Purpose: Conventional breast MRI is highly sensitive for cancer detection but prompts some false-positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion weighted imaging (DWI) can decrease MRI false-positives. Experimental Design: 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. Receiver operating characteristic (ROC) analysis was employed to assess diagnostic performance of centrally-measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. Results: Of 107 women enrolled, 67 patients (median age 49, range 24–75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. 67/81 lesions were BI-RADS 4 (n=63) or 5 (n=4) and recommended for biopsy. Malignancies exhibited lower mean centrally-measured ADCs (mm2/s) than benign lesions (1.21×10−3 vs.1.47×10−3, p<0.0001, area under ROC curve=0.75, 95% confidence interval [CI] 0.65–0.84). In centralized analysis, application of an ADC threshold (1.53×10−3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI 11.2–31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68×10−3mm2/s) to site-derived ADCs reduced the biopsy rate by 26.2%(16/61) but missed three cancers. Conclusion: DWI can re-classify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future Phase III studies.

The purpose of this study was to systematically review recent literature on diagnostic performance of strain ratio and length ratio, two different strain measurements in ultrasound elastography, for differentiating benign and malignant breast masses. A literature search of PubMed and other medical and general purpose databases from inception through January 2012 was conducted. Published studies that evaluated the diagnostic performance of ultrasound elastography alone reporting either strain ratio or length ratio for characterization of focal breast lesions and using cytology (fine needle aspiration) or histology (core biopsy) as a reference standard were included. Summary diagnostic performance measures were assessed using bivariate generalized linear mixed modeling. Nine studies reported strain ratio for 2,087 breast masses (667 cancers, 1,420 benign lesions). Summary sensitivity and specificity were 88 % (95 % Credible Interval (CrI), 84-91 %), and 83 % (95 % CrI, 78-88 %), respectively. The positive and negative likelihood ratios (LR) were 5.57 (95 % CrI, 3.85-8.01) and 0.14 (95 % CrI, 0.09-0.20), respectively. The inconsistency index for heterogeneity was 6 % (95 % CrI, 1-22 %) for sensitivity and 8 % (95 % CrI, 3-24 %) for specificity. Analysis of three studies reporting length ratio for 450 breast masses demonstrated sensitivity and specificity of 98 % (95 % CrI, 93-99 %) and 72 % (95 % CrI, 31-96 %), respectively. Strain ratio and length ratio have good diagnostic performance for distinguishing benign from malignant breast masses. Although, this performance may not be incrementally superior to that of breast imaging reporting and data system (BIRADS) in B-mode ultrasound, the application of USE using strain ratio or length ratio in combination with USB may have the potential to benefit the patients, and this requires further comparative effectiveness and cost-effectiveness analyses.

All fluid collections (21/21) were located between the deep fat and fascia, with a shape that was fusiform in 12 (60%) of 20, flat in 5 (25%), and lobular in 3 (15%) (shape not determined in 1 case). Regarding echogenicity, 15 (71%) of the 21 collections were hypoechoic, and 6 (29%) were anechoic; 13 (62%) were heterogeneous, and 8 (38%) were homogeneous. The lobular fluid collections were all less than 2 weeks of age, and the flat fluid collections were all greater than 6 months of age. All homogeneous fluid collections were greater than 8 months of age. There was no relationship between the age of a fluid collection and its echogenicity. Conclusions. Morel-Lavallée lesions had a variable appearance, being more homogeneous and flat or fusiform in shape with a well-defined margin as the lesions aged. All Morel-Lavallée lesions were hypoechoic or anechoic, compressible, and located between the deep fat and overlying fascia.

There has been controversy regarding the accuracy of breast ultrasound elastography (USE) compared to conventional B-mode Ultrasound (USB). The purpose of this study was to conduct a direct comparative effectiveness analysis of USB versus USE or their combination in differentiating breast lesions through systematically reviewing recent literature. An extensive literature search of PubMed and other medical and general purpose databases from inception through August 2011 was conducted. Published studies that reported a direct comparison of the diagnostic performance of USE, using elasticity score versus USB, using breast imaging reporting and data system (BIRADS) for characterization of focal breast lesions were included. Summary diagnostic performance measures were assessed for each of the tests and their combination using bivariate generalized linear mixed modeling. The two tests were combined as: (1) conjunctive, where the outcome of the combination of tests is positive only if both test results are positive; (2) disjunctive, where the outcome of a combination of tests is negative only if both tests are negative. Twenty nine studies provided relevant information on 5,511 breast masses (2,065 cancers, 3,446 benign lesions). Sensitivity of USB, USE, and their conjunctive and disjunctive combinations were 96% (95% credible interval (CrI), 93-98%), 79% (95% CrI, 74-83%), 73% (95% CrI, 67-78%), and 99% (95% CrI, 98-99%), respectively. Specificity of USB, USE, and their conjunctive and disjunctive combinations were 70% (95% CrI, 55-83%), 88% (95% CrI, 82-92%), 97% (95% CrI, 95-99%), and 56% (95% CrI, 43-69%), respectively. The application of USE as a single test is not superior to USB alone. However, in low risk patients it is recommended to perform an USE following a positive USB result to decrease the rate of unnecessary biopsies.

