Characterization of Cystic Lesions by Spectral Mammography

Erhard, Klaus; Kilburn‐Toppin, Fleur; Willsher, Paula; Moa, Elin; Fredenberg, Erik; Wieberneit, Nataly; Buelow, Thomas; Wallis, Matthew

doi:10.1097/rli.0000000000000246

Cited by 17 publications

(36 citation statements)

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“…The present measurements on fresh tumour tissue showed a smaller, although still significant, difference compared to cyst fluid in terms of and . Hence, discrimination of these two tissue types in clinical practice may be more challenging than previously believed, but is still possible as also evidenced by a clinical pilot study conducted by Erhard et al (2016). Despite the large spread, no solid samples fall within the shaded region of the cyst distribution ( Figure 2), but 15 malignant samples (56% of the total number) overlap with the cyst distribution in terms of (Figure 2, area below the dotted line), and these samples would therefore be challenging to distinguish from cyst fluid.…”

Section: Discrimination Between Tissue Typesmentioning

confidence: 99%

Measurement of breast-tissue x-ray attenuation by spectral imaging: fresh and fixed normal and malignant tissue

Fredenberg¹,

Willsher²,

Moa³

et al. 2018

Phys. Med. Biol.

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Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. In mammography, measurement of breast density, dose estimation, and differentiation between cysts and solid tumours are example applications requiring accurate data on tissue attenuation. Published attenuation data are, however, sparse and cover a relatively wide range. To supplement available data we have previously measured the attenuation of cyst fluid and solid lesions using photon-counting spectral mammography. The present study aims to measure the attenuation of normal adipose and glandular tissue, and to measure the effect of formalin fixation, a major uncertainty in published data. A total of 27 tumour specimens, 7 fibro-glandular tissue specimens, and 15 adipose tissue specimens were included. Spectral (energy-resolved) images of the samples were acquired and the image signal was mapped to equivalent thicknesses of two known reference materials, from which x-ray attenuation as a function of energy can be derived. The spread in attenuation between samples was relatively large, partly because of natural variation. The variation of malignant and glandular tissue was similar, whereas that of adipose tissue was lower. Formalin fixation slightly altered the attenuation of malignant and glandular tissue, whereas the attenuation of adipose tissue was not significantly affected. The difference in attenuation between fresh tumour tissue and cyst fluid was smaller than has previously been measured for fixed tissue, but the difference was still significant and discrimination of these two tissue types is still possible. The difference between glandular and malignant tissue was close-to significant; it is reasonable to expect a significant difference with a larger set of samples. We believe that our studies have contributed to lower the overall uncertainty of breast tissue attenuation in the literature due to the relatively large sample sets, the novel measurement method, and by clarifying the difference between fresh and fixed tissue.

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Section: Discrimination Between Tissue Typesmentioning

confidence: 99%

Measurement of breast-tissue x-ray attenuation by spectral imaging: fresh and fixed normal and malignant tissue

Fredenberg¹,

Willsher²,

Moa³

et al. 2018

Phys. Med. Biol.

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“…Recent advances in spectral mammography based on energy-resolved photon-counting x-ray detectors provide unique advantages in measuring breast tissue properties without injection of a contrast agent. Previous studies have shown that breast imaging using a photon-counting detector can improve signal-to-noise ratio through energy weighting, [12][13][14][15] improve lesion conspicuity, 16 discriminate between solid and cystic masses using material decomposition algorithms, 17 and allow for accurate estimates of breast density. [18][19][20] Photon-counting detectors are able to count individual photons and sort them according to their energies with energy resolution of a few keV.…”

Section: Introductionmentioning

confidence: 99%

Investigating the feasibility of classifying breast microcalcifications using photon-counting spectral mammography: A simulation study

Ghammraoui

Glick

2017

Med. Phys.

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Simulation results indicated that photon-counting spectral mammography with dual energy material decomposition has the potential to be used as a non-invasive method for discrimination between Type I and Type II microcalcifications that can potentially improve early breast cancer diagnosis and reduce the number of negative breast biopsies. Additional studies using breast specimens and clinical data should be performed to further explore the feasibility of this approach.

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“…MI could be used alongside breast tomosynthesis as well as mammography, though the effects need to be investigated. Erhard et al investigated using spectral mammography to avoid recalls by distinguishing fluid-filled cysts from malignant lesions [24]. If all recalls of fluid-filled cysts could be avoided, the total decrease of recalls would be 20%, with less than one missed cancer per 625 correctly identified cysts.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning recall rates, the prospective studies show an increase, while the retrospective studies generally show a decrease [15–17, 19–22]. Spectral mammography is another alternative, with a recent study demonstrating its ability to distinguish between cystic and solid lesions [24]. …”

Section: Introductionmentioning

confidence: 99%

Can mechanical imaging increase the specificity of mammography screening?

et al. 2017

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ObjectivesThis study aimed to investigate the effects of adding adjunct mechanical imaging to mammography breast screening. We hypothesized that mechanical imaging could detect increased local pressure caused by both malignant and benign breast lesions and that a pressure threshold for malignancy could be established. The impact of this on breast screening was investigated with regard to reductions in recall and biopsy rates.Methods155 women recalled from breast screening were included in the study, which was approved by the regional ethical review board (dnr 2013/620). Mechanical imaging readings were acquired of the symptomatic breast. The relative mean pressure on the suspicious area (RMPA) was defined and a threshold for malignancy was established.ResultsBiopsy-proven invasive cancers had a median RMPA of 3.0 (interquartile range (IQR) = 3.7), significantly different from biopsy-proven benign at 1.3 (IQR = 1.0) and non-biopsied cases at 1.0 (IQR = 1.3) (P < 0.001). The lowest RMPA for invasive cancer was 1.4, with 23 biopsy-proven benign and 33 non-biopsied cases being below this limit. Had these women not been recalled, recall rates would have been reduced by 36% and biopsy rates by 32%.ConclusionsIf implemented in a screening situation, this may substantially lower the number of false positives.Key Points• Mechanical imaging is used as an adjunct to mammography in breast screening. • A threshold pressure can be established for malignant breast cancer. • Recalls and biopsies can be substantially reduced.

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Characterization of Cystic Lesions by Spectral Mammography

Cited by 17 publications

References 0 publications

Measurement of breast-tissue x-ray attenuation by spectral imaging: fresh and fixed normal and malignant tissue

Measurement of breast-tissue x-ray attenuation by spectral imaging: fresh and fixed normal and malignant tissue

Investigating the feasibility of classifying breast microcalcifications using photon-counting spectral mammography: A simulation study

Can mechanical imaging increase the specificity of mammography screening?

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