Radioguided localisation of non-palpable lesions of the breast in Costa Rica: review of results of our first 800 patients in private practice.

PubMed

Aguilar, Marisel; Alfaro, Sabrina; Aguilar, Ricardo

2017-01-01

Surgical treatment of non-palpable breast lesions is controversial. At the European Institute of Oncology in Milan, Italy, Prof Umberto Veronesi introduced a new technique called the radioguided occult lesion localisation (ROLL) in 1996 to replace conventional methods and their disadvantages (Zurrida S, Galimberti V, and Monti S et al (1998) Radioguided localization of occult breast lesions Breast 7 11-13 https://doi.org/10.1016/S0960-9776(98)90044-3). Given the success experienced in that institution, the method became the technique of choice for the early diagnosis of breast cancer. In this paper, we will examine the technical aspects of ROLL and the results from a large series of patients treated in our private practice in Costa Rica. We analysed the first 816 patients with different non-palpable breast lesions detected by ultrasound or mammography within our private practice in Costa Rica. In 774 patients, technetium 99m labelled with human serum albumin (7-10 MBq) in 0.2 ml of saline solution was injected into the lesion under mammographic or ultrasound guidance. The excisional biopsy was done by means of a gamma-probe and complete excision of the lesion was verified by X-ray on the specimen in lesions that were visible by mammography and ultrasound 4 months after surgery. In the remaining 42 patients, the localisation of the lesion was carried out by wire. The tracer was correctly positioned in the first attempt in 772/816 (94.6%) of cases and in the second attempt in two other cases. In 42/816 (5.1%) cases, the localisation of the lesion had to be performed with the traditional method. X-rays showed that the lesion was entirely removed in 770/772 (99.74%) of cases. The ROLL is a simple and excellent option for the removal of hidden breast lesions in clinical practice. It offers the advantage of making resections safer and with tumour-free margins, in addition to reducing the number of reinterventions. Since it makes it possible to specify to the pathologist

Characterization of invisible breast cancers in digital mammography and tomosynthesis: radio-pathological correlation.

PubMed

Aguilar Angulo, P M; Romero Castellano, C; Ruiz Martín, J; Sánchez-Camacho González-Carrato, M P; Cruz Hernández, L M

To review the radio-pathologic features of symptomatic breast cancers not detected at digital mammography (DM) and digital breast tomosynthesis (DBT). Retrospective analysis of 169 lesions from symptomatic patients with breast cancer that were studied with DM, DBT, ultrasound (US) and magnetic resonance (MR). We identified occult lesions (true false negatives) in DM and DBT. Clinical data, density, US and MR findings were analyzed as well as histopathological results. We identified seven occult lesions in DM and DBT. 57% (4/7) of the lesions were identified in high-density breasts (type c and d), and the rest of them in breasts of density type b. Six carcinomas were identified at US and MR (BI-RADS 4 masses); the remaining lesion was only identified at MR. The tumor size was larger than 3cm at MRI in 57% of the lesions. All tumors were ductal infiltrating carcinomas, six of them with high stromal proportion. According to molecular classification, we found only one triple-negative breast cancer, the other lesions were luminal-type. We analyzed the tumor margins of two resected carcinomas that were not treated with neoadjuvant chemotherapy, both lesions presented margins that displaced the adjacent parenchyma without infiltrating it. Occult breast carcinomas in DM and DBT accounted for 4% of lesions detected in patients with symptoms. They were mostly masses, all of them presented the diagnosis of infiltrating ductal carcinoma (with predominance of the luminal immunophenotype) and were detected in breasts of density type b, c and d. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Supine breast US: how to correlate breast lesions from prone MRI.

PubMed

Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato A; Angelelli, Giuseppe; Moschetta, Marco

2016-01-01

To evaluate spatial displacement of breast lesions from prone MR to supine ultrasound positions, and to determine whether the degree of displacement may be associated with breast density and lesion histotype. 380 patients underwent breast MR and second-look ultrasound. The MR and ultrasound lesion location within the breast gland, distances from anatomical landmarks (nipple, skin and pectoral muscle), spatial displacement (distance differences from the landmarks within the same breast region) and region displacement (breast region change) were prospectively evaluated. Differences between MR and ultrasound measurements, association between the degree of spatial displacement and both breast density and lesion histotypes were calculated. In 290/380 (76%) patients, 300 MR lesions were detected. 285/300 (95%) lesions were recognized on ultrasound. By comparing MR and ultrasound, spatial displacement occurred in 183/285 (64.3%) cases while region displacement in 102/285 (35.7%) cases with a circumferential movement along an arc centred on the nipple, having supine ultrasound as the reference standard. A significant association between the degree of lesion displacement and breast density was found (p < 0.00001) with a significant higher displacement in case of fatty breasts. No significant association between the degree of displacement and lesion histotype was found (p = 0.1). Lesion spatial displacement from MRI to ultrasound may occur especially in adipose breasts. Lesion-nipple distance and circumferential displacement from the nipple need to be considered for ultrasound lesion detection. Second-look ultrasound breast lesion detection could be improved by calculating the lesion-nipple distance and considering that spatial displacement from MRI occurs with a circumferential movement along an arc centred on the nipple.

Supine breast US: how to correlate breast lesions from prone MRI

PubMed Central

Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato A; Angelelli, Giuseppe

2016-01-01

Objective: To evaluate spatial displacement of breast lesions from prone MR to supine ultrasound positions, and to determine whether the degree of displacement may be associated with breast density and lesion histotype. Methods: 380 patients underwent breast MR and second-look ultrasound. The MR and ultrasound lesion location within the breast gland, distances from anatomical landmarks (nipple, skin and pectoral muscle), spatial displacement (distance differences from the landmarks within the same breast region) and region displacement (breast region change) were prospectively evaluated. Differences between MR and ultrasound measurements, association between the degree of spatial displacement and both breast density and lesion histotypes were calculated. Results: In 290/380 (76%) patients, 300 MR lesions were detected. 285/300 (95%) lesions were recognized on ultrasound. By comparing MR and ultrasound, spatial displacement occurred in 183/285 (64.3%) cases while region displacement in 102/285 (35.7%) cases with a circumferential movement along an arc centred on the nipple, having supine ultrasound as the reference standard. A significant association between the degree of lesion displacement and breast density was found (p < 0.00001) with a significant higher displacement in case of fatty breasts. No significant association between the degree of displacement and lesion histotype was found (p = 0.1). Conclusion: Lesion spatial displacement from MRI to ultrasound may occur especially in adipose breasts. Lesion–nipple distance and circumferential displacement from the nipple need to be considered for ultrasound lesion detection. Advances in knowledge: Second-look ultrasound breast lesion detection could be improved by calculating the lesion–nipple distance and considering that spatial displacement from MRI occurs with a circumferential movement along an arc centred on the nipple. PMID:26689093

Analysis of brain and spinal cord lesions to occult brain damage in seropositive and seronegative neuromyelitis optica.

PubMed

Sun, Jie; Sun, Xianting; Zhang, Ningnannan; Wang, Qiuhui; Cai, Huanhuan; Qi, Yuan; Li, Ting; Qin, Wen; Yu, Chunshui

2017-09-01

According to aquaporin-4 antibody (AQP4-Ab), neuromyelitis optica (NMO) can be divided into seropositive and seronegative subgroups. The purpose of this study was to a) compare the distribution of spinal cord and brain magnetic resonance imaging (MRI) lesions between seropositive and seronegative NMO patients; b) explore occult brain damage in seropositive and seronegative NMO patients; and c) explore the contribution of visible lesions to occult grey and white matter damage in seropositive and seronegative NMO patients. Twenty-two AQP4-Ab seropositive and 14 seronegative NMO patients and 30 healthy controls were included in the study. Two neuroradiologists independently measured the brain lesion volume (BLV) and the length of spinal cord lesion (LSCL) and recorded the region of brain lesions. The normal-appearing grey matter volume (NAGM-GMV) and white matter fractional anisotropy (NAWM-FA) were calculated for each subject to evaluate occult brain damage. The seropositive patients displayed more extensive damage in the spinal cord than the seronegative patients, and the seronegative group had a higher proportion of patients with brainstem lesions (28.57%) than the seropositive group (4.55%, P=0.064). Both NMO subgroups exhibited reduced NAGM-GMV and NAWM-FA compared with the healthy controls. NAGM-GMV was negatively correlated with LSCL in the seropositive group (r s =-0.444, P=0.044) and with BLV in the seronegative group (r s =-0.768, P=0.002). NAWM-FA was also negatively correlated with BLV in the seropositive group (r s =-0.682, P<0.001). Our findings suggest that the occult brain damage in these two NMO subgroups may be due to different mechanisms, which need to be further clarified. Copyright © 2017 Elsevier B.V. All rights reserved.

Does pre-operative breast magnetic resonance imaging in addition to mammography and breast ultrasonography change the operative management of breast carcinoma?

PubMed

Lim, Hye In; Choi, Jae Hyuck; Yang, Jung-Hyun; Han, Boo-Kyung; Lee, Jeong Eon; Lee, Se-Kyung; Kim, Wan Wook; Kim, Sangmin; Kim, Jee Soo; Kim, Jung-Han; Choe, Jun-Ho; Cho, Eun Yoon; Kang, Seok Seon; Shin, Jung Hee; Ko, Eun Young; Kim, Sang Wook; Nam, Seok Jin

2010-01-01

Magnetic resonance imaging (MRI) has been used for the local staging of breast cancer, especially to determine the extent of multiple lesions and to identify occult malignancies. The aim of this study was to evaluate the effect of pre-operative MRI on the surgical treatment of breast cancer. Between January 2006 and May 2007, 535 newly diagnosed breast cancer patients who planned to undergo breast conserving surgery had clinical examinations, bilateral mammography, breast ultrasonography, and breast MRI. The radiologic findings and clinicopathologic data were reviewed retrospectively. Ninety-eight (18.3%) patients had additional lesions, shown as suspicious lesions on breast MRI, but not detected with conventional methods. Eighty-four (15.7%) of these patients had a change in surgical treatment plans based on the MRI results. Forty-seven (8.8%) of the 84 patients had additional malignancies;the other 37 patients (6.9%) had benign lesions. The positive predictive value for MRI-based surgery was 56.0% (47 of 84 patients). During the period of study, the use of pre-operative MRI was increased with time (OR 1.20; 95% CI 1.16-1.23; P < 0.001), but the mastectomy rate did not change significantly (OR 0.98; 95% CI 0.95-1.00; P = 0.059). Multiple factors were analyzed to identify the patients more likely to undergo appropriate and complete surgery based on the additional findings of the pre-operative MRI, but the results were not statistically significant. This research suggests that a pre-operative MRI can potentially lower the rate of incompletely excised malignancies by identifying additional occult cancer prior to surgery and does not lead to an increase in the mastectomy rate; however, because some benign lesions are indistinguishable from suspicious or malignant lesions, excessive surgical procedures are unnecessarily performed in a significant portion of patients. In the future, the criteria for the use of MRI in local staging of breast cancer should be established.

Factors affecting the palpability of breast lesion by self-examination.

PubMed

Lam, W W M; Chan, C P; Chan, C F; Mak, C C C; Chan, C F; Chong, K W H; Leung, M H J; Tang, M H

2008-03-01

This study aims to assess the accuracy of detection of breast lesion by breast self-examination and to assess different factors affecting the accuracy. All consecutive Chinese female patients, who attended our breast imaging unit in 2001, completed our questionnaire, had retrievable hard copy films, and had more than three years clinical follow-up, were recruited for this study. Different factors, such as age, menopausal status, previous experience of breastfeeding, family history of breast cancer, previous history of mastectomy or lumpectomy, hormonal therapy, oral contraceptive pills and previous history of mammography, were correlated with accuracy in self-detection of breast lesions retrospectively. The nature, size and location of the lesion, and breast size based on imaging, were also correlated with the accuracy in self-detection of breast lesions. A total of 163 questionnaires were analysed. 111 patients detected a breast lesion themselves and 24 of these lesions were false-positives. A total of 173 lesions (27 cancerous, 146 benign lesions) were documented by either ultrasonography and/or mammography, and confirmed by either histology or three-year clinical follow-up. The overall sensitivity in detecting both benign and malignant breast lesions was 71% when number of breast lesions was used as the denominator, and up to 78% sensitivity was achieved when number of patients was used as the denominator. History of mastectomy, and size and nature of the lesions were found to affect the accuracy of self-detection of breast lesions. Overall, breast self-examinations were effective in the detection of breast lesions and factors such as size of lesion, nature of the lesion and history of mastectomy affect the accuracy of the detections. Breast self-examination should be promoted for early detection of breast cancer.

Primary epidermoid carcinoma of the breast presenting as a breast abscess and sepsis.

PubMed

Damin, Andrea Pires; Nascimento, Fernanda Costa; Andreola, João Batista; Cerutti, Talita Haubert; Roehe, Adriana; Damin, Daniel Carvalho

2011-12-01

Squamous cell carcinoma (SCC) of the breast is an extremely rare form of cancer, accounting for approximately 0.04% of all malignant breast tumors. To date, only a limited number of cases of SCC of the breast have been reported, and most of them presented like the usual breast carcinomas. A 39-year-old woman presented with a large breast abscess and signs of sepsis. After surgical debridement of the lesion, histopathological examination of the abscess capsule revealed the presence of SCC of the breast. The definitive treatment for the tumor consisted of modified radical mastectomy with resection of the residual lesion in the right breast. This unusual case illustrates how an apparently benign disorder such as a breast abscess might be related to a clinically occult malignancy. A review of the literature on SCC of the breast is presented.

Fibroadenomatoid mastopathy: another distractive breast lesion?

PubMed

Tan, P E; Looi, L M

1991-12-01

Although most anatomical pathologists have encountered breast lesions with the composite histological features of fibroadenoma (FA) and fibrocystic change (FC), referred to as fibroadenomatosis or fibroadenomatoid mastopathy (FAM), little is known about its prevalence or clinico-pathological significance. In a retrospective histological review of 400 consecutive breast lesions, among both East and West Malaysians, coded either as FA or FC in the files of the Department of Pathology, University of Malaya, we found 45 (11.3%) cases of FAM. Typically, FAM lesions showed fibroadenomatoid foci in a background of fibrocystic change. The finding of FAM among lesions coded as FC was higher (18.5%) than among FA (4%). The mean age of patients with FAM (32.1 years) was similar to FC (35.1 years) but significantly older than that of FA (26.1 years). The notion that FA and FC are lesions at two ends of a spectrum of growth disorder of breast related to oestrogen-progesterone interplay, and that FAM occupies a position intermediate between the two, may explain its morphological and age patterns, but remains speculative. It is hoped that increasing awareness of this condition will lead to better understanding of breast pathophysiology. Nevertheless, until its biological nature, histogenesis and malignant potential are more clearly understood, defining FAM as a distinct form of breast disease may not be meaningful to patient management.

Neutrosophic segmentation of breast lesions for dedicated breast CT

NASA Astrophysics Data System (ADS)

Lee, Juhun; Nishikawa, Robert M.; Reiser, Ingrid; Boone, John M.

2017-03-01

We proposed the neutrosophic approach for segmenting breast lesions in breast Computer Tomography (bCT) images. The neutrosophic set (NS) considers the nature and properties of neutrality (or indeterminacy), which is neither true nor false. We considered the image noise as an indeterminate component, while treating the breast lesion and other breast areas as true and false components. We first transformed the image into the NS domain. Each voxel in the image can be described as its membership in True, Indeterminate, and False sets. Operations α-mean, β-enhancement, and γ-plateau iteratively smooth and contrast-enhance the image to reduce the noise level of the true set. Once the true image no longer changes, we applied one existing algorithm for bCT images, the RGI segmentation, on the resulting image to segment the breast lesions. We compared the segmentation performance of the proposed method (named as NS-RGI) to that of the regular RGI segmentation. We used a total of 122 breast lesions (44 benign, 78 malignant) of 123 non-contrasted bCT cases. We measured the segmentation performances of the NS-RGI and the RGI using the DICE coefficient. The average DICE value of the NS-RGI was 0.82 (STD: 0.09), while that of the RGI was 0.8 (STD: 0.12). The difference between the two DICE values was statistically significant (paired t test, p-value = 0.0007). We conducted a subsequent feature analysis on the resulting segmentations. The classifier performance for the NS-RGI (AUC = 0.8) improved over that of the RGI (AUC = 0.69, p-value = 0.006).

Localization techniques for guided surgical excision of non-palpable breast lesions.

PubMed

Chan, Benjamin K Y; Wiseberg-Firtell, Jill A; Jois, Ramesh H S; Jensen, Katrin; Audisio, Riccardo A

2015-12-31

Breast cancer is the most common form of cancer and the second leading cause of death amongst women in Europe. Amongst five invasive cancers per 1000 women detected in screening, 2.7 were < 15 mm in diameter; and others reported that over one third of excised breast lesions were clinically occult. The challenge is to accurately locate small non-palpable lesions intraoperatively for optimal therapeutic outcome. A secondary important goal is to remove the smallest amount possible of healthy glandular tissue for optimal cosmesis. Currently the most widely adopted approach (80% in one survey) in guided breast-conserving surgery for excising non-palpable breast lesions is wire-guided localization (WGL). With the clinical setting shifting towards earlier non-palpable breast lesions being detected through screening, we investigated whether the current standard in assisting surgical excision of these lesions, WGL, yields the best therapeutic outcome for women with breast cancer. To assess the therapeutic outcomes of any new form of guided surgical intervention for non-palpable breast lesions against wire-guided localization, the current gold standard. We searched the Cochrane Breast Cancer Group's (CBCG) Specialized Register, MEDLINE (via PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal from the earliest available date up to 30 March 2015. We also handsearched recent conference proceedings and sought information from experts in the field. Two review authors, BC and RJ, independently screened by title and abstract the studies we had identified through the search strategy; when this was inconclusive, they examined the full-text article for inclusion. We resolved any discrepancies regarding eligibility by discussion with a third review author, RA. Three review authors, BC, JW, and RJ, independently extracted data using a standardized data sheet

The breast lesion excision system (BLES) A preliminary experience.

PubMed

Citgez, Bulent; Atay, Murat; Yetkin, Gu Rkan; Kartal, Abdulcabbar; Mihmanli, Mehmet; Uludag, Mehmet

2016-01-01

BLES (Intact Breast lesion Excision System) is a new defined system which can remove the lesion completely. We aimed to evaluate and compare the results of BLES used for breast lesions requiring histological verification with other percutaneous biopsy methods in the literature. Patients with breast lesions smaller than 20mm and for whom biopsy was indicated were involved in the study. 18(1 male, 17 female, mean age: 41. 83, age range: 26-72) patients were included the study. BLES is applied with a single insertion. Radiofrequency is used to excise the breast tissue after the insertion. Around the lesion, tissue capture basket is moved back and forth. Once captured, the basket and the probe is removed from the incision area. All of the lesions were excised en-bloc. The only complication occured was subdermal hematoma in one case (5.5%) which resolved spontenously. Pathological analysis of the specimens revealed 9 fibroadenoma, 3 fibroadenomatosis hyperplasia, 3 complicated and calcified cysts, 1 ductal epithelial hyperplasia, 1 carcinoma in situ with intraductal papillary carcinoma focus and 1 ductal carcinoma in situ with 2 mm invasive carcinoma focus. The last two cases underwent resectıon and sentınal lymph node procedure. BLES is a is non-invasive method which has no need for additional initiatives in benign cases, provide sufficient samples for pathological diagnosis and remove the lesion in one piece. BLES method can be applied in selected cases. Breast Lesion Excision System, Breast, Biopsy, Radiofrequency, Lesion.

Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts.

PubMed

Corsetti, V; Ferrari, A; Ghirardi, M; Bergonzini, R; Bellarosa, S; Angelini, O; Bani, C; Ciatto, S

2006-04-01

The purpose of this study was to assess the usefulness of routine ultrasonography in women with negative mammography and dense breasts [Breast Imaging Reporting and Data System (BIRADS D3-4)]. We applied a protocol involving routine ultrasonography in a consecutive series of subjects with negative mammography and dense breasts. After evaluation by internal and external reviewers of cancers detected by ultrasonography performed to confirm negative mammography, we determined the additional cancer detection rate of ultrasonography and the cost of the protocol. Out of 17,883 total mammographies, 167 cancers were diagnosed (detection rate: 0.93%). Out of 257 suspicious mammographies, 138 cancers were detected. Out of 17,626 negative mammographies, 6,449 (36.5%) were classified as "dense breast" and underwent ultrasonography: 29 cancers were detected (detection rate: 0.44%, or 17.3% of total cancers). Out of 25 cancer cases reviewed, negative mammography and asymptomatic status was confirmed in 15 (detection rate 0.23%, or 8.9% of total cancers). The cancer detection rate was 0.11%, 0.22%, 0.32% and 0.14% for age groups <40, 40-49, 50-59 and >59, respectively. The cost per additional carcinoma detected by ultrasonography alone was euro 25,847.85 whereas that per examined woman was euro 21.68. The study confirms the possibility that ultrasonography can detect mammographically occult breast carcinoma in dense breasts. The evidence is insufficient to recommend this policy in routine screening practice but suggests that, at least in current clinical practice, adding ultrasonography in dense breasts may be useful despite the substantial costs.

Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review.

PubMed

Xu, Ruixin; Li, Jianbin; Zhang, Yingjie; Jing, Hongbiao; Zhu, Youzhe

2017-12-01

Occult breast cancer (OBC) is extremely rare in males with neither symptoms in the breast nor abnormalities upon imaging examination. This current case report presents a young male patient who was diagnosed with male OBC first manifesting as axillary lymph node metastasis. The physical and imaging examination showed no primary lesions in either breasts or in other organs. The pathological results revealed infiltrating ductal carcinoma in the axillary lymph nodes. Immunohistochemical (IHC) staining was negative for estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK)20 and thyroid transcription factor-1 (TTF-1), positive for CK7, gross cystic disease fluid protein-15 (GCDFP-15), epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), and suspicious positive for human epidermal receptor-2 (Her-2). On basis of IHC markers, particularly such as CK7, CK20 and GCDFP-15, and eliminating other malignancies, male OBC was identified in spite of negativity for hormone receptors. The patient underwent left axillary lymph node dissection (ALND) but not mastectomy. After the surgery, the patient subsequently underwent chemotherapy and radiotherapy. The patient is currently being followed up without any signs of recurrence. Carefully imaging examination and pathological analysis were particularly essential in the diagnosis of male OBC. The guidelines for managing male OBC default to those of female OBC and male breast cancer. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Diffusion-weighted MR imaging: role in the differential diagnosis of breast lesions.

PubMed

Altay, C; Balci, P; Altay, S; Karasu, S; Saydam, S; Canda, T; Dicle, O

2014-01-01

To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) using apparent diffusion coefficient (ADC) values to the characterization of breast lesions and differentiation of benign and malignant lesions. Thirty-seven women (mean age, 38 years) with 37 enrolled in the study. DWI and ADC maps in the axial plane were obtained using a 1.5 Tesla MRI device. Mean ADC measurements were calculated among cysts, normal fibroglandular tissue, benign lesions and malignant lesions were evaluated. Out of 37 women, 4 had normally breast MRI findings. The diagnosis of remaining 33 patients with 37 breast lesions were as follows; malign lesions (n = 23), benign lesions (n = 10) and simple breast cyst (n = 4). The ADC values were as follows (in units of 10(-3) mm2/s): Normal fibroglandular tissue (range: 1.39-2.06; mean: 1.61 ± 0.23), benign breast lesions (range: 1.09-1.76; mean: 1.47 ± 0.25), cyts (range: 2.27-2.46, mean: 2.37 ± 0.07) and malignant breast lesions (range: 0.78-1.26, mean: 0.96 ± 0.25). The mean ADC obtained from malignant breast lesions was statistically different from that observed in benign solid lesions (p < < 0.01) and normal fibroglandular breast tissue (p < 0.01). Furthermore, the mean ADC values of benign breast lesions was not statistically different from cyst (p ≥ 0.01) and normal fibroglandular breast tissue (p ≥ 0.01). A ADC value of 1.1 x 10(-3) mm'/s as a treshold value provided differantiation for malign and benign lesions, with a sensitivity of 91.3% and a specificity of 85.7% compared with conventional breast MRI values. DWI with quantitative ADC measurements is a reliable tool for differentiation of benign and malignant breast lesions.

Differentiation of benign and malignant breast lesions by mechanical imaging

PubMed Central

Kearney, Thomas; Pollak, Stanley B.; Rohatgi, Chand; Sarvazyan, Noune; Airapetian, Suren; Browning, Stephanie; Sarvazyan, Armen

2009-01-01

Mechanical imaging yields tissue elasticity map and provides quantitative characterization of a detected pathology. The changes in the surface stress patterns as a function of applied load provide information about the elastic composition and geometry of the underlying tissue structures. The objective of this study is the clinical evaluation of breast mechanical imager for breast lesion characterization and differentiation between benign and malignant lesions. The breast mechanical imager includes a probe with pressure sensor array, an electronic unit providing data acquisition from the pressure sensors and communication with a touch-screen laptop computer. We have developed an examination procedure and algorithms to provide assessment of breast lesion features such as hardness related parameters, mobility, and shape. A statistical Bayesian classifier was constructed to distinguish between benign and malignant lesions by utilizing all the listed features as the input. Clinical results for 179 cases, collected at four different clinical sites, have demonstrated that the breast mechanical imager provides a reliable image formation of breast tissue abnormalities and calculation of lesion features. Malignant breast lesions (histologically confirmed) demonstrated increased hardness and strain hardening as well as decreased mobility and longer boundary length in comparison with benign lesions. Statistical analysis of differentiation capability for 147 benign and 32 malignant lesions revealed an average sensitivity of 91.4% and specificity of 86.8% with a standard deviation of ±6.1%. The area under the receiver operating characteristic curve characterizing benign and malignant lesion discrimination is 86.1% with the confidence interval ranging from 80.3 to 90.9%, with a significance level of P = 0.0001 (area = 50%). The multisite clinical study demonstrated the capability of mechanical imaging for characterization and differentiation of benign and malignant breast

Pathologic Findings of Breast Lesions Detected on Magnetic Resonance Imaging.

PubMed

Jabbar, Seema B; Lynch, Beverly; Seiler, Stephen; Hwang, Helena; Sahoo, Sunati

2017-11-01

- Breast magnetic resonance imaging (MRI) is now used routinely for high-risk screening and in the evaluation of the extent of disease in newly diagnosed breast cancer patients. Morphologic characteristics and the kinetic pattern largely determine how suspicious a breast lesion is on MRI. Because of its high sensitivity, MRI identifies a large number of suspicious lesions. However, the low to moderate specificity and the additional cost have raised questions regarding its frequent use. - To identify the pathologic entities that frequently present as suspicious enhancing lesions and to identify specific MRI characteristics that may be predictive of malignancy. - One hundred seventy-seven MRI-guided biopsies from 152 patients were included in the study. The indication for MRI, MRI features, pathologic findings, and patient demographics were recorded. The MRI findings and the pathology slides were reviewed by a dedicated breast radiologist and breast pathologists. - Seventy-one percent (126 of 177) of MRI-guided breast biopsies were benign, 11% (20 of 177) showed epithelial atypia, and 18% (31 of 177) showed malignancy. The vast majority (84%; 62 of 74) of MRI lesions with persistent kinetics were benign. However, 57% (17 of 30) of lesions with washout kinetics and 65% (62 of 95) of mass lesions were also benign. - Magnetic resonance imaging detects malignancies undetected by other imaging modalities but also detects a wide variety of benign lesions. Benign and malignant lesions identified by MRI share similar morphologic and kinetic features, necessitating biopsy for histologic confirmation.

Occult Primary Neuroendocrine Tumor Metastasis to the Breast Detected on Screening Mammogram.

PubMed

Policeni, Fabiana; Pakalniskis, Brittany; Yang, Limin

2016-01-01

Metastatic tumors are rare in the breast. Well-differentiated neuroendocrine tumors (WDNETs) are slow-growing neoplasms that arise from neuroendocrine cells, particularly in the gastrointestinal tract and bronchial tree. Metastatic WDNET to the breast is a rare entity. We present a case report of ileal WDNET metastatic to the breast which was initially identified as a small mass in the patient's left breast on screening mammography. Targeted ultrasound identified a suspicious mass, and ultrasound-guided percutaneous core biopsy was performed. Pathology revealed metastatic WDNET. Breast magnetic resonance imaging (MRI) was then performed and demonstrated left axillary Level 2 lymphadenopathy, and liver lesions were suspicious for metastasis. The patient underwent abdominal computed tomography (CT) to evaluate for distant metastatic disease. A spiculated mass was found near the ileocecal valve, suggestive of primary ileal WDNET. In addition, CT identified multiple liver lesions, most compatible with metastasis. Indium 111 OctreoScan confirmed radiotracer uptake in the ileum consistent with primary neuroendocrine tumor. In this report, we review the imaging characteristics of metastatic WDNET to the breast by different imaging modalities including mammogram, ultrasound, and breast MRI.

Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): A retrospective comparison in 66 breast lesions.

PubMed

Li, L; Roth, R; Germaine, P; Ren, S; Lee, M; Hunter, K; Tinney, E; Liao, L

2017-02-01

The purpose of this study was to retrospectively compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) with that of breast magnetic resonance imaging (BMRI) in breast cancer detection using parameters, including sensitivity, positive predictive value (PPV), lesion size, morphology, lesion and background enhancement, and examination time. A total of 48 women (mean age, 56years±10.6 [SD]) with breast lesions detected between October 2012 and March 2014 were included. Both CESM and BMRI were performed for each patient within 30 days. The enhancement intensity of lesions and breast background parenchyma was subjectively assessed for both modalities and was quantified for comparison. Statistical significance was analyzed using paired t-test for mean size of index lesions in all malignant breasts (an index lesion defined as the largest lesion in each breast), and a mean score of enhancement intensity for index lesions and breast background. PPV, sensitivity, and accuracy were calculated for both CESM and BMRI. The average duration time of CESM and MRI examinations was also compared. A total of 66 lesions were identified, including 62 malignant and 4 benign lesions. Both CESM and BMRI demonstrated a sensitivity of 100% for detection of breast cancer. There was no statistically significant difference between the mean size of index lesions (P=0.108). The enhancement intensity of breast background was significantly lower for CESM than for BMRI (P<0.01). The mean score of enhancement intensity of index lesions on CESM was significantly less than that for BMRI (P<0.01). The smallest lesion that was detected by both modalities measured 4mm. CESM had a higher PPV than BMRI (P>0.05). The average examination time for CESM was significantly shorter than that of BMRI (P<0.01). CESM has similar sensitivity than BMRI in breast cancer detection, with higher PPV and less background enhancement. CESM is associate with significantly shorter exam time thus a

Hematolymphoid lesions of the breast.

PubMed

Hoffmann, Jenny; Ohgami, Robert S

2017-09-01

Hematolymphoid malignancies of the breast are most commonly neoplasms of mature B-lymphocytes, and may arise as a primary disease or by secondary involvement of a systemic disease. Primary breast lymphomas (PBL) account for 0.04-0.5% of breast malignancies, less than 1% of all non-Hodgkin's lymphomas (NHL), and less than 5% of extranodal lymphomas (Lakhani et al., 2012; Swerdlow et al., 2008; Joks et al., 2011; Barişta et al., 2000; Giardini et al., 1992; Brogi and Harris, 1999; Topalovski et al., 1999). 1-7 Secondary breast lymphomas (SBL) are also rare, with an estimated annual incidence of 0.07% (Domchek et al., 2002; Talwalkar et al., 2008). 8,9 Recognition of breast lesions as hematolymphoid is critical to distinguish them from other entities that can occur in the breast. Copyright © 2017. Published by Elsevier Inc.

Radioimmune localization of occult carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duda, R.B.; Zimmer, A.M.; Rosen, S.T.

1990-07-01

Patients with a rising serum carcinoembryonic antigen level and no clinical or roentgenographic evidence of recurrent or metastatic cancer present a treatment dilemma. Eleven such patients, 10 with a previously treated colorectal carcinoma and 1 with a previously treated breast carcinoma, received an injection of the anticarcinoembryonic antigen monoclonal antibody ZCE-025 labeled with the radioisotope indium 111. Nuclear scintigraphy was performed on days 3 and 5 through 7 to detect potential sites of tumor recurrence. The monoclonal antibody scan accurately predicted the presence or absence of occult malignancy in 7 (64%) patients. Second-look laparotomy confirmed the monoclonal antibody scan resultsmore » in the patients with colorectal cancer, and magnetic resonance imaging confirmed metastatic breast cancer. This study demonstrates that In-ZCE-025 can localize occult carcinoma and may assist the surgeon in facilitating the operative exploration. In-ZCE-025 assisted in the initiation of adjuvant therapy for the patient with breast cancer.« less

Computerized analysis of sonograms for the detection of breast lesions

NASA Astrophysics Data System (ADS)

Drukker, Karen; Giger, Maryellen L.; Horsch, Karla; Vyborny, Carl J.

2002-05-01

With a renewed interest in using non-ionizing radiation for the screening of high risk women, there is a clear role for a computerized detection aid in ultrasound. Thus, we are developing a computerized detection method for the localization of lesions on breast ultrasound images. The computerized detection scheme utilizes two methods. Firstly, a radial gradient index analysis is used to distinguish potential lesions from normal parenchyma. Secondly, an image skewness analysis is performed to identify posterior acoustic shadowing. We analyzed 400 cases (757 images) consisting of complex cysts, solid benign lesions, and malignant lesions. The detection method yielded an overall sensitivity of 95% by image, and 99% by case at a false-positive rate of 0.94 per image. In 51% of all images, only the lesion itself was detected, while in 5% of the images only the shadowing was identified. For malignant lesions these numbers were 37% and 9%, respectively. In summary, we have developed a computer detection method for lesions on ultrasound images of the breast, which may ultimately aid in breast cancer screening.

