RPS 1002b - Interactions between breast radiology and pathology

Purpose:

To identify the relationship between human epidermal growth factor receptor 2 (HER2) status and cone-beam breast CT (CBBCT) characteristics in surgically resected breast cancer.

Methods and materials:

Preoperative CBBCT of patients with BI-RADS 4 or 5 lesions identified on mammography or ultrasound and dense or very dense breast tissue were retrospectively evaluated in 181 surgically resected breast cancers (triple-negative excluded) between October 2012 to August 2015. A set of CBBCT descriptors was semiquantitatively assessed by consensus double reading. Multivariate logistic regression analysis using backward elimination method (BEA) was performed to identify independent predictive factors of harbouring HER2/neu. Principle component analysis (PCA) was used to determine characteristics that might differentiate HER2 status. Receiver operating characteristic (ROC) curve analyses were conducted to determine the predictive capability.

Results:

HER2 positive was found in 101 (55.8%) of 181 patients. Based on BEA, pathologic grade, maximum dimension, lobulation, ΔCT, and calcification morphology were confirmed as independent predictive factors of HER2/neu overexpression. PCA showed that calcification- and border-related characteristics were the most important for differentiation. ROC curve analyses showed that CBBCT features (AUC = 0.853) were superior to clinicopathologic features (AUC = 0.613, P < 0.001) and comparable to combination (AUC = 0.856, P = 0.866).

Conclusion:

CBBCT features could be used to prognosticate HER2 status independently, which are potentially complementary to histopathologic result and helpful in guiding biopsy.

Limitations:

We limited our analyses to non-triple-negative breast cancer, surgically resected, and non-preoperative treated specimens.

Ethics committee approval

The institutional review board approved this study and written informed consent was obtained from all patients.

Funding:

National Key R&D Program of China (No. 2017YFC0112600 and 2017YFC0112601). National Natural Science Foundation of China (No. 81571671).

Purpose:

This study focused on women with previously treated breast cancer who were recalled for further imaging due to microcalcifications. We aimed to determine our ability to characterise these; which factors increased risk of recurrence, timeframe of recurrence, and results of biopsies.

Methods and materials:

Data was collected for patients recalled between June 2013 and February 2019, specifically time interval, original diagnosis, original mammographic appearance, and the outcome of recall.

Results:

194 women were recalled for microcalcifications for further views +/ biopsy. 126 were for ipsilateral to the original cancer, 66 contralateral, and 2 bilateral. 104 (54%) underwent biopsies, the remainder were considered benign. 66% confirmed recurrence/new cancer. 3 microcalcifications were recalled and not biopsied, then subsequently determined to be a recurrence. The time interval for recurrence ranged from 1 to 12 years, with an average of 4.4 years. 74% recurred within 5 years. Of the 40 ipsilateral recurrences, 29 had DCIS with their original cancer and 26 had microcalcifications in their initial cancer.

Conclusion:

Our study proved that we perform well in the characterisation of mammographic calcifications in the treated breast. Biopsy rates were appropriate as a large percentage confirmed histological recurrence. Reassuringly, only 3 recurrences were missed (0.02% of all recalls). The presence of DCIS and calcifications in the original cancer increased the risk of recurrence. 25% of recurrences and new cancers were beyond 5 years of follow-up, suggesting that our health board’s protocol of following up treated breast cancer for 10 years is appropriate.

Limitations:

Data regarding previous mammogram/pathology results were not available for patients who were treated prior to electronic records. The record recalled patients is maintained manually by a mammographer and may not include all patients in the program.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

The Brevera breast biopsy device provides real-time visualisation of representative calcifications during biopsy potentially, allowing fewer samples, minimising trauma, and ensuring the accuracy of the biopsy. This study examines how many sequential specimens containing calcifications are required for accurate diagnosis.

Methods and materials:

A prospective study using tomosynthesis-guided 9 gauge vacuum biopsy (VAB) of screen-detected microcalcifications with realtime imaging of specimen radiograph. A minimum of 12 samples or more until representative calcifications were obtained. Sequential imaging of breast specimens was correlated with the histological assessment for the presence of calcifications and pathology. Final correlation with any lesions undergoing vacuum excision for B3 (high-risk lesions) or surgery.

Results:

157 VABB were performed on 155 patients with calcifications ranging from 2-120 mm (mean 16.3 mm) with pathological calcifications confirmed in 152 (96.8%). 82 (52.2%) were benign, 20 (12.7%) B3 (high risk), 3 suspicious (1.9%), and 47 (29.9%) malignant. 43% of calcifications were obtained on the first specimen. For benign lesions, there was a 85% accuracy on the first positive specimen and 100% by the fourth. For DCIS, the diagnosis was obtained on the first positive specimen in 92% and 100% by the fourth. Three lesions (1 B3 and 1 B4) were upgraded to DCIS on vacuum excision. 10 DCIS were upgraded to the invasive disease at surgery in spite of representative calcifications in 3-7 specimens.