Preoperative axillary US excluded 96% of N2 and N3 invasive ductal metastases. The false-negative rate for N2 and N3 invasive lobular cancer was significantly higher than that for invasive ductal cancer, which suggests that axillary US cannot be used to exclude N2 and N3 metastases in these patients.

PurposeTo evaluate diffusion weighted MRI (DW-MR) as a response metric for assessment of neoadjuvant chemotherapy (NAC) in patients with primary breast cancer using prospective multi-center trials which provided MR scans along with clinical outcome information.Materials and MethodsA total of 39 patients with locally advanced breast cancer accrued from three different prospective clinical trials underwent DW-MR examination prior to and at 3–7 days (Hull University), 8–11 days (University of Michigan) and 35 days (NeoCOMICE) post-treatment initiation. Thirteen patients, 12 of which participated in treatment response study, from UM underwent short interval (<1hr) MRI examinations, referred to as “test-retest” for examination of repeatability. To further evaluate stability in ADC measurements, a thermally controlled diffusion phantom was used to assess repeatability of diffusion measurements. MRI sequences included contrast-enhanced T1-weighted, when appropriate, and DW images acquired at b-values of 0 and 800 s/mm2. Histogram analysis and a voxel-based analytical technique, the Parametric Response Map (PRM), were used to derive diffusion response metrics for assessment of treatment response prediction.ResultsMean tumor apparent diffusion coefficient (ADC) values generated from patient test-retest examinations were found to be very reproducible (|ΔADC|<0.1x10-3mm2/s). This data was used to calculate the 95% CI from the linear fit of tumor voxel ADC pairs of co-registered examinations (±0.45x10-3mm2/s) for PRM analysis of treatment response. Receiver operating characteristic analysis identified the PRM metric to be predictive of outcome at the 8–11 (AUC = 0.964, p = 0.01) and 35 day (AUC = 0.770, p = 0.05) time points (p<.05) while whole-tumor ADC changes where significant at the later 35 day time interval (AUC = 0.825, p = 0.02).ConclusionThis study demonstrates the feasibility of performing a prospective analysis of DW-MRI as a predictive biomarker of NAC in breast cancer patients. In addition, we provide experimental evidence supporting the use of sensitive analytical tools, such as PRM, for evaluating ADC measurements.

With imaging that did not include x-ray source motion or patient motion during acquisition of the projection views, narrow-angle DBT digital breast tomosynthesis provided higher sensitivity and conspicuity than wide-angle DBT digital breast tomosynthesis for subtle microcalcification clusters.

The effect of acquisition geometry in digital breast tomosynthesis (DBT) was evaluated with studies of contrast-to-noise ratios (CNRs) and observer preference. Contrast-detail (CD) test objects in 5 cm thick phantoms with breast-like backgrounds were imaged. Twelve different angular acquisitions (average glandular dose for each ~1.1 mGy) were performed ranging from narrow angle 16° with 17 projection views (16d17p) to wide angle 64d17p. Focal slices of SART-reconstructed images of the CD arrays were selected for CNR computations and the reader preference study. For the latter, pairs of images obtained with different acquisition geometries were randomized and scored by 7 trained readers. The total scores for all images and readings for each acquisition geometry were compared as were the CNRs. In general, readers preferred images acquired with wide angle as opposed to narrow angle geometries. The mean percent preferred was highly correlated with tomosynthesis angle (R=0.91). The highest scoring geometries were 60d21p (95%), 64d17p (80%), and 48d17p (72%); the lowest scoring were 16d17p (4%), 24d9p (17%) and 24d13p (33%). The measured CNRs for the various acquisitions showed much overlap but were overall highest for wide-angle acquisitions. Finally, the mean reader scores were well correlated with the mean CNRs (R=0.83).