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).

PubMed

Rageth, Christoph J; O'Flynn, Elizabeth Am; Comstock, Christopher; Kurtz, Claudia; Kubik, Rahel; Madjar, Helmut; Lepori, Domenico; Kampmann, Gert; Mundinger, Alexander; Baege, Astrid; Decker, Thomas; Hosch, Stefanie; Tausch, Christoph; Delaloye, Jean-François; Morris, Elisabeth; Varga, Zsuzsanna

2016-09-01

The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group-a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions

PubMed Central

Chung, Jin; Lee, Won Kyung; Cha, Eun-Suk; Lee, Jee Eun; Kim, Jeoung Hyun; Ryu, Young Hoon

2016-01-01

Objective To evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions. Methods This study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC). Results Of the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4–94.4%; specificity, 42.6–88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions. Conclusion SWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions. PMID:27893857

Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome - MONET - study.

PubMed

Peters, Nicky H G M; Borel Rinkes, Inne H M; Mali, Willem P T M; van den Bosch, Maurice A A J; Storm, Remmert K; Plaisier, Peter W; de Boer, Erwin; van Overbeeke, Adriaan J; Peeters, Petra H M

2007-11-28

In recent years there has been an increasing interest in MRI as a non-invasive diagnostic modality for the work-up of suspicious breast lesions. The additional value of Breast MRI lies mainly in its capacity to detect multicentric and multifocal disease, to detect invasive components in ductal carcinoma in situ lesions and to depict the tumor in a 3-dimensional image. Breast MRI therefore has the potential to improve the diagnosis and provide better preoperative staging and possibly surgical care in patients with breast cancer. The aim of our study is to assess whether performing contrast enhanced Breast MRI can reduce the number of surgical procedures due to better preoperative staging and whether a subgroup of women with suspicious nonpalpable breast lesions can be identified in which the combination of mammography, ultrasound and state-of-the-art contrast-enhanced Breast MRI can provide a definite diagnosis. The MONET - study (MR mammography Of Nonpalpable BrEast Tumors) is a randomized controlled trial with diagnostic and therapeutic endpoints. We aim to include 500 patients with nonpalpable suspicious breast lesions who are referred for biopsy. With this number of patients, the expected 12% reduction in surgical procedures due to more accurate preoperative staging with Breast MRI can be detected with a high power (90%). The secondary outcome is the positive and negative predictive value of contrast enhanced Breast MRI. If the predictive values are deemed sufficiently close to those for large core biopsy then the latter, invasive, procedure could possibly be avoided in some women. The rationale, study design and the baseline characteristics of the first 100 included patients are described. Study protocol number NCT00302120.

[The lesions of flat epithelial atypia diagnosed on breast biopsy].

PubMed

Peres, A; Becette, V; Guinebretiere, J-M; Cherel, P; Barranger, E

2011-10-01

Among pre-invasive breast diseases, the lesion of flat epithelial atypia has a level of risk that remains unclear. The clinical significance of these lesions and how to behave during their diagnostic biopsy (monitoring vs. surgery) are still uncertain, because few studies (including monitoring) are available and because of the polymorphic spectrum of lesions and their many denominations across the studies in the literature. This article aims to update our knowledge and provide elements for the management of these lesions diagnosed on breast biopsy. Copyright © 2011. Published by Elsevier SAS.

21 CFR 884.2990 - Breast lesion documentation system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... system is a device for use in producing a surface map of the breast as an aid to document palpable breast... Lesion Documentation System.” See § 884.1(e) for the availability of this guidance document. [68 FR 44415...

[Breast tomosynthesis: a new tool for diagnosing breast cancer].

PubMed

Martínez Miravete, P; Etxano, J

2015-01-01

Breast cancer continues to be the most common malignant tumor in women in occidental countries. Mammography is currently the technique of choice for screening programs; however, although it has been widely validated, mammography has its limitations, especially in dense breasts. Breast tomosynthesis is a revolutionary advance in the diagnosis of breast cancer. It makes it possible to define lesions that are occult in the glandular tissue and therefore to detect breast tumors that are impossible to see on conventional mammograms. In considering the combined use of mammography and tomosynthesis, many factors must be taken into account apart from cancer detection; these include additional radiation, the recall rate, and the time necessary to carry out and interpret the two tests. In this article, we review the technical principles of tomosynthesis, it main uses, and the future perspective for this imaging technique. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Role of multidetector computed tomography in evaluating incidentally detected breast lesions.

PubMed

Moschetta, Marco; Scardapane, Arnaldo; Lorusso, Valentina; Rella, Leonarda; Telegrafo, Michele; Serio, Gabriella; Angelelli, Giuseppe; Ianora, Amato Antonio Stabile

2015-01-01

Computed tomography (CT) does not represent the primary method for the evaluation of breast lesions; however, it can detect breast abnormalities, even when performed for other reasons related to thoracic structures. The aim of this study is to evaluate the potential benefits of 320-row multidetector CT (MDCT) in evaluating and differentiating incidentally detected breast lesions by using vessel probe and 3D analysis software with net enhancement value. Sixty-two breast lesions in 46 patients who underwent 320-row chest CT examination were retrospectively evaluated. CT scans were assessed searching for the presence, location, number, morphological features, and density of breast nodules. Net enhancement was calculated by subtracting precontrast density from the density obtained by postcontrast values. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CT were calculated for morphological features and net enhancement. Thirty of 62 lesions were found to be malignant at histological examination and 32 were found to be benign. When morphological features were considered, the sensitivity, specificity, accuracy, PPV, and NPV of CT were 87%, 100%, 88%, 100%, and 50%, respectively. Based on net enhancement, CT reached a sensitivity, specificity, accuracy, PPV, and NPV of 100%, 94%, 97%, 94%, and 100%, respectively. MDCT allows to recognize and characterize breast lesions based on morphological features. Net enhancement can be proposed as an additional accurate feature of CT.

Nonpalpable breast tumors: diagnosis with stereotaxic localization and fine-needle aspiration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dowlatshahi, K.; Gent, H.J.; Schmidt, R.

1989-02-01

Modern mammography is the most effective means of detecting nonpalpable breast cancers, but correct diagnosis for malignancy is made in only 20%-30% of the cases. The conventional method of lesion localization usually results in approximate placement of the hookwire in the breast. The authors report the results of stereotaxic localization, combined with fine-needle aspiration and cytologic study, performed in 528 cases. Clinically occult breast lesions were localized precisely (within 2 mm 96% of the time), sampled by means of a 23-gauge needle, and marked with either methylene blue or a hookwire for subsequent open excisional biopsy. The results indicate amore » sensitivity of 95%, specificity of 91%, and accuracy of 92% for the fine-needle aspiration procedure. This technique offers a significantly improved preoperative method of diagnosing small breast lesions with minimal pain, no complications, reduced cost, and no disfigurement or scar interfering with subsequent mammographic follow-up.« less

Use of shear wave elastography to differentiate benign and malignant breast lesions.

PubMed

Çebi Olgun, Deniz; Korkmazer, Bora; Kılıç, Fahrettin; Dikici, Atilla Süleyman; Velidedeoğlu, Mehmet; Aydoğan, Fatih; Kantarcı, Fatih; Yılmaz, Mehmet Halit

2014-01-01

We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions. A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied. Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%). SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.

Intraoperative Localisation of Impalpable Breast Lesions Utilising the ROLLIS Technique Following Peritumoral ^99mTc-colloid Sentinel Node Lymphoscintigraphy.

PubMed

Hung, Te-Jui; Burrage, John; Bourke, Anita; Taylor, Donna

2017-08-24

Ultrasound or stereotactic guided hook-wire localisation has been the standard-of-care for the pre-surgical localisation of impalpable breast lesions, which account for approximately a third of all breast cancer. Radioguided occult lesion localisation using I-125 seeds (ROLLIS) is a relatively new technique for guiding surgical excision of impalpable breast lesions, and is a promising alternative to the traditional hook-wire method. When combined with Tc-99m labelled colloid for sentinel node mapping in clinically indicated cases, there has been uncertainty regarding whether the downscatter of Tc-99m into the I-125 energy spectrum could adversely affect the intra-operative detection of the I-125 seed, especially pertaining to a peritumoral injection. To evaluate the percentage contribution of downscattered activity from Tc-99m into the I-125 energy spectrum in simulated intra-operative resections of an I-125 seed following different sentinel node injection techniques. Two scenarios were simulated using breast phantoms with lean chicken breast. The first scenario, with a 2cm distance between the Tc-99m injection site and the I-125 seed, simulated a periareolar ipsiquadrant injection with the subdermal or intradermal technique. The second scenario simulated a peritumoral injection technique with the Tc-99m bolus and an I-125 seed at the same site. Count rates were acquired with a hand-held gamma probe, and the percentage contribution of downscattered Tc-99m gamma photons to the I-125 energy window was calculated. In scenarios one and two, downscattered Tc-99m activity contributed 0.5% and 33% respectively to the detected count rate in the I-125 energy window. In both scenarios, the I-125 seed was successfully localised and removed using the gamma probe. There is no significant contribution of downscattered activity associated with a peritumoral injection of Tc-99m to adversely affect the accurate intra-operative localisation of an I- 125 seed. Copyright© Bentham

The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

DOE Office of Scientific and Technical Information (OSTI.GOV)

Niwinska, Anna, E-mail: alphaonetau@poczta.onet.p; Tacikowska, Malgorzata; Murawska, Magdalena

2010-07-15

Purpose: The aim of the study is to evaluate disease-free survival, survival from the detection of brain metastases, overall survival, and cause of death in patients with occult brain metastases (Group I) vs. patients with symptomatic brain metastases (Group II). Methods and Materials: In 80 HER2-positive breast cancer patients, treated with trastuzumab and cytostatic agents for metastatic disease, magnetic resonance imaging screening of the brain was performed, and in 29 patients (36%) occult brain metastasis was detected (Group I). Whole-brain radiotherapy was delivered to Group I. This first group was compared with 52 patients who had symptomatic brain metastases (Groupmore » II) and was treated the same way, at the same clinic, during the same time period. Results: Median disease-free survival was 17 months in Group I and 19.9 months in Group II (p = 0.58). The median time interval between the dissemination of the disease and the detection of occult or symptomatic brain metastases was 9 and 15 months, respectively (p = 0.11). When the brain metastases were detected, the median survival was 9 and 8.78 months, respectively (p = 0.80). The median overall survival was 53 and 51 months, respectively (p = 0.94). In the group with occult brain metastases (Group I) 16% of patients died because of progression within the brain. In the group with symptomatic brain metastases (Group II) the rate of cerebral death was 48% (p = 0.009). Conclusions: Whole-brain radiotherapy of occult brain metastases in HER2-positive breast cancer patients with visceral dissemination produces a three-fold decrease in cerebral deaths but does not prolong survival.« less

MR-guided fine needle aspiration of breast lesions: Initial experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wald, D.S.; Weinreb, J.C.; Newstead, G.

1996-01-01

Fine needle aspiration (FNA) is a minimally invasive procedure that is used to obtain cytologic specimens of suspicious lesions in the breast. The goal of this study was to evaluate the logistics and limitations of MR-guided FNA using a prototype breast localization coil. MR-guided FNAs were attempted on 18 lesions (detected on mammography and/or palpation) in 16 patients. Patients were prone with their compressed mediolaterally between two plates in a circularly polarized RF coil. Lesion position was determined by reference to fiducial makers that corresponded to a grid of holes placed at 5 mm intervals in compression plate. FNA wasmore » performed with a 22G non-ferromagnetic needle. FNA was successful for 11 of 18 lesions (61%). Of the seven unsuccessful cases, there were four in which the lesions were too posteriorly placed to be accessed through the compression plate by the needle. Three cases were too anteriorly placed to be effectively immobilized and, although successfully localized, were insufficiently sampled by the FNA technique. MR-guided FNA is possible using a prototype breast localization device in a select group of patients. Current coil design limits its use in performing MR-guided FNA on the most anteriorly and posteriorly placed breast lesions. Unique requirements of FNA under MR guidance as compared to needle localization and biopsy have been identified. Modifications in localization hardware and cytology aspiration needles should overcome these restrictions. 15 refs., 3 figs.« less

Use of shear wave elastography to differentiate benign and malignant breast lesions

PubMed Central

Olgun, Deniz Çebi; Korkmazer, Bora; Kılıç, Fahrettin; Dikici, Atilla Süleyman; Velidedeoğlu, Mehmet; Aydoğan, Fatih; Kantarcı, Fatih; Yılmaz, Mehmet Halit

2014-01-01

PURPOSE We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions. MATERIALS and METHODS A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied. RESULTS Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%). CONCLUSION SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy. PMID:24509183

Radiologically occult medulloblastoma with hydrocephalus: case report.

PubMed

Honma, Hirokuni; Ogiwara, Hideki

2017-09-01

There have been no reports of occult medulloblastoma nor noncommunicating hydrocephalus due to radiologically occult brain tumors. Herein, we report radiologically occult medulloblastoma with noncommunicating hydrocephalus. A 3-year-old boy presented with macrocephaly, visual field constriction, and papilledema. Neuroimagings showed enlargement of the ventricles without any mass lesions. The CT cisternography did not show influx of the contrast into the ventricles, which suggested local cerebrospinal fluid (CSF) circulatory disturbance at the outlet of the fourth ventricle. Due to possible obstructive nature of hydrocephalus, endoscopic third ventriculostomy (ETV) was performed. Three months after the ETV, he presented with repeated vomiting. Neuroimagings showed a 3-cm fourth ventricular mass with progressive hydrocephalus. Surgical resection was performed, which revealed the pathology was medulloblastoma. We report the case of radiologically occult medulloblastoma which was demonstrated radiologically in the follow-up period of ETV for noncommunicating hydrocephalus of uncertain etiology. This is the first description of a radiologically occult medulloblastoma and also the first description of an occult brain tumor with noncommunicating hydrocephalus. The occult brain tumor may be included in the etiology of hydrocephalus.

Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation

PubMed Central

Denis, Max; Gregory, Adriana; Mehrmohammadi, Mohammad; Kumar, Viksit; Meixner, Duane; Fazzio, Robert T.; Fatemi, Mostafa

2017-01-01

Background Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE) performance in differentiating breast masses. Methods With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19–85 years, mean 59.93±14.96 years) with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm) were analyzed. CUSE was performed on all patients. Three regions of interest (ROI), 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young’s modulus. In correlation to pathology results, statistical analyses were performed. Results Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3) were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108), 89.92% specificity (107 of 119), 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P<0.0001). Stiffness maps showed spatial continuity such that maximum and average elasticity did not have significantly different results (P > 0.21). Conclusion CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their

Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation.

PubMed

Bayat, Mahdi; Denis, Max; Gregory, Adriana; Mehrmohammadi, Mohammad; Kumar, Viksit; Meixner, Duane; Fazzio, Robert T; Fatemi, Mostafa; Alizad, Azra

2017-01-01

Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE) performance in differentiating breast masses. With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19-85 years, mean 59.93±14.96 years) with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm) were analyzed. CUSE was performed on all patients. Three regions of interest (ROI), 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young's modulus. In correlation to pathology results, statistical analyses were performed. Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3) were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108), 89.92% specificity (107 of 119), 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P<0.0001). Stiffness maps showed spatial continuity such that maximum and average elasticity did not have significantly different results (P > 0.21). CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their stiffness.

Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome – MONET – study

PubMed Central

Peters, Nicky HGM; Borel Rinkes, Inne HM; Mali, Willem PTM; van den Bosch, Maurice AAJ; Storm, Remmert K; Plaisier, Peter W; de Boer, Erwin; van Overbeeke, Adriaan J; Peeters, Petra HM

2007-01-01

Background In recent years there has been an increasing interest in MRI as a non-invasive diagnostic modality for the work-up of suspicious breast lesions. The additional value of Breast MRI lies mainly in its capacity to detect multicentric and multifocal disease, to detect invasive components in ductal carcinoma in situ lesions and to depict the tumor in a 3-dimensional image. Breast MRI therefore has the potential to improve the diagnosis and provide better preoperative staging and possibly surgical care in patients with breast cancer. The aim of our study is to assess whether performing contrast enhanced Breast MRI can reduce the number of surgical procedures due to better preoperative staging and whether a subgroup of women with suspicious nonpalpable breast lesions can be identified in which the combination of mammography, ultrasound and state-of-the-art contrast-enhanced Breast MRI can provide a definite diagnosis. Methods/Design The MONET – study (MR mammography Of Nonpalpable BrEast Tumors) is a randomized controlled trial with diagnostic and therapeutic endpoints. We aim to include 500 patients with nonpalpable suspicious breast lesions who are referred for biopsy. With this number of patients, the expected 12% reduction in surgical procedures due to more accurate preoperative staging with Breast MRI can be detected with a high power (90%). The secondary outcome is the positive and negative predictive value of contrast enhanced Breast MRI. If the predictive values are deemed sufficiently close to those for large core biopsy then the latter, invasive, procedure could possibly be avoided in some women. The rationale, study design and the baseline characteristics of the first 100 included patients are described. Trial registration Study protocol number NCT00302120 PMID:18045470

Hybrid radioguided occult lesion localization (hybrid ROLL) of (18)F-FDG-avid lesions using the hybrid tracer indocyanine green-(99m)Tc-nanocolloid.

PubMed

KleinJan, G H; Brouwer, O R; Mathéron, H M; Rietbergen, D D D; Valdés Olmos, R A; Wouters, M W; van den Berg, N S; van Leeuwen, F W B

2016-01-01

To assess if combined fluorescence- and radio-guided occult lesion localization (hybrid ROLL) is feasible in patients scheduled for surgical resection of non-palpable (18)F-FDG-avid lesions on PET/CT. Four patients with (18)F-FDG-avid lesions on follow-up PET/CT that were not palpable during physical examination but were suspected to harbor metastasis were enrolled. Guided by ultrasound, the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid was injected centrally in the target lesion. SPECT/CT imaging was used to confirm tracer deposition. Intraoperatively, lesions were localized using a hand-held gamma ray detection probe, a portable gamma camera, and a fluorescence camera. After excision, the gamma camera was used to check the wound bed for residual activity. A total of six (18)F-FDG-avid lymph nodes were identified and scheduled for hybrid ROLL. Comparison of the PET/CT images with the acquired SPECT/CT after hybrid tracer injection confirmed accurate tracer deposition. No side effects were observed. Combined radio- and fluorescence-guidance enabled localization and excision of the target lesion in all patients. Five of the six excised lesions proved tumor-positive at histopathology. The hybrid ROLL approach appears to be feasible and can facilitate the intraoperative localization and excision of non-palpable lesions suspected to harbor tumor metastases. In addition to the initial radioguided detection, the fluorescence component of the hybrid tracer enables high-resolution intraoperative visualization of the target lesion. The procedure needs further evaluation in a larger cohort and wider range of malignancies to substantiate these preliminary findings. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions.

PubMed

Coopey, Suzanne B; Mazzola, Emanuele; Buckley, Julliette M; Sharko, John; Belli, Ahmet K; Kim, Elizabeth M H; Polubriaginof, Fernanda; Parmigiani, Giovanni; Garber, Judy E; Smith, Barbara L; Gadd, Michele A; Specht, Michelle C; Guidi, Anthony J; Roche, Constance A; Hughes, Kevin S

2012-12-01

Women with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and severe ADH are at increased risk of breast cancer, but a systematic quantification of this risk and the efficacy of chemoprevention in the clinical setting is still lacking. The objective of this study is to evaluate a woman's risk of breast cancer based on atypia type and to determine the effect of chemoprevention in decreasing this risk. Review of 76,333 breast pathology reports from three institutions within Partners Healthcare System, Boston, from 1987 to 2010 using natural language processing was carried out. This approach identified 2,938 women diagnosed with atypical breast lesions. The main outcome of this study is breast cancer occurrence. Of the 2,938 patients with atypical breast lesions, 1,658 were documented to have received no chemoprevention, and 184/1,658 (11.1 %) developed breast cancer at a mean follow-up of 68 months. Estimated 10-year cancer risks were 17.3 % with ADH, 20.7 % with ALH, 23.7 % with LCIS, and 26.0 % with severe ADH. In a subset of patients treated from 1999 on (the chemoprevention era), those who received no chemoprevention had an estimated 10-year breast cancer risk of 21.3 %, whereas those treated with chemoprevention had a 10-year risk of 7.5 % (p < 0.001). Chemoprevention use significantly reduced breast cancer risk for all atypia types (p < 0.05). The risk of breast cancer with atypical breast lesions is substantial. Physicians should counsel patients with ADH, ALH, LCIS, and severe ADH about the benefit of chemoprevention in decreasing their breast cancer risk.

Prediction of occult invasive disease in ductal carcinoma in situ using computer-extracted mammographic features

NASA Astrophysics Data System (ADS)

Shi, Bibo; Grimm, Lars J.; Mazurowski, Maciej A.; Marks, Jeffrey R.; King, Lorraine M.; Maley, Carlo C.; Hwang, E. Shelley; Lo, Joseph Y.

2017-03-01

Predicting the risk of occult invasive disease in ductal carcinoma in situ (DCIS) is an important task to help address the overdiagnosis and overtreatment problems associated with breast cancer. In this work, we investigated the feasibility of using computer-extracted mammographic features to predict occult invasive disease in patients with biopsy proven DCIS. We proposed a computer-vision algorithm based approach to extract mammographic features from magnification views of full field digital mammography (FFDM) for patients with DCIS. After an expert breast radiologist provided a region of interest (ROI) mask for the DCIS lesion, the proposed approach is able to segment individual microcalcifications (MCs), detect the boundary of the MC cluster (MCC), and extract 113 mammographic features from MCs and MCC within the ROI. In this study, we extracted mammographic features from 99 patients with DCIS (74 pure DCIS; 25 DCIS plus invasive disease). The predictive power of the mammographic features was demonstrated through binary classifications between pure DCIS and DCIS with invasive disease using linear discriminant analysis (LDA). Before classification, the minimum redundancy Maximum Relevance (mRMR) feature selection method was first applied to choose subsets of useful features. The generalization performance was assessed using Leave-One-Out Cross-Validation and Receiver Operating Characteristic (ROC) curve analysis. Using the computer-extracted mammographic features, the proposed model was able to distinguish DCIS with invasive disease from pure DCIS, with an average classification performance of AUC = 0.61 +/- 0.05. Overall, the proposed computer-extracted mammographic features are promising for predicting occult invasive disease in DCIS.

Fibroadenomatosis (fibroadenomatoid mastopathy): a benign breast lesion with composite pathologic features.

PubMed

Hanson, C A; Snover, D C; Dehner, L P

1987-10-01

A benign breast lesion with the composite histologic features of a fibroadenoma and fibrocystic changes has been referred to previously as fibroadenomatosis or fibroadenomatoid mastopathy; this lesion is distinct from the typical well circumscribed fibroadenoma that may have fibrocystic changes. The purpose of our study was to ascertain the frequency of this change among 200 consecutive breast biopsies and excisions with a coded pathologic diagnosis of fibroadenoma and/or "fibrocystic disease"; we identified these changes in 23 (11.5%) specimens. The lesion was characterized by microscopic fibroadenomatoid foci intermingled with dilated ducts, epitheliosis, and adenosis. It is suggested that fibroadenomatosis is yet another pattern in the complex morphologic spectrum known as benign proliferative breast disease. From our experience, this particular lesion was often appreciated as a unique finding, but the appropriate diagnostic designation was in question. The natural history of fibroadenomatosis is essentially unknown. It may represent a morphologic stage in the development of fibroadenoma(s).

Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer.

PubMed

Behrendt, Carolyn E; Tumyan, Lusine; Gonser, Laura; Shaw, Sara L; Vora, Lalit; Paz, I Benjamin; Ellenhorn, Joshua D I; Yim, John H

2014-08-01

Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence. Copyright © 2014 Elsevier Ltd. All rights reserved.

Dual modality surgical guidance of non-palpable breast lesions

NASA Astrophysics Data System (ADS)

Judy, Patricia Goodale

Although breast conserving therapy has some advantages over the traditional mastectomy procedure, the biggest disadvantage is the chance of local re-occurrence in which a second surgery is often required. Adequate surgical removal of breast tumors requires accurate tumor localization in order to ensure a balance between optimal cosmetic results and minimization of the risk for local re-occurrence. These challenges have motivated the search for alternative, more accurate methods for intraoperative localization of non-palpable breast lesions. The overall goal of this project was to develop an innovative technique for radioguided localization of non-palpable breast lesions that is more accurate, easier for the breast surgeon, and more comfortable for the patient than the current practice of wire localization. The technique uses a dual modality breast imaging system to place a marker composed of radiolabeled albumin (99mTc-MAA or 111ln-MAA) into the lesion. Preliminary studies were made to evaluate the localization accuracy of the system, which showed that the dual modality breast scanner is capable of accurate 3-dimensional localization using either X-ray or gamma ray imaging. A 3-axis needle positioning system was built and integrated into the dual modality breast scanner and its accuracy tested. A pilot clinical trial to evaluate the dual-modality surgical guidance technique was designed and preliminary clinical data collected. Detailed results were presented on the first three subjects; although a total of seven subjects have been recruited to the study to date. So far, it has been demonstrated that the radioguided surgery technique can be performed with approximately 10 times less radiomarker activity than is currently being used by other researchers employing 99mTc-MAA as a radiomarker, while maintaining comparable localization accuracy. Although the DMSG technique has not been tested in a large cohort of subjects, the preliminary data on the first few are

Application of whole-lesion histogram analysis of pharmacokinetic parameters in dynamic contrast-enhanced MRI of breast lesions with the CAIPIRINHA-Dixon-TWIST-VIBE technique.

PubMed

Li, Zhiwei; Ai, Tao; Hu, Yiqi; Yan, Xu; Nickel, Marcel Dominik; Xu, Xiao; Xia, Liming

2018-01-01

To investigate the application of whole-lesion histogram analysis of pharmacokinetic parameters for differentiating malignant from benign breast lesions on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). In all, 92 women with 97 breast lesions (26 benign and 71 malignant lesions) were enrolled in this study. Patients underwent dynamic breast MRI at 3T using a prototypical CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence and a subsequent surgery or biopsy. Inflow rate of the agent between plasma and interstitium (K trans ), outflow rate of agent between interstitium and plasma (K ep ), extravascular space volume per unit volume of tissue (v e ) including mean value, 25th/50th/75th/90th percentiles, skewness, and kurtosis were then calculated based on the whole lesion. A single-sample Kolmogorov-Smirnov test, paired t-test, and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Malignant breast lesions had significantly higher K trans , K ep , and lower v e in mean values, 25th/50th/75th/90th percentiles, and significantly higher skewness of v e than benign breast lesions (all P < 0.05). There was no significant difference in kurtosis values between malignant and benign breast lesions (all P > 0.05). The 90th percentile of K trans , the 90th percentile of K ep , and the 50th percentile of v e showed the greatest areas under the ROC curve (AUC) for each pharmacokinetic parameter derived from DCE-MRI. The 90th percentile of K ep achieved the highest AUC value (0.927) among all histogram-derived values. The whole-lesion histogram analysis of pharmacokinetic parameters can improve the diagnostic accuracy of breast DCE-MRI with the CDT-VIBE technique. The 90th percentile of K ep may be the best indicator in differentiation between malignant and benign breast lesions. 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:91-96. © 2017 International Society for Magnetic Resonance in Medicine.

Visualization of suspicious lesions in breast MRI based on intelligent neural systems

NASA Astrophysics Data System (ADS)

Twellmann, Thorsten; Lange, Oliver; Nattkemper, Tim Wilhelm; Meyer-Bäse, Anke

2006-05-01

Intelligent medical systems based on supervised and unsupervised artificial neural networks are applied to the automatic visualization and classification of suspicious lesions in breast MRI. These systems represent an important component of future sophisticated computer-aided diagnosis systems and enable the extraction of spatial and temporal features of dynamic MRI data stemming from patients with confirmed lesion diagnosis. By taking into account the heterogenity of the cancerous tissue, these techniques reveal the malignant, benign and normal kinetic signals and and provide a regional subclassification of pathological breast tissue. Intelligent medical systems are expected to have substantial implications in healthcare politics by contributing to the diagnosis of indeterminate breast lesions by non-invasive imaging.

Finding lesion correspondences in different views of automated 3D breast ultrasound

NASA Astrophysics Data System (ADS)

Tan, Tao; Platel, Bram; Hicks, Michael; Mann, Ritse M.; Karssemeijer, Nico

2013-02-01

Screening with automated 3D breast ultrasound (ABUS) is gaining popularity. However, the acquisition of multiple views required to cover an entire breast makes radiologic reading time-consuming. Linking lesions across views can facilitate the reading process. In this paper, we propose a method to automatically predict the position of a lesion in the target ABUS views, given the location of the lesion in a source ABUS view. We combine features describing the lesion location with respect to the nipple, the transducer and the chestwall, with features describing lesion properties such as intensity, spiculation, blobness, contrast and lesion likelihood. By using a grid search strategy, the location of the lesion was predicted in the target view. Our method achieved an error of 15.64 mm+/-16.13 mm. The error is small enough to help locate the lesion with minor additional interaction.

Breast MR segmentation and lesion detection with cellular neural networks and 3D template matching.

PubMed

Ertaş, Gökhan; Gülçür, H Ozcan; Osman, Onur; Uçan, Osman N; Tunaci, Mehtap; Dursun, Memduh

2008-01-01

A novel fully automated system is introduced to facilitate lesion detection in dynamic contrast-enhanced, magnetic resonance mammography (DCE-MRM). The system extracts breast regions from pre-contrast images using a cellular neural network, generates normalized maximum intensity-time ratio (nMITR) maps and performs 3D template matching with three layers of 12x12 cells to detect lesions. A breast is considered to be properly segmented when relative overlap >0.85 and misclassification rate <0.10. Sensitivity, false-positive rate per slice and per lesion are used to assess detection performance. The system was tested with a dataset of 2064 breast MR images (344slicesx6 acquisitions over time) from 19 women containing 39 marked lesions. Ninety-seven percent of the breasts were segmented properly and all the lesions were detected correctly (detection sensitivity=100%), however, there were some false-positive detections (31%/lesion, 10%/slice).

Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases.

PubMed

Reid-Nicholson, Michelle D; Tong, Guoxia; Cangiarella, Joan F; Moreira, Andre L

2006-08-25

Breast masses occur in men far less commonly than women and are infrequently subjected to fine-needle aspiration (FNA) biopsy. Papillary lesions of the male breast are rare and are comprised of a spectrum of lesions ranging from papillary hyperplasia in gynecomastia to invasive papillary carcinoma. The following study describes the cytomorphology of papillary breast lesions in 11 men. The patients ranged in age from 23 to 78 years old and each presented with an unilateral subareolar or periareolar breast mass that varied in size from 0.5 to 3 cm. Two patients presented with bloody nipple discharge. Archival material (8-year period) from FNA biopsies of papillary lesions of the male breast was reviewed. The reviewed cases were correlated with appropriate clinicopathologic follow-up. The smears had variable cellularity but all showed papillary clusters of mammary epithelial cells with and without fibrovascular cores. Single epithelial cells with a high nuclear-to-cytoplasmic ratio and eccentric nuclei were seen in all smears; however, these were more numerous in cases of adenocarcinoma. Hemosiderin-laden macrophages were present in all cases. Nipple discharge was seen only in the 2 benign lesions. All adenocarcinomas occurred in older men. The only cytologic criteria that differentiated benign from malignant papillary lesions were marked cellularity and the presence of abundant 3-dimensional clusters. To the best of the authors' knowledge, the current series is the largest in the English literature to date that examines the cytomorphologic features of papillary breast lesions in men. Copyright 2006 American Cancer Society.

Low-contrast lesion detection in tomosynthetic breast imaging using a realistic breast phantom

NASA Astrophysics Data System (ADS)

Zhou, Lili; Oldan, Jorge; Fisher, Paul; Gindi, Gene

2006-03-01

Tomosynthesis mammography is a potentially valuable technique for detection of breast cancer. In this simulation study, we investigate the efficacy of three different tomographic reconstruction methods, EM, SART and Backprojection, in the context of an especially difficult mammographic detection task. The task is the detection of a very low-contrast mass embedded in very dense fibro-glandular tissue - a clinically useful task for which tomosynthesis may be well suited. The project uses an anatomically realistic 3D digital breast phantom whose normal anatomic variability limits lesion conspicuity. In order to capture anatomical object variability, we generate an ensemble of phantoms, each of which comprises random instances of various breast structures. We construct medium-sized 3D breast phantoms which model random instances of ductal structures, fibrous connective tissue, Cooper's ligaments and power law structural noise for small scale object variability. Random instances of 7-8 mm irregular masses are generated by a 3D random walk algorithm and placed in very dense fibro-glandular tissue. Several other components of the breast phantom are held fixed, i.e. not randomly generated. These include the fixed breast shape and size, nipple structure, fixed lesion location, and a pectoralis muscle. We collect low-dose data using an isocentric tomosynthetic geometry at 11 angles over 50 degrees and add Poisson noise. The data is reconstructed using the three algorithms. Reconstructed slices through the center of the lesion are presented to human observers in a 2AFC (two-alternative-forced-choice) test that measures detectability by computing AUC (area under the ROC curve). The data collected in each simulation includes two sources of variability, that due to the anatomical variability of the phantom and that due to the Poisson data noise. We found that for this difficult task that the AUC value for EM (0.89) was greater than that for SART (0.83) and Backprojection (0.66).

Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast.

PubMed

Cuneo, Kyle C; Dash, Rajesh C; Wilke, Lee G; Horton, Janet K; Koontz, Bridget F

2012-09-01

Benign papillary lesions of the breast include papilloma and papillomatosis. A retrospective analysis of patients with a papillary breast lesion diagnosed between October 1992 and December 2009 was performed. Patients were excluded if they had a previous or concurrent diagnosis of invasive or in situ cancer or less than 6 months of follow-up. The Kaplan-Meier method was used to determine the risk of developing subsequent malignancy. The log rank test was used to compare groups of patients. Median follow-up for the 167 patients included in the study was 4.6 years. Fifty-one patients had a papillary lesion with atypia and 116 patients had a papillary lesion without atypia. Patients with a papillary lesion with atypia were more likely to develop invasive or in situ breast cancer with a 5 year risk of 13.0% versus 4.6% in patients with no atypia (p = 0.03). © 2012 Wiley Periodicals, Inc.

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma.

PubMed

Park, Seog Yun; Jung, Yuh-S; Ryu, Chang Hwan; Lee, Chang Yoon; Lee, You Jin; Lee, Eun Kyung; Kim, Seok-Ki; Kim, Tae Sung; Kim, Tae Hyun; Jang, Jeyun; Park, Daeyoon; Dong, Seung Myung; Kang, Jae-Goo; Lee, Jin Soo; Ryu, Junsun

2015-08-01

We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11-8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68-15.08) and extrathyroidal extensions (OR, 3.03; 95% CI, 1.03-8.95) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients. © 2015 Society for Endocrinology.

Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium

PubMed Central

Menes, Tehillah S.; Rosenberg, Robert; Balch, Steven; Jaffer, Shabnam; Kerlikowske, Karla; Miglioretti, Diana L.

2013-01-01

Background Upgrade rates of high-risk breast lesions after screening mammography were examined. Study design The Breast Cancer Surveillance Consortium registry was used to identify all BI-RADS 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. Results High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (N=685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia and 2% in papillary). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, those associated with lobular neoplasia were mostly (56%) invasive. During further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. Conclusion Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on BI-RADS 4 mammograms among asymptomatic women do not justify surgical excision. PMID:24112677

Do breast columnar cell lesions with atypia need to be excised?

PubMed

Datrice, Nicole; Narula, Navneet; Maggard, Melinda; Butler, John; Hsiang, David; Baick, Choong; Lane, Karen

2007-10-01

Columnar cell lesion with atypia (CCLA) is a newly recognized pathologic entity seen in breast specimens. The breast cancer risk associated with this finding is unclear, although CCLA had been found adjacent to both in situ and invasive carcinomas, but the incidence is unknown. Breast specimens from patients with a columnar cell lesion were reviewed by a pathologist for atypia. Twenty-one specimens with CCLA were identified [core biopsy (8), excisional biopsy (11), and simple mastectomy (2)]. Six of eight specimens with CCLA on core had adjacent abnormal pathology: infiltrating ductal carcinoma (IDC)/lobular carcinoma in situ (LCIS) (1), ductal carcinoma in situ (DCIS)/LCIS (1), DCIS (1), LCIS (1), and papillomatosis (2). Five of 11 specimens with CCLA on excisional biopsy had adjacent abnormal pathology: IDC (3), DCIS/LCIS (1), and atypical ductal hyperplasia/papilloma (1). Two of two simple mastectomy specimens had CCLA associated with IDC (1) and DCIS (1). Overall, abnormal pathology was found adjacent to CCLA in 62 per cent of specimens (13/21). Breast pathologic specimens containing a columnar cell lesion should be carefully examined for atypia. Surgical excision is warranted for CCLA found on core biopsy. The future risk of breast cancer based on the finding of CCLA alone requires further investigation.

Breast lesion characterization using whole-lesion histogram analysis with stretched-exponential diffusion model.

PubMed

Liu, Chunling; Wang, Kun; Li, Xiaodan; Zhang, Jine; Ding, Jie; Spuhler, Karl; Duong, Timothy; Liang, Changhong; Huang, Chuan

2018-06-01

Diffusion-weighted imaging (DWI) has been studied in breast imaging and can provide more information about diffusion, perfusion and other physiological interests than standard pulse sequences. The stretched-exponential model has previously been shown to be more reliable than conventional DWI techniques, but different diagnostic sensitivities were found from study to study. This work investigated the characteristics of whole-lesion histogram parameters derived from the stretched-exponential diffusion model for benign and malignant breast lesions, compared them with conventional apparent diffusion coefficient (ADC), and further determined which histogram metrics can be best used to differentiate malignant from benign lesions. This was a prospective study. Seventy females were included in the study. Multi-b value DWI was performed on a 1.5T scanner. Histogram parameters of whole lesions for distributed diffusion coefficient (DDC), heterogeneity index (α), and ADC were calculated by two radiologists and compared among benign lesions, ductal carcinoma in situ (DCIS), and invasive carcinoma confirmed by pathology. Nonparametric tests were performed for comparisons among invasive carcinoma, DCIS, and benign lesions. Comparisons of receiver operating characteristic (ROC) curves were performed to show the ability to discriminate malignant from benign lesions. The majority of histogram parameters (mean/min/max, skewness/kurtosis, 10-90 th percentile values) from DDC, α, and ADC were significantly different among invasive carcinoma, DCIS, and benign lesions. DDC 10% (area under curve [AUC] = 0.931), ADC 10% (AUC = 0.893), and α mean (AUC = 0.787) were found to be the best metrics in differentiating benign from malignant tumors among all histogram parameters derived from ADC and α, respectively. The combination of DDC 10% and α mean , using logistic regression, yielded the highest sensitivity (90.2%) and specificity (95.5%). DDC 10% and α mean derived from

Accuracy of lesion boundary tracking in navigated breast tumor excision

NASA Astrophysics Data System (ADS)

Heffernan, Emily; Ungi, Tamas; Vaughan, Thomas; Pezeshki, Padina; Lasso, Andras; Gauvin, Gabrielle; Rudan, John; Engel, C. Jay; Morin, Evelyn; Fichtinger, Gabor

2016-03-01

PURPOSE: An electromagnetic navigation system for tumor excision in breast conserving surgery has recently been developed. Preoperatively, a hooked needle is positioned in the tumor and the tumor boundaries are defined in the needle coordinate system. The needle is tracked electromagnetically throughout the procedure to localize the tumor. However, the needle may move and the tissue may deform, leading to errors in maintaining a correct excision boundary. It is imperative to quantify these errors so the surgeon can choose an appropriate resection margin. METHODS: A commercial breast biopsy phantom with several inclusions was used. Location and shape of a lesion before and after mechanical deformation were determined using 3D ultrasound volumes. Tumor location and shape were estimated from initial contours and tracking data. The difference in estimated and actual location and shape of the lesion after deformation was quantified using the Hausdorff distance. Data collection and analysis were done using our 3D Slicer software application and PLUS toolkit. RESULTS: The deformation of the breast resulted in 3.72 mm (STD 0.67 mm) average boundary displacement for an isoelastic lesion and 3.88 mm (STD 0.43 mm) for a hyperelastic lesion. The difference between the actual and estimated tracked tumor boundary was 0.88 mm (STD 0.20 mm) for the isoelastic and 1.78 mm (STD 0.18 mm) for the hyperelastic lesion. CONCLUSION: The average lesion boundary tracking error was below 2mm, which is clinically acceptable. We suspect that stiffness of the phantom tissue affected the error measurements. Results will be validated in patient studies.

Orbital Metastasis: Rare Initial Presentation of an Occult Gall Bladder Carcinoma.

PubMed

Jain, Tarun Kumar; Parihar, Ashwin Singh; Sood, Ashwani; Basher, Rajender Kumar; Bollampally, Neeraja; Shekhawat, Amit Singh; Mittal, Bhagwant Rai

2018-03-01

Orbital metastases are known to arise from primary breast carcinoma followed by prostate, malignant melanoma, and lung carcinoma. We report a case of orbital metastasis as the initial presentation of an occult primary gall bladder carcinoma. The FDG PET/CT helped in localizing the occult distant primary site, which previously escaped detection, and also enabled the evaluation of orbital metastasis.

Computerized Analysis of MR and Ultrasound Images of Breast Lesions

DTIC Science & Technology

2001-07-01

Although general rules for the differentiation between benign and malignant mammographically identified breast lesions exist, considerable...round-robin runs yielded A(sub z) values of 0.94 and 0.87 in the task of distinguishing between benign and malignant lesions in the entire database

Computerized Analysis of MR and Ultrasound Images of Breast Lesions

DTIC Science & Technology

2000-07-01

Although general rules for the differentiation between benign and malignant mammographically identified breast lesions exist, considerable...round-robin runs yielded Az values of 0.94 and 0.87 in the task of distinguishing between benign and malignant lesions in the entire database and the

Textural kinetics: a novel dynamic contrast-enhanced (DCE)-MRI feature for breast lesion classification.

PubMed

Agner, Shannon C; Soman, Salil; Libfeld, Edward; McDonald, Margie; Thomas, Kathleen; Englander, Sarah; Rosen, Mark A; Chin, Deanna; Nosher, John; Madabhushi, Anant

2011-06-01

Dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of the breast has emerged as an adjunct imaging tool to conventional X-ray mammography due to its high detection sensitivity. Despite the increasing use of breast DCE-MRI, specificity in distinguishing malignant from benign breast lesions is low, and interobserver variability in lesion classification is high. The novel contribution of this paper is in the definition of a new DCE-MRI descriptor that we call textural kinetics, which attempts to capture spatiotemporal changes in breast lesion texture in order to distinguish malignant from benign lesions. We qualitatively and quantitatively demonstrated on 41 breast DCE-MRI studies that textural kinetic features outperform signal intensity kinetics and lesion morphology features in distinguishing benign from malignant lesions. A probabilistic boosting tree (PBT) classifier in conjunction with textural kinetic descriptors yielded an accuracy of 90%, sensitivity of 95%, specificity of 82%, and an area under the curve (AUC) of 0.92. Graph embedding, used for qualitative visualization of a low-dimensional representation of the data, showed the best separation between benign and malignant lesions when using textural kinetic features. The PBT classifier results and trends were also corroborated via a support vector machine classifier which showed that textural kinetic features outperformed the morphological, static texture, and signal intensity kinetics descriptors. When textural kinetic attributes were combined with morphologic descriptors, the resulting PBT classifier yielded 89% accuracy, 99% sensitivity, 76% specificity, and an AUC of 0.91.

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions.

PubMed

Mohamed Kamal, Rasha; Hussien Helal, Maha; Wessam, Rasha; Mahmoud Mansour, Sahar; Godda, Iman; Alieldin, Nelly

2015-06-01

To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Quantification of breast lesion compositions using low-dose spectral mammography: A feasibility study

PubMed Central

Ding, Huanjun; Sennung, David; Cho, Hyo-Min; Molloi, Sabee

2016-01-01

Purpose: The positive predictive power for malignancy can potentially be improved, if the chemical compositions of suspicious breast lesions can be reliably measured in screening mammography. The purpose of this study is to investigate the feasibility of quantifying breast lesion composition, in terms of water and lipid contents, with spectral mammography. Methods: Phantom and tissue samples were imaged with a spectral mammography system based on silicon-strip photon-counting detectors. Dual-energy calibration was performed for material decomposition, using plastic water and adipose-equivalent phantoms as the basis materials. The step wedge calibration phantom consisted of 20 calibration configurations, which ranged from 2 to 8 cm in thickness and from 0% to 100% in plastic water density. A nonlinear rational fitting function was used in dual-energy calibration of the imaging system. Breast lesion phantoms, made from various combinations of plastic water and adipose-equivalent disks, were embedded in a breast mammography phantom with a heterogeneous background pattern. Lesion phantoms with water densities ranging from 0% to 100% were placed at different locations of the heterogeneous background phantom. The water density in the lesion phantoms was measured using dual-energy material decomposition. The thickness and density of the background phantom were varied to test the accuracy of the decomposition technique in different configurations. In addition, an in vitro study was also performed using mixtures of lean and fat bovine tissue of 25%, 50%, and 80% lean weight percentages as the background. Lesions were simulated by using breast lesion phantoms, as well as small bovine tissue samples, composed of carefully weighed lean and fat bovine tissues. The water densities in tissue samples were measured using spectral mammography and compared to measurement using chemical decomposition of the tissue. Results: The thickness of measured and known water contents was

Contrast enhanced dual energy spectral mammogram, an emerging addendum in breast imaging

PubMed Central

Gnanaprakasam, Francis; Anand, Subhapradha; Krishnaswami, Murali; Ramachandran, Madan

2016-01-01

Objective: To assess the role of contrast-enhanced dual-energy spectral mammogram (CEDM) as a problem-solving tool in equivocal cases. Methods: 44 consenting females with equivocal findings on full-field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three-point Likert scale and probability of cancer was assigned on Breast Imaging Reporting and Data System scoring. Histopathology was taken as the gold standard. Statistical analyses of all variables were performed. Results: 44 breast lesions were included in the study, among which 77.3% lesions were malignant or precancerous and 22.7% lesions were benign or inconclusive. 20% of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9% of cases, multifocality was established in 9.1% of cases and ductal extension was demonstrated in 6.8% of cases. Statistical significance for CEDM was p-value <0.05. Interobserver kappa value was 0.837. Conclusion: CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence, we conclude that CEDM is a useful complementary tool to standard mammogram. Advances in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with the advantage of feasibility of stereotactic biopsy in the same setting. Hence, it has the potential to be a screening modality with need for further studies and validation. PMID:27610475

Contrast enhanced dual energy spectral mammogram, an emerging addendum in breast imaging.

PubMed

Kariyappa, Kalpana D; Gnanaprakasam, Francis; Anand, Subhapradha; Krishnaswami, Murali; Ramachandran, Madan

2016-11-01

To assess the role of contrast-enhanced dual-energy spectral mammogram (CEDM) as a problem-solving tool in equivocal cases. 44 consenting females with equivocal findings on full-field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three-point Likert scale and probability of cancer was assigned on Breast Imaging Reporting and Data System scoring. Histopathology was taken as the gold standard. Statistical analyses of all variables were performed. 44 breast lesions were included in the study, among which 77.3% lesions were malignant or precancerous and 22.7% lesions were benign or inconclusive. 20% of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9% of cases, multifocality was established in 9.1% of cases and ductal extension was demonstrated in 6.8% of cases. Statistical significance for CEDM was p-value <0.05. Interobserver kappa value was 0.837. CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence, we conclude that CEDM is a useful complementary tool to standard mammogram. Advances in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with the advantage of feasibility of stereotactic biopsy in the same setting. Hence, it has the potential to be a screening modality with need for further studies and validation.

Invasion in breast lesions: the role of the epithelial-stroma barrier.

PubMed

Rakha, Emad A; Miligy, Islam M; Gorringe, Kylie L; Toss, Michael S; Green, Andrew R; Fox, Stephen B; Schmitt, Fernando C; Tan, Puay-Hoon; Tse, Gary M; Badve, Sunil; Decker, Thomas; Vincent-Salomon, Anne; Dabbs, David J; Foschini, Maria P; Moreno, Filipa; Wentao, Yang; Geyer, Felipe C; Reis-Filho, Jorge S; Pinder, Sarah E; Lakhani, Sunil R; Ellis, Ian O

2018-06-01

Despite the significant biological, behavioural and management differences between ductal carcinoma in situ (DCIS) and invasive carcinoma of the breast, they share many morphological and molecular similarities. Differentiation of these two different lesions in breast pathological diagnosis is based typically on the presence of an intact barrier between the malignant epithelial cells and stroma; namely, the myoepithelial cell (MEC) layer and surrounding basement membrane (BM). Despite being robust diagnostic criteria, the identification of MECs and BM to differentiate in-situ from invasive carcinoma is not always straightforward. The MEC layer around DCIS may be interrupted and/or show an altered immunoprofile. MECs may be absent in some benign locally infiltrative lesions such as microglandular adenosis and infiltrating epitheliosis, and occasionally in non-infiltrative conditions such as apocrine lesions, and in these contexts this does not denote malignancy or invasive disease with metastatic potential. MECs may also be absent around some malignant lesions such as some forms of papillary carcinoma, yet these behave in an indolent fashion akin to some DCIS. In Paget's disease, malignant mammary epithelial cells extend anteriorly from the ducts to infiltrate the epidermis of the nipple but do not typically infiltrate through the BM into the dermis. Conversely, BM-like material can be seen around invasive carcinoma cells and around metastatic tumour cell deposits. Here, we review the role of MECs and BM in breast pathology and highlight potential clinical implications. We advise caution in interpretation of MEC features in breast pathology and mindfulness of the substantive evidence base in the literature associated with behaviour and clinical outcome of lesions classified as benign on conventional morphological examination before changing classification to an invasive lesion on the sole basis of MEC characteristics. © 2017 John Wiley & Sons Ltd.

Novel Breast Imaging and Machine Learning: Predicting Breast Lesion Malignancy at Cone-Beam CT Using Machine Learning Techniques.

PubMed

Uhlig, Johannes; Uhlig, Annemarie; Kunze, Meike; Beissbarth, Tim; Fischer, Uwe; Lotz, Joachim; Wienbeck, Susanne

2018-05-24

The purpose of this study is to evaluate the diagnostic performance of machine learning techniques for malignancy prediction at breast cone-beam CT (CBCT) and to compare them to human readers. Five machine learning techniques, including random forests, back propagation neural networks (BPN), extreme learning machines, support vector machines, and K-nearest neighbors, were used to train diagnostic models on a clinical breast CBCT dataset with internal validation by repeated 10-fold cross-validation. Two independent blinded human readers with profound experience in breast imaging and breast CBCT analyzed the same CBCT dataset. Diagnostic performance was compared using AUC, sensitivity, and specificity. The clinical dataset comprised 35 patients (American College of Radiology density type C and D breasts) with 81 suspicious breast lesions examined with contrast-enhanced breast CBCT. Forty-five lesions were histopathologically proven to be malignant. Among the machine learning techniques, BPNs provided the best diagnostic performance, with AUC of 0.91, sensitivity of 0.85, and specificity of 0.82. The diagnostic performance of the human readers was AUC of 0.84, sensitivity of 0.89, and specificity of 0.72 for reader 1 and AUC of 0.72, sensitivity of 0.71, and specificity of 0.67 for reader 2. AUC was significantly higher for BPN when compared with both reader 1 (p = 0.01) and reader 2 (p < 0.001). Machine learning techniques provide a high and robust diagnostic performance in the prediction of malignancy in breast lesions identified at CBCT. BPNs showed the best diagnostic performance, surpassing human readers in terms of AUC and specificity.

Mucocele-Like Lesions of the Breast: Clinical Outcome and Histological Analysis of 102 Cases

PubMed Central

Meares, Annie L.; Frank, Ryan D.; Degnim, Amy C.; Vierkant, Robert A.; Frost, Marlene H.; Hartmann, Lynn C.; Winham, Stacey J.; Visscher, Daniel W.

2016-01-01

Mucocele-like lesions (MLL) of the breast are characterized by cystic architecture with stromal mucin and frequent atypia, but it is unknown whether they convey long term breast cancer risk. We evaluated 102MLL that were derived from a single institution benign breast disease (BBD) cohort of 13412 women who underwent biopsy from 1967–2001.MLL were histologically characterized by type of lining epithelium, architecture of the lesion, associated atypical hyperplasia (AH) and for incidence of breast cancer (14.8 years median follow-up). A relatively large proportion of MLL (42%) were diagnosed in women >55 years of age AH was significantly more frequent in MML patient compared to the cohort overall (27% vs 5%, p<0.001). Breast cancer has developed in 13 patients with MLL.. This frequency is only slightly higher than population expected rates overall (Standardized incidence ratio (SIR) 2.28, 95% CI 1.21–3.91), and not significantly different from women in the cohort with (non atypical) proliferative breast lesions. Younger women (<45) with MLL had a non-significant increase in risk of cancer compared to the general population (SIR 5.16, 95% CI 1.41–13.23). We conclude MLL is an uncommon breast lesion that is often associated with co-existing AH. However, in women over age 45, MLL do not convey additional risk of breast cancer beyond that associated with the presence of proliferative disease. PMID:26826407

Fatal Neonatal Herpes Simplex Infection Likely from Unrecognized Breast Lesions.

PubMed

Field, Scott S

2016-02-01

Type 1 herpes simplex virus (HSV-1) is very prevalent yet in rare circumstances can lead to fatal neonatal disease. Genital acquisition of type 2 HSV is the usual mode for neonatal herpes, but HSV-1 transmission by genital or extragenital means may result in greater mortality rates. A very rare scenario is presented in which the mode of transmission was likely through breast lesions. The lesions were seen by nurses as well as the lactation consultant and obstetrician in the hospital after delivery of the affected baby but not recognized as possibly being caused by herpes. The baby died 9 days after birth with hepatic failure and disseminated intravascular coagulation. Peripartum health care workers need to be aware of potential nongenital (including from the breast[s]) neonatal herpes acquisition, which can be lethal. © The Author(s) 2015.

Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions.

PubMed

Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe; Moschetta, Marco

2015-10-01

To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard. Two hundred eighty consecutive patients (age range, 27-73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI. UE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found. Breast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization. Copyright © 2015 Elsevier Inc. All rights reserved.

A case of synchronous metastasis of breast cancer to stomach and colon.

PubMed

Takeuchi, Hideya; Hiroshige, Shozi; Yoshikawa, Yasuji; Kusumoto, Tetusya; Muto, Yoichi

2012-09-01

A case of synchronous metastasis of breast cancer to the stomach and colon is reported. A 38-year-old woman with a history of bilateral breast cancer was admitted for endoscopic examination because of occult blood. Endoscopic examination showed elevated lesions on the mucosal surface of the stomach and cecum. Histopathological examination of the biopsy specimens obtained from both sites showed adenocarcinoma, comprised of tumor cells with structural and nuclear atypia, which were similar to those of the primary breast cancer cells. In immunohistochemical analysis, these tumor cells stained positive for ER. Therefore, we diagnosed a synchronous metastasis of breast cancer to the stomach and colon. Synchronous metastasis of breast cancer to the stomach and colon without liver metastasis or peritoneal dissemination is extremely rare, with only 4 reported cases existing in literature.

Diagnostic challenges of tubercular lesions of breast

PubMed Central

Jairajpuri, Zeeba Shamim; Jetley, Sujata; Rana, Safia; Khetrapal, Shaan; Khan, Sabina; Hassan, Mohammad Jaseem

2018-01-01

INTRODUCTION: Tuberculosis (TB) in the developing countries presents with both pulmonary and extrapulmonary manifestations. Breast TB, however, remains a rare presentation. Its importance lies in the fact that it may mimic malignancy or present as inflammatory lump/abscess. AIMS AND OBJECTIVE: The aim of the present study is to highlight the importance of breast TB and its diagnostic challenges. MATERIALS AND METHODS: It was a retrospective study conducted at a tertiary care hospital, over 2 years between 2013 and 2015 during which eight cases of breast lesions were diagnosed as of tubercular origin. RESULTS: Granulomas were seen in five cases while three cases revealed only few epithelioid cells, and necrosis was seen in all cases on fine-needle aspiration cytology. Histopathological evaluation was available in six out of the eight cases, while acid–fast bacilli were positive in three cases, the characteristic granulomas were seen in all the six cases evaluated. CONCLUSION: Significance of TB breast lies in the fact that it may masquerade as breast malignancy or pyogenic abscess. India is a developing country where TB is endemic, a high index of suspicion should be expressed in evaluating breast masses, and TB should be considered in the differential diagnosis. PMID:29692584

Anisotropy of Solid Breast Lesions in 2D Shear Wave Elastography is an Indicator of Malignancy.

PubMed

Skerl, Katrin; Vinnicombe, Sarah; Thomson, Kim; McLean, Denis; Giannotti, Elisabetta; Evans, Andrew

2016-01-01

To investigate if anisotropy at two-dimensional shear wave elastography (SWE) suggests malignancy and whether it correlates with prognostic and predictive factors in breast cancer. Study group A of 244 solid breast lesions was imaged with SWE between April 2013 and May 2014. Each lesion was imaged in radial and in antiradial planes, and the maximum elasticity, mean elasticity, and standard deviation were recorded and correlated with benign/malignant status, and if malignant, correlated with conventional predictive and prognostic factors. The results were compared to a study group B of 968 solid breast lesions, which were imaged in sagittal and in axial planes between 2010 and 2013. Neither benign nor malignant lesion anisotropy is plane dependent. However, malignant lesions are more anisotropic than benign lesions (P ≤ 0.001). Anisotropy correlates with increasing elasticity parameters, breast imaging-reporting and data system categories, core biopsy result, and tumor grade. Large cancers are significantly more anisotropic than small cancers (P ≤ 0.001). The optimal anisotropy cutoff threshold for benign/malignant differentiation of 150 kPa(2) achieves the best sensitivity (74%) with a reasonable specificity (63%). Anisotropy may be useful during benign/malignant differentiation of solid breast masses using SWE. Anisotropy also correlates with some prognostic factors in breast cancer. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Quantifying heterogeneity of lesion uptake in dynamic contrast enhanced MRI for breast cancer diagnosis

NASA Astrophysics Data System (ADS)

Karahaliou, A.; Vassiou, K.; Skiadopoulos, S.; Kanavou, T.; Yiakoumelos, A.; Costaridou, L.

2009-07-01

The current study investigates whether texture features extracted from lesion kinetics feature maps can be used for breast cancer diagnosis. Fifty five women with 57 breast lesions (27 benign, 30 malignant) were subjected to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on 1.5T system. A linear-slope model was fitted pixel-wise to a representative lesion slice time series and fitted parameters were used to create three kinetic maps (wash out, time to peak enhancement and peak enhancement). 28 grey level co-occurrence matrices features were extracted from each lesion kinetic map. The ability of texture features per map in discriminating malignant from benign lesions was investigated using a Probabilistic Neural Network classifier. Additional classification was performed by combining classification outputs of most discriminating feature subsets from the three maps, via majority voting. The combined scheme outperformed classification based on individual maps achieving area under Receiver Operating Characteristics curve 0.960±0.029. Results suggest that heterogeneity of breast lesion kinetics, as quantified by texture analysis, may contribute to computer assisted tissue characterization in DCE-MRI.

Breast-Lesion Characterization using Textural Features of Quantitative Ultrasound Parametric Maps.

PubMed

Sadeghi-Naini, Ali; Suraweera, Harini; Tran, William Tyler; Hadizad, Farnoosh; Bruni, Giancarlo; Rastegar, Rashin Fallah; Curpen, Belinda; Czarnota, Gregory J

2017-10-20

This study evaluated, for the first time, the efficacy of quantitative ultrasound (QUS) spectral parametric maps in conjunction with texture-analysis techniques to differentiate non-invasively benign versus malignant breast lesions. Ultrasound B-mode images and radiofrequency data were acquired from 78 patients with suspicious breast lesions. QUS spectral-analysis techniques were performed on radiofrequency data to generate parametric maps of mid-band fit, spectral slope, spectral intercept, spacing among scatterers, average scatterer diameter, and average acoustic concentration. Texture-analysis techniques were applied to determine imaging biomarkers consisting of mean, contrast, correlation, energy and homogeneity features of parametric maps. These biomarkers were utilized to classify benign versus malignant lesions with leave-one-patient-out cross-validation. Results were compared to histopathology findings from biopsy specimens and radiology reports on MR images to evaluate the accuracy of technique. Among the biomarkers investigated, one mean-value parameter and 14 textural features demonstrated statistically significant differences (p < 0.05) between the two lesion types. A hybrid biomarker developed using a stepwise feature selection method could classify the legions with a sensitivity of 96%, a specificity of 84%, and an AUC of 0.97. Findings from this study pave the way towards adapting novel QUS-based frameworks for breast cancer screening and rapid diagnosis in clinic.

Extraction of breast lesions from ultrasound imagery: Bhattacharyya gradient flow approach

NASA Astrophysics Data System (ADS)

Torkaman, Mahsa; Sandhu, Romeil; Tannenbaum, Allen

2018-03-01

Breast cancer is one of the most commonly diagnosed neoplasms among American women and the second leading cause of death among women all over the world. In order to reduce the mortality rate and cost of treatment, early diagnosis and treatment are essential. Accurate and reliable diagnosis is required in order to ensure the most effective treatment and a second opinion is often advisable. In this paper, we address the problem of breast lesion detection from ultrasound imagery by means of active contours, whose evolution is driven by maximizing the Bhattacharyya distance1 between the probability density functions (PDFs). The proposed method was applied to ultrasound breast imagery, and the lesion boundary was obtained by maximizing the distance-based energy functional such that the maximum (optimal contour) is attained at the boundary of the potential lesion. We compared the results of the proposed method quantitatively using the Dice coefficient (similarity index)2 to well-known GrowCut segmentation method3 and demonstrated that Bhattacharyya approach outperforms GrowCut in most of the cases.

Autofluorescence imaging can identify preinvasive or clinically occult lesions in fallopian tube epithelium: a promising step towards screening and early detection.

PubMed

McAlpine, J N; El Hallani, S; Lam, S F; Kalloger, S E; Luk, M; Huntsman, D G; MacAulay, C; Gilks, C B; Miller, D M; Lane, P M

2011-03-01

Optical imaging systems are robust, portable, relatively inexpensive, and have proven utility in detecting precancerous lesions in the lung, esophagus, colon, oral cavity and cervix. We describe the use of light-induced endogenous fluorescence (autofluorescence) in identifying preinvasive and occult carcinomas in ex vivo samples of human fallopian tube (FT) epithelium. Women undergoing surgery for an i) ovarian mass, ii) a history suggestive of hereditary breast-ovarian cancer, or iii) known serous ovarian cancer following neoadjuvant chemotherapy (NAC) were approached for informed consent. Immediately following surgery, FT's were photographed in reflectance and fluorescence at high resolution. Images included: (1) white-light reflectance of luminal/epithelial surface; (2) narrow-band green reflectance (570 nm) (3) green autofluorescence (405/436 nm excitation); and (4) blue autofluorescence (405 nm excitation). Areas revealing a loss of natural tissue fluorescence or marked increase in tissue microvasculature were recorded and compared to final histopathologic diagnosis (SEE-FIM protocol). Fifty-six cases involving one or both fallopian tubes underwent reflectance and fluorescence visualization. Nine cases were excluded, either secondary to non-ovarian primary pathology (7) or excessive trauma (2) rendering tissue interpretation impossible. Of the 47 cases remaining, there were 11 high grade serous (HGS) and 9 non-serous ovarian carcinomas undergoing primary debulking surgery, 5 serous carcinomas having received NAC, 8 benign ovarian tumors, and 14 women undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). Methodology was feasible, efficient, and reproducible. TIC or carcinoma was identified in 7/11 HGS, 3/5 NAC, and 1/14 RRBSO. Optical images were reviewed to determine test positive or negative based on standardized criteria. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the entire

Detecting mammographically occult cancer in women with dense breasts using Radon Cumulative Distribution Transform: a preliminary analysis

NASA Astrophysics Data System (ADS)

Lee, Juhun; Nishikawa, Robert M.; Rohde, Gustavo K.

2018-02-01

We propose using novel imaging biomarkers for detecting mammographically-occult (MO) cancer in women with dense breast tissue. MO cancer indicates visually occluded, or very subtle, cancer that radiologists fail to recognize as a sign of cancer. We used the Radon Cumulative Distribution Transform (RCDT) as a novel image transformation to project the difference between left and right mammograms into a space, increasing the detectability of occult cancer. We used a dataset of 617 screening full-field digital mammograms (FFDMs) of 238 women with dense breast tissue. Among 238 women, 173 were normal with 2 - 4 consecutive screening mammograms, 552 normal mammograms in total, and the remaining 65 women had an MO cancer with a negative screening mammogram. We used Principal Component Analysis (PCA) to find representative patterns in normal mammograms in the RCDT space. We projected all mammograms to the space constructed by the first 30 eigenvectors of the RCDT of normal cases. Under 10-fold crossvalidation, we conducted quantitative feature analysis to classify normal mammograms and mammograms with MO cancer. We used receiver operating characteristic (ROC) analysis to evaluate the classifier's output using the area under the ROC curve (AUC) as the figure of merit. Four eigenvectors were selected via a feature selection method. The mean and standard deviation of the AUC of the trained classifier on the test set were 0.74 and 0.08, respectively. In conclusion, we utilized imaging biomarkers to highlight differences between left and right mammograms to detect MO cancer using novel imaging transformation.

Characterization of focal breast lesions by means of elastography.

PubMed

Fischer, T; Sack, I; Thomas, A

2013-09-01

The modern method of sonoelastography of the breast is used for differentiating focal lesions. This review gives an overview of the different techniques available and discusses their roles in the routine clinical setting. The presented techniques include compression or vibration elastography as well as shear wave elastography. Descriptions of the methods are supplemented by a discussion of the clinical role of each technique based on the most recent literature. We discuss by outlining two recent experimental approaches - MRI and tomosynthesis elastography. Currently available data suggest that elastography is an important supplementary tool for the differentiation of breast tumors under routine clinical conditions. The specificity improves with the immediate availability of additional diagnostic information using real-time techniques and/or the calculation of strain ratios (SR). Elastography is especially helpful in women with involuted breasts for differentiating BI-RADS-US 3 and 4 lesions and for evaluating very small cancers without the typical imaging features of malignancy. Here, elastography techniques are highly specific, while the sensitivity decreases compared to B-mode ultrasound. SR calculation is especially helpful in women who have a high risk of breast cancer and high pretest likelihood. B-mode ultrasound is still the first-line method for the initial evaluation of the breast. If suspicious findings are detected, elastography with or without SR calculation is the most crucial supplementary tool. © Georg Thieme Verlag KG Stuttgart · New York.

