.

Results:

During the study period, 155 prone S-guided VAB in 155 patients (mean age, 56 years; age range, 39–84 years) and 151 DBT guided VAB in 151 patients (mean age, 57 years; age range, 33–84 years) were performed. Mean procedure time was briefer with DBT-guided VAB versus S-guided VAB (14,5 vs 17,4 minutes, respectively; P <0,001), and fewer expositions were acquired with DBT-guided VAB versus S-guided VAB (8 vs 11, respectively; P <0,001); therefore the average glandular dose (AGD) was significantly lower in DBT-guided VAB versus S-guided VAB (11,8 mGy vs 18 mGy respectively; P <0,001). There were no differences in the distribution of histologic results (P = 0,74) and in breast density (P = 0,09) between the two groups. No major complications were observed in either group.

Conclusion:

Performance of prone DBT-guided VAB was superior to prone S-guided VAB, because it allows a faster procedure, with a fewer radiological expositions and lower radiation dose.

Limitations:

We included in our study all the procedures that were actually performed in our institution, so technical success was not considered.

Ethics committee approval

The institutional review board approved this retrospective study and informed consent was waived.

Funding:

No funding was received for this work.