Conclusion:

Realtime sequential visualisation of confirmed representative calcifications can reduce the number of samples required during biopsy. Lesions containing calcifications can be confidently diagnosed when 4 specimens containing calcifications are obtained. Careful correlation with direct histological analysis in the multidisciplinary meeting is required. Underestimation of invasive malignancy can still occur.

Limitations:

Single institution. Ongoing to accrue numbers.

Ethics committee approval

n/a

Funding:

Loan of equipment.

Purpose:

To determinate the prevalence, pathological significance, and risk factors associated with papillary lesions when solitary dilated duct is visualised at mammography.

Methods and materials:

Prospectively evaluation of consecutive mammography was performed in a specialised breast cancer control centre, in accordance with local ethical approval. Patients that presented solitary dilated duct at mammography were later evaluated with ultrasonography (US). Cases that exhibited intraductal components were submitted to percutaneous biopsy, following anatomopathological correlation.

Results:

In the period from March 17, 2016, to March 10, 2017, 9,035 mammographic exams were included, 8,125 (90%) representing screening and 910 (10%) diagnostic exams. The mammographic study identified 135 solitary dilated duct (SDD) cases (1.49%) and 94 (1.04%) of them followed US evaluation. Percutaneous and/or surgical biopsy were performed in all 24 cases with intraductal components and it revealed 8 papilloma lesions: 6 papillomas, one papillary lesion, and one sclerosing papilloma. Association with pathological papilloma findings with statistical significance (p< 0.05) using Chi Quadrado were menopause, parity, papillary discharge, breast density category (a) entirely fatty and (b) there are scattered areas of fibroglandular, microcalcifications on mammogram, and mass on ultrasound.

Conclusion:

Solitary dilated duct findings without other suspicious signs at mammography benefits from US analysis for intraductal content’s evaluation, which often represents benign findings. When associated with intraductal mass, biopsy should be considered and the expected result should be papilloma.

Limitations:

The limitation was the 32 cases in which it was not possible to perform a complementary study of US.

Ethics committee approval

This paper had the local ethical committee approval and all participants provided written informed consent.

Funding:

No funding was received for this work.

Purpose:

To evaluate the role of contrast-enhanced digital mammography (CEDM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the management of lesions of uncertain malignant potential (B3).

Methods and materials:

We screened 374 women with histological diagnosis of B3 from July 2016 to December 2018, who underwent open excision (OE), vacuum-assisted excision (VAE), or with proof of stability on follow-up. We retrospectively included 252 patients who performed CEDM or DCE-MRI within 30 days before or after a biopsy. Positive predictive values (PPV) and negative predictive values (NPV) of B3 malignancy of the different contrast-enhanced imaging techniques were calculated. Fisher’s exact test was used to compare CEDM and DCE-MRI groups. Contrast-enhanced imaging concordance was evaluated for B3 lesions, which underwent both techniques.

Results:

189 (75.0%) patients performed CEDM, 75 (29.8%) DCE-MRI, and 17 (6.7%) both. Out of 123 B3 enhancing on CEDM, 34 (27.6%) resulted in cancers (19 carcinomas in situ, 15 invasive), while out of 53 B3 enhancing onDCE-MRI, 24 (45.3%) resulted in cancers (17 carcinomas in situ, 7 invasive). Sensitivity and NPV of CEDM and DCE-MRI were 100%, specificity was 42.6% vs 43.1%, while accuracy was 52.9% vs 61.3%, respectively. In 11 lesions studied with both techniques, concordance was 100%.

Conclusion:

Our results showed that contrast-enhanced imaging is a fundamental tool in B3 management with the high negative predictive value of malignancy since no upgraded B3 lesion showed enhancement. No differences between CEDM and DCE-MRI were found in the group which underwent both techniques.

Limitations:

Restrospective study. Not every patient had undergone the two contrast-enhanced imaging techinques. Small sample of study.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To compare clinical and biological features and prognosis of screen detected and clinically detected breast cancers in women aged 50 to 68 years.

Methods and materials:

We collected the mammograms and clinical data of 825 patients diagnosed with the invasive breast cancer for the first time in Tampere between 2006 and 2014. Of these, 572 cancers were found by screening mammography (69%), 171 cancers were diagnosed between the screening rounds (21%), and 82 cancers were found in women who had not participated in the screening program (10%).