Breast lesion shape and margin evaluation: BI-RADS based metrics understate radiologists' actual levels of agreement.

PubMed

Rawashdeh, Mohammad; Lewis, Sarah; Zaitoun, Maha; Brennan, Patrick

2018-05-01

While there is much literature describing the radiologic detection of breast cancer, there are limited data available on the agreement between experts when delineating and classifying breast lesions. The aim of this work is to measure the level of agreement between expert radiologists when delineating and classifying breast lesions as demonstrated through Breast Imaging Reporting and Data System (BI-RADS) and quantitative shape metrics. Forty mammographic images, each containing a single lesion, were presented to nine expert breast radiologists using a high specification interactive digital drawing tablet with stylus. Each reader was asked to manually delineate the breast masses using the tablet and stylus and then visually classify the lesion according to the American College of Radiology (ACR) BI-RADS lexicon. The delineated lesion compactness and elongation were computed using Matlab software. Intraclass Correlation Coefficient (ICC) and Cohen's kappa were used to assess inter-observer agreement for delineation and classification outcomes, respectively. Inter-observer agreement was fair for BI-RADS shape (kappa = 0.37) and moderate for margin (kappa = 0.58) assessments. Agreement for quantitative shape metrics was good for lesion elongation (ICC = 0.82) and excellent for compactness (ICC = 0.93). Fair to moderate levels of agreement was shown by radiologists for shape and margin classifications of cancers using the BI-RADS lexicon. When quantitative shape metrics were used to evaluate radiologists' delineation of lesions, good to excellent inter-observer agreement was found. The results suggest that qualitative descriptors such as BI-RADS lesion shape and margin understate the actual level of expert radiologist agreement. Copyright © 2018 Elsevier Ltd. All rights reserved.

Role of shear wave sonoelastography in differentiation between focal breast lesions.

PubMed

Dobruch-Sobczak, Katarzyna; Nowicki, Andrzej

2015-02-01

Our goal in this study was to evaluate the relevance of shear wave sonoelastography (SWE) in the differential diagnosis of masses in the breast with respect to ultrasound (US). US and SWE were performed (Aixplorer System, SuperSonic Imagine, Aix en Provence, France) in 76 women (aged 24 to 85) with 84 lesions (43 malignant, 41 benign). The study included BI-RADS-US (Breast Imaging Reporting and Data System for Ultrsound) category 3-5 lesions. In elastograms, the following values were calculated: mean elasticity in lesions (E(av.l)) and in fat tissue (E(av.f.)) and maximal (E(max.adj.)) and mean (E(av.adj.)) elasticity in lesions and adjacent tissues. The sensitivity and specificity of the BI-RADS category 4a/4b cutoff value were 97.7% and 90.2%. For an E(av.adj.) of 68.5 kPa, the cutoff sensitivity was 86.1% and the specificity was 87.8%, and for an E(max.adj.) of 124.1 kPa, 74.4% and 92.7%, respectively. For BI-RADS-US category 3 lesions, E(av.l), E(max.adj.) and E(av.adj.) were below cutoff levels. On the basis of our findings, E(av.adj.) had lower sensitivity and specificity compared with US. Emax.adj. improved the specificity of breast US with loss of sensitivity. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Characterization of breast lesion using T1-perfusion magnetic resonance imaging: Qualitative vs. quantitative analysis.

PubMed

Thakran, S; Gupta, P K; Kabra, V; Saha, I; Jain, P; Gupta, R K; Singh, A

2018-06-14

The objective of this study was to quantify the hemodynamic parameters using first pass analysis of T 1 -perfusion magnetic resonance imaging (MRI) data of human breast and to compare these parameters with the existing tracer kinetic parameters, semi-quantitative and qualitative T 1 -perfusion analysis in terms of lesion characterization. MRI of the breast was performed in 50 women (mean age, 44±11 [SD] years; range: 26-75) years with a total of 15 benign and 35 malignant breast lesions. After pre-processing, T 1 -perfusion MRI data was analyzed using qualitative approach by two radiologists (visual inspection of the kinetic curve into types I, II or III), semi-quantitative (characterization of kinetic curve types using empirical parameters), generalized-tracer-kinetic-model (tracer kinetic parameters) and first pass analysis (hemodynamic-parameters). Chi-squared test, t-test, one-way analysis-of-variance (ANOVA) using Bonferroni post-hoc test and receiver-operating-characteristic (ROC) curve were used for statistical analysis. All quantitative parameters except leakage volume (Ve), qualitative (type-I and III) and semi-quantitative curves (type-I and III) provided significant differences (P<0.05) between benign and malignant lesions. Kinetic parameters, particularly volume transfer coefficient (K trans ) provided a significant difference (P<0.05) between all grades except grade-II vs III. The hemodynamic parameter (relative-leakage-corrected-breast-blood-volume [rBBVcorr) provided a statistically significant difference (P<0.05) between all grades. It also provided highest sensitivity and specificity among all parameters in differentiation between different grades of malignant breast lesions. Quantitative parameters, particularly rBBVcorr and K trans provided similar sensitivity and specificity in differentiating benign from malignant breast lesions for this cohort. Moreover, rBBVcorr provided better differentiation between different grades of malignant breast

Improved characterization of molecular phenotypes in breast lesions using 18F-FDG PET image homogeneity

NASA Astrophysics Data System (ADS)

Cao, Kunlin; Bhagalia, Roshni; Sood, Anup; Brogi, Edi; Mellinghoff, Ingo K.; Larson, Steven M.

2015-03-01

Positron emission tomography (PET) using uorodeoxyglucose (18F-FDG) is commonly used in the assessment of breast lesions by computing voxel-wise standardized uptake value (SUV) maps. Simple metrics derived from ensemble properties of SUVs within each identified breast lesion are routinely used for disease diagnosis. The maximum SUV within the lesion (SUVmax) is the most popular of these metrics. However these simple metrics are known to be error-prone and are susceptible to image noise. Finding reliable SUV map-based features that correlate to established molecular phenotypes of breast cancer (viz. estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) expression) will enable non-invasive disease management. This study investigated 36 SUV features based on first and second order statistics, local histograms and texture of segmented lesions to predict ER and PR expression in 51 breast cancer patients. True ER and PR expression was obtained via immunohistochemistry (IHC) of tissue samples from each lesion. A supervised learning, adaptive boosting-support vector machine (AdaBoost-SVM), framework was used to select a subset of features to classify breast lesions into distinct phenotypes. Performance of the trained multi-feature classifier was compared against the baseline single-feature SUVmax classifier using receiver operating characteristic (ROC) curves. Results show that texture features encoding local lesion homogeneity extracted from gray-level co-occurrence matrices are the strongest discriminator of lesion ER expression. In particular, classifiers including these features increased prediction accuracy from 0.75 (baseline) to 0.82 and the area under the ROC curve from 0.64 (baseline) to 0.75.

Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Landman, Joanne; Kulawansa, Sagarika; McCarthy, Michael

2015-03-15

Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL. Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphymore » and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins. Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases. ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.« less

Feasibility of spatial frequency-domain imaging for monitoring palpable breast lesions

NASA Astrophysics Data System (ADS)

Robbins, Constance M.; Raghavan, Guruprasad; Antaki, James F.; Kainerstorfer, Jana M.

2017-12-01

In breast cancer diagnosis and therapy monitoring, there is a need for frequent, noninvasive disease progression evaluation. Breast tumors differ from healthy tissue in mechanical stiffness as well as optical properties, which allows optical methods to detect and monitor breast lesions noninvasively. Spatial frequency-domain imaging (SFDI) is a reflectance-based diffuse optical method that can yield two-dimensional images of absolute optical properties of tissue with an inexpensive and portable system, although depth penetration is limited. Since the absorption coefficient of breast tissue is relatively low and the tissue is quite flexible, there is an opportunity for compression of tissue to bring stiff, palpable breast lesions within the detection range of SFDI. Sixteen breast tissue-mimicking phantoms were fabricated containing stiffer, more highly absorbing tumor-mimicking inclusions of varying absorption contrast and depth. These phantoms were imaged with an SFDI system at five levels of compression. An increase in absorption contrast was observed with compression, and reliable detection of each inclusion was achieved when compression was sufficient to bring the inclusion center within ˜12 mm of the phantom surface. At highest compression level, contrasts achieved with this system were comparable to those measured with single source-detector near-infrared spectroscopy.

Interactive lesion segmentation on dynamic contrast enhanced breast MRI using a Markov model

NASA Astrophysics Data System (ADS)

Wu, Qiu; Salganicoff, Marcos; Krishnan, Arun; Fussell, Donald S.; Markey, Mia K.

2006-03-01

The purpose of this study is to develop a method for segmenting lesions on Dynamic Contrast-Enhanced (DCE) breast MRI. DCE breast MRI, in which the breast is imaged before, during, and after the administration of a contrast agent, enables a truly 3D examination of breast tissues. This functional angiogenic imaging technique provides noninvasive assessment of microcirculatory characteristics of tissues in addition to traditional anatomical structure information. Since morphological features and kinetic curves from segmented lesions are to be used for diagnosis and treatment decisions, lesion segmentation is a key pre-processing step for classification. In our study, the ROI is defined by a bounding box containing the enhancement region in the subtraction image, which is generated by subtracting the pre-contrast image from 1st post-contrast image. A maximum a posteriori (MAP) estimate of the class membership (lesion vs. non-lesion) for each voxel is obtained using the Iterative Conditional Mode (ICM) method. The prior distribution of the class membership is modeled as a multi-level logistic model, a Markov Random Field model in which the class membership of each voxel is assumed to depend upon its nearest neighbors only. The likelihood distribution is assumed to be Gaussian. The parameters of each Gaussian distribution are estimated from a dozen voxels manually selected as representative of the class. The experimental segmentation results demonstrate anatomically plausible breast tissue segmentation and the predicted class membership of voxels from the interactive segmentation algorithm agrees with the manual classifications made by inspection of the kinetic enhancement curves. The proposed method is advantageous in that it is efficient, flexible, and robust.

Targeting Premalignant Lesions: Implications for Early Breast Cancer Detection and Intervention

DTIC Science & Technology

2016-04-01

prostate, lung, colon and pancreas and have been also reported in the premalignant lesions. This peptide could provide us with an opportunity to...including those of the breast, prostate, lung, colon and pancreas and have been also reported in the premalignant lesions (Erez N, et. al Cancer Cell

Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions.

PubMed

Park, Chang Suk; Kim, Sung Hun; Jung, Na Young; Choi, Jae Jung; Kang, Bong Joo; Jung, Hyun Seouk

2015-03-01

Elastographpy is a newly developed noninvasive imaging technique that uses ultrasound (US) to evaluate tissue stiffness. The interpretation of the same elastographic images may be variable according to reviewers. Because breast lesions are usually reported according to American College of Radiology Breast Imaging and Data System (ACR BI-RADS) lexicons and final category, we tried to compare observer variability between lexicons and final categorization of US BI-RADS and the elasticity score of US elastography. From April 2009 to February 2010, 1356 breast lesions in 1330 patients underwent ultrasound-guided core biopsy. Among them, 63 breast lesions in 55 patients (mean age, 45.7 years; range, 21-79 years) underwent both conventional ultrasound and elastography and were included in this study. Two radiologists independently performed conventional ultrasound and elastography, and another three observers reviewed conventional ultrasound images and elastography videos. Observers independently recorded the elasticity score for a 5-point scoring system proposed by Itoh et al., BI-RADS lexicons and final category using ultrasound BI-RADS. The histopathologic results were obtained and used as the reference standard. Interobserver variability was evaluated. Of the 63 lesions, 42 (66.7 %) were benign, and 21 (33.3 %) were malignant. The highest value of concordance among all variables was achieved for the elasticity score (k = 0.59), followed by shape (k = 0.54), final category (k = 0.48), posterior acoustic features (k = 0.44), echogenecity and orientation (k = 0.43). The least concordances were margin (k = 0.26), lesion boundary (k = 0.29) and calcification (k = 0.3). Elasticity score showed a higher level of interobserver agreement for the diagnosis of breast lesions than BI-RADS lexicons and final category.

Parametric imaging using subharmonic signals from ultrasound contrast agents in patients with breast lesions.

PubMed

Eisenbrey, John R; Dave, Jaydev K; Merton, Daniel A; Palazzo, Juan P; Hall, Anne L; Forsberg, Flemming

2011-01-01

Parametric maps showing perfusion of contrast media can be useful tools for characterizing lesions in breast tissue. In this study we show the feasibility of parametric subharmonic imaging (SHI), which allows imaging of a vascular marker (the ultrasound contrast agent) while providing near complete tissue suppression. Digital SHI clips of 16 breast lesions from 14 women were acquired. Patients were scanned using a modified LOGIQ 9 scanner (GE Healthcare, Waukesha, WI) transmitting/receiving at 4.4/2.2 MHz. Using motion-compensated cumulative maximum intensity (CMI) sequences, parametric maps were generated for each lesion showing the time to peak (TTP), estimated perfusion (EP), and area under the time-intensity curve (AUC). Findings were grouped and compared according to biopsy results as benign lesions (n = 12, including 5 fibroadenomas and 3 cysts) and carcinomas (n = 4). For each lesion CMI, TTP, EP, and AUC parametric images were generated. No significant variations were detected with CMI (P = .80), TTP (P = .35), or AUC (P = .65). A statistically significant variation was detected for the average pixel EP (P = .002). Especially, differences were seen between carcinoma and benign lesions (mean ± SD, 0.10 ± 0.03 versus 0.05 ± 0.02 intensity units [IU]/s; P = .0014) and between carcinoma and fibroadenoma (0.10 ± 0.03 versus 0.04 ± 0.01 IU/s; P = .0044), whereas differences between carcinomas and cysts were found to be nonsignificant. In conclusion, a parametric imaging method for characterization of breast lesions using the high contrast to tissue signal provided by SHI has been developed. While the preliminary sample size was limited, results show potential for breast lesion characterization based on perfusion flow parameters.

Ultrasound-guided cable-free 13-gauge vacuum-assisted biopsy of non-mass breast lesions

PubMed Central

Seo, Jiwoon; Jang, Mijung; Yun, Bo La; Lee, Soo Hyun; Kim, Eun-Kyu; Kang, Eunyoung; Park, So Yeon; Moon, Woo Kyung; Choi, Hye Young; Kim, Bohyoung

2017-01-01

Purpose To compare the outcomes of ultrasound-guided core biopsy for non-mass breast lesions by the novel 13-gauge cable-free vacuum-assisted biopsy (VAB) and by the conventional 14-gauge semi-automated core needle biopsy (CCNB). Materials and methods Our institutional review board approved this prospective study, and all patients provided written informed consent. Among 1840 ultrasound-guided percutaneous biopsies performed from August 2013 to December 2014, 145 non-mass breast lesions with suspicious microcalcifications on mammography or corresponding magnetic resonance imaging finding were subjected to 13-gauge VAB or 14-gauge CCNB. We evaluated the technical success rates, average specimen numbers, and tissue sampling time. We also compared the results of percutaneous biopsy and final surgical pathologic diagnosis to analyze the rates of diagnostic upgrade or downgrade. Results Ultrasound-guided VAB successfully targeted and sampled all lesions, whereas CCNB failed to demonstrate calcification in four (10.3%) breast lesions with microcalcification on specimen mammography. The mean sampling time were 238.6 and 170.6 seconds for VAB and CCNB, respectively. No major complications were observed with either method. Ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) lesions were more frequently upgraded after CCNB (8/23 and 3/5, respectively) than after VAB (2/26 and 0/4, respectively P = 0.028). Conclusion Non-mass breast lesions were successfully and accurately biopsied using cable-free VAB. The underestimation rate of ultrasound-detected non-mass lesion was significantly lower with VAB than with CCNB. Trial registration CRiS KCT0002267. PMID:28628656

An infrared image based methodology for breast lesions screening

NASA Astrophysics Data System (ADS)

Morais, K. C. C.; Vargas, J. V. C.; Reisemberger, G. G.; Freitas, F. N. P.; Oliari, S. H.; Brioschi, M. L.; Louveira, M. H.; Spautz, C.; Dias, F. G.; Gasperin, P.; Budel, V. M.; Cordeiro, R. A. G.; Schittini, A. P. P.; Neto, C. D.

2016-05-01

The objective of this paper is to evaluate the potential of utilizing a structured methodology for breast lesions screening, based on infrared imaging temperature measurements of a healthy control group to establish expected normality ranges, and of breast cancer patients, previously diagnosed through biopsies of the affected regions. An analysis of the systematic error of the infrared camera skin temperature measurements was conducted in several different regions of the body, by direct comparison to high precision thermistor temperature measurements, showing that infrared camera temperatures are consistently around 2 °C above the thermistor temperatures. Therefore, a method of conjugated gradients is proposed to eliminate the infrared camera direct temperature measurement imprecision, by calculating the temperature difference between two points to cancel out the error. The method takes into account the human body approximate bilateral symmetry, and compares measured dimensionless temperature difference values (Δ θ bar) between two symmetric regions of the patient's breast, that takes into account the breast region, the surrounding ambient and the individual core temperatures, and doing so, the results interpretation for different individuals become simple and non subjective. The range of normal whole breast average dimensionless temperature differences for 101 healthy individuals was determined, and admitting that the breasts temperatures exhibit a unimodal normal distribution, the healthy normal range for each region was considered to be the dimensionless temperature difference plus/minus twice the standard deviation of the measurements, Δ θ bar ‾ + 2σ Δ θ bar ‾ , in order to represent 95% of the population. Forty-seven patients with previously diagnosed breast cancer through biopsies were examined with the method, which was capable of detecting breast abnormalities in 45 cases (96%). Therefore, the conjugated gradients method was considered effective

Prevalence of colorectal diseases in immunological fecal occult blood test (I-FOBT) positive patients in a tertiary care hospital in Bangladesh.

PubMed

Mollick, S H; Roy, P K; Bhuiyan, M R; Mia, A R; Alam, M S; Mollick, K A; Pervin, S; Hassan, M Q

2014-10-01

Bleeding lesion anywhere in the GI tract can cause positive reaction to Immunological Fecal Occult Blood Test (FOBT). Although any colonic lesion can cause occult lower GI bleeding, relative frequency of this lesion not known. Guaic based tests require prior preparation and dietary restriction and less sensitive and specific than IFOBT for detection of occult bleeding .IFOBT is specific for human hemoglobin and is more sensitive and specific for detection of occult bleeding from any colonic lesion. Aim of this study was to diagnose occult gastrointestinal bleeding with positive IFOBT and the prevalence of colorectal disease in IFOBT positive patients in a tertiary care hospital in Bangladesh. This was a prospective cross sectional study conducted in Department of gastroenterology in collaboration with clinical pathology, BSMMU, Dhaka during the period of January 2009 to December 2009. In this study 200 patients meeting the inclusion criteria were included. Detailed clinical history and physical findings were recorded; FOBT was done on single stool specimen. Positive occult bleeding was confirmed in 90 patients of whom 80 patients underwent colonoscopy. The mean age of study population was 36.73±13.64 (range 16 to 72) years. At colonoscopy lesion were identified in 46(57.50%) patients, of which colonic polyp in12 (15%), colorectal cancer in 11(13.7%), inflammatory bowel disease in 3(3.75%), hemorrhoids and anal fissure in 7(8.75%), tuberculosis in 5(6.25%), and proctitis in 1(1.25%) cases. A positive IFOBT is more sensitive and specific test than other FOBT for detection of occult lower GI bleeding of colonic origin. In this study colorectal diseases were detected in 57.50% of the IFOBT positive patients, so IOBT can be used as an important diagnostic tool for detection of occult lower GI bleeding.

Automatic ultrasound image enhancement for 2D semi-automatic breast-lesion segmentation

NASA Astrophysics Data System (ADS)

Lu, Kongkuo; Hall, Christopher S.

2014-03-01

Breast cancer is the fastest growing cancer, accounting for 29%, of new cases in 2012, and second leading cause of cancer death among women in the United States and worldwide. Ultrasound (US) has been used as an indispensable tool for breast cancer detection/diagnosis and treatment. In computer-aided assistance, lesion segmentation is a preliminary but vital step, but the task is quite challenging in US images, due to imaging artifacts that complicate detection and measurement of the suspect lesions. The lesions usually present with poor boundary features and vary significantly in size, shape, and intensity distribution between cases. Automatic methods are highly application dependent while manual tracing methods are extremely time consuming and have a great deal of intra- and inter- observer variability. Semi-automatic approaches are designed to counterbalance the advantage and drawbacks of the automatic and manual methods. However, considerable user interaction might be necessary to ensure reasonable segmentation for a wide range of lesions. This work proposes an automatic enhancement approach to improve the boundary searching ability of the live wire method to reduce necessary user interaction while keeping the segmentation performance. Based on the results of segmentation of 50 2D breast lesions in US images, less user interaction is required to achieve desired accuracy, i.e. < 80%, when auto-enhancement is applied for live-wire segmentation.

Improved Hardware for Higher Spatial Resolution Strain-ENCoded (SENC) Breast MRI for Strain Measurements

PubMed Central

Harouni, Ahmed A.; Hossain, Jakir; Jacobs, Michael A.; Osman, Nael F.

2012-01-01

Introduction Early detection of breast lesions using mammography has resulted in lower mortality-rates. However, some breast lesions are mammography occult and magnetic resonance imaging (MRI) is recommended, but has lower specificity. It is possible to achieve higher specificity by using Strain-ENCoded (SENC) MRI and/or magnetic resonance elastography(MRE). SENC breast MRI can measure the strain properties of breast tissue. Similarly, MRE is used to measure elasticity (i.e., shear stiffness) of different tissue compositions interrogating the tissue mechanical properties. Reports have shown that malignant tumors are 3–13 times stiffer than normal tissue and benign tumors. Methods We have developed a Strain-ENCoded (SENC) breast hardware device capable of periodically compressing the breast, thus allowing for longer scanning time and measuring the strain characteristics of breast tissue. This hardware enabled us to use SENC MRI with high spatial resolution (1×1×5mm3) instead of Fast SENC(FSENC). Simple controls and multiple safety measures were added to ensure accurate, repeatable and safe in-vivo experiments. Results Phantom experiments showed that SENC breast MRI has higher SNR and CNR than FSENC under different scanning resolutions. Finally, the SENC breast device reproducibility measurements resulted in a difference of less than one mm with a 1% strain difference. Conclusion SENC breast MR images have higher SNR and CNR than FSENC images. Thus, combining SENC breast strain measurements with diagnostic breast MRI to differentiate benign from malignant lesions could potentially increase the specificity of diagnosis in the clinical setting. PMID:21440464

Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI

PubMed Central

Seymer, A; Keinrath, P; Holzmannhofer, J; Pirich, C; Hergan, K; Meissnitzer, M W

2015-01-01

Objective: To prospectively analyse the diagnostic value of semi-quantitative breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions compared with that of mammography (MG), breast ultrasound and MRI of the breast. Methods: Within a 15-month period, 67 patients with 92 breast lesions rated as Category IV or V according to the breast imaging reporting and data system detected with MG and/or ultrasound were included into the study. After the injection of 740–1110 MBq of Technetium-99m (99mTc) SestaMIBI intravenously, scintigrams were obtained in two projections comparable to MG. The BSGI was analysed visually and semi-quantitatively by calculating a relative uptake factor (X). With the exception of two patients with cardiac pacemakers, all patients underwent 3-T breast MRI. Biopsy results were obtained as the reference standard in all patients. Sensitivity, specificity, positive- and negative-predictive values, accuracy and area under the curve were calculated for each modality. Results: Among the 92 lesions, 67 (72.8%) were malignant. 60 of the 67 cancers of any size were detected by BSGI with an overall sensitivity of 90%, only exceeded by ultrasound with a sensitivity of 99%. The sensitivity of BSGI for lesions <1 cm declined significantly to 60%. Overall specificity of ultrasound was only 20%. Specificity, accuracy and positive-predictive value were the highest for BSGI (56%, 80% and 85%, respectively). X was significantly higher for malignant lesions (mean, 4.27) and differed significantly between ductal types (mean, 4.53) and the other histopathological entities (mean, 3.12). Conclusion: Semi-quantitative BSGI with calculation of the relative uptake factor (X) can help to characterize breast lesions. BSGI negativity may obviate the need for biopsy of breast lesions >1 cm with low or intermediate prevalence for malignancy. Advances in knowledge: Compared with morphological imaging modalities, specificity, positive

Comparison of strain and acoustic radiation force impulse elastography of breast lesions by qualitative evaluation.

PubMed

Zhao, Qing; Wang, Xiao-Lei; Sun, Jia-Wei; Jiang, Zhao-Peng; Tao, Lin; Zhou, Xian-Li

2018-04-13

To compare the diagnostic performance of conventional strain elastography (CSE) and acoustic radiation force impulse (ARFI) induced SE for qualitative assessment of breast lesions and evaluate the additional value of the two techniques combined with Breast Imaging Reporting and Data System (BI-RADS) respectively for the differentiation of benign and malignant breast lesions. In a cohort of 110 women, the conventional ultrasound (US) features and the elasticity scores of CSE and ARFI induced SE were recorded. The diagnostic performances of BI-RADS, elastography and BI-RADS plus elastography were evaluated, including the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy. Pathologically, there were forty-eight malignant and sixty-two benign breast lesions in the final analysis. The AUCs for CSE and ARFI induced SE are similar (CSE, 0.807; ARFI induced SE, 0.846; p > 0.05), however, the specificity of the latter method was significantly higher than that of CSE (83.9% vs. 58.1%, p = 0.004) in differentiating breast lesions. The accuracy and specificity of BI-RADS plus ARFI induced SE (84.5%, 80.6%, respectively) were significantly higher than BI-RADS alone (73.6%, 54.8%, respectively) and BI-RADS plus conventional SE (72.7%, 56.5%, respectively), respectively (p < 0.05) without loss of sensitivity. Our study showed that BI-RADS plus ARFI induced SE had a better diagnostic performance in the diagnosis of breast lesions in comparison with BI-RADS alone or BI-RADS plus CSE.

Whole-lesion histogram analysis metrics of the apparent diffusion coefficient as a marker of breast lesions characterization at 1.5 T.

PubMed

Bougias, H; Ghiatas, A; Priovolos, D; Veliou, K; Christou, A

2017-05-01

To retrospectively assess the role of whole-lesion apparent diffusion coefficient (ADC) in the characterization of breast tumors by comparing different histogram metrics. 49 patients with 53 breast lesions underwent magnetic resonance imaging (MRI). ADC histogram parameters, including the mean, mode, 10th/50th/90th percentile, skewness, kurtosis, and entropy ADCs, were derived for the whole-lesion volume in each patient. Mann-Whitney U-test, area under the receiver-operating characteristic curve (AUC) were used for statistical analysis. The mean, mode and 10th/50th/90th percentile ADC values were significantly lower in malignant lesions compared with benign ones (all P < 0.0001), while skewness was significantly higher in malignant lesions P = 0.02. However, no significant difference was found between entropy and kurtosis values in malignant lesions compared with benign ones (P = 0.06 and P = 1.00, respectively). Univariate logistic regression showed that 10th and 50th percentile ADC yielded the highest AUC (0.985; 95% confidence interval [CI]: 0.902, 1.000 and 0.982; 95% confidence interval [CI]: 0.896, 1.000 respectively), whereas kurtosis value yielded the lowest AUC (0.500; 95% CI: 0.355, 0.645), indicating that 10th and 50th percentile ADC values may be more accurate for lesion discrimination. Whole-lesion ADC histogram analysis could be a helpful index in the characterization and differentiation between benign and malignant breast lesions with the 10th and 50th percentile ADC be the most accurate discriminators. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Spectrum of the Breast Lesions With Increased 18F-FDG Uptake on PET/CT

PubMed Central

Dong, Aisheng; Wang, Yang; Lu, Jianping; Zuo, Changjing

2016-01-01

Abstract Interpretation of 18F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging. PMID:26975010

3-Dimensional shear wave elastography of breast lesions

PubMed Central

Chen, Ya-ling; Chang, Cai; Zeng, Wei; Wang, Fen; Chen, Jia-jian; Qu, Ning

2016-01-01

Abstract Color patterns of 3-dimensional (3D) shear wave elastography (SWE) is a promising method in differentiating tumoral nodules recently. This study was to evaluate the diagnostic accuracy of color patterns of 3D SWE in breast lesions, with special emphasis on coronal planes. A total of 198 consecutive women with 198 breast lesions (125 malignant and 73 benign) were included, who underwent conventional ultrasound (US), 3D B-mode, and 3D SWE before surgical excision. SWE color patterns of Views A (transverse), T (sagittal), and C (coronal) were determined. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were calculated. Distribution of SWE color patterns was significantly different between malignant and benign lesions (P = 0.001). In malignant lesions, “Stiff Rim” was significantly more frequent in View C (crater sign, 60.8%) than in View A (51.2%, P = 0.013) and View T (54.1%, P = 0.035). AUC for combination of “Crater Sign” and conventional US was significantly higher than View A (0.929 vs 0.902, P = 0.004) and View T (0.929 vs 0.907, P = 0.009), and specificity significantly increased (90.4% vs 78.1%, P = 0.013) without significant change in sensitivity (85.6% vs 88.0%, P = 0.664) as compared with conventional US. In conclusion, combination of conventional US with 3D SWE color patterns significantly increased diagnostic accuracy, with “Crater Sign” in coronal plane of the highest value. PMID:27684820

Strategies to Increase Cancer Detection: Review of True-Positive and False-Negative Results at Digital Breast Tomosynthesis Screening

PubMed Central

Weinstein, Susan P.; McDonald, Elizabeth S.; Conant, Emily F.

2016-01-01

Digital breast tomosynthesis (DBT) represents a valuable addition to breast cancer screening by decreasing recall rates while increasing cancer detection rates. The increased accuracy achieved with DBT is due to the quasi–three-dimensional format of the reconstructed images and the ability to “scroll through” breast tissue in the reconstructed images, thereby reducing the effect of tissue superimposition found with conventional planar digital mammography. The margins of both benign and malignant lesions are more conspicuous at DBT, which allows improved lesion characterization, increased reader confidence, and improved screening outcomes. However, even with the improvements in accuracy achieved with DBT, there remain differences in breast cancer conspicuity by mammographic view. Early data suggest that breast cancers may be more conspicuous on craniocaudal (CC) views than on mediolateral oblique (MLO) views. While some very laterally located breast cancers may be visualized on only the MLO view, the increased conspicuity of cancers on the CC view compared with the MLO view suggests that DBT screening should be performed with two-view imaging. Even with the improved conspicuity of lesions at DBT, there may still be false-negative studies. Subtle lesions seen on only one view may be discounted, and dense and/or complex tissue patterns may make some cancers occult or extremely difficult to detect. Therefore, radiologists should be cognizant of both perceptual and cognitive errors to avoid potential pitfalls in lesion detection and characterization. ©RSNA, 2016 Online supplemental material is available for this article. PMID:27715711

Comparative performance of multiview stereoscopic and mammographic display modalities for breast lesion detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Webb, Lincoln J.; Samei, Ehsan; Lo, Joseph Y.

2011-04-15

Purpose: Mammography is known to be one of the most difficult radiographic exams to interpret. Mammography has important limitations, including the superposition of normal tissue that can obscure a mass, chance alignment of normal tissue to mimic a true lesion and the inability to derive volumetric information. It has been shown that stereomammography can overcome these deficiencies by showing that layers of normal tissue lay at different depths. If standard stereomammography (i.e., a single stereoscopic pair consisting of two projection images) can significantly improve lesion detection, how will multiview stereoscopy (MVS), where many projection images are used, compare to mammography?more » The aim of this study was to assess the relative performance of MVS compared to mammography for breast mass detection. Methods: The MVS image sets consisted of the 25 raw projection images acquired over an arc of approximately 45 deg. using a Siemens prototype breast tomosynthesis system. The mammograms were acquired using a commercial Siemens FFDM system. The raw data were taken from both of these systems for 27 cases and realistic simulated mass lesions were added to duplicates of the 27 images at the same local contrast. The images with lesions (27 mammography and 27 MVS) and the images without lesions (27 mammography and 27 MVS) were then postprocessed to provide comparable and representative image appearance across the two modalities. All 108 image sets were shown to five full-time breast imaging radiologists in random order on a state-of-the-art stereoscopic display. The observers were asked to give a confidence rating for each image (0 for lesion definitely not present, 100 for lesion definitely present). The ratings were then compiled and processed using ROC and variance analysis. Results: The mean AUC for the five observers was 0.614{+-}0.055 for mammography and 0.778{+-}0.052 for multiview stereoscopy. The difference of 0.164{+-}0.065 was statistically significant

Characteristics of quantitative perfusion parameters on dynamic contrast‐enhanced MRI in mammographically occult breast cancer

PubMed Central

Ryu, Jung Kyu; Rhee, Sun Jung; Song, Jeong Yoon; Cho, Soo Hyun

2016-01-01

The purpose of this study was to compare the characteristics of quantitative perfusion parameters obtained from dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) in patients with mammographically occult (MO) breast cancers and those with mammographically visible (MV) breast cancers. Quantitative parameters (AUC, Ktrans,kep,ve,vp, and wi) from 13 MO breast cancers and 16 MV breast cancers were mapped after the DCE‐MRI data were acquired. Various prognostic factors, including axillary nodal status, estrogen receptor (ER), progesterone receptor (PR), Ki‐67, p53, E‐cadherin, and human epidermal growth factor receptor 2 (HER2) were obtained in each group. Fisher's exact test was used to compare any differences of the various prognostic factors between the two groups. The Mann‐Whitney U test was applied to compare the quantitative parameters between these two groups. Finally, Spearman's correlation was used to investigate the relationships between perfusion indices and four factors — age, tumor size, Ki‐67, and p53 — for each group. Although age, tumor size, and the prognostic factors were not statistically different between the two groups, the mean values of the quantitative parameters, except wi in the MV group, were higher than those in the MO group without statistical significance (p=0.219). The kep value was significantly different between the two groups (p=0.048), but the other parameters were not. In the MO group, vp with size, ve with p53, and Ktrans and vp with Ki‐67 had significant correlations (p<0.05). However, in the MV group, only kep showed significant correlation with age. The kep value was only the perfusion parameter of statistical significance between MO and MV breast cancers. PACS number(s): 87.19.U‐, 87.61.‐c PMID:27685105

Radiologically occult pulmonary lymphangitic carcinomatosis detected by /sup 67/Ga-citrate scintiscan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Band, P.R.; Lentle, B.C.; Amy, R.

