Contrast-enhanced Dedicated Breast CT: Initial Clinical Experience

Contrast-enhanced Dedicated Breast CT: Initial Clinical Experience
Nicolas D. Prionas, Karen K. Lindfors, Shonket Ray, Shih-Ying Huang, Laurel A. Beckett, Wayne L. Monsky, and John M. Boone
Radiology 2010;256 714-723

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Conspicuity of malignant breast masses at contrast-enhanced breast CT is significantly better than that at mammography or unenhanced breast CT, whereas conspicuity of lesions associated with malignant calcifications is better at contrast-enhanced breast CT than at unenhanced breast CT and is similar at contrast-enhanced breast CT and mammography

Learning Points:

Malignant mass lesions are significantly more conspicuous than benign lesions at contrast-enhanced dedicated breast CT when compared with mammography and unenhanced breast CT (P < .001 for each comparison).

Visualization of malignant calcifications (malignant lesions manifested mammographically as microcalcifications only) at contrast-enhanced breast CT is improved over that at unenhanced breast CT (P < .001) and is similar to that at mammography (P = .64).

Malignant breast lesions enhance by a mean of 38 HU more than do benign lesions (P < .001), and receiver operating characteristic curve analysis yields an area under the receiver operating characteristic curve of 0.876

Mammographic Features of Breast Cancers at Single Reading with Computer-aided Detection and at Double Reading in a Large Multicenter Prospective Trial of Computer-aided Detection: CADET II

Mammographic Features of Breast Cancers at Single Reading with Computer-aided Detection and at Double Reading in a Large Multicenter Prospective Trial of Computer-aided Detection: CADET II
Jonathan J. James, Fiona J. Gilbert, Matthew G. Wallis, Maureen G. C. Gillan, Susan M. Astley, Caroline R. M. Boggis, Olorunsola F. Agbaje, Adam R. Brentnall, and Stephen W. Duffy
Radiology 2010;256 379-386

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Purpose: To evaluate the mammographic features of breast cancer that favor lesion detection with single reading and computer-aided detection (CAD) or with double reading

Results: A total of 227 cancers were detected in 28 204 women. A total of 170 cases were recalled with both reading regimens. Lesion types were masses (66%), microcalcifications (25%), parenchymal deformities (6%), and asymmetric densities (3%). The ability of the reading regimens to correctly prompt the reader to recall cases varied significantly by lesion type (P < .001). More parenchymal deformities were recalled with double reading, whereas more asymmetric densities were recalled with single reading with CAD. There was no difference in the ability of either reading regimen to prompt the reader to correctly recall masses or microcalcifications. CAD correctly prompted 100% of microcalcifications, 87% of mass lesions, 80% of asymmetric densities, and 50% of parenchymal deformities. CAD correctly marked 93% of spiculated masses compared with 80% of ill-defined masses (P = .054). There was a significant trend for cancers detected with double reading to occur only in women with a denser mammographic background pattern (P = .02). Size had no effect on lesion detection.

Conclusion: Readers using either single reading with CAD or double reading need to be aware of the strengths and weaknesses of reading regimens to avoid missing the more challenging cancer cases

Early-Stage Invasive Breast Cancers: Potential Role of Optical Tomography with US Localization in Assisting Diagnosis

Early-Stage Invasive Breast Cancers: Potential Role of Optical Tomography with US Localization in Assisting Diagnosis
Quing Zhu, Poornima U. Hegde, Andrew Ricci, Jr, Mark Kane, Edward B. Cronin, Yasaman Ardeshirpour, Chen Xu, Andres Aguirre, Scott H. Kurtzman, Peter J. Deckers, and Susan H. Tannenbaum
Radiology 2010;256 367-378

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Purpose: To investigate the potential role of optical tomography in the near-infrared (NIR) spectrum with ultrasonographic (US) localization as a means of differentiating early-stage cancers from benign lesions of the breast. 

We showed that intrinsic angiogenesis (tHb - total hemoglobin concentration) contrast imaged by using the NIR technique with US holds promise as an adjunct to mammography and US for distinguishing early-stage invasive breast cancers from benign lesions

Multiparametric Imaging of Tumor Response to Therapy

Multiparametric Imaging of Tumor Response to Therapy
Anwar R. Padhani and Kenneth A. Miles
Radiology 2010;256 348-364

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By combining quantitative biomarker data from a number of imaging techniques one may begin to understand how novel therapies affect tumor cells and tissue microenvironments

Time Trends in Radiologists’ Interpretive Performance at Screening Mammography from the Community-based Breast Cancer Surveillance Consortium, 1996–2004

Time Trends in Radiologists’ Interpretive Performance at Screening Mammography from the Community-based Breast Cancer Surveillance Consortium, 1996–2004
Laura E. Ichikawa, William E. Barlow, Melissa L. Anderson, Stephen H. Taplin, Berta M. Geller, R. James Brenner for the National Cancer Institute–sponsored Breast Cancer Surveillance Consortium
Radiology 2010;256 74-82

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We found an overall improvement in radiologists’ interpretive performance at subsequent screening mammography, 1996–2004, in a large national sample of women aged 40–79 years, with increases in both sensitivity and recall rate and a decrease in specificity

Recall rate and sensitivity for screening mammograms increased, whereas specificity decreased from 1996 to 2004 among women with a prior mammogram. This trend remained after accounting for risk factors. The net effect was an improvement in overall discrimination, a measure of the probability that a mammogram with cancer in the follow-up period has a higher Breast Imaging Reporting and Data System assessment category than does a mammogram without cancer in the follow-up period

Diffusion-weighted Imaging Improves the Diagnostic Accuracy of Conventional 3.0-T Breast MR Imaging

Diffusion-weighted Imaging Improves the Diagnostic Accuracy of Conventional 3.0-T Breast MR Imaging
Riham H. EI Khouli, Michael A. Jacobs, Sarah D. Mezban, Peng Huang, Ihab R. Kamel, Katarzyna J. Macura, and David A. Bluemke
Radiology 2010;256 64-73

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Adding quantitative diffusion-weighted imaging to the conventional MR imaging protocol resulted in significant diagnostic improvement.

DW imaging with glandular tissue–normalized ADC assessment improves the characterization of breast lesions beyond the characterization achieved with conventional 3D T1-weighted and dynamic contrast-enhanced MR imaging at 3.0 T

BI-RADS Data Should Not Be Used to Estimate ROC Curves

BI-RADS Data Should Not Be Used to Estimate ROC Curves
Yulei Jiang and Charles E. Metz
Radiology 2010;256 29-31

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After applauding the recent trend of employing receiver operating characteristic (ROC) analysis to measure diagnostic performance in large clinical studies, we discuss why Breast Imaging Reporting and Data System data should not be used to estimate ROC curves in screening mammography

However, to truly realize the benefit of this assessment method, one must estimate ROC curves appropriately, addressing additional issues that arise as ROC analysis migrates from the laboratory to the clinic. Hypothetical perturbation of results from a recent study indicates that BI-RADS data do not provide a reliable basis for estimating ROC curves in screening mammography. Although we appreciate the potential benefit of—and therefore, the motivation for—estimating ROC curves from existing clinical cases in which BI-RADS assessments are recorded, we must recommend caution until an approach is found that overcomes the problems we have identified here. Any future methodologic innovations in prospective clinical study design that will allow diagnostic confidence to be reported on a true ordinal scale without introducing additional bias are welcome and should be exploited to help address these problems