Results:

Of all cancers, 96 were HER2+ (12%) and 47 TN (6%). Majority of HER2+ (59%) and of TN breast cancers (57%) were found by screening.

Screen-detected tumours of HER2+ and TN subtype were smaller and less frequently node positive than those clinically detected. Of HER2+ cancers found by screening, T1 cancers were 79% and N0 81%, and TN cancers were T1 81% and N0 64%. Outside of the screening, these percentages were clearly smaller. During the follow-up (average 7.3 years), distant metastases appeared in screen-detected HER2+ cancers for only 4% of patients and TN cancers for 7% of patients. When in interval and not participation groups, the amounts were evidently larger.

Conclusion:

A significant number of HER2+ and TN cancers are found by mammography screening. Despite the fact that HER2+ and TN cancers are considered to be clinically aggressive, the screening showed that their prognosis in this data is very good and clearly better than the cancers found between the screening rounds.

Limitations:

The evaluation is based on the results of a single screening unit and the number of cases is not very large.

Ethics committee approval

Approved by the ethics committee.

Funding:

Supported by Eka Grant of The Finnish Medical Foundation.

Purpose:

To investigate the predictive role of peritumoural oedema assessed at MRI T2-STIR sequences in patients with invasive breast cancer considering disease free-survival and overall survival time.

Methods and materials:

We conducted a retrospective study on 107 patients (mean age: 53 years) with biopsy-proven invasive breast cancers, who underwent preoperative breast MRI on 1.5 T scanner from January 2010 to July 2011. Images were reviewed by two radiologists in consensus, assessing peritumoural oedema on the basis of the degree of the signal intensity surrounding the tumour on T2-STIR images. The MRI protocol included pre-contrast T2-STIR images, DWI, and dynamic GRE T1 images before and after contrast injection, also with the subtraction technique. We categorised patients into two main groups according to the presence or absence of peritumoural oedema on T2-STIR sequences. We retrospectively collected other lesions characteristics, such as size, histology, molecular pattern, absence/presence of positive lymph nodes, and type of surgery. Statistical analysis was performed to assess the disease-free survival and overall survival using the Kaplan-Meier curves.

Results:

The median follow-up of patients included in the study was 7.7 ± 1.3 years. Based on MRI findings, peritumoural oedema was found on 52 among 107 lesions (48.9%). In this group, recurrence occurred in 9 patients, while in the second group (absence of peritumoural oedema) in 4 patients. Disease-free survival according to Kaplan-Meier test did not statistically differ between the two groups (p=0.11). In the peritumoural oedema group, overall survival time was statistically (p=0.045) lower compared to the other group.

Conclusion:

The presence of peritumoural oedema detected on MRI T2-STIR sequences could be considered as a valid ancillary feature of predictability of worse survival outcome.

Limitations:

Small sample, monocentric study.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

This study focused on women with previously treated breast cancer who were recalled for further imaging due to microcalcifications. We aimed to determine our ability to characterise these; which factors increased risk of recurrence, timeframe of recurrence, and results of biopsies.

Methods and materials:

Data was collected for patients recalled between June 2013 and February 2019, specifically time interval, original diagnosis, original mammographic appearance, and the outcome of recall.

Results:

194 women were recalled for microcalcifications for further views +/ biopsy. 126 were for ipsilateral to the original cancer, 66 contralateral, and 2 bilateral. 104 (54%) underwent biopsies, the remainder were considered benign. 66% confirmed recurrence/new cancer. 3 microcalcifications were recalled and not biopsied, then subsequently determined to be a recurrence. The time interval for recurrence ranged from 1 to 12 years, with an average of 4.4 years. 74% recurred within 5 years. Of the 40 ipsilateral recurrences, 29 had DCIS with their original cancer and 26 had microcalcifications in their initial cancer.

Conclusion:

Our study proved that we perform well in the characterisation of mammographic calcifications in the treated breast. Biopsy rates were appropriate as a large percentage confirmed histological recurrence. Reassuringly, only 3 recurrences were missed (0.02% of all recalls). The presence of DCIS and calcifications in the original cancer increased the risk of recurrence. 25% of recurrences and new cancers were beyond 5 years of follow-up, suggesting that our health board’s protocol of following up treated breast cancer for 10 years is appropriate.

Limitations:

Data regarding previous mammogram/pathology results were not available for patients who were treated prior to electronic records. The record recalled patients is maintained manually by a mammographer and may not include all patients in the program.

Ethics committee approval

n/a

Funding:

No funding was received for this work.