1976-10-01

The use of gallium-67-citrate scintiscanning in the diagnosis of radiologically occult lung metastases is illustrated. The technique was used to demonstrate pulmonary lymphangitic carcinomatosis metastatic from breast cancer. (ERB)

Diagnostic value of coustic radiation force impulse for BI-RADS category 4 breast lesions of different sizes.

PubMed

Wu, Rong

2018-04-14

To determine the diagnostic value of combined conventional ultrasound (US) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of BI-RADS category 4 breast lesions of different sizes. From April 2013 to January 2015, 283 patients (with a total of 292 breast lesions) who underwent US and ARFI examination were included in this retrospective study. The SWV for the lesion and adjacent normal breast tissue were measured and the SWV ratio was calculated. VTI grade was also assessed. The lesions were separated into three groups on the basis of size, and two combinations of ARFI parameters (SWV + VTI and SWV ratio + VTI) were applied to reassess the BI-RADS categories. Diagnoses were confirmed by pathological examination after biopsy or surgery. ROC analysis was performed to assess the diagnostic efficiency of each method. The Z test was used to compare the difference between AUC of the two methods. Significant improvement was seen in the diagnostic performance of US with the use of the ARFI parameters SWV + VTI (77/179 [43.0%] of BI-RADS category 4A breast lesions were downgraded) and SWV ratio + VTI (64/179 [35.8%] of BI-RADS category 4A breast lesions were downgraded, including two malignant cases that were misdiagnosed as benign) (P < 0.01). The difference between the performances of the two combinations-SWV + VTI and SWV ratio + VTI-was significant only in breast lesions <10 mm in size, where the AUC of SWV ratio + VTI was significantly greater than the AUC of SWV + VTI (0.929 vs. 0.874; P < 0.01). Combination of US with ARFI can improve diagnostic performance and help avoid unnecessary biopsy in BI-RADS category 4 breast lesions. The combination of SWV ratio + VTI can improve BI-RADS classification of small lesions (<10 mm size).

A new background distribution-based active contour model for three-dimensional lesion segmentation in breast DCE-MRI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Hui; Liu, Yiping; Qiu, Tianshuang

2014-08-15

Purpose: To develop and evaluate a computerized semiautomatic segmentation method for accurate extraction of three-dimensional lesions from dynamic contrast-enhanced magnetic resonance images (DCE-MRIs) of the breast. Methods: The authors propose a new background distribution-based active contour model using level set (BDACMLS) to segment lesions in breast DCE-MRIs. The method starts with manual selection of a region of interest (ROI) that contains the entire lesion in a single slice where the lesion is enhanced. Then the lesion volume from the volume data of interest, which is captured automatically, is separated. The core idea of BDACMLS is a new signed pressure functionmore » which is based solely on the intensity distribution combined with pathophysiological basis. To compare the algorithm results, two experienced radiologists delineated all lesions jointly to obtain the ground truth. In addition, results generated by other different methods based on level set (LS) are also compared with the authors’ method. Finally, the performance of the proposed method is evaluated by several region-based metrics such as the overlap ratio. Results: Forty-two studies with 46 lesions that contain 29 benign and 17 malignant lesions are evaluated. The dataset includes various typical pathologies of the breast such as invasive ductal carcinoma, ductal carcinomain situ, scar carcinoma, phyllodes tumor, breast cysts, fibroadenoma, etc. The overlap ratio for BDACMLS with respect to manual segmentation is 79.55% ± 12.60% (mean ± s.d.). Conclusions: A new active contour model method has been developed and shown to successfully segment breast DCE-MRI three-dimensional lesions. The results from this model correspond more closely to manual segmentation, solve the weak-edge-passed problem, and improve the robustness in segmenting different lesions.« less

Breast lesions of uncertain malignant nature and limited metastatic potential: Proposals to improve their recognition and clinical management

PubMed Central

Rakha, Emad A.; Badve, Sunil; Eusebi, Vincenzo; Reis-Filho, Jorge S.; Fox, Stephen B.; Dabbs, David J.; Decker, Thomas; Hodi, Zsolt; Ichihara, Shu; Lee, Andrew HS.; Palacios, José; Richardson, Andrea L.; Vincent-Salomon, Anne; Schmitt, Fernando C.; Tan, Puay-Hoon; Tse, Gary M.; Ellis, Ian O.

2016-01-01

Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are traditionally classified into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey-zone between benign and malignant as their behaviour cannot be predicted reliably. Defined pathological categorisation of such lesions is challenging and for some entities is recognised to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over-treatment or under-treatment. The rarity of these lesions makes acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification, behaviour and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions remain of uncertain malignant nature such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of 1) breast lesions of uncertain malignant nature and 2) breast lesions of limited metastatic potential, are proposed with details of which histological entities could be included in each category, and their management implications are discussed. PMID:26348644

Mammographic quantitative image analysis and biologic image composition for breast lesion characterization and classification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drukker, Karen, E-mail: kdrukker@uchicago.edu; Giger, Maryellen L.; Li, Hui

2014-03-15

Purpose: To investigate whether biologic image composition of mammographic lesions can improve upon existing mammographic quantitative image analysis (QIA) in estimating the probability of malignancy. Methods: The study population consisted of 45 breast lesions imaged with dual-energy mammography prior to breast biopsy with final diagnosis resulting in 10 invasive ductal carcinomas, 5 ductal carcinomain situ, 11 fibroadenomas, and 19 other benign diagnoses. Analysis was threefold: (1) The raw low-energy mammographic images were analyzed with an established in-house QIA method, “QIA alone,” (2) the three-compartment breast (3CB) composition measure—derived from the dual-energy mammography—of water, lipid, and protein thickness were assessed, “3CBmore » alone”, and (3) information from QIA and 3CB was combined, “QIA + 3CB.” Analysis was initiated from radiologist-indicated lesion centers and was otherwise fully automated. Steps of the QIA and 3CB methods were lesion segmentation, characterization, and subsequent classification for malignancy in leave-one-case-out cross-validation. Performance assessment included box plots, Bland–Altman plots, and Receiver Operating Characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) for distinguishing between benign and malignant lesions (invasive and DCIS) was 0.81 (standard error 0.07) for the “QIA alone” method, 0.72 (0.07) for “3CB alone” method, and 0.86 (0.04) for “QIA+3CB” combined. The difference in AUC was 0.043 between “QIA + 3CB” and “QIA alone” but failed to reach statistical significance (95% confidence interval [–0.17 to + 0.26]). Conclusions: In this pilot study analyzing the new 3CB imaging modality, knowledge of the composition of breast lesions and their periphery appeared additive in combination with existing mammographic QIA methods for the distinction between different benign and malignant lesion types.« less

Angiosonography in suspicious breast lesions with non-diagnostic FNAC: comparison with power Doppler US.

PubMed

Caumo, F; Carbognin, G; Casarin, A; Pinali, L; Vasori, S; D'Onofrio, M; Pozzi Mucelli, R

2006-02-01

The purpose of this study was to evaluate the accuracy of angiosonography in comparison with colour Doppler ultrasound (US) in the discrimination of suspicious breast lesions with nondiagnostic fine-needle aspiration cytology (FNAC). Pre-operative Power Doppler US and angiosonography were prospectively performed in 20 suspicious breast lesions with non-diagnostic FNAC. A second-generation US contrast agent was utilised with a high-frequency transducer and a contrast-specific algorithm (low acoustic pressure CnTI). The enhancement characteristics of all lesions were analysed using qualitative and quantitative parameters obtained from time-intensity curves with the different imaging modalities. The final diagnosis was confirmed at pathology in all cases. Microvessel density (MVD) was assessed in the surgical specimen using CD34. The correct assessment of biological behaviour was achieved in all cases by angiosonography (sensitivity of 100%; specificity of 91%) and colour Doppler US (45% sensitivity; 78% specificity). MVD correlated with the biological behaviour. Angiosonography is more accurate than colour Doppler US in the correct assessment of biological behaviour of suspicious breast lesions.

Targeting Premalignant Lesions - Implications for Early Breast Cancer Detection and Intervention

DTIC Science & Technology

2017-04-01

lesions. Peptide conjugated AgNP were injected intravenously in mice and mammary glands were isolated and analyzed for nanoparticle accumulation by silver ...Furthermore, these probes will be used to develop targeted therapeutic nanoparticles for early intervention in breast cancer. 2. KEYWORDS...cancer (Months 18-24) (To be done) Specific Aim 3: Target premalignant lesions utilizing peptide-conjugated nanoparticles to prevent/delay

Transfer learning with convolutional neural networks for lesion classification on clinical breast tomosynthesis

NASA Astrophysics Data System (ADS)

Mendel, Kayla R.; Li, Hui; Sheth, Deepa; Giger, Maryellen L.

2018-02-01

With growing adoption of digital breast tomosynthesis (DBT) in breast cancer screening protocols, it is important to compare the performance of computer-aided diagnosis (CAD) in the diagnosis of breast lesions on DBT images compared to conventional full-field digital mammography (FFDM). In this study, we retrospectively collected FFDM and DBT images of 78 lesions from 76 patients, each containing lesions that were biopsy-proven as either malignant or benign. A square region of interest (ROI) was placed to fully cover the lesion on each FFDM, DBT synthesized 2D images, and DBT key slice images in the cranial-caudal (CC) and mediolateral-oblique (MLO) views. Features were extracted on each ROI using a pre-trained convolutional neural network (CNN). These features were then input to a support vector machine (SVM) classifier, and area under the ROC curve (AUC) was used as the figure of merit. We found that in both the CC view and MLO view, the synthesized 2D image performed best (AUC = 0.814, AUC = 0.881 respectively) in the task of lesion characterization. Small database size was a key limitation in this study, and could lead to overfitting in the application of the SVM classifier. In future work, we plan to expand this dataset and to explore more robust deep learning methodology such as fine-tuning.

Evaluation of the SAVI SCOUT Surgical Guidance System for Localization and Excision of Nonpalpable Breast Lesions: A Feasibility Study.

PubMed

Mango, Victoria; Ha, Richard; Gomberawalla, Ameer; Wynn, Ralph; Feldman, Sheldon

2016-06-15

The purpose of this study is to evaluate the feasibility of the SAVI SCOUT surgical guidance system, which uses a nonradioactive infrared-activated electromagnetic wave reflector, to localize and excise nonpalpable breast lesions. We evaluated the system's use in 15 nonpalpable breast lesions in 13 patients. Image-guided placement was successful for 15 of 15 (100%) reflectors. The final pathologic analysis found that lesion excision was successful, including five malignancies with negative margins. No patients required reexcision or experienced complications. SAVI SCOUT is a feasible method for breast lesion localization and excision.

Model–Free Visualization of Suspicious Lesions in Breast MRI Based on Supervised and Unsupervised Learning

PubMed Central

Twellmann, Thorsten; Meyer-Baese, Anke; Lange, Oliver; Foo, Simon; Nattkemper, Tim W.

2008-01-01

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important tool in breast cancer diagnosis, but evaluation of multitemporal 3D image data holds new challenges for human observers. To aid the image analysis process, we apply supervised and unsupervised pattern recognition techniques for computing enhanced visualizations of suspicious lesions in breast MRI data. These techniques represent an important component of future sophisticated computer-aided diagnosis (CAD) systems and support the visual exploration of spatial and temporal features of DCE-MRI data stemming from patients with confirmed lesion diagnosis. By taking into account the heterogeneity of cancerous tissue, these techniques reveal signals with malignant, benign and normal kinetics. They also provide a regional subclassification of pathological breast tissue, which is the basis for pseudo-color presentations of the image data. Intelligent medical systems are expected to have substantial implications in healthcare politics by contributing to the diagnosis of indeterminate breast lesions by non-invasive imaging. PMID:19255616

Ectopic Male Breast Cancer: A Case Report

PubMed Central

Samanta, Dipti Rani; Upadhyay, Ashish; Sheet, Saikat; Senapati, Surendra Nath

2015-01-01

Carcinoma of male breast constitutes 1% of total breast malignancy. Carcinoma arising from ectopic breast tissue in male is an extremely rare entity and can be misdiagnosed. Ectopic breast tissue may be supernumerary or aberrant one. Despite morphologic difference, ectopic breast tissue presents characteristics analogous to orthoptic breast in terms of functional and pathologic degeneration. Most of the ectopic breast tissue occurs in thoracic or abdominal portion of milk line. If found in a location outside the milk line, it proves a diagnostic dilemma. We are reporting a case of 60-year-old male who presented with a fixed mass of size 10cm×8cm, in right chest wall infraclavicular area of 6 months duration. Histopathology of the mass revealed invasive duct carcinoma. He had no evidence of malignant or occult primary lesion in the bilateral mammary glands. Due to the paucity of the literature, incidence of ectopic male breast cancer and its management is not well understood. There is high probability of misdiagnosis of this disease. To the best of our knowledge this is the first described case of ectopic male breast cancer in the chest wall, not along the milk line, which is being reported here for documentation. PMID:26436033

Preliminary Results of Acoustic Radiation Force Impulse Imaging by Combined Qualitative and Quantitative Analyses for Evaluation of Breast Lesions.

PubMed

Wang, Lin; Wan, Cai-Feng; Du, Jing; Li, Feng-Hua

2018-04-15

The purpose of this study was to evaluate the application of a new elastographic technique, acoustic radiation force impulse (ARFI) imaging, and its diagnostic performance for characterizing breast lesions. One hundred consecutive female patients with 126 breast lesions were enrolled in our study. After routine breast ultrasound examinations, the patients underwent ARFI elasticity imaging. Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (Siemens Medical Solutions, Mountain View, CA) were used to qualitatively and quantitatively analyze the elasticity and hardness of tumors. A receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of ARFI for discrimination between benign and malignant breast lesions. Pathologic analysis revealed 40 lesions in the malignant group and 86 lesions in the benign group. Different VTI patterns were observed in benign and malignant breast lesions. Eighty lesions (93.0%) of benign group had pattern 1, 2, or 3, whereas all pattern 4b lesions (n = 20 [50.0%]) were malignant. Regarding the quantitative analysis, the mean VTI-to-B-mode area ratio, internal shear wave velocity, and marginal shear wave velocity of benign lesions were statistically significantly lower than those of malignant lesions (all P < .001). The cutoff point for a scoring system constructed to evaluate the diagnostic performance of ARFI was estimated to be between 3 and 4 points for malignancy, with sensitivity of 77.5%, specificity of 96.5%, accuracy of 90.5%, and an area under the curve of 0.933. The application of ARFI technology has shown promising results by noninvasively providing substantial complementary information and could potentially serve as an effective diagnostic tool for differentiation between benign and malignant breast lesions. © 2018 by the American Institute of Ultrasound in Medicine.

3 Tesla breast MR imaging as a problem-solving tool: Diagnostic performance and incidental lesions

PubMed Central

Spick, Claudio; Szolar, Dieter H. M.; Preidler, Klaus W.; Reittner, Pia; Rauch, Katharina; Brader, Peter; Tillich, Manfred

2018-01-01

Purpose To investigate the diagnostic performance and incidental lesion yield of 3T breast MRI if used as a problem-solving tool. Methods This retrospective, IRB-approved, cross-sectional, single-center study comprised 302 consecutive women (mean: 50±12 years; range: 20–79 years) who were undergoing 3T breast MRI between 03/2013-12/2014 for further workup of conventional and clinical breast findings. Images were read by experienced, board-certified radiologists. The reference standard was histopathology or follow-up ≥ two years. Sensitivity, specificity, PPV, and NPV were calculated. Results were stratified by conventional and clinical breast findings. Results The reference standard revealed 53 true-positive, 243 true-negative, 20 false-positive, and two false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 96.4% (53/55), 92.4% (243/263), 72.6% (53/73), and 99.2% (243/245), respectively. In 5.3% (16/302) of all patients, incidental MRI lesions classified BI-RADS 3–5 were detected, 37.5% (6/16) of which were malignant. Breast composition and the imaging findings that had led to referral had no significant influence on the diagnostic performance of breast MR imaging (p>0.05). Conclusion 3T breast MRI yields excellent diagnostic results if used as a problem-solving tool independent of referral reasons. The number of suspicious incidental lesions detected by MRI is low, but is associated with a substantial malignancy rate. PMID:29293582

Spontaneous feline mammary intraepithelial lesions as a model for human estrogen receptor- and progesterone receptor-negative breast lesions

PubMed Central

2010-01-01

Background Breast cancer is the most frequently diagnosed cancer in women. Intraepithelial lesions (IELs), such as usual ductal hyperplasia (UH), atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) are risk factors that predict a woman's chance of developing invasive breast cancer. Therefore, a comparative study that establishes an animal model of pre-invasive lesions is needed for the development of preventative measures and effective treatment for both mammary IELs and tumors. The purpose of this study was to characterize the histologic and molecular features of feline mammary IELs and compare them with those in women. Methods Formalin-fixed, paraffin-embedded specimens (n = 205) from 203 female cats with clinical mammary disease were retrieved from the archives of the Purdue University Animal Disease Diagnostic Laboratory and Veterinary Teaching Hospital (West Lafayette, IN), and the Department of Pathology and Veterinary Clinic, School of Veterinary Medicine (Sassari, Italy). Histologic sections, stained with hematoxylin and eosin (HE), were evaluated for the presence of IELs in tissue adjacent to excised mammary tumors. Lesions were compared to those of humans. Immunohistochemistry for estrogen receptor (ER-alpha), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2/neu) and Ki-67 was performed in IELs and adjacent tumor tissues. Results Intraepithelial lesions were found in 57 of 203 (28%) feline mammary specimens and were categorized as UH (27%), ADH (29%), and DCIS (44%). Most IELs with atypia (ADH and DCIS) were associated with mammary cancer (91%), whereas UH was associated with benign lesions in 53% of cases. Feline IELs were remarkably similar to human IELs. No ER or PR immunoreactivity was detected in intermediate-grade or high-grade DCIS or their associated malignant tumors. HER-2 protein overexpression was found in 27% of IELs. Conclusion The remarkable similarity of feline mammary IELs to those of humans

Impact of compressed breast thickness and dose on lesion detectability in digital mammography: FROC study with simulated lesions in real mammograms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salvagnini, Elena, E-mail: elena.salvagnini@gmail.

Purpose: The aim of this work was twofold: (1) to examine whether, with standard automatic exposure control (AEC) settings that maintain pixel values in the detector constant, lesion detectability in clinical images decreases as a function of breast thickness and (2) to verify whether a new AEC setup can increase lesion detectability at larger breast thicknesses. Methods: Screening patient images, acquired on two identical digital mammography systems, were collected over a period of 2 yr. Mammograms were acquired under standard AEC conditions (part 1) and subsequently with a new AEC setup (part 2), programmed to use the standard AEC settingsmore » for compressed breast thicknesses ≤49 mm, while a relative dose increase was applied above this thickness. The images were divided into four thickness groups: T1 ≤ 29 mm, T2 = 30–49 mm, T3 = 50–69 mm, and T4 ≥ 70 mm, with each thickness group containing 130 randomly selected craniocaudal lesion-free images. Two measures of density were obtained for every image: a BI-RADS score and a map of volumetric breast density created with a software application (VolparaDensity, Matakina, NZ). This information was used to select subsets of four images, containing one image from each thickness group, matched to a (global) BI-RADS score and containing a region with the same (local) VOLPARA volumetric density value. One selected lesion (a microcalcification cluster or a mass) was simulated into each of the four images. This process was repeated so that, for a given thickness group, half the images contained a single lesion and half were lesion-free. The lesion templates created and inserted in groups T3 and T4 for the first part of the study were then inserted into the images of thickness groups T3 and T4 acquired with higher dose settings. Finally, all images were visualized using the ViewDEX software and scored by four radiologists performing a free search study. A statistical jackknife-alternative free-response receiver

Real-time virtual sonography, a coordinated sonography and MRI system that uses magnetic navigation, improves the sonographic identification of enhancing lesions on breast MRI.

PubMed

Nakano, Shogo; Yoshida, Miwa; Fujii, Kimihito; Yorozuya, Kyoko; Kousaka, Junko; Mouri, Yukako; Fukutomi, Takashi; Ohshima, Yukihiko; Kimura, Junko; Ishiguchi, Tsuneo

2012-01-01

This study verified that recently developed real-time virtual sonography (RVS) to coordinate a sonography image and the magnetic resonance imaging (MRI) multiplanar reconstruction (MPR) with magnetic navigation was useful. The purpose of this study was to evaluate the accuracy of RVS to sonographically identify enhancing lesions by breast MRI. Between December 2008 and May 2009, RVS was performed in 51 consecutive patients with 63 enhancing lesions. MRI was performed with the patients in the supine position using a 1.5-T imager with a body surface coil to achieve the same position as with sonography. To assess the accuracy of the RVS, the following three issues were analyzed: (i) The sonographic detection rate of enhancing lesions, (ii) the comparison of the tumor size measured by sonography and the MRI-MPR and (iii) the positioning errors as the distance from the actual sonographic position to the expected MRI position in 3-D. Among the 63 enhancing lesions, 42 (67%) lesions were identified by conventional B-mode, whereas the remaining 21 (33%) initial conventional B-mode occult lesions were identified by RVS alone. The sonographic size of the lesions detected by RVS alone was significantly smaller than that of lesions detected by conventional B-mode (p < 0.001). The mean tumor size provided by RVS was 12.3 mm for real-time sonography and 14.1 mm for MRI-MPR (r = 0.848, p < 0.001). The mean positioning errors for the transverse and sagittal planes and the depth from the skin were 7.7, 6.9 and 2.8 mm, respectively. The overall mean 3D positioning error was 12.0 mm. Our results suggest that RVS has good targeting accuracy to directly compare a sonographic image with MRI results without operator dependence. Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

[Management of occult malformations at the lateral skull base].

PubMed

Bryson, E; Draf, W; Hofmann, E; Bockmühl, U

2005-12-01

Occult malformations of the lateral skull base are rare anomalies, but can cause severe complications such as recurrent meningitis. Therefore, they need to be precisely delineated and sufficient surgical closure is mandatory. Between 1986 and 2004 twenty patients (10 children and 10 adults) with occult malformations at the lateral skull base were treated surgically at the ENT-Department of the Hospital Fulda gAG. Of these 3 Mondini-malformations, 11 defects of the tegmen tympani or the mastoidal roof, 2 dural lesions to the posterior fossa and 4 malformations within the pyramidal apex have been found. Four patients have had multiple anomalies. Routing symptom was in all cases at least one previous meningitis. Radiological diagnostics included high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) as well as CT- or MR-cisternography. Depending on type and localisation of the defect the following surgical algorithm was carried out: The trans-mastoidal approach was used in all cases of Mondini-malformation (including obliteration of the ear), in case of lesions to the posterior fossa as well as partly in anomalies at the tegmen tympani and mastoidal roof, respectively. Defects of the pyramidal apex should be explored via the trans-mastoidal way if the lesion is located caudally to the inner auditory canal (IAC), whereas the trans-temporal approach should be used if the lesion is situated ventral to the IAC and dorso-medially to the internal carotid artery (ICA). The trans-temporal approach was also performed in large defects of the tegmen tympani and mastoidal roof as well as in recurrences. In all cases of recurrent meningitis caused by agents of the upper airway tract the basic principle should be to search for occult skull base malformations radiologically as well as by sodium fluorescein endoscopy as long as the anomaly is detected.

Technical Note: Development of a combined molecular breast imaging/ultrasound system for diagnostic evaluation of MBI-detected lesions.

PubMed

O'Connor, Michael K; Morrow, Melissa M; Tran, Thuy; Hruska, Carrie B; Conners, Amy L; Hunt, Katie N

2017-02-01

The purpose of this study was to perform a pilot evaluation of an integrated molecular breast imaging/ultrasound (MBI/US) system designed to enable, in real-time, the registration of US to MBI and diagnostic evaluation of breast lesions detected on MBI. The MBI/US system was constructed by modifying an existing dual-head cadmium zinc telluride (CZT)-based MBI gamma camera. The upper MBI detector head was replaced with a mesh panel, which allowed an ultrasound probe to access the breast. An optical tracking system was used to monitor the location of the ultrasound transducer, referenced to the MBI detector. The lesion depth at which ultrasound was targeted was estimated from analysis of previously acquired dual-head MBI datasets. A software tool was developed to project the US field of view onto the current MBI image. Correlation of lesion location between both modalities with real-time MBI/US scanning was confirmed in a breast phantom model and assessed in 12 patients with a breast lesion detected on MBI. Combined MBI/US scanning allowed for registration of lesions detected on US and MBI as validated in phantom experiments. In patient studies, successful registration was achieved in 8 of 12 (67%) patients, with complete registration achieved in seven and partial registration achieved in one patient. In 4 of 12 (37%) patients, lesion registration was not achieved, partially attributed to uncertainty in lesion depth estimates from MBI. The MBI/US system enabled successful registration of US to MBI in over half of patients studied in this pilot evaluation. Future studies are needed to determine if real-time, registered US imaging of MBI-detected lesions may obviate the need to proceed to more expensive procedures such as contrast-enhanced breast MRI for diagnostic workup or biopsy of MBI findings. © 2016 American Association of Physicists in Medicine.

Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision.

PubMed

Mango, Victoria L; Wynn, Ralph T; Feldman, Sheldon; Friedlander, Lauren; Desperito, Elise; Patel, Sejal N; Gomberawalla, Ameer; Ha, Richard

2017-08-01

Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI

Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers.

PubMed

Andersen, Klaus Kaae; Olsen, Tom Skyhøj

2018-06-04

Manifest cancer is associated with increased risk of stroke. The risk of stroke in people with occult cancer in comparison to the risk in the background population without cancer has not been investigated. Smoking is a risk factor for both cancer and stroke, but the role of smoking for the risk of stroke in cancer has not been investigated. We identified all incident cases of cancer in Denmark 2003 to 2012 (n=264.376) from the Danish Cancer Registry. Each person with cancer was matched by age, sex, and income with 10 randomly selected persons without cancer at index date (n=2.571.260). Linking data to the Danish Stroke Registry, we studied risk of ischemic/hemorrhagic stroke the year before (occult cancer) and after cancer diagnosis was established in the Danish Stroke Registry (manifest cancer) and stratified into the 15 most common cancer types related (lung, colon, bladder, rectum, pancreas, kidney, stomach, and head and neck cancer) and unrelated (non-Hodgkin lymphoma, breast, prostate, melanoma, central nervous system, ovary and endometrial) to smoking. Risk of ischemic/hemorrhagic stroke was increased for both occult (relative risk, 1.75/2.00) and manifest cancers (relative risk, 1.30/1.41). For occult cancer, risk of ischemic stroke was increased for all of the smoking-related cancers, but among cancers unrelated to smoking, only lymphoma, central nervous system, and endometrial cancer were associated with increased risk of stroke; breast, prostate, melanoma, and ovarian cancers were not. For occult cancer, risk of hemorrhagic stroke was generally increased for smoking-related cancers while not for cancers unrelated to smoking. For manifest cancer, risk of ischemic and hemorrhagic stroke was generally increased for cancers related to smoking while not for cancers unrelated to smoking. Cancer, occult and manifest, is associated with increased risks for stroke. The increased risk is linked mainly to cancers related to smoking. © 2018 American Heart

Segmentation of malignant lesions in 3D breast ultrasound using a depth-dependent model.

PubMed

Tan, Tao; Gubern-Mérida, Albert; Borelli, Cristina; Manniesing, Rashindra; van Zelst, Jan; Wang, Lei; Zhang, Wei; Platel, Bram; Mann, Ritse M; Karssemeijer, Nico

2016-07-01

Automated 3D breast ultrasound (ABUS) has been proposed as a complementary screening modality to mammography for early detection of breast cancers. To facilitate the interpretation of ABUS images, automated diagnosis and detection techniques are being developed, in which malignant lesion segmentation plays an important role. However, automated segmentation of cancer in ABUS is challenging since lesion edges might not be well defined. In this study, the authors aim at developing an automated segmentation method for malignant lesions in ABUS that is robust to ill-defined cancer edges and posterior shadowing. A segmentation method using depth-guided dynamic programming based on spiral scanning is proposed. The method automatically adjusts aggressiveness of the segmentation according to the position of the voxels relative to the lesion center. Segmentation is more aggressive in the upper part of the lesion (close to the transducer) than at the bottom (far away from the transducer), where posterior shadowing is usually visible. The authors used Dice similarity coefficient (Dice) for evaluation. The proposed method is compared to existing state of the art approaches such as graph cut, level set, and smart opening and an existing dynamic programming method without depth dependence. In a dataset of 78 cancers, our proposed segmentation method achieved a mean Dice of 0.73 ± 0.14. The method outperforms an existing dynamic programming method (0.70 ± 0.16) on this task (p = 0.03) and it is also significantly (p < 0.001) better than graph cut (0.66 ± 0.18), level set based approach (0.63 ± 0.20) and smart opening (0.65 ± 0.12). The proposed depth-guided dynamic programming method achieves accurate breast malignant lesion segmentation results in automated breast ultrasound.

ROC analysis of lesion descriptors in breast ultrasound images

NASA Astrophysics Data System (ADS)

Andre, Michael P.; Galperin, Michael; Phan, Peter; Chiu, Peter

2003-05-01

Breast biopsy serves as the key diagnostic tool in the evaluation of breast masses for malignancy, yet the procedure affects patients physically and emotionally and may obscure results of future mammograms. Studies show that high quality ultrasound can distinguish a benign from malignant lesions with accuracy, however, it has proven difficult to teach and clinical results are highly variable. The purpose of this study is to develop a means to optimize an automated Computer Aided Imaging System (CAIS) to assess Level of Suspicion (LOS) of a breast mass. We examine the contribution of 15 object features to lesion classification by calculating the Wilcoxon area under the ROC curve, AW, for all combinations in a set of 146 masses with known findings. For each interval A, the frequency of appearance of each feature and its combinations with others was computed as a means to find an "optimum" feature vector. The original set of 15 was reduced to 6 (area, perimeter, diameter ferret Y, relief, homogeneity, average energy) with an improvement from Aw=0.82-/+0.04 for the original 15 to Aw=0.93-/+0.02 for the subset of 6, p=0.03. For comparison, two sub-specialty mammography radiologists also scored the images for LOS resulting in Az of 0.90 and 0.87. The CAIS performed significantly higher, p=0.02.

Can continuous scans in orthogonal planes improve diagnostic performance of shear wave elastography for breast lesions?

PubMed

Yang, Pan; Peng, Yulan; Zhao, Haina; Luo, Honghao; Jin, Ya; He, Yushuang

2015-01-01

Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.

Fully automatic lesion segmentation in breast MRI using mean-shift and graph-cuts on a region adjacency graph.

PubMed

McClymont, Darryl; Mehnert, Andrew; Trakic, Adnan; Kennedy, Dominic; Crozier, Stuart

2014-04-01

To present and evaluate a fully automatic method for segmentation (i.e., detection and delineation) of suspicious tissue in breast MRI. The method, based on mean-shift clustering and graph-cuts on a region adjacency graph, was developed and its parameters tuned using multimodal (T1, T2, DCE-MRI) clinical breast MRI data from 35 subjects (training data). It was then tested using two data sets. Test set 1 comprises data for 85 subjects (93 lesions) acquired using the same protocol and scanner system used to acquire the training data. Test set 2 comprises data for eight subjects (nine lesions) acquired using a similar protocol but a different vendor's scanner system. Each lesion was manually delineated in three-dimensions by an experienced breast radiographer to establish segmentation ground truth. The regions of interest identified by the method were compared with the ground truth and the detection and delineation accuracies quantitatively evaluated. One hundred percent of the lesions were detected with a mean of 4.5 ± 1.2 false positives per subject. This false-positive rate is nearly 50% better than previously reported for a fully automatic breast lesion detection system. The median Dice coefficient for Test set 1 was 0.76 (interquartile range, 0.17), and 0.75 (interquartile range, 0.16) for Test set 2. The results demonstrate the efficacy and accuracy of the proposed method as well as its potential for direct application across different MRI systems. It is (to the authors' knowledge) the first fully automatic method for breast lesion detection and delineation in breast MRI.

Ex vivo MRI evaluation of breast tumors: a novel tool for verifying resection of nonpalpable only MRI detected lesions.

