Role of breast MRI in predicting histologic upgrade risks in high-risk breast lesions: A review

Li, Xue; Kim, Sun; Chai, Weimin; Zhu, Hong; Yan, Fuhua

doi:10.1016/j.ejrad.2021.109855

Cited by 7 publications

(18 citation statements)

References 54 publications

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“…Dynamic MRI has a high NPV in evaluating IDPLs, its specificity is low. Moreover, MRI is expensive and requires injection of contrast material 39 . Although contrast‐enhanced US is offered as an alternative method in evaluating vascularization, intravenous contrast material administration and its relatively invasive nature make it difficult to use in daily practice, just like MRI 48 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, targeting of small IDPLs may be difficult, and false‐negative results are possible 10,37 . The upgrade rate of papillary lesions that undergo surgery after core biopsy has been reported to be between 0 and 33% in various series 8–10,38–40 . This rate is around 9% if atypia is present and drops down to 5% when there is no atypia 9,38,39 .…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][38][39][40] This rate is around 9% if atypia is present and drops down to 5% when there is no atypia. 9,38,39 The low upgrade rate in papillomas without atypia raises the question of whether additional surgery is absolutely necessary for these lesions. 38,40 At this point, vacuum-assisted biopsy (under stereotaxy, US or magnetic resonance imaging [MRI] guidance) emerges as an alternative method to surgery, as it is less invasive and allows adequate sampling and even total excision.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, MRI is expensive and requires injection of contrast material. 39 Although contrastenhanced US is offered as an alternative method in evaluating vascularization, intravenous contrast material administration and its relatively invasive nature make it difficult to use in daily practice, just like MRI. 48 SMI is a relatively new modality that is an alternative to the methods mentioned above, as it is inexpensive, noninvasive, easy to apply, and provides quantitative data in the evaluation of vascular density.…”

Section: Discussionmentioning

confidence: 99%

“…10,37 The upgrade rate of papillary lesions that undergo surgery after core biopsy has been reported to be between 0 and 33% in various series. [8][9][10][38][39][40] This rate is around 9% if atypia is present and drops down to 5% when there is no atypia. 9,38,39 The low upgrade rate in papillomas without atypia raises the question of whether additional surgery is absolutely necessary for these lesions.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma‐Like Lesions

Kayadibi

Bulut

Kurt

et al. 2021

J of Ultrasound Medicine

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Objectives The aim of this study was to investigate the role of quantitative values obtained by superb microvascular imaging (SMI) and shearwave elastography (SWE) in the prediction of malignancy in intraductal papilloma‐like lesions (IDPL). Methods In the study, 61 patients between the ages of 14 to 73 years (mean age 44) diagnosed with IDPL on ultrasound (US) examination between the years 2020 and 2021 were included. The B‐Mode US findings (shape, margins, size, echo pattern, and accompanying ductal dilatation), SMI vascular index (SMIvi), E‐mean, and SWE‐ratio values were recorded. Results There was a statistically significant difference between malignant (n = 14) and benign (n = 47) groups in terms of symptoms (P = .005), size (P = .042), shape (P = .002), margins (P = .001), echogenicity (P = .023), microcalcifications (P = .009), SMIvi (P = .031), E‐mean (P < .005), and SWE‐ratio (P = .007). According to receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, accuracy, area under the curve (AUC), positive predictive values (PPV), and negative predictive values (NPV) were 57.1%, 87.2%, 80%, 0.722, 57.1%, 87.2% for US; 71.4%, 49%, 55.7%, 0.692, 30.3%, 85.7% for SMIvi; 85.7%, 71%, 74%, 0.864, 46%, 94.3% for E‐mean, and 50%, 75.4%, 83%, 0.707, 91.5%, and 50% for SWE‐ratio, respectively. Best results were obtained when SMI and SWE values were used together, achieving a sensitivity, specificity, accuracy, AUC, PPD, NPD of 78.6%, 93.6%, 93.4%, 0.872, 91.7%, and 93.9%, respectively. Conclusions The SMI and SWE examinations are successful in the differentiation of benign and malignant intraductal lesions. They complement each other and contribute to B‐mode US in managing IDPLs especially when used together. Our study is the first to compare the quantitative data of SWE and SMI in the differentiation of IDPLs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma‐Like Lesions

Kayadibi

Bulut

Kurt

et al. 2021

J of Ultrasound Medicine

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Evaluating Upstaging in Ductal Carcinoma In Situ Using Preoperative MRI‐Based Radiomics

Hong

Fan

et al. 2022

Magnetic Resonance Imaging

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Background: About 20%-40% of patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) will develop invasive cancer at the time of excision. Improving the preoperative diagnosis of DCIS is important for surgical planning. Purpose: To establish an MRI-based radiomics nomogram for preoperatively evaluating the upstaging of DCIS patients and help with risk stratification. Study Type: Retrospective. Population: A total of 227 patients (50.5 AE 9.7 years; 67 upstaged DCIS) were divided into training (n = 109), internal (n = 47), and external (n = 71) validation cohort. Field Strength/Sequence: 1.5-T or 3-T, dynamic contrast-enhanced (DCE) imaging, and diffusion-weighted imaging (DWI). Assessment: DCIS lesions were manually segmented using ITK-SNAP software and 1304 radiomic features were extracted from DCE, DWI, and apparent diffusion coef-ficient (ADC) maps, respectively. A radscore was calculated by a random forest algo-rithm based on DCIS upstaging-related radiomic features, which selected by a coarse-to-fine method including interclass correlation coefficient, single-factor anal-ysis, and the least absolute shrinkage and selection operator (LASSO) method. Uni-variate and multivariate logistic regression was used to analyze the independent risk factors, including age, location, lesion size, estrogen receptor (ER) status, and other clinico-pathologic factors. Finally, Mann-Whitney U tests were performed to com-pare the differences in radscore between low/intermediate and high nuclear grade groups for pure DCIS patients. Statistical Tests: Student's t-tests or Mann-Whitney U tests, chi-square-tests, or Fisher's-tests, univariate and multivariate logistic regression analysis, calibration curve, Youden index, the area under the curve (AUC), Delong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses. Results: Eight important radiomic features (two from ADC, three from DWI, and three from DCE) were selected for calculating radscore. Clinical model including age and ER was established with AUCs of 0.747 and 0.738 in the internal and external validation cohorts, respectively. A combined model integrating age, estrogen receptor (ER), and radscore were also constructed with AUCs of 0.887 and 0.881. Further subgroup analysis showed that pure DCIS patients with different nuclear grade have significant differences in radscore. Data Conclusion: Multisequence MRI radiomics may preoperatively evaluate the upstaging of DCIS and might provide personalized image-based clinical decision support. Evidence Level: 4. Technical Efficacy: Stage 2.

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Is simultaneous multi-slice readout-segmented echo-planar imaging valuable for predicting molecular subtypes of breast cancer?

Zhu

Kim

et al. 2022

European Journal of Radiology

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Role of breast MRI in predicting histologic upgrade risks in high-risk breast lesions: A review

Cited by 7 publications

References 54 publications

The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma‐Like Lesions

The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma‐Like Lesions

Evaluating Upstaging in Ductal Carcinoma In Situ Using Preoperative MRI‐Based Radiomics

Is simultaneous multi-slice readout-segmented echo-planar imaging valuable for predicting molecular subtypes of breast cancer?

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