Assessment of Functional Differences in Malignant and Benign Breast Lesions and Improvement of Diagnostic Accuracy by Using US-guided Diffuse Optical Tomography in Conjunction with Conventional US

Abstract

Purpose To investigate ultrasonography (US)-guided diffuse optical tomography to distinguish the functional differences of hemoglobin concentrations in a wide range of malignant and benign breast lesions and to improve breast cancer diagnosis in conjunction with conventional US. Materials and Methods The study protocol was approved by the institutional review boards and was HIPAA compliant. Written informed consent was obtained from all patients. Patients (288 women; mean age, 50 years; range, 17-94 years) who underwent US-guided biopsy were imaged with a handheld US and optical probe. The US-imaged lesion was used to guide reconstruction of light absorption maps at four wavelengths, and total hemoglobin (tHb), oxygenated hemoglobin (oxyHb), and deoxygenated hemoglobin (deoxyHb) were computed from the absorption maps. A threshold (80 μmol/L) was chosen on the basis of this study population. Two radiologists retrospectively evaluated US images on the basis of the US Breast Imaging Reporting and Data System lexicon, and a lesion was considered malignant when a score of 4C or 5 was given or a lesion had tHb greater than 80 μmol/L. A two-sample t test was used to calculate significance between groups, and Spearman ρ was computed between hemoglobin parameters and tumor pathologic grades. Results Three tumors were Tis, 37 were T1, 19 were T2-T4 carcinomas, and 233 were benign lesions. The mean maximum tHb, oxyHb, and deoxyHb of Tis-T1 and T2-T4 groups were 89.3 μmol/L ± 20.2 (standard deviation), 65.0 μmol/L ± 20.8, and 33.5 μmol/L ± 11.3, respectively, and 84.7 μmol/L ± 32.8, 57.1 μmol/L ± 19.8, and 34.7 μmol/L ± 18.9, respectively. The corresponding values of benign lesions were 54.1 μmol/L ± 23.5, 38.0 μmol/L ± 17.4, and 25.2 μmol/L ± 13.8, respectively. The mean maximum tHb, oxyHb, and deoxyHb were significantly higher in the malignant groups than the benign group (P <.001, <.001, and .041, respectively). For malignant lesions, the mean maximum tHb moderately correlated with tumor histologic grade and nuclear grade (ρ = 0.283 and 0.315, respectively). The mean maximum oxyHb moderately correlated with tumor nuclear grade (ρ = 0.267). When radiologists' US diagnosis and the tHb were used together, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.6%-100%, 77.3%-83.3%, 52.7%-59.4%, and 99.0%-100%, respectively, for the combined malignant group. Conclusion The tHb and oxyHb correlate with breast cancer pathologic grade and can be used as an adjunct to US to improve sensitivity and negative predictive value in breast cancer diagnosis. (©) RSNA, 2016 Online supplemental material is available for this article.

Diffuse optical tomography reconstruction method using ultrasound images as prior for regularization matrix

“…We further compared these two methods to the US-guided dual-zone mesh method developed by our group and successfully used to characterize malignant and benign lesions of more than 400 patient data. [29][30][31] In single-target phantom experiments, applying US prior provides more accurate absorption coefficient of the targets and good agreement with results obtained from US-guided dualzone mesh method. Furthermore, the reconstructed target shape (for both the high and the low contrast targets) is closer to the original spherical target shape.…”

A Pivotal Study of Optoacoustic Imaging to Diagnose Benign and Malignant Breast Masses: A New Evaluation Tool for Radiologists

“…In brief, the first-generation OA/US device utilizes a single handheld duplex probe that functions both as a standalone grayscale US transducer and as a duplex optoacoustic imaging device. earlier techniques variably reported as optoacoustic tomography, photoacoustic mammography, and photoacoustic imaging, has achieved translational status from preclinical research in phantoms and animal models to clinical trials (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Clinical studies using human prototype systems have validated the feasibility of optoacoustic technology to detect molecular constituents of breast tissue including endogenous constituents, like oxygenated and deoxygenated hemoglobin, that may facilitate distinction between benign and malignant tumors.…”

Diffuse optical tomography using semiautomated coregistered ultrasound measurements

“…These measurements could be effectively used to diagnose cancers versus benign lesions and monitor treatment response because malignant tumors typically have higher hemoglobin content as compared with benign lesions and the hemoglobin changes differ between treatment responders and nonresponders. [6][7][8][9][10] However, DOT suffers from intensive light scattering inside the tissue, and scattering causes uncertainty in reconstructed target location and inaccuracy of target quantification. These problems can be largely overcome using other imaging techniques to guide the DOT for localization and reconstruction.…”

“…These problems can be largely overcome using other imaging techniques to guide the DOT for localization and reconstruction. US, mammography, and MRI-guided DOT [10][11][12] have been investigated, and promising results have been reported. US-guided DOT has been developed by our group, and its utility in cancer diagnosis and treatment monitoring has been demonstrated from several clinical studies.…”

“…US-guided DOT has been developed by our group, and its utility in cancer diagnosis and treatment monitoring has been demonstrated from several clinical studies. 10,13,14 In the US-guided DOT approach, coregistered US images are captured and measurements of size and depth are then incorporated in DOT reconstruction as a region of interest (ROI). A dual-zone mesh image reconstruction 15 is used to segment the ROI and background region with fine and coarse mesh sizes.…”