PubMed

Agresti, Roberto; Trecate, Giovanna; Ferraris, Cristina; Valeri, Barbara; Maugeri, Ilaria; Pellitteri, Cristina; Martelli, Gabriele; Migliavacca, Silvana; Carcangiu, Maria Luisa; Bohm, Silvia; Maffioli, Lorenzo; Vergnaghi, Daniele; Panizza, Pietro

2013-01-01

A fundamental question in surgery of only magnetic resonance imaging (MRI)-detected breast lesions is to ensure their removal when they are not palpable by clinical examination and surgical exploration. This is especially relevant in the case of small tumors, carcinoma in situ or lobular carcinoma. Thirty-nine patients were enrolled in the study, 21 patients with breast lesions detected by both conventional imaging and breast MRI (bMRI) and 18 patients with bMRI findings only. Preoperative bMRI allowed staging the disease and localizing the lesion. In the operating theater, contrast medium was injected 1 minute before skin incision. After removal, surgical specimens were submitted to ex vivo MRI, performed using a dedicated surface coil and Spair inversion recovery sequences for suppression of fat signal intensity. All MRI enhancing lesions were completely included within the surgical specimen and visualized by ex vivo MRI. In the first 21 patients, bMRI was able to visualize branching margins or satellite nodules around the core lesion, and allowed for better staging of the surrounding in situ carcinoma; in the last 18 patients, eight of whom were breast cancer type 1 susceptibility protein (BRCA) mutation carriers, bMRI identified 12 malignant tumors, otherwise undetectable, that were all visualized by ex vivo MRI. This is the first description of a procedure that re-enhances breast lesions within a surgical specimen, demonstrating the surgical removal of nonpalpable breast lesions diagnosed only with bMRI. This new strategy reproduces the morphology and the entire extension of the primary lesion on the specimen, with potentially better local surgical control, reducing additional unplanned surgery. © 2013 Wiley Periodicals, Inc.

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

PubMed Central

Ackermann, S.; Schoenenberger, C.-A.; Zanetti-Dällenbach, R.

2016-01-01

Purpose: Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions. Materials and Methods: We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011. Results: The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification. Conclusion: Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3. PMID:27689181

Size assessment of breast lesions by means of a computer-aided detection (CAD) system for magnetic resonance mammography.

PubMed

Levrini, G; Sghedoni, R; Mori, C; Botti, A; Vacondio, R; Nitrosi, A; Iori, M; Nicoli, F

2011-10-01

The aim of this study was to investigate the efficacy of a dedicated software tool for automated volume measurement of breast lesions in contrast-enhanced (CE) magnetic resonance mammography (MRM). The size of 52 breast lesions with a known histopathological diagnosis (three benign, 49 malignant) was automatically evaluated using different techniques. The volume of all lesions was measured automatically (AVM) from CE 3D MRM examinations by means of a computer-aided detection (CAD) system and compared with the size estimates based on maximum diameter measurement (MDM) on MRM, ultrasonography (US), mammography and histopathology. Compared with histopathology as the reference method, AVM understimated lesion size by 4% on average. This result was similar to MDM (3% understimation, not significantly different) but significantly better than US and mammographic lesion measurements (24% and 33% size underestimation, respectively). AVM is as accurate as MDM but faster. Both methods are more accurate for size assessment of breast lesions compared with US and mammography.

Quantitative DWI implemented after DCE-MRI yields increased specificity for BI-RADS 3 and 4 breast lesions.

PubMed

Dijkstra, Hildebrand; Dorrius, Monique D; Wielema, Mirjam; Pijnappel, Ruud M; Oudkerk, Matthijs; Sijens, Paul E

2016-12-01

To assess if specificity can be increased when semiautomated breast lesion analysis of quantitative diffusion-weighted imaging (DWI) is implemented after dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) in the workup of BI-RADS 3 and 4 breast lesions larger than 1 cm. In all, 120 consecutive patients (mean-age, 48 years; age range, 23-75 years) with 139 breast lesions (≥1 cm) were examined (2010-2014) with 1.5T DCE-MRI and DWI (b = 0, 50, 200, 500, 800, 1000 s/mm 2 ) and the BI-RADS classification and histopathology were obtained. For each lesion malignancy was excluded using voxelwise semiautomated breast lesion analysis based on previously defined thresholds for the apparent diffusion coefficient (ADC) and the three intravoxel incoherent motion (IVIM) parameters: molecular diffusion (D slow ), microperfusion (D fast ), and the fraction of D fast (f fast ). The sensitivity (Se), specificity (Sp), and negative predictive value (NPV) based on only IVIM parameters combined in parallel (D slow , D fast , and f fast ), or the ADC or the BI-RADS classification by DCE-MRI were compared. Subsequently, the Se, Sp, and NPV of the combination of the BI-RADS classification by DCE-MRI followed by the IVIM parameters in parallel (or the ADC) were compared. In all, 23 of 139 breast lesions were benign. Se and Sp of DCE-MRI was 100% and 30.4% (NPV = 100%). Se and Sp of IVIM parameters in parallel were 92.2% and 52.2% (NPV = 57.1%) and for the ADC 95.7% and 17.4%, respectively (NPV = 44.4%). In all, 26 of 139 lesions were classified as BI-RADS 3 (n = 7) or BI-RADS 4 (n = 19). DCE-MRI combined with ADC (Se = 99.1%, Sp = 34.8%) or IVIM (Se = 99.1%, Sp = 56.5%) did significantly improve (P = 0.016) Sp of DCE-MRI alone for workup of BI-RADS 3 and 4 lesions (NPV = 92.9%). Quantitative DWI has a lower NPV compared to DCE-MRI for evaluation of breast lesions and may therefore not be able to replace DCE-MRI; when

Liquid biopsy in the diagnosis of HPV DNA in breast lesions.

PubMed

Carolis, Sabrina De; Pellegrini, Alice; Santini, Donatella; Ceccarelli, Claudio; De Leo, Antonio; Alessandrini, Federica; Arienti, Chiara; Pignatta, Sara; Tesei, Anna; Mantovani, Vilma; Zamagni, Claudio; Taffurelli, Mario; Sansone, Pasquale; Bonafé, Massimiliano; Cricca, Monica

2018-02-01

HPV DNA has never been investigated in nipple discharges (ND) and serum-derived extracellular vesicles, although its presence has been reported in ductal lavage fluids and blood specimens. We analyzed 50 ND, 22 serum-derived extracellular vesicles as well as 51 pathologic breast tissues for the presence of 16 HPV DNA types. We show that the presence of HPV DNA in the ND is predictive of HPV DNA-positive breast lesions and that HPV DNA is more represented in intraductal papillomas. We also show the presence of HPV DNA in the serum-derived extracellular vesicles. Our data supports the use of liquid biopsy to detect HPV DNA in breast pathology.

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

PubMed

Durur-Subasi, Irmak; Durur-Karakaya, Afak; Karaman, Adem; Seker, Mehmet; Demirci, Elif; Alper, Fatih

2017-05-01

To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T 1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (± standard deviation) was 1.61 ± 0.51 in carcinomas, and it was 0.65 ± 0.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field.

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

PubMed Central

Durur-Karakaya, Afak; Karaman, Adem; Seker, Mehmet; Demirci, Elif; Alper, Fatih

2017-01-01

Objective: To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant–benign differentiation of necrotic breast lesions. Methods: Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. Results: A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (± standard deviation) was 1.61 ± 0.51 in carcinomas, and it was 0.65 ± 0.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. Conclusion: The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field. PMID

Measurement of breast-tissue x-ray attenuation by spectral mammography: solid lesions

NASA Astrophysics Data System (ADS)

Fredenberg, Erik; Kilburn-Toppin, Fleur; Willsher, Paula; Moa, Elin; Danielsson, Mats; Dance, David R.; Young, Kenneth C.; Wallis, Matthew G.

2016-04-01

Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to distinguish between cysts and solid tumours at mammography screening would be highly desirable to reduce recalls, but the development requires knowledge of the x-ray attenuation for cysts and tumours. We have previously measured the attenuation of cyst fluid using photon-counting spectral mammography. Data on x-ray attenuation for solid breast lesions are available in the literature, but cover a relatively wide range, likely caused by natural spread between samples, random measurement errors, and different experimental conditions. In this study, we have adapted a previously developed spectral method to measure the linear attenuation of solid breast lesions. A total of 56 malignant and 5 benign lesions were included in the study. The samples were placed in a holder that allowed for thickness measurement. Spectral (energy-resolved) images of the samples were acquired and the image signal was mapped to equivalent thicknesses of two known reference materials, which can be used to derive the x-ray attenuation as a function of energy. The spread in equivalent material thicknesses was relatively large between samples, which is likely to be caused mainly by natural variation and only to a minor extent by random measurement errors and sample inhomogeneity. No significant difference in attenuation was found between benign and malignant solid lesions. The separation between cyst-fluid and tumour attenuation was, however, significant, which suggests it may be possible to distinguish cystic from solid breast lesions, and the results lay the groundwork for a clinical trial. In addition, the study adds a relatively large sample set to the published data and may contribute to a reduction in the overall uncertainty in the literature.

Role of exponential apparent diffusion coefficient in characterizing breast lesions by 3.0 Tesla diffusion-weighted magnetic resonance imaging

PubMed Central

Kothari, Shweta; Singh, Archana; Das, Utpalendu; Sarkar, Diptendra K; Datta, Chhanda; Hazra, Avijit

2017-01-01

Objective: To evaluate the role of exponential apparent diffusion coefficient (ADC) as a tool for differentiating benign and malignant breast lesions. Patients and Methods: This prospective observational study included 88 breast lesions in 77 patients (between 18 and 85 years of age) who underwent 3T breast magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) using b-values of 0 and 800 s/mm2 before biopsy. Mean exponential ADC and ADC of benign and malignant lesions obtained from DWI were compared. Receiver operating characteristics (ROC) curve analysis was undertaken to identify any cut-off for exponential ADC and ADC to predict malignancy. P value of <0.05 was considered statistically significant. Histopathology was taken as the gold standard. Results: According to histopathology, 65 lesions were malignant and 23 were benign. The mean ADC and exponential ADC values of malignant lesions were 0.9526 ± 0.203 × 10−3 mm2/s and 0.4774 ± 0.071, respectively, and for benign lesions were 1.48 ± 0.4903 × 10−3 mm2/s and 0.317 ± 0.1152, respectively. For both the parameters, differences were highly significant (P < 0.001). Cut-off value of ≤0.0011 mm2/s (P < 0.0001) for ADC provided 92.3% sensitivity and 73.9% specificity, whereas with an exponential ADC cut-off value of >0.4 (P < 0.0001) for malignant lesions, 93.9% sensitivity and 82.6% specificity was obtained. The performance of ADC and exponential ADC in distinguishing benign and malignant breast lesions based on respective cut-offs was comparable (P = 0.109). Conclusion: Exponential ADC can be used as a quantitative adjunct tool for characterizing breast lesions with comparable sensitivity and specificity as that of ADC. PMID:28744085

Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions.

PubMed

Ianculescu, Victor; Ciolovan, Laura Maria; Dunant, Ariane; Vielh, Philippe; Mazouni, Chafika; Delaloge, Suzette; Dromain, Clarisse; Blidaru, Alexandru; Balleyguier, Corinne

2014-05-01

To determine the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) Virtual Touch IQ shear wave elastography in the discrimination of benign and malignant breast lesions. Conventional B-mode and elasticity imaging were used to evaluate 110 breast lesions. Elastographic assessment of breast tissue abnormalities was done using a shear wave based technique, Virtual Touch IQ (VTIQ), implemented on a Siemens Acuson S3000 ultrasound machine. Tissue mechanical properties were interpreted as two-dimensional qualitative and quantitative colour maps displaying relative shear wave velocity. Wave speed measurements in m/s were possible at operator defined regions of interest. The pathologic diagnosis was established on samples obtained by ultrasound guided core biopsy or fine needle aspiration. BIRADS based B-mode evaluation of the 48 benign and 62 malignant lesions achieved 92% sensitivity and 62.5% specificity. Subsequently performed VTIQ elastography relying on visual interpretation of the colour overlay displaying relative shear wave velocities managed similar standalone diagnostic performance with 92% sensitivity and 64.6% specificity. Lesion and surrounding tissue shear wave speed values were calculated and a significant difference was found between the benign and malignant populations (Mann-Whitney U test, p<0.0001). By selecting a lesion cut-off value of 3.31m/s we achieved 80.4% sensitivity and 73% specificity. Applying this threshold only to BIRADS 4a masses, we reached overall levels of 92% sensitivity and 72.9% specificity. VTIQ qualitative and quantitative elastography has the potential to further characterise B-mode detected breast lesions, increasing specificity and reducing the number of unnecessary biopsies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions

PubMed Central

Travieso Aja, Maria Del Mar; Munoz, Purificacion; Rodriguez Rodriguez, Mario; Vega Benitez, Victor; Luzardo, Octavio P.

2016-01-01

Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS). PMID:27853496

Image guidance improves localization of sonographically occult colorectal liver metastases

NASA Astrophysics Data System (ADS)

Leung, Universe; Simpson, Amber L.; Adams, Lauryn B.; Jarnagin, William R.; Miga, Michael I.; Kingham, T. Peter

2015-03-01

Assessing the therapeutic benefit of surgical navigation systems is a challenging problem in image-guided surgery. The exact clinical indications for patients that may benefit from these systems is not always clear, particularly for abdominal surgery where image-guidance systems have failed to take hold in the same way as orthopedic and neurosurgical applications. We report interim analysis of a prospective clinical trial for localizing small colorectal liver metastases using the Explorer system (Path Finder Technologies, Nashville, TN). Colorectal liver metastases are small lesions that can be difficult to identify with conventional intraoperative ultrasound due to echogeneity changes in the liver as a result of chemotherapy and other preoperative treatments. Interim analysis with eighteen patients shows that 9 of 15 (60%) of these occult lesions could be detected with image guidance. Image guidance changed intraoperative management in 3 (17%) cases. These results suggest that image guidance is a promising tool for localization of small occult liver metastases and that the indications for image-guided surgery are expanding.

[Diagnostic value of quantitative pharmacokinetic parameters and relative quantitative pharmacokinetic parameters in breast lesions with dynamic contrast-enhanced MRI].

PubMed

Sun, T T; Liu, W H; Zhang, Y Q; Li, L H; Wang, R; Ye, Y Y

2017-08-01

Objective: To explore the differential between the value of dynamic contrast-enhanced MRI quantitative pharmacokinetic parameters and relative pharmacokinetic quantitative parameters in breast lesions. Methods: Retrospective analysis of 255 patients(262 breast lesions) who was obtained by clinical palpation , ultrasound or full-field digital mammography , and then all lessions were pathologically confirmed in Zhongda Hospital, Southeast University from May 2012 to May 2016. A 3.0 T MRI scanner was used to obtain the quantitative MR pharmacokinetic parameters: volume transfer constant (K(trans)), exchange rate constant (k(ep))and extravascular extracellular volume fraction (V(e)). And measured the quantitative pharmacokinetic parameters of normal glands tissues which on the same side of the same level of the lesions; and then calculated the value of relative pharmacokinetic parameters: rK(rans)、rk(ep) and rV(e).To explore the diagnostic value of two pharmacokinetic parameters in differential diagnosis of benign and malignant breast lesions using receiver operating curves and model of logistic regression. Results: (1)There were significant differences between benign lesions and malignant lesions in K(trans) and k(ep) ( t =15.489, 15.022, respectively, P <0.05), there were no significant differences between benign lesions and malignant lesions in V(e)( t =-2.346, P >0.05). The areas under the ROC curve(AUC)of K(trans), k(ep) and V(e) between malignant and benign lesions were 0.933, 0.948 and 0.387, the sensitivity of K(trans), k(ep) and V(e) were 77.1%, 85.0%, 51.0% , and the specificity of K(trans), k(ep) and V(e) were 96.3%, 93.6%, 60.8% for the differential diagnosis of breast lesions if taken the maximum Youden's index as cut-off. (2)There were significant differences between benign lesions and malignant lesions in rK(trans), rk(ep) and rV(e) ( t =14.177, 11.726, 2.477, respectively, P <0.05). The AUC of rK(trans), rk(ep) and rV(e) between malignant and benign

Artificial neural network in breast lesions from fine-needle aspiration cytology smear.

PubMed

Subbaiah, R M; Dey, Pranab; Nijhawan, Raje

2014-03-01

Artificial neural networks (ANNs) are applied in engineering and certain medical fields. ANN has immense potential and is rarely been used in breast lesions. In this present study, we attempted to build up a complete robust back propagation ANN model based on cytomorphological data, morphometric data, nuclear densitometric data, and gray level co-occurrence matrix (GLCM) of ductal carcinoma and fibroadenomas of breast cases diagnosed on fine-needle aspiration cytology (FNAC). We selected 52 cases of fibroadenomas and 60 cases of infiltrating ductal carcinoma of breast diagnosed on FNAC by two cytologists. Essential cytological data was quantitated by two independent cytologists (SRM, PD). With the help of Image J software, nuclear morphomeric, densitometric, and GLCM features were measured in all the cases on hematoxylin and eosin-stained smears. With the available data, an ANN model was built up with the help of Neurointelligence software. The network was designed as 41-20-1 (41 input nodes, 20 hidden nodes, 1 output node). The network was trained by the online back propagation algorithm and 500 iterations were done. Learning was adjusted after every iteration. ANN model correctly identified all cases of fibroadenomas and infiltrating carcinomas in the test set. This is one of the first successful composite ANN models of breast carcinomas. This basic model can be used to diagnose the gray zone area of the breast lesions on FNAC. We assume that this model may have far-reaching implications in future. Copyright © 2013 Wiley Periodicals, Inc.

What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?

PubMed

Vinnicombe, S J; Whelehan, P; Thomson, K; McLean, D; Purdie, C A; Jordan, L B; Hubbard, S; Evans, A J

2014-04-01

Shear wave elastography (SWE) is a promising adjunct to greyscale ultrasound in differentiating benign from malignant breast masses. The purpose of this study was to characterise breast cancers which are not stiff on quantitative SWE, to elucidate potential sources of error in clinical application of SWE to evaluation of breast masses. Three hundred and two consecutive patients examined by SWE who underwent immediate surgery for breast cancer were included. Characteristics of 280 lesions with suspicious SWE values (mean stiffness >50 kPa) were compared with 22 lesions with benign SWE values (<50 kPa). Statistical significance of the differences was assessed using non-parametric goodness-of-fit tests. Pure ductal carcinoma in situ (DCIS) masses were more often soft on SWE than masses representing invasive breast cancer. Invasive cancers that were soft were more frequently: histological grade 1, tubular subtype, ≤10 mm invasive size and detected at screening mammography. No significant differences were found with respect to the presence of invasive lobular cancer, vascular invasion, hormone and HER-2 receptor status. Lymph node positivity was less common in soft cancers. Malignant breast masses classified as benign by quantitative SWE tend to have better prognostic features than those correctly classified as malignant. • Over 90 % of cancers assessable with ultrasound have a mean stiffness >50 kPa. • 'Soft' invasive cancers are frequently small (≤10 mm), low grade and screen-detected. • Pure DCIS masses are more often soft than invasive cancers (>40 %). • Large symptomatic masses are better evaluated with SWE than small clinically occult lesions. • When assessing small lesions, 'softness' should not raise the threshold for biopsy.

Direct-Conversion Molecular Breast Imaging of Invasive Breast Cancer: Imaging Features, Extent of Invasive Disease, and Comparison Between Invasive Ductal and Lobular Histology.

PubMed

Conners, Amy Lynn; Jones, Katie N; Hruska, Carrie B; Geske, Jennifer R; Boughey, Judy C; Rhodes, Deborah J

2015-09-01

The purposes of this study were to compare the tumor appearance of invasive breast cancer on direct-conversion molecular breast imaging using a standardized lexicon and to determine how often direct-conversion molecular breast imaging identifies all known invasive tumor foci in the breast, and whether this differs for invasive ductal versus lobular histologic profiles. Patients with prior invasive breast cancer and concurrent direct-conversion molecular breast imaging examinations were retrospectively reviewed. Blinded review of direct-conversion molecular breast imaging examinations was performed by one of two radiologists, according to a validated lexicon. Direct-conversion molecular breast imaging findings were matched with lesions described on the pathology report to exclude benign reasons for direct-conversion molecular breast imaging findings and to document direct-conversion molecular breast imaging-occult tumor foci. Associations between direct-conversion molecular breast imaging findings and tumor histologic profiles were examined using chi-square tests. In 286 patients, 390 invasive tumor foci were present in 294 breasts. A corresponding direct-conversion molecular breast imaging finding was present for 341 of 390 (87%) tumor foci described on the pathology report. Invasive ductal carcinoma (IDC) tumor foci were more likely to be a mass (40% IDC vs 15% invasive lobular carcinoma [ILC]; p < 0.001) and to have marked intensity than were ILC foci (63% IDC vs 32% ILC; p < 0.001). Direct-conversion molecular breast imaging correctly revealed all pathology-proven foci of invasive disease in 79.8% of cases and was more likely to do so for IDC than for ILC (86.1% vs 56.7%; p < 0.0001). Overall, direct-conversion molecular breast imaging showed all known invasive foci in 249 of 286 (87%) patients. Direct-conversion molecular breast imaging features of invasive cancer, including lesion type and intensity, differ by histologic subtype. Direct-conversion molecular

Design, Implementation, and Characterization of a Dedicated Breast Computed Mammotomography System for Enhanced Lesion Imaging

DTIC Science & Technology

2006-03-01

Evaluation of fully 3D emission mammotomography with a compact cadmium zinc telluride detector,” IEEE Trans. Med. Imag. (Submitted) 2005. [16] M.P...times over a few months, and the degradation due to compromised adipose tissue boundaries as well as other physical breast features are becoming...breast lesions, especially in radiographically dense breasts,2,11-13 through the removal of contrast-reducing overlying tissue ; (2) uncompressed

Diagnostic value of virtual touch tissue imaging quantification for benign and malignant breast lesions with different sizes

PubMed Central

Liu, Hui; Zhao, Li-Xia; Xu, Guang; Yao, Ming-Hua; Zhang, Ai-Hong; Xu, Hui-Xiong; Wu, Rong

2015-01-01

The study was to explore diagnostic value of the virtual touch tissue imaging quantification (VTIQ) in distinguishing benign and malignant breast lesions of variable sizes. We performed conventional ultrasound and VTIQ in 139 breast lesions. The lesions were categorized into three groups according to size (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm), and their mean, min, and max shear wave velocities (SWVs) were measured. Diagnoses were confirmed by pathological examination after surgery or needle biopsy. Receiver-operating characteristic curves (ROC) were constructed to determine the optimum cut-off values, calculate the area under curve (AUC), the sensitivity, specificity and accuracy for each velocity. For all groups, the mean, min, and max SWVs of malignant lesions were significantly higher than those of benign lesions (P < 0.05). The cut-off values of mean, min, and max SWVs were not significantly different among the three groups. In addition, the diagnostic performance of mean, min, and max SWV values is analogous, regardless of lesion size. In conclusion, VTIQ is a strong complement to conventional ultrasound, which is a promising method in the differential diagnosis of the breast lesions with different sizes. Further studies validate our results as well as reduce the number of unnecessary biopsies, regardless of size is warranted. PMID:26550234

Reflective Occultation Mask for Evaluation of Occulter Designs for Planet Finding

NASA Technical Reports Server (NTRS)

Hagopian, John; Lyon, Richard; Shiri, Shahram; Roman, Patrick

2011-01-01

Advanced formation flying occulter designs utilize a large occulter mask flying in formation with an imaging telescope to block and null starlight to allow imaging of faint planets in exosolar systems. A paper describes the utilization of subscale reflective occultation masks to evaluate formation flying occulter designs. The use of a reflective mask allows mounting of the occulter by conventional means and simplifies the test configuration. The innovation alters the test set-up to allow mounting of the mask using standard techniques to eliminate the problems associated with a standard configuration. The modified configuration uses a reflective set-up whereby the star simulator reflects off of a reflective occulting mask and into an evaluation telescope. Since the mask is sized to capture all rays required for the imaging test, it can be mounted directly to a supporting fixture without interfering with the beam. Functionally, the reflective occultation mask reflects light from the star simulator instead of transmitting it, with a highly absorptive carbon nanotube layer simulating the occulter blocking mask. A subscale telescope images the star source and companion dim source that represents a planet. The primary advantage of this is that the occulter can be mounted conventionally instead of using diffractive wires or magnetic levitation.

Fine needle aspiration cytology of radiation-induced changes in nonneoplastic breast lesions. Possible pitfalls in cytodiagnosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peterse, J.L.; Thunnissen, F.B.; van Heerde, P.

1989-03-01

The range of radiation-induced changes in fine needle aspiration (FNA) smears of the breast is described. In 41 of more than 800 patients who underwent breast-conserving treatment, a palpable breast lesion developed, and FNA was performed. In six cases, a recurrent carcinoma was present. In the remaining cases, three patterns of nonneoplastic lesions could be discerned: epithelial atypia (14 cases), fat necrosis (10 cases) and poorly cellular smears without epithelial atypia or fat necrosis (13 cases). It is important to be familiar with the patterns of radiation-induced epithelial atypia, since such atypia may lead to a misdiagnosis of recurrent carcinoma.more » These atypical cells may show impressive anisocytosis and anisonucleosis; however, the nuclear/cytoplasmic ratio remains normal and an admixture of bipolar cells is present. Cell dissociation and necrotic cell debris, as often seen in breast cancer smears, were never encountered in FNA smears from radiated nonneoplastic breasts.« less

Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study.

PubMed

Harvey, James R; Lim, Yit; Murphy, John; Howe, Miles; Morris, Julie; Goyal, Amit; Maxwell, Anthony J

2018-06-01

Wire localization has several disadvantages, notably wire migration and difficulty scheduling the procedure close to surgery. Radioactive seed localization overcomes these disadvantages, but implementation is limited due to radiation safety requirements. Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed, with easier implementation. This study was designed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization. A two-centre open-label cohort study to assess the feasibility and safety of magnetic seed (Magseed) localization of breast lesions. Magseeds were placed under radiological guidance into women having total mastectomy surgery. The primary outcome measure was seed migration distance. Secondary outcome measures included accuracy of placement, ease of transcutaneous detection, seed integrity and safety. Twenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance. There was no migration of the seeds between placement and surgery. Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away. All seeds were detectable transcutaneously in all breast sizes and at all depths. There were no complications or safety issues. Magnetic seeds are a feasible and safe method of breast lesion localization. They can be accurately placed, demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue. Now that safety and feasibility have been demonstrated, further clinical studies are required to evaluate the seed's effectiveness in wide local excision surgery.

Research on the lesion segmentation of breast tumor MR images based on FCM-DS theory

NASA Astrophysics Data System (ADS)

Zhang, Liangbin; Ma, Wenjun; Shen, Xing; Li, Yuehua; Zhu, Yuemin; Chen, Li; Zhang, Su

2017-03-01

Magnetic resonance imaging (MRI) plays an important role in the treatment of breast tumor by high intensity focused ultrasound (HIFU). The doctors evaluate the scale, distribution and the statement of benign or malignancy of breast tumor by analyzing variety modalities of MRI, such as the T2, DWI and DCE images for making accurate preoperative treatment plan and evaluating the effect of the operation. This paper presents a method of lesion segmentation of breast tumor based on FCM-DS theory. Fuzzy c-means clustering (FCM) algorithm combined with Dempster-Shafer (DS) theory is used to process the uncertainty of information, segmenting the lesion areas on DWI and DCE modalities of MRI and reducing the scale of the uncertain parts. Experiment results show that FCM-DS can fuse the DWI and DCE images to achieve accurate segmentation and display the statement of benign or malignancy of lesion area by Time-Intensity Curve (TIC), which could be beneficial in making preoperative treatment plan and evaluating the effect of the therapy.

Magnetic resonance mammography in comparison with mammography in the discovery of multifocal, multicentric and bilateral lesions of breast cancer.

PubMed

Bakhtavar, Khadijeh; Saran, Maryam; Behzadifar, Masoud; Farsi, Maryam

2017-08-01

Breast cancer is one of the health system problems and important diseases that is rising in developing and advanced countries. This study aimed to determine the difference of Magnetic Resonance Mammography (MRM) findings versus mammography in detecting multifocal, multi-centric and malignant bilateral lesions in patients with known breast cancer in Tehran. This cross-sectional study was conducted in Iran and Tehran among breast cancer patients between January 2015 and February 2016. Patients were included in the study prior to surgery, at the request of a surgeon with the aim of detecting multifocal, multi-centric and bilateral lesions. Demographic information was also collected from patients. The results for quantitative variables were expressed as mean and standard deviations, and for qualitative variables, were expressed as relative and absolute frequency. Chi-square test was used to compare the two methods. SPSS Ver.24 (IBM) software was used to analyze the data. Thirty-nine patients were enrolled in the study. The mean age of patients in this study was 48.46±6.836. In mammography, 13 (33.3%) had Composition C and 26 (66.7%) had Composition D according to the type of Composition. In total, 25 patients (89.3%) had one lesion and 3 patients (10.7%) had more than two lesions. In MRM, all lesions observed were mass (54 masses). The number of lesions found in MRM was 27 patients with one lesion (58.9%), 6 patients with two lesions (20.5%) and 5 patients with three lesions (20.6%). MRM detected more lesions compared to mammography (p<0.0001). The value of Chi-square test with a degree of freedom and error level of 0.05 was 3.71 and p<0.0001 that showed a significant relationship between the number of MRM findings in comparison with mammography. The results of our study showed that two or more lesions and bilateral lesions in MRM were more than mammography in women with B Breast Composition C, D; the findings showed that MRM has a better ability to detect breast

Recurrent neural networks for breast lesion classification based on DCE-MRIs

NASA Astrophysics Data System (ADS)

Antropova, Natasha; Huynh, Benjamin; Giger, Maryellen

2018-02-01

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) plays a significant role in breast cancer screening, cancer staging, and monitoring response to therapy. Recently, deep learning methods are being rapidly incorporated in image-based breast cancer diagnosis and prognosis. However, most of the current deep learning methods make clinical decisions based on 2-dimentional (2D) or 3D images and are not well suited for temporal image data. In this study, we develop a deep learning methodology that enables integration of clinically valuable temporal components of DCE-MRIs into deep learning-based lesion classification. Our work is performed on a database of 703 DCE-MRI cases for the task of distinguishing benign and malignant lesions, and uses the area under the ROC curve (AUC) as the performance metric in conducting that task. We train a recurrent neural network, specifically a long short-term memory network (LSTM), on sequences of image features extracted from the dynamic MRI sequences. These features are extracted with VGGNet, a convolutional neural network pre-trained on a large dataset of natural images ImageNet. The features are obtained from various levels of the network, to capture low-, mid-, and high-level information about the lesion. Compared to a classification method that takes as input only images at a single time-point (yielding an AUC = 0.81 (se = 0.04)), our LSTM method improves lesion classification with an AUC of 0.85 (se = 0.03).

Non-invasive optical estimate of tissue composition to differentiate malignant from benign breast lesions: A pilot study

NASA Astrophysics Data System (ADS)

Taroni, Paola; Paganoni, Anna Maria; Ieva, Francesca; Pifferi, Antonio; Quarto, Giovanna; Abbate, Francesca; Cassano, Enrico; Cubeddu, Rinaldo

2017-01-01

Several techniques are being investigated as a complement to screening mammography, to reduce its false-positive rate, but results are still insufficient to draw conclusions. This initial study explores time domain diffuse optical imaging as an adjunct method to classify non-invasively malignant vs benign breast lesions. We estimated differences in tissue composition (oxy- and deoxyhemoglobin, lipid, water, collagen) and absorption properties between lesion and average healthy tissue in the same breast applying a perturbative approach to optical images collected at 7 red-near infrared wavelengths (635-1060 nm) from subjects bearing breast lesions. The Discrete AdaBoost procedure, a machine-learning algorithm, was then exploited to classify lesions based on optically derived information (either tissue composition or absorption) and risk factors obtained from patient’s anamnesis (age, body mass index, familiarity, parity, use of oral contraceptives, and use of Tamoxifen). Collagen content, in particular, turned out to be the most important parameter for discrimination. Based on the initial results of this study the proposed method deserves further investigation.

Study of nuclear morphometry on cytology specimens of benign and malignant breast lesions: A study of 122 cases.

PubMed

Kashyap, Anamika; Jain, Manjula; Shukla, Shailaja; Andley, Manoj

2017-01-01

Breast cancer has emerged as a leading site of cancer among women in India. Fine needle aspiration cytology (FNAC) has been routinely applied in assessment of breast lesions. Cytological evaluation in breast lesions is subjective with a "gray zone" of 6.9-20%. Quantitative evaluation of nuclear size, shape, texture, and density parameters by morphometry can be of diagnostic help in breast tumor. To apply nuclear morphometry on cytological breast aspirates and assess its role in differentiating between benign and malignant breast lesions with derivation of suitable cut-off values between the two groups. The present study was a descriptive cross-sectional hospital-based study of nuclear morphometric parameters of benign and malignant cases. The study included 50 benign breast disease (BBD), 8 atypical ductal hyperplasia (ADH), and 64 carcinoma cases. Image analysis was performed on Papanicolaou-stained FNAC slides by Nikon Imaging Software (NIS)-Elements Advanced Research software (Version 4.00). Nuclear morphometric parameters analyzed included 5 nuclear size, 2 shape, 4 texture, and 2 density parameters. Nuclear morphometry could differentiate between benign and malignant aspirates with a gradually increasing nuclear size parameters from BBD to ADH to carcinoma. Cut-off values of 31.93 μm 2 , 6.325 μm, 5.865 μm, 7.855 μm, and 21.55 μm for mean nuclear area, equivalent diameter, minimum feret, maximum ferret, and perimeter, respectively, were derived between benign and malignant cases, which could correctly classify 7 out of 8 ADH cases. Nuclear morphometry is a highly objective tool that could be used to supplement FNAC in differentiating benign from malignant lesions, with an important role in cases with diagnostic dilemma.

Diagnostic value of 99mTc-bombesin scintigraphy for differentiation of malignant from benign breast lesions.

PubMed

Shariati, Farzaneh; Aryana, Kamran; Fattahi, Asiehsadat; Forghani, Mohammad N; Azarian, Azita; Zakavi, Seyed R; Sadeghi, Ramin; Ayati, Narjes; Sadri, Keyvan

2014-06-01

In this study, we evaluated the diagnostic accuracy of (99m)Tc-bombesin scintigraphy for differentiation of benign from malignant palpable breast lesions. (99m)Tc-Bombesin is a tracer with high affinity for gastrin-releasing peptide receptor, which is overexpressed on a variety of human tumors including breast carcinoma. We examined 33 consecutive women who were referred to our center with suspicious palpable breast lesions but had no definitive diagnosis in other imaging procedures. A volume of 370-444 MBq of (99m)Tc-bombesin was injected and dynamic 1-min images were taken for 20 min immediately after injection in anterior view. Thereafter, two static images in anterior and prone-lateral views were taken for 5 min. Finally, single-photon emission computed tomography images were taken for each patient. Definitive diagnosis was based on biopsy and histopathological evaluation. The scan findings were positive in 19 patients and negative in 11 on visual assessment of the planar and single-photon emission computed tomography images. Pathologic examination confirmed breast carcinoma in 12 patients with positive scans and benign pathology for 18 patients. The overall sensitivity, specificity, negative and positive predictive values, and accuracy of this radiotracer for diagnosis of breast cancer were 100, 66.1, 100, 63, and 76%, respectively. Semiquantitative analysis improved the specificity of the visual assessment from 66 to 84%. Our study showed that (99m)Tc-bombesin scintigraphy has a high sensitivity and negative predictive value for detecting malignant breast lesions, but the specificity and positive predictive value of this radiotracer for differentiation of malignant breast abnormalities from benign ones are relatively low.

Pathological criteria and practical issues in papillary lesions of the breast - a review.

PubMed

Ni, Yun-Bi; Tse, Gary M

2016-01-01

Papillary lesions of the breast include a broad spectrum of lesions, ranging from benign papilloma, papilloma with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) to papillary carcinoma. The accurate diagnosis of mammary papillary lesions is a challenge for pathologists, owing to the overlapping features among these lesions. In this review, some of the diagnostic criteria of papillary lesions are discussed, with special emphasis on some key morphological features, namely fibrovascular cores, epithelial proliferation in a solid pattern, intraductal papilloma complicated by ADH or DCIS, and invasion and its mimics. The roles of immunohistochemistry, and the interpretation of myoepithelial cell markers, hormone receptors, and high molecular weight cytokeratin, are addressed. Finally, novel biomarkers and genetic aberrations in papillary lesions are summarized. © 2015 John Wiley & Sons Ltd.

Classification of breast MRI lesions using small-size training sets: comparison of deep learning approaches

NASA Astrophysics Data System (ADS)

Amit, Guy; Ben-Ari, Rami; Hadad, Omer; Monovich, Einat; Granot, Noa; Hashoul, Sharbell

2017-03-01

Diagnostic interpretation of breast MRI studies requires meticulous work and a high level of expertise. Computerized algorithms can assist radiologists by automatically characterizing the detected lesions. Deep learning approaches have shown promising results in natural image classification, but their applicability to medical imaging is limited by the shortage of large annotated training sets. In this work, we address automatic classification of breast MRI lesions using two different deep learning approaches. We propose a novel image representation for dynamic contrast enhanced (DCE) breast MRI lesions, which combines the morphological and kinetics information in a single multi-channel image. We compare two classification approaches for discriminating between benign and malignant lesions: training a designated convolutional neural network and using a pre-trained deep network to extract features for a shallow classifier. The domain-specific trained network provided higher classification accuracy, compared to the pre-trained model, with an area under the ROC curve of 0.91 versus 0.81, and an accuracy of 0.83 versus 0.71. Similar accuracy was achieved in classifying benign lesions, malignant lesions, and normal tissue images. The trained network was able to improve accuracy by using the multi-channel image representation, and was more robust to reductions in the size of the training set. A small-size convolutional neural network can learn to accurately classify findings in medical images using only a few hundred images from a few dozen patients. With sufficient data augmentation, such a network can be trained to outperform a pre-trained out-of-domain classifier. Developing domain-specific deep-learning models for medical imaging can facilitate technological advancements in computer-aided diagnosis.

A deep learning framework for supporting the classification of breast lesions in ultrasound images.

PubMed

Han, Seokmin; Kang, Ho-Kyung; Jeong, Ja-Yeon; Park, Moon-Ho; Kim, Wonsik; Bang, Won-Chul; Seong, Yeong-Kyeong

2017-09-15

In this research, we exploited the deep learning framework to differentiate the distinctive types of lesions and nodules in breast acquired with ultrasound imaging. A biopsy-proven benchmarking dataset was built from 5151 patients cases containing a total of 7408 ultrasound breast images, representative of semi-automatically segmented lesions associated with masses. The dataset comprised 4254 benign and 3154 malignant lesions. The developed method includes histogram equalization, image cropping and margin augmentation. The GoogLeNet convolutionary neural network was trained to the database to differentiate benign and malignant tumors. The networks were trained on the data with augmentation and the data without augmentation. Both of them showed an area under the curve of over 0.9. The networks showed an accuracy of about 0.9 (90%), a sensitivity of 0.86 and a specificity of 0.96. Although target regions of interest (ROIs) were selected by radiologists, meaning that radiologists still have to point out the location of the ROI, the classification of malignant lesions showed promising results. If this method is used by radiologists in clinical situations it can classify malignant lesions in a short time and support the diagnosis of radiologists in discriminating malignant lesions. Therefore, the proposed method can work in tandem with human radiologists to improve performance, which is a fundamental purpose of computer-aided diagnosis.

A deep learning framework for supporting the classification of breast lesions in ultrasound images

NASA Astrophysics Data System (ADS)

Han, Seokmin; Kang, Ho-Kyung; Jeong, Ja-Yeon; Park, Moon-Ho; Kim, Wonsik; Bang, Won-Chul; Seong, Yeong-Kyeong

2017-10-01

In this research, we exploited the deep learning framework to differentiate the distinctive types of lesions and nodules in breast acquired with ultrasound imaging. A biopsy-proven benchmarking dataset was built from 5151 patients cases containing a total of 7408 ultrasound breast images, representative of semi-automatically segmented lesions associated with masses. The dataset comprised 4254 benign and 3154 malignant lesions. The developed method includes histogram equalization, image cropping and margin augmentation. The GoogLeNet convolutionary neural network was trained to the database to differentiate benign and malignant tumors. The networks were trained on the data with augmentation and the data without augmentation. Both of them showed an area under the curve of over 0.9. The networks showed an accuracy of about 0.9 (90%), a sensitivity of 0.86 and a specificity of 0.96. Although target regions of interest (ROIs) were selected by radiologists, meaning that radiologists still have to point out the location of the ROI, the classification of malignant lesions showed promising results. If this method is used by radiologists in clinical situations it can classify malignant lesions in a short time and support the diagnosis of radiologists in discriminating malignant lesions. Therefore, the proposed method can work in tandem with human radiologists to improve performance, which is a fundamental purpose of computer-aided diagnosis.

Classification of small lesions in dynamic breast MRI: Eliminating the need for precise lesion segmentation through spatio-temporal analysis of contrast enhancement over time.

PubMed

Nagarajan, Mahesh B; Huber, Markus B; Schlossbauer, Thomas; Leinsinger, Gerda; Krol, Andrzej; Wismüller, Axel

2013-10-01

Characterizing the dignity of breast lesions as benign or malignant is specifically difficult for small lesions; they don't exhibit typical characteristics of malignancy and are harder to segment since margins are harder to visualize. Previous attempts at using dynamic or morphologic criteria to classify small lesions (mean lesion diameter of about 1 cm) have not yielded satisfactory results. The goal of this work was to improve the classification performance in such small diagnostically challenging lesions while concurrently eliminating the need for precise lesion segmentation. To this end, we introduce a method for topological characterization of lesion enhancement patterns over time. Three Minkowski Functionals were extracted from all five post-contrast images of sixty annotated lesions on dynamic breast MRI exams. For each Minkowski Functional, topological features extracted from each post-contrast image of the lesions were combined into a high-dimensional texture feature vector. These feature vectors were classified in a machine learning task with support vector regression. For comparison, conventional Haralick texture features derived from gray-level co-occurrence matrices (GLCM) were also used. A new method for extracting thresholded GLCM features was also introduced and investigated here. The best classification performance was observed with Minkowski Functionals area and perimeter , thresholded GLCM features f8 and f9, and conventional GLCM features f4 and f6. However, both Minkowski Functionals and thresholded GLCM achieved such results without lesion segmentation while the performance of GLCM features significantly deteriorated when lesions were not segmented ( p < 0.05). This suggests that such advanced spatio-temporal characterization can improve the classification performance achieved in such small lesions, while simultaneously eliminating the need for precise segmentation.

Computer-aided US diagnosis of breast lesions by using cell-based contour grouping.

PubMed

Cheng, Jie-Zhi; Chou, Yi-Hong; Huang, Chiun-Sheng; Chang, Yeun-Chung; Tiu, Chui-Mei; Chen, Kuei-Wu; Chen, Chung-Ming

2010-06-01

To develop a computer-aided diagnostic algorithm with automatic boundary delineation for differential diagnosis of benign and malignant breast lesions at ultrasonography (US) and investigate the effect of boundary quality on the performance of a computer-aided diagnostic algorithm. This was an institutional review board-approved retrospective study with waiver of informed consent. A cell-based contour grouping (CBCG) segmentation algorithm was used to delineate the lesion boundaries automatically. Seven morphologic features were extracted. The classifier was a logistic regression function. Five hundred twenty breast US scans were obtained from 520 subjects (age range, 15-89 years), including 275 benign (mean size, 15 mm; range, 5-35 mm) and 245 malignant (mean size, 18 mm; range, 8-29 mm) lesions. The newly developed computer-aided diagnostic algorithm was evaluated on the basis of boundary quality and differentiation performance. The segmentation algorithms and features in two conventional computer-aided diagnostic algorithms were used for comparative study. The CBCG-generated boundaries were shown to be comparable with the manually delineated boundaries. The area under the receiver operating characteristic curve (AUC) and differentiation accuracy were 0.968 +/- 0.010 and 93.1% +/- 0.7, respectively, for all 520 breast lesions. At the 5% significance level, the newly developed algorithm was shown to be superior to the use of the boundaries and features of the two conventional computer-aided diagnostic algorithms in terms of AUC (0.974 +/- 0.007 versus 0.890 +/- 0.008 and 0.788 +/- 0.024, respectively). The newly developed computer-aided diagnostic algorithm that used a CBCG segmentation method to measure boundaries achieved a high differentiation performance. Copyright RSNA, 2010

MRI-Guided Diffuse Optical Spectroscopy of Malignant and Benign Breast Lesions1

PubMed Central

Ntziachristos, Vasilis; Yodh, A G; Schnall, Mitchell D; Chance, Britton

2002-01-01

Abstract We present the clinical implementation of a novel hybrid system that combines magnetic resonance imaging (MRI) and near-infrared (NIR) optical measurements for the noninvasive study of breast cancer in vivo. Fourteen patients were studied with a MR-NIR prototype imager and spectrometer. A diffuse optical tomographic scheme employed the MR images as a priori information to implement an image-guided NIR localized spectroscopic scheme. All patients who entered the study also underwent gadolinium-enhanced MRI and biopsy so that the optical findings were cross-validated with MR readings and histopathology. The technique quantified the oxy- and deoxyhemoglobin of five malignant and nine benign breast lesions in vivo. Breast cancers were found with decreased oxygen saturation and higher blood concentration than most benign lesions. The average hemoglobin concentration ([H]) of cancers was 0.130±0.100 mM, and the average hemoglobin saturation (Y) was 60±9% compared to [H]=0.018±0.005 mM and Y=69±6% of background tissue. Fibroadenomas exhibited high hemoglobin concentration [H]=0.060±0.010 mM and mild decrease in oxygen saturation Y=67±2%. Cysts and other normal lesions were easily differentiated based on intrinsic contrast information. This novel optical technology can be a significant add-on in MR examinations and can be used to characterize functional parameters of cancers with diagnostic and treatment prognosis potential. It is foreseen that the technique can play a major role in functional activation studies of brain and muscle as well. PMID:12082551

Association between power law coefficients of the anatomical noise power spectrum and lesion detectability in breast imaging modalities

NASA Astrophysics Data System (ADS)

Chen, Lin; Abbey, Craig K.; Boone, John M.

2013-03-01

Previous research has demonstrated that a parameter extracted from a power function fit to the anatomical noise power spectrum, β, may be predictive of breast mass lesion detectability in x-ray based medical images of the breast. In this investigation, the value of β was compared with a number of other more widely used parameters, in order to determine the relationship between β and these other parameters. This study made use of breast CT data sets, acquired on two breast CT systems developed in our laboratory. A total of 185 breast data sets in 183 women were used, and only the unaffected breast was used (where no lesion was suspected). The anatomical noise power spectrum computed from two-dimensional region of interests (ROIs), was fit to a power function (NPS(f) = α f-β), and the exponent parameter (β) was determined using log/log linear regression. Breast density for each of the volume data sets was characterized in previous work. The breast CT data sets analyzed in this study were part of a previous study which evaluated the receiver operating characteristic (ROC) curve performance using simulated spherical lesions and a pre-whitened matched filter computer observer. This ROC information was used to compute the detectability index as well as the sensitivity at 95% specificity. The fractal dimension was computed from the same ROIs which were used for the assessment of β. The value of β was compared to breast density, detectability index, sensitivity, and fractal dimension, and the slope of these relationships was investigated to assess statistical significance from zero slope. A statistically significant non-zero slope was considered to be a positive association in this investigation. All comparisons between β and breast density, detectability index, sensitivity at 95% specificity, and fractal dimension demonstrated statistically significant association with p < 0.001 in all cases. The value of β was also found to be associated with patient age and

Study of nuclear morphometry on cytology specimens of benign and malignant breast lesions: A study of 122 cases

PubMed Central

Kashyap, Anamika; Jain, Manjula; Shukla, Shailaja; Andley, Manoj

2017-01-01

Background: Breast cancer has emerged as a leading site of cancer among women in India. Fine needle aspiration cytology (FNAC) has been routinely applied in assessment of breast lesions. Cytological evaluation in breast lesions is subjective with a “gray zone” of 6.9–20%. Quantitative evaluation of nuclear size, shape, texture, and density parameters by morphometry can be of diagnostic help in breast tumor. Aims: To apply nuclear morphometry on cytological breast aspirates and assess its role in differentiating between benign and malignant breast lesions with derivation of suitable cut-off values between the two groups. Settings and Designs: The present study was a descriptive cross-sectional hospital-based study of nuclear morphometric parameters of benign and malignant cases. Materials and Methods: The study included 50 benign breast disease (BBD), 8 atypical ductal hyperplasia (ADH), and 64 carcinoma cases. Image analysis was performed on Papanicolaou-stained FNAC slides by Nikon Imaging Software (NIS)–Elements Advanced Research software (Version 4.00). Nuclear morphometric parameters analyzed included 5 nuclear size, 2 shape, 4 texture, and 2 density parameters. Results: Nuclear morphometry could differentiate between benign and malignant aspirates with a gradually increasing nuclear size parameters from BBD to ADH to carcinoma. Cut-off values of 31.93 μm2, 6.325 μm, 5.865 μm, 7.855 μm, and 21.55 μm for mean nuclear area, equivalent diameter, minimum feret, maximum ferret, and perimeter, respectively, were derived between benign and malignant cases, which could correctly classify 7 out of 8 ADH cases. Conclusion: Nuclear morphometry is a highly objective tool that could be used to supplement FNAC in differentiating benign from malignant lesions, with an important role in cases with diagnostic dilemma. PMID:28182052

Fear of missing a lesion: use of simulated breast models to decrease student anxiety when learning clinical breast examinations.

PubMed

Pugh, Carla M; Salud, Lawrence H

2007-06-01

Medical students experience a considerable amount of discomfort during their training. The purpose of the current study was to identify sources of student anxiety when learning clinical breast examinations (CBEs) and to evaluate the effects of simulated breast models on student comfort. Simulated breast models were introduced into the curriculum for 175 second-year medical students. Using surveys, students identified sources of anxiety and rated their comfort levels when learning CBE skills. "Fear of missing a lesion" and the "Intimate/personal nature of the exam" accounted for 73.8% of student anxiety when learning CBEs. In addition, there were significant improvements (P < .05) in student comfort levels when using simulated breast models to learn CBE skills. We have identified 2 of the top causes of anxiety for second-year medical students learning CBE. In addition, we found simulated breast models to be effective in increasing student comfort levels when learning CBEs.

Accuracy of MRI volume measurements of breast lesions: comparison between automated, semiautomated and manual assessment.

PubMed

Rominger, Marga B; Fournell, Daphne; Nadar, Beenarose Thanka; Behrens, Sarah N M; Figiel, Jens H; Keil, Boris; Heverhagen, Johannes T

2009-05-01

The aim of this study was to investigate the efficacy of a dedicated software tool for automated and semiautomated volume measurement in contrast-enhanced (CE) magnetic resonance mammography (MRM). Ninety-six breast lesions with histopathological workup (27 benign, 69 malignant) were re-evaluated by different volume measurement techniques. Volumes of all lesions were extracted automatically (AVM) and semiautomatically (SAVM) from CE 3D MRM and compared with manual 3D contour segmentation (manual volume measurement, MVM, reference measurement technique) and volume estimates based on maximum diameter measurement (MDM). Compared with MVM as reference method MDM, AVM and SAVM underestimated lesion volumes by 63.8%, 30.9% and 21.5%, respectively, with significantly different accuracy for benign (102.4%, 18.4% and 11.4%) and malignant (54.9%, 33.0% and 23.1%) lesions (p < 0.05). Inter- and intraobserver reproducibility was best for AVM (mean difference +/- 2SD, 1.0 +/- 9.7% and 1.8 +/- 12.1%) followed by SAVM (4.3 +/- 25.7% and 4.3 +/- 7.9%), MVM (2.3 +/- 38.2% and 8.6 +/- 31.8%) and MDM (33.9 +/- 128.4% and 9.3 +/- 55.9%). SAVM is more accurate for volume assessment of breast lesions than MDM and AVM. Volume measurement is less accurate for malignant than benign lesions.

Efficiency of Core Biopsy for BI-RADS-5 Breast Lesions.

PubMed

Wolf, Ronald; Quan, Glenda; Calhoun, Kris; Soot, Laurel; Skokan, Laurie

2008-01-01

Stereotactic biopsy has proven more cost effective for biopsy of lesions associated with moderately suspicious mammograms. Data regarding selection of stereotactic biopsy (CORE) instead of excisional biopsy (EB) as the first diagnostic procedure in patients with nonpalpable breast lesions and highest suspicion breast imaging-reporting and data system (BI-RADS)-5 mammograms are sparse. Records from a regional health system radiology database were screened for mammograms associated with image-guided biopsy. A total of 182 nonpalpable BI-RADS-5 lesions were sampled in 178 patients over 5 years, using CORE or EB. Initial surgical margins, number of surgeries, time from initial procedure to last related surgical procedure, and hospital and professional charges for related admissions were compared using chi-squared, t-test, and Wilcoxon Mann-Whitney tests. A total of 108 CORE and 74 EB were performed as the first diagnostic procedure. Invasive or in situ carcinoma was diagnosed in 156 (86%) of all biopsies, 95 in CORE and 61 in EB groups. Negative margins of the first surgical procedure were more frequent in CORE (n = 70, 74%) versus EB (n = 17, 28%), p < 0.05. Use of CORE was associated with fewer total surgical procedures per lesion (1.29 +/- 0.05 versus 1.8 +/- 0.05, p < 0.05). Time of initial diagnostic procedure to final treatment did not vary significantly according to group (27 +/- 2 days versus 22 +/- 2 days, CORE versus EB). Mean charges including the diagnostic procedure and all subsequent surgeries were not different between CORE and EB groups ($10,500 +/- 300 versus $11,500 +/- 500, p = 0.08). Use of CORE as the first procedure in patients with highly suspicious mammograms is associated with improved pathologic margins and need for fewer surgical procedures than EB, and should be considered the preferred initial diagnostic approach.

All pure flat atypical atypia lesions of the breast diagnosed using percutaneous vacuum-assisted breast biopsy do not need surgical excision.

PubMed

Ouldamer, Lobna; Poisson, Elodie; Arbion, Flavie; Bonneau, Carole; Vildé, Anne; Body, Gilles; Michenet, Patrick

2018-04-14

The purposes of this study were to evaluate the outcome of women with pure flat atypical atypia (FEA) diagnosed at vacuum-assisted breast biopsy (VABB) targeting microcalcifications and to determine whether clinical, radiological and pathologic parameters are able to predict which lesions will be upgraded to malignancy. 2414 cases of consecutive VABB for microcalcifications using VA 8-, 10- or 11-Gauge stereotactically guided core biopsy performed between January 2005 and December 2011 from two french breast cancer centers were evaluated. Data of women with VABB-diagnosed pure FEA who underwent either excisional surgery or mammographic follow-up were analyzed. Cases with mass lesions or ipsilateral cancers were excluded. Two pathologists (FA,PM) reviewed the results of procedures performed. Clinical, radiological, as well as histological criteria have been studied in order to determine the correlation between these factors and carcinoma underestimation. This study included 70 cases of pure FEA. Twenty women underwent surgical excision and 50 had clinical and mammographic surveillance only. In three women FEA was upgraded to breast cancer on excision. Clinical and mammographic follow-up for a mean of 56 months ± 27 in the group without excision showed two cancers in the same breast (Intermediate grade DCIS, and invasive ductal carcinoma 84 and 48 months respectively after VABB). Three factors were significantly predictive of underestimation or occurence of cancer for pure FEA when the radiologic lesions are calcifications: age≥ 57 years, radiologic size >10 mm and number of FEA foci ≥4. Copyright © 2018. Published by Elsevier Ltd.

Automated classification of focal breast lesions according to S-detect: validation and role as a clinical and teaching tool.

PubMed

Di Segni, Mattia; de Soccio, Valeria; Cantisani, Vito; Bonito, Giacomo; Rubini, Antonello; Di Segni, Gabriele; Lamorte, Sveva; Magri, Valentina; De Vito, Corrado; Migliara, Giuseppe; Bartolotta, Tommaso Vincenzo; Metere, Alessio; Giacomelli, Laura; de Felice, Carlo; D'Ambrosio, Ferdinando

2018-06-01

To assess the diagnostic performance and the potential as a teaching tool of S-detect in the assessment of focal breast lesions. 61 patients (age 21-84 years) with benign breast lesions in follow-up or candidate to pathological sampling or with suspicious lesions candidate to biopsy were enrolled. The study was based on a prospective and on a retrospective phase. In the prospective phase, after completion of baseline US by an experienced breast radiologist and S-detect assessment, 5 operators with different experience and dedication to breast radiology performed elastographic exams. In the retrospective phase, the 5 operators performed a retrospective assessment and categorized lesions with BI-RADS 2013 lexicon. Integration of S-detect to in-training operators evaluations was performed by giving priority to S-detect analysis in case of disagreement. 2 × 2 contingency tables and ROC analysis were used to assess the diagnostic performances; inter-rater agreement was measured with Cohen's k; Bonferroni's test was used to compare performances. A significance threshold of p = 0.05 was adopted. All operators showed sensitivity > 90% and varying specificity (50-75%); S-detect showed sensitivity > 90 and 70.8% specificity, with inter-rater agreement ranging from moderate to good. Lower specificities were improved by the addition of S-detect. The addition of elastography did not lead to any improvement of the diagnostic performance. S-detect is a feasible tool for the characterization of breast lesions; it has a potential as a teaching tool for the less experienced operators.

[Surgical Diagnosis and Treatment of Primary Hyperthyroidism Complicated with Occult Thyroid Carcinoma].

PubMed

Wu, Xin; Yu, Jian-chun; Kang, Wei-ming; Ma, Zhi-qiang; Ye, Xin

2015-08-01

To evaluate the surgical diagnosis and treatment of primary hyperthyroidism complicated with occult thyroid carcinoma. Data of 51 cases of primary hyperthyroidism complicated with occult thyroid carcinoma admitted during January 2004 to November 2014 were analyzed retrospectively. The incidence of occult thyroid carcinoma was 5.03% in hyperthyroidism,and 47 cases (92.16%) were female. The preoperative diagnosis of all these 51 cases was primary hyperthyroidism and 11 cases were diagnosed thyroid carcinoma at the same time;25 cases were diagnosed thyroid carcinoma by frozen section and the remaining 26 cases were diagnosed by postoperative pathology. Finally,26 cases underwent subtotal thyroidectomy,4 cases underwent total thyroidectomy, and 21 cases underwent total thyroidectomy with lymphadenectomy. The tumor size ranged from 0.1 to 1.0 cm [mean:(0.63 ± 0.35) cm]. The lesions were less than or equal to 0.5 cm in 28 cases (54.9%). The follow-up lasted from 1 to 121 months [mean:(28.6 ± 22.7)months] in 43 patients,and all of them survived. Primary hyperthyroidism complicated with occult thyroid carcinoma is commonly found in female patients. Preoperative diagnosis is difficult. Ultrasound is the major examining method. Frozen section can increase the detection rate. The postoperative prognosis of hyperthyroidism complicated with occult thyroid carcinoma is satisfactory.

Computer-assisted assessment of ultrasound real-time elastography: initial experience in 145 breast lesions.

PubMed

Zhang, Xue; Xiao, Yang; Zeng, Jie; Qiu, Weibao; Qian, Ming; Wang, Congzhi; Zheng, Rongqin; Zheng, Hairong

2014-01-01

To develop and evaluate a computer-assisted method of quantifying five-point elasticity scoring system based on ultrasound real-time elastography (RTE), for classifying benign and malignant breast lesions, with pathologic results as the reference standard. Conventional ultrasonography (US) and RTE images of 145 breast lesions (67 malignant, 78 benign) were performed in this study. Each lesion was automatically contoured on the B-mode image by the level set method and mapped on the RTE image. The relative elasticity value of each pixel was reconstructed and classified into hard or soft by the fuzzy c-means clustering method. According to the hardness degree inside lesion and its surrounding tissue, the elasticity score of the RTE image was computed in an automatic way. Visual assessments of the radiologists were used for comparing the diagnostic performance. Histopathologic examination was used as the reference standard. The Student's t test and receiver operating characteristic (ROC) curve analysis were performed for statistical analysis. Considering score 4 or higher as test positive for malignancy, the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8% (136/145), 92.5% (62/67), 94.9% (74/78), 93.9% (62/66), and 93.7% (74/79) for the computer-assisted scheme, and 89.7% (130/145), 85.1% (57/67), 93.6% (73/78), 92.0% (57/62), and 88.0% (73/83) for manual assessment. Area under ROC curve (Az value) for the proposed method was higher than the Az value for visual assessment (0.96 vs. 0.93). Computer-assisted quantification of classical five-point scoring system can significantly eliminate the interobserver variability and thereby improve the diagnostic confidence of classifying the breast lesions to avoid unnecessary biopsy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

MR evaluation of breast lesions obtained by diffusion-weighted imaging with background body signal suppression (DWIBS) and correlations with histological findings.

PubMed

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Capolongo, Arcangela; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-07-01

Diffusion imaging represents a new imaging tool for the diagnosis of breast cancer. This study aims to investigate the role of diffusion-weighted MRI with background body signal suppression (DWIBS) for evaluating breast lesions. 90 patients were prospectively evaluated by MRI with STIR, TSE-T2, contrast enhanced THRIVE-T1 and DWIBS sequences. DWIBS were analyzed searching for the presence of breast lesions and calculating the ADC value. ADC values of ≤1.44×10(-3)mm(2)/s were considered suspicious for malignancy. This analysis was then compared with the histological findings. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated. In 53/90 (59%) patients, DWIBS indicated the presence of breast lesions, 16 (30%) with ADC values of >1.44 and 37 (70%) with ADC≤1.44. The comparison with histology showed 25 malignant and 28 benign lesions. DWIBS sequences obtained sensitivity, specificity, DA, PPV and NPV values of 100, 82, 87, 68 and 100%, respectively. DWIBS can be proposed in the MRI breast protocol representing an accurate diagnostic complement. Copyright © 2014 Elsevier Inc. All rights reserved.

Towards an in-plane methodology to track breast lesions using mammograms and patient-specific finite-element simulations

NASA Astrophysics Data System (ADS)

Lapuebla-Ferri, Andrés; Cegoñino-Banzo, José; Jiménez-Mocholí, Antonio-José; Pérez del Palomar, Amaya

2017-11-01

In breast cancer screening or diagnosis, it is usual to combine different images in order to locate a lesion as accurately as possible. These images are generated using a single or several imaging techniques. As x-ray-based mammography is widely used, a breast lesion is located in the same plane of the image (mammogram), but tracking it across mammograms corresponding to different views is a challenging task for medical physicians. Accordingly, simulation tools and methodologies that use patient-specific numerical models can facilitate the task of fusing information from different images. Additionally, these tools need to be as straightforward as possible to facilitate their translation to the clinical area. This paper presents a patient-specific, finite-element-based and semi-automated simulation methodology to track breast lesions across mammograms. A realistic three-dimensional computer model of a patient’s breast was generated from magnetic resonance imaging to simulate mammographic compressions in cranio-caudal (CC, head-to-toe) and medio-lateral oblique (MLO, shoulder-to-opposite hip) directions. For each compression being simulated, a virtual mammogram was obtained and posteriorly superimposed to the corresponding real mammogram, by sharing the nipple as a common feature. Two-dimensional rigid-body transformations were applied, and the error distance measured between the centroids of the tumors previously located on each image was 3.84 mm and 2.41 mm for CC and MLO compression, respectively. Considering that the scope of this work is to conceive a methodology translatable to clinical practice, the results indicate that it could be helpful in supporting the tracking of breast lesions.

A modified Seeded Region Growing algorithm for vessel segmentation in breast MRI images for investigating the nature of potential lesions

NASA Astrophysics Data System (ADS)

Glotsos, D.; Vassiou, K.; Kostopoulos, S.; Lavdas, El; Kalatzis, I.; Asvestas, P.; Arvanitis, D. L.; Fezoulidis, I. V.; Cavouras, D.

2014-03-01

The role of Magnetic Resonance Imaging (MRI) as an alternative protocol for screening of breast cancer has been intensively investigated during the past decade. Preliminary research results have indicated that gadolinium-agent administrative MRI scans may reveal the nature of breast lesions by analyzing the contrast-agent's uptake time. In this study, we attempt to deduce the same conclusion, however, from a different perspective by investigating, using image processing, the vascular network of the breast at two different time intervals following the administration of gadolinium. Twenty cases obtained from a 3.0-T MRI system (SIGNA HDx; GE Healthcare) were included in the study. A new modification of the Seeded Region Growing (SRG) algorithm was used to segment vessels from surrounding background. Delineated vessels were investigated by means of their topology, morphology and texture. Results have shown that it is possible to estimate the nature of the lesions with approximately 94.4% accuracy, thus, it may be claimed that the breast vascular network does encodes useful, patterned, information, which can be used for characterizing breast lesions.

Analysis of false results in a series of 835 fine needle aspirates of breast lesions.

PubMed

Willis, S L; Ramzy, I

1995-01-01

To analyze cases of false diagnoses from a large series to help increase the accuracy of fine needle aspiration of palpable breast lesions. The results of FNA of 835 palpable breast lesions were analyzed to determine the reasons for false positive, false negative and false suspicious diagnoses. Of the 835 aspirates, 174 were reported as positive, 549 as negative and 66 as suspicious or atypical but not diagnostic of malignancy. Forty-six cases were considered unsatisfactory. Tissue was available for comparison in 286 cases. The cytologic diagnoses in these cases were reported as follows: positive, 125 (43.7%); suspicious, 33 (11.5%); atypical, 18 (6.2%); negative, 92 (32%); and unsatisfactory, 18 (6.2%). There was one false positive diagnosis, yielding a false positive rate of 0.8%. This lesion was a case of fibrocystic change with hyperplasia, focal fat necrosis and reparative atypia. There were 14 false negative cases, resulting in a false negative rate of 13.2%. Nearly all these cases were sampling errors and included infiltrating ductal carcinomas (9), ductal carcinomas in situ (2), infiltrating lobular carcinomas (2) and tubular carcinoma (1). Most of the suspicious and atypical lesions proved to be carcinomas (35/50). The remainder were fibroadenomas (6), fibrocystic change (4), gynecomastia (2), adenosis (2) and granulomatous mastitis (1). A positive diagnosis of malignancy by FNA is reliable in establishing the diagnosis and planning the treatment of breast cancer. The false-positive rate is very low, with only a single case reported in 835 aspirates. Most false negatives are due to sampling and not to interpretive difficulties. The category "suspicious but not diagnostic of malignancy" serves a useful purpose in management of patients with breast lumps.

Predicted occultation of Regulus

NASA Astrophysics Data System (ADS)

Waagen, Elizabeth O.

2014-03-01

The predicted occultation of Regulus (alpha Leo) by the magnitude-12.4 V asteroid (163) Erigone on 2014 March 20 at approximately 02:06 a.m. EDT (06:06 UT) is discussed. The occultation track includes Bermuda and northwest along a corridor stretching from the mid-Atlantic USA through Ontario, Canada. Unusual things about this occultation include the facts that the track includes major metropolitan areas such as New York City, and the star being occulted is one of the brightest in the Northern sky and is in a constellation pattern that makes it easy to find. The International Occultation Timing Association (IOTA) website (http://occultations.org/Regulus2014/) has comprehensive information about this predicted occultation and observing and reporting instructions, as well as links to other resources. In addition to witnessing a very rare event (Regulus is the brightest star ever to be predicted to be occulted from the USA), the possibilities for science include these three:! determining the shape of Erigone, detecting a possible companion of Erigone, and detecting the suspected white dwarf companion of Regulus. See the Alert Notice for details.

Diagnostic Pitfalls in Papillary Lesions of the Breast: Experience from a Single Tertiary Care Center

PubMed Central

Basavaiah, Sridevi Hanaganahalli; Sreeram, Saraswathy; Suresh, Pooja Kundapur; Kini, Hema; Adiga, Deepa; Sahu, Kausalya Kumari; Pai, Radha R

2016-01-01

Introduction Papillary neoplasms are a group of lesions that are characterized by presence of papillae supported by fibrovascular cores lined by epithelial cells with or without myoepithelial cell layer. These neoplasms may be benign, atypical or malignant. Aims This study was conducted to analyse the clinicopathological characteristics of papillary lesions of the breast. Materials and Methods A retrospective and prospective analysis of 34 cases of papillary lesions received over a period of 7 years from 2009 to 2015 was done. The patient’s clinical details were collected from medical archives and the histopathological findings were reviewed. The lesions were classified into benign, atypical and malignant categories. Results During the study period, there were 34 cases of papillary lesions of breast. The mean age was 58 years. The central quadrant was the most common location (66.6%). The most common presenting complaint was lump (76.5% cases). Papillary lesions presented more commonly as solitary lump (82.4%) rather than multifocal disease. Benign papillary lesions were more common than the atypical and malignant lesions. The most common papillary lesion accounting for 43% of the cases was intraductal papilloma. Malignant lesions accounted for 41.2% cases with intraductal papillary carcinoma and invasive papillary carcinoma constituting 14.7% cases each. Conclusion Diagnosis of papillary carcinoma is challenging and its classification includes different entities that have specific diagnostic criteria. Due to their heterozygosity in morphology with benign, atypical and malignant subtypes, morphological features such as type of fibrovascular core and continuity of myoepithelial layer along with immunohistochemical stains for myoepithelial cells should be considered for proper and accurate diagnosis. PMID:27656446

Benign breast lesions at risk of developing cancer--a challenging problem in breast cancer screening programs: five years' experience of the Breast Cancer Screening Program in Verona (1999-2004).

PubMed

Manfrin, Erminia; Mariotto, Renata; Remo, Andrea; Reghellin, Daniela; Falsirollo, Francesca; Dalfior, Daniela; Bricolo, Paola; Piazzola, Elena; Bonetti, Franco

2009-02-01

Cytology and core-needle biopsies are not always sufficient to exclude malignancy in benign breast lesions (BBL) that are at risk of developing cancer, and open biopsy often is mandatory. In screening programs, open biopsies performed for lesions that are at risk of developing malignancy are considered benign. The authors of this report evaluated the impact of the screen-detected BBL at risk of developing cancer that were counted in the quota of benign breast open biopsies in the Breast Cancer Screening Program of Verona. Benign open biopsies were subdivided into 4 groups according to their risk of developing cancer: Histo1, normal histology; Histo2, 'pure' BBL (fibroadenoma, fibrocystic disease, mastitis, adenosis); Histo3, BBL with a low risk of developing cancer (radial scar, papilloma, papillomatosis, phyllodes tumor, mucocele-like lesion); and Histo4, BBL with a high risk of developing cancer (atypical columnar cell hyperplasia, atypical ductal hyperplasia, atypical lobular hyperplasia). Of 510 open biopsies, 83 biopsies were benign, and the ratio of benign to malignant biopsies was 1:5. Histo1 was observed in 4.8% of all benign open biopsies, Histo2 was observed in 37.4%, Histo3 was observed in 31.3%, and Histo4 was observed 26.5%. BBL at risk of developing cancer may be numerous in screening programs. It is inappropriate to include BBL at risk of developing cancer in the overall benign open biopsy rate. The authors propose separating pure BBL from lesions at higher risk of developing cancer. To date, there is no evidence to support the premise that detecting high-risk proliferative lesions leads to benefits in terms of reduced mortality; however, these lesions need to be counted separately for future evaluations. (c) 2008 American Cancer Society.

[Tumor and tumor-like benign mesenchymal lesions of the breast].

PubMed

Bisceglia, M; Nirchio, V; Carosi, I; Cappucci, U; Decata, A; Paragone, T; Di Mattia, A L

1995-02-01

All the spectrum is encompassed of those miscellaneous pathologic entities occurring in the mammary stroma which are on record up to date other than "mixed fibroepithelial" tumors (fibroadenomas and phyllodes tumors) and tumors both "pure" and "mixed" originating from myoepithelium (adenomyoepitheliomas and pleomorphic adenomas). Also they were excluded those dysreactive-autoimmune diseases (sarcoidosis, sclerosing lymphocytic lobulitis, lobular granulomatous mastitis) and those inflammatory-infectious conditions (tuberculosis, actinomycosis, foreign body reactions, Mondor's disease) which can mimick breast tumors clinically or on image analysis, but on the contrary not evoking the idea of a tumor on histology. Specifically, inflammatory pseudotumor, myofibroblastoma, leiomyoma, neurinoma/neurofibroma, benign fibrous histiocytoma, hemangiopericytoma, fibromatosis, nodular fascitis, variants of lipoma, mesenchymoma, amartoma and its variants, hemangiomas, pseudoangiomatous hyperplasia of stroma, amyloid tumor, granular cell tumor, are consecutively described and discussed, with a large list of references enclosed to each rubric. Most of the pictures are taken from personally observed lesions of the breast. Only few pictures referred to are from their analogue lesions which occurred in soft parts of other locations, with specific mention of that when it was the case. Of note after reviewing the literature the fact that no glomus tumor, nor Kaposi's sarcoma either sporadic or in the context of any immunodeficiency, nor myelolipoma has been recorded yet.

Fast MRI-guided vacuum-assisted breast biopsy: initial experience.

PubMed

Liberman, Laura; Morris, Elizabeth A; Dershaw, D David; Thornton, Cynthia M; Van Zee, Kimberly J; Tan, Lee K

2003-11-01

The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision. SUBJECTS AND METHODS. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Vacuum-assisted biopsy and surgical histology were correlated. Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4-6.4 cm). Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24-48 min). Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. One complication occurred: a hematoma that resolved with compression. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI.

TU-CD-207-02: Quantification of Breast Lesion Compositions Using Low-Dose Spectral Mammography: A Feasibility Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cho, H; Ding, H; Sennung, D

2015-06-15

Purpose: To investigate the feasibility of measuring breast lesion composition with spectral mammography using physical phantoms and bovine tissue. Methods: Phantom images were acquired with a spectral mammography system with a silicon-strip based photon-counting detector. Plastic water and adipose-equivalent phantoms were used to calibrate the system for dual-energy material decomposition. The calibration phantom was constructed in range of 2–8 cm thickness and water densities in the range of 0% to 100%. A non-linear rational fitting function was used to calibrate the imaging system. The phantom studies were performed with uniform background phantom and non-uniform background phantom. The breast lesion phantomsmore » (2 cm in diameter and 0.5 cm in thickness) were made with water densities ranging from 0 to 100%. The lesion phantoms were placed in different positions and depths on the phantoms to investigate the accuracy of the measurement under various conditions. The plastic water content of the lesion was measured by subtracting the total decomposed plastic water signal from a surrounding 2.5 mm thick border outside the lesion. In addition, bovine tissue samples composed of 80 % lean were imaged as background for the simulated lesion phantoms. Results: The thickness of measured and known water contents was compared. The rootmean-square (RMS) errors in water thickness measurements were 0.01 cm for the uniform background phantom, 0.04 cm for non-uniform background phantom, and 0.03 cm for 80% lean bovine tissue background. Conclusion: The results indicate that the proposed technique using spectral mammography can be used to accurately characterize breast lesion compositions.« less

Virtopsy -- noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction.

PubMed

Buck, Ursula; Christe, Andreas; Naether, Silvio; Ross, Steffen; Thali, Michael J

2009-05-01

In traffic accidents with pedestrians, cyclists or motorcyclists, patterned impact injuries as well as marks on clothes can be matched to the injury-causing vehicle structure in order to reconstruct the accident and identify the vehicle which has hit the person. Therefore, the differentiation of the primary impact injuries from other injuries is of great importance. Impact injuries can be identified on the external injuries of the skin, the injured subcutaneous and fat tissue, as well as the fractured bones. Another sign of impact is a bone bruise. The bone bruise, or occult bone lesion, means a bleeding in the subcortical bone marrow, which is presumed to be the result of micro-fractures of the medullar trabeculae. The aim of this study was to prove that bleeding in the subcortical bone marrow of the deceased can be detected using the postmortem noninvasive magnetic resonance imaging. This is demonstrated in five accident cases, four involving pedestrians and one a cyclist, where bone bruises were detected in different bones as a sign of impact occurring in the same location as the external and soft tissue impact injuries.

Deep shadow occulter

NASA Technical Reports Server (NTRS)

Cash, Webster (Inventor)

2010-01-01

Methods and apparatus are disclosed for occulting light. The occulter shape suppresses diffraction at any given size or angle and is practical to build because it can be made binary to avoid scatter. Binary structures may be fully opaque or fully transmitting at specific points. The diffraction suppression is spectrally broad so that it may be used with incoherent white light. An occulter may also include substantially opaque inner portion and an at least partially transparent outer portion. Such occulters may be used on the ground to create a deep shadow in a short distance, or may be used in space to suppress starlight and reveal exoplanets.

Combination of two-dimensional shear wave elastography with ultrasound breast imaging reporting and data system in the diagnosis of breast lesions: a new method to increase the diagnostic performance.

PubMed

Li, Dan-Dan; Xu, Hui-Xiong; Guo, Le-Hang; Bo, Xiao-Wan; Li, Xiao-Long; Wu, Rong; Xu, Jun-Mei; Zhang, Yi-Feng; Zhang, Kun

2016-09-01

To evaluate the diagnostic performance of a new method of combined two-dimensional shear wave elastography (i.e. virtual touch imaging quantification, VTIQ) and ultrasound (US) Breast Imaging Reporting and Data System (BI-RADS) in the differential diagnosis of breast lesions. From September 2014 to December 2014, 276 patients with 296 pathologically proven breast lesions were enrolled in this study. The conventional US images were interpreted by two independent readers. The diagnosis performances of BI-RADS and combined BI-RADS and VTIQ were evaluated, including the area under the receiver operating characteristic curve (AUROC), sensitivity and specificity. Observer consistency was also evaluated. Pathologically, 212 breast lesions were benign and 84 were malignant. Compared with BI-RADS alone, the AUROCs and specificities of the combined method for both readers increased significantly (AUROC: 0.862 vs. 0.693 in reader 1, 0.861 vs. 0.730 in reader 2; specificity: 91.5 % vs. 38.7 % in reader 1, 94.8 % vs. 47.2 % in reader 2; all P < .05). The Kappa value between the two readers for BI-RADS assessment was 0.614, and 0.796 for the combined method. The combined VTIQ and BI-RADS had a better diagnostic performance in the diagnosis of breast lesions in comparison with BI-RADS alone. • Combination of conventional ultrasound and elastography distinguishes breast cancers more effectively. • Combination of conventional ultrasound and elastography increases observer consistency. • BI-RADS weights more than the 2D-SWE with an increase in malignancy probability.

Comparison of synthetic mammography, reconstructed from digital breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories.

PubMed

Mariscotti, Giovanna; Durando, Manuela; Houssami, Nehmat; Fasciano, Mirella; Tagliafico, Alberto; Bosco, Davide; Casella, Cristina; Bogetti, Camilla; Bergamasco, Laura; Fonio, Paolo; Gandini, Giovanni

2017-12-01

To compare the interpretive performance of synthetic mammography (SM), reconstructed from digital breast tomosynthesis (DBT), and full-field digital mammography (FFDM) in a diagnostic setting, covering different conditions of breast density and mammographic signs. A retrospective analysis was conducted on 231 patients, who underwent FFDM and DBT (from which SM images were reconstructed) between September 2014-September 2015. The study included 250 suspicious breast lesions, all biopsy proven: 148 (59.2%) malignant and 13 (5.2%) high-risk lesions were confirmed by surgery, 89 (35.6%) benign lesions had radiological follow-up. Two breast radiologists, blinded to histology, independently reviewed all cases. Readings were performed with SM alone, then with FFDM, collecting data on: probability of malignancy for each finding, lesion conspicuity, mammographic features and dimensions of detected lesions. Agreement between readers was good for BI-RADS classification (Cohen's k-coefficient = 0.93 ± 0.02) and for lesion dimension (Wilcoxon's p = 0.76). Visibility scores assigned to SM and FFDM for each lesion were similar for non-dense and dense breasts, however, there were significant differences (p = 0.0009) in distribution of mammographic features subgroups. SM and FFDM had similar sensitivities in non-dense (respectively 94 vs. 91%) and dense breasts (88 vs. 80%) and for all mammographic signs (93 vs. 87% for asymmetric densities, 96 vs. 75% for distortion, 92 vs. 85% for microcalcifications, and both 94% for masses). Based on all data, there was a significant difference in sensitivity for SM (92%) vs. FFDM (87%), p = 0.02, whereas the two modalities yielded similar results for specificity (SM: 60%, FFDM: 62%, p = 0.21). SM alone showed similar interpretive performance to FFDM, confirming its potential role as an alternative to FFDM in women having tomosynthesis, with the added advantage of halving the patient's dose exposure.

Model observer for assessing digital breast tomosynthesis for multi-lesion detection in the presence of anatomical noise

NASA Astrophysics Data System (ADS)

Wen, Gezheng; Markey, Mia K.; Miner Haygood, Tamara; Park, Subok

2018-02-01

Model observers are widely used in task-based assessments of medical image quality. The presence of multiple abnormalities in a single set of images, such as in multifocal multicentric breast cancer (MFMC), has an immense clinical impact on treatment planning and survival outcomes. Detecting multiple breast tumors is challenging as MFMC is relatively uncommon, and human observers do not know the number or locations of tumors a priori. Digital breast tomosynthesis (DBT), in which an x-ray beam sweeps over a limited angular range across the breast, has the potential to improve the detection of multiple tumors. However, prior studies of DBT image quality all focus on unifocal breast cancers. In this study, we extended our 2D multi-lesion (ML) channelized Hotelling observer (CHO) into a 3D ML-CHO that detects multiple lesions from volumetric imaging data. Then we employed the 3D ML-CHO to identify optimal DBT acquisition geometries for detection of MFMC. Digital breast phantoms with multiple embedded synthetic lesions were scanned by simulated DBT scanners of different geometries (wide/narrow angular span, different number of projections per scan) to simulate MFMC cases. With new implementations of 3D partial least squares (PLS) and modified Laguerre-Gauss (LG) channels, the 3D ML-CHO made detection decisions based upon the overall information from individual DBT slices and their correlations. Our evaluation results show that: (1) the 3D ML-CHO could achieve good detection performance with a small number of channels, and 3D PLS channels on average outperform the counterpart LG channels; (2) incorporating locally varying anatomical backgrounds and their correlations as in the 3D ML-CHO is essential for multi-lesion detection; (3) the most effective DBT geometry for detection of MFMC may vary when the task of clinical interest changes, and a given DBT geometry may not yield images that are equally informative for detecting MF, MC, and unifocal cancers.

Time to enhancement derived from ultrafast breast MRI as a novel parameter to discriminate benign from malignant breast lesions.

PubMed

Mus, Roel D; Borelli, Cristina; Bult, Peter; Weiland, Elisabeth; Karssemeijer, Nico; Barentsz, Jelle O; Gubern-Mérida, Albert; Platel, Bram; Mann, Ritse M

2017-04-01

To investigate time to enhancement (TTE) as novel dynamic parameter for lesion classification in breast magnetic resonance imaging (MRI). In this retrospective study, 157 women with 195 enhancing abnormalities (99 malignant and 96 benign) were included. All patients underwent a bi-temporal MRI protocol that included ultrafast time-resolved angiography with stochastic trajectory (TWIST) acquisitions (1.0×0.9×2.5mm, temporal resolution 4.32s), during the inflow of contrast agent. TTE derived from TWIST series and relative enhancement versus time curve type derived from volumetric interpolated breath-hold examination (VIBE) series were assessed and combined with basic morphological information to differentiate benign from malignant lesions. Receiver operating characteristic analysis and kappa statistics were applied. TTE had a significantly better discriminative ability than curve type (p<0.001 and p=0.026 for reader 1 and 2, respectively). Including morphology, sensitivity of TWIST and VIBE assessment was equivalent (p=0.549 and p=0.344, respectively). Specificity and diagnostic accuracy were significantly higher for TWIST than for VIBE assessment (p<0.001). Inter-reader agreement in differentiating malignant from benign lesions was almost perfect for TWIST evaluation (κ=0.86) and substantial for conventional assessment (κ=0.75). TTE derived from ultrafast TWIST acquisitions is a valuable parameter that allows robust differentiation between malignant and benign breast lesions with high accuracy. Copyright © 2017 Elsevier B.V. All rights reserved.

Radiosensitive orbital metastasis as presentation of occult colonic adenocarcinoma.

PubMed

Ludmir, Ethan B; McCall, Shannon J; Czito, Brian G; Palta, Manisha

2014-09-19

An 82-year-old man presented with progressive right frontal headaches. The patient's history was significant for benign polyps on surveillance colonoscopy 2 years prior, without high-grade dysplasia or carcinoma. MRI revealed an enhancing lesion arising within the superomedial aspect of the right orbit. Lesion biopsy demonstrated histological appearance and immunophenotype suggestive of colonic adenocarcinoma. Staging positron emission tomography/CT showed visceral metastases and diffuse activity in the posterior rectosigmoid, consistent with metastatic colon cancer. Treatment of the orbital lesion with external beam radiotherapy to 30 Gy resulted in significant palliation of the patient's headaches. The patient expired 2 months following treatment completion due to disease progression. Orbital metastasis as the initial presentation of an occult colorectal primary lesion is exceedingly rare, and occurred in this patient despite surveillance colonoscopy. Radiotherapy remains an efficacious modality for treatment of orbital metastases. 2014 BMJ Publishing Group Ltd.

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions.

PubMed

Testa, Ilaria; Salvatori, Cristina; Prestipino, Marco; Laurenti, Maria Elena; Gerli, Paolo; Di Cara, Giuseppe; Principi, Nicola; Esposito, Susanna; Bertozzi, Mirko

2018-05-11

Introduction : Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3⁻0.9% of all breast tumours. These tumours typically occur in women aged 30⁻70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation : A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US) revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion : This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be considered to confirm

Color-coded automated signal intensity curves for detection and characterization of breast lesions: preliminary evaluation of a new software package for integrated magnetic resonance-based breast imaging.

PubMed

Pediconi, Federica; Catalano, Carlo; Venditti, Fiammetta; Ercolani, Mauro; Carotenuto, Luigi; Padula, Simona; Moriconi, Enrica; Roselli, Antonella; Giacomelli, Laura; Kirchin, Miles A; Passariello, Roberto

2005-07-01

The objective of this study was to evaluate the value of a color-coded automated signal intensity curve software package for contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected breast cancer. Thirty-six women with suspected breast cancer based on mammographic and sonographic examinations were preoperatively evaluated on CE-MRM. CE-MRM was performed on a 1.5-T magnet using a 2D Flash dynamic T1-weighted sequence. A dosage of 0.1 mmol/kg of Gd-BOPTA was administered at a flow rate of 2 mL/s followed by 10 mL of saline. Images were analyzed with the new software package and separately with a standard display method. Statistical comparison was performed of the confidence for lesion detection and characterization with the 2 methods and of the diagnostic accuracy for characterization compared with histopathologic findings. At pathology, 54 malignant lesions and 14 benign lesions were evaluated. All 68 (100%) lesions were detected with both methods and good correlation with histopathologic specimens was obtained. Confidence for both detection and characterization was significantly (P < or = 0.025) better with the color-coded method, although no difference (P > 0.05) between the methods was noted in terms of the sensitivity, specificity, and overall accuracy for lesion characterization. Excellent agreement between the 2 methods was noted for both the determination of lesion size (kappa = 0.77) and determination of SI/T curves (kappa = 0.85). The novel color-coded signal intensity curve software allows lesions to be visualized as false color maps that correspond to conventional signal intensity time curves. Detection and characterization of breast lesions with this method is quick and easily interpretable.

Diagnostic efficacy of contrast-enhanced sonography by combined qualitative and quantitative analysis in breast lesions: a comparative study with magnetic resonance imaging.

PubMed

Wang, Lin; Du, Jing; Li, Feng-Hua; Fang, Hua; Hua, Jia; Wan, Cai-Feng

2013-10-01

The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced sonography for differentiation of breast lesions by combined qualitative and quantitative analyses in comparison to magnetic resonance imaging (MRI). Fifty-six patients with American College of Radiology Breast Imaging Reporting and Data System category 3 to 5 breast lesions on conventional sonography were evaluated by contrast-enhanced sonography and MRI. A comparative analysis of diagnostic results between contrast-enhanced sonography and MRI was conducted in light of the pathologic findings. Pathologic analysis showed 26 benign and 30 malignant lesions. The predominant enhancement patterns of the benign lesions on contrast-enhanced sonography were homogeneous, centrifugal, and isoenhancement or hypoenhancement, whereas the patterns of the malignant lesions were mainly heterogeneous, centripetal, and hyperenhancement. The detection rates for perfusion defects and peripheral radial vessels in the malignant group were much higher than those in the benign group (P < .05). As to quantitative analysis, statistically significant differences were found in peak and time-to-peak values between the groups (P < .05). With pathologic findings as the reference standard, the sensitivity, specificity, and accuracy of contrast-enhanced sonography and MRI were 90.0%, 92.3%, 91.1% and 96.7%, 88.5%, and 92.9%, respectively. The two methods had a concordant rate of 87.5% (49 of 56), and the concordance test gave a value of κ = 0.75, indicating that there was high concordance in breast lesion assessment between the two diagnostic modalities. Contrast-enhanced sonography provided typical enhancement patterns and valuable quantitative parameters, which showed good agreement with MRI in diagnostic efficacy and may potentially improve characterization of breast lesions.

Inter- and Intra-Observer Agreement in Ultrasound BI-RADS Classification and Real-Time Elastography Tsukuba Score Assessment of Breast Lesions.

PubMed

Schwab, Fabienne; Redling, Katharina; Siebert, Matthias; Schötzau, Andy; Schoenenberger, Cora-Ann; Zanetti-Dällenbach, Rosanna

2016-11-01

Our aim was to prospectively evaluate inter- and intra-observer agreement between Breast Imaging Reporting and Data System (BI-RADS) classifications and Tsukuba elasticity scores (TSs) of breast lesions. The study included 164 breast lesions (63 malignant, 101 benign). The BI-RADS classification and TS of each breast lesion was assessed by the examiner and twice by three reviewers at an interval of 2 months. Weighted κ values for inter-observer agreement ranged from moderate to substantial for BI-RADS classification (κ = 0.585-0.738) and was substantial for TS (κ = 0.608-0.779). Intra-observer agreement was almost perfect for ultrasound (US) BI-RADS (κ = 0.847-0.872) and TS (κ = 0.879-0.914). Overall, individual reviewers are highly self-consistent (almost perfect intra-observer agreement) with respect to BI-RADS classification and TS, whereas inter-observer agreement was moderate to substantial. Comprehensive training is essential for achieving high agreement and minimizing the impact of subjectivity. Our results indicate that breast US and real-time elastography can achieve high diagnostic performance. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Computer-aided detection of breast lesions in DCE-MRI using region growing based on fuzzy C-means clustering and vesselness filter

NASA Astrophysics Data System (ADS)

B. Shokouhi, Shahriar; Fooladivanda, Aida; Ahmadinejad, Nasrin

2017-12-01

A computer-aided detection (CAD) system is introduced in this paper for detection of breast lesions in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The proposed CAD system firstly compensates motion artifacts and segments the breast region. Then, the potential lesion voxels are detected and used as the initial seed points for the seeded region-growing algorithm. A new and robust region-growing algorithm incorporating with Fuzzy C-means (FCM) clustering and vesselness filter is proposed to segment any potential lesion regions. Subsequently, the false positive detections are reduced by applying a discrimination step. This is based on 3D morphological characteristics of the potential lesion regions and kinetic features which are fed to the support vector machine (SVM) classifier. The performance of the proposed CAD system is evaluated using the free-response operating characteristic (FROC) curve. We introduce our collected dataset that includes 76 DCE-MRI studies, 63 malignant and 107 benign lesions. The prepared dataset has been used to verify the accuracy of the proposed CAD system. At 5.29 false positives per case, the CAD system accurately detects 94% of the breast lesions.

Importance of confirming HER2 overexpression of recurrence lesion in breast cancer patients.

PubMed

Nakamura, Rikiya; Yamamoto, Naohito; Onai, Yasuhide; Watanabe, Yoshihiro; Kawana, Hidetada; Miyazaki, Masaru

2013-10-01

The systemic management of metastatic breast cancer (MBC) is usually based on ER or HER2 status of the primary tumor. However, the hormonal status or the overexpression of human epidermal growth factor 2 (HER2) may change in every metastatic site because of the effects of the long-term treatment of metastatic cancer with endocrine therapy, chemotherapy, or biological agents. The purpose of this study was to investigate the frequency of change in HER2 expression in primary and distant metastatic tumors in breast cancer patients. Another objective of the study was to examine the effect of the clinical therapy on the basis of HER2 expression in a metastatic tumor. In our hospital between 1991 to December 2010, retrospectively, 156 patients had biopsy or surgical resection of their metastatic site. All sample were analyzed pathologically to confirm metastatic disease and, second, to evaluate HER2 status by immunohistochemistry or by FISH. The recurrence lesions were resected from the breast or lymph node (n = 67, local lesion), brain (n = 27), lung (n = 16), liver (n = 20), bone (n = 16), and from the stomach, intestine, ovary, and uterus (n = 10). Loss, increase, or no change in HER2 overexpression was observed in 3, 5, and 92%, respectively. Positive changes of HER2 in metastatic sites were 3 (4%) local lesion, 3 (11%) brain, 1 (7%) lung, 0 (0%) liver, 2 (17%) bone, and 0 (0%) others. In 3 of these 8 patients, trastuzumab was administered. In 2 of 3 patients, trastuzumab achieved long stable disease. The negative conversion rate of HER2 expression in metastatic lesions was 37% in patients treated with trastuzumab and 6% in those not treated with trastuzumab, a significant difference between the two groups (P < 0.05). The results of this study emphasize the significance of confirming HER2 expression in a recurrence lesion. For patients with positive conversion of HER2 status, more treatment options may be available. On the other hand, the rate of loss of

Digital Subtraction Angiography (DSA) Techniques For The Evaluation Of Breast Lesions

NASA Astrophysics Data System (ADS)

Flynn, Michael J.; Ackerman, Laurens; Wilderman, Scott; Block, Roger; Watt, Christine; Burke, Matt; Shetty, P. C.

1984-08-01

Digital subtraction angiography of the breast may permit the differentiation of benign and malignant breast lesions. We have developed specific techniques for performing DSAB. The patient is examined in an oblique prone position with the involved breast in an immobilization device of our own design. The immobilization device adapts to our angiographic patient table and provides a water bolus with slight compression. The central ray of the x-ray beam is positioned for a lateral view of the breast, similar to the lateral view obtained in a mammogram. Iodinated contrast is injected from a catheter position in the superior vena cava. A kilovoltage of 50 kVp is employed which produces a near optimal signal to noise ratio for iodine contrast. The iodine signal to noise ratio characteristics of breast DSA have been modeled using a computer program which estimates the x-ray spectrum, filtration effects(tube, tissue, iodine, and grid), and image intensifier energy absorption. The energy absorbed in the input phosphor of the image intensifier is determined using a Monte Carlo radiation transport technique. Images are acquired in a 512 x 512 x 10 matrix with a 9" image intensifier using a geometric magnification of approximately 2. Typically, 10 mAs per exposure is required. A maximum of 40 exposures are made in three phases totalling 5 minutes. The average absorbed dose to the breast for a single exposure is 48 millirads (6 cm thickness) as determined by a Monte Carlo radiation transport computation of energy absorbed in breast tissue.

Management of occult adrenocorticotropin-secreting bronchial carcinoids: limits of endocrine testing and imaging techniques.

PubMed

Loli, P; Vignati, F; Grossrubatscher, E; Dalino, P; Possa, M; Zurleni, F; Lomuscio, G; Rossetti, O; Ravini, M; Vanzulli, A; Bacchetta, C; Galli, C; Valente, D

2003-03-01

The differential diagnosis and the identification of the source of ACTH in occult ectopic Cushing's syndrome due to a bronchial carcinoid still represents a challenge for the endocrinologist. We report our experience in six patients with occult bronchial carcinoid in whom extensive hormonal, imaging, and scintigraphic evaluation was performed. All patients presented with hypercortisolism associated with high plasma ACTH values. The CRH test and high dose dexamethasone suppression test suggested an ectopic source of ACTH in three of six patients. During bilateral inferior petrosal sinus sampling, none of the patients showed a central to peripheral ACTH gradient. At the time of diagnosis, none of the patients had radiological evidence of the ectopic source of ACTH, whereas pentetreotide scintigraphy identified the lesion in two of four patients. Finally, a chest computed tomography scan revealed the presence of a bronchial lesion in all patients, and pentetreotide scintigraphy identified four of six lesions. In all patients a bronchial carcinoid was found and removed. In one patient with scintigraphic evidence of residual disease after two operations, radioguided surgery, using a hand-held gamma probe after iv administration of radiolabeled pentetreotide, was performed; this allowed detection and removal of residual multiple mediastinal lymph node metastases. In conclusion, our data show that there is not a single endocrine test or imaging procedure accurate enough to diagnose and localize occult ectopic ACTH-secreting bronchial carcinoids. Radioguided surgery appears to be promising in the presence of multiple tumor foci and previous incomplete removal of the tumor.

A finite element model of remote palpation of breast lesions using radiation force: factors affecting tissue displacement.

PubMed

Nightingale, K R; Nightingale, R W; Palmeri, M L; Trahey, G E

2000-01-01

The early detection of breast cancer reduces patient mortality. The most common method of breast cancer detection is palpation. However, lesions that lie deep within the breast are difficult to palpate when they are small. Thus, a method of remote palpation, which may allow the detection of small lesions lying deep within the breast, is currently under investigation. In this method, acoustic radiation force is used to apply localized forces within tissue (to tissue volumes on the order of 2 mm3) and the resulting tissue displacements are mapped using ultrasonic correlation based methods. A volume of tissue that is stiffer than the surrounding medium (i.e., a lesion) distributes the force throughout the tissue beneath it, resulting in larger regions of displacement, and smaller maximum displacements. The resulting displacement maps may be used to image tissue stiffness. A finite-element-model (FEM) of acoustic remote palpation is presented in this paper. Using this model, a parametric analysis of the affect of varying tissue and acoustic beam characteristics on radiation force induced tissue displacements is performed. The results are used to evaluate the potential of acoustic remote palpation to provide useful diagnostic information in a clinical setting. The potential for using a single diagnostic transducer to both generate radiation force and track the resulting displacements is investigated.

Facial paralysis due to an occult parotid abscess.

PubMed

Orhan, Kadir Serkan; Demirel, Tayfun; Kocasoy-Orhan, Elif; Yenigül, Kubilay

2008-01-01

Facial paralysis associated with benign diseases of the parotid gland is very rare. It has been reported in approximately 16 cases of acute suppurative parotitis or parotid abscess. We presented a 45-year-old woman who developed facial paralysis secondary to an occult parotid abscess. Initially, there was no facial paralysis and the signs and symptoms were suggestive of acute parotitis, for which medical treatment was initiated. Three days later, left-sided facial palsy of HB (House-Brackmann) grade 5 developed. Ultrasonography revealed a pretragal, hypoechoic mass, 10x8 mm in size, causing inflammation in the surrounding tissue. Fine needle aspiration biopsy obtained from the mass revealed polymorphonuclear leukocytes and lymphocytes. No malignant cells were observed. The lesion was diagnosed as an occult parotid abscess. After a week, the mass disappeared and facial paralysis improved to HB grade 4. At the end of the first month, facial paralysis improved to HB grade 1. At three months, facial nerve function was nearly normal.

A contrast enhancement method for improving the segmentation of breast lesions on ultrasonography.

PubMed

Flores, Wilfrido Gómez; Pereira, Wagner Coelho de Albuquerque

2017-01-01

This paper presents an adaptive contrast enhancement method based on sigmoidal mapping function (SACE) used for improving the computerized segmentation of breast lesions on ultrasound. First, from the original ultrasound image an intensity variation map is obtained, which is used to generate local sigmoidal mapping functions related to distinct contextual regions. Then, a bilinear interpolation scheme is used to transform every original pixel to a new gray level value. Also, four contrast enhancement techniques widely used in breast ultrasound enhancement are implemented: histogram equalization (HEQ), contrast limited adaptive histogram equalization (CLAHE), fuzzy enhancement (FEN), and sigmoid based enhancement (SEN). In addition, these contrast enhancement techniques are considered in a computerized lesion segmentation scheme based on watershed transformation. The performance comparison among techniques is assessed in terms of both the quality of contrast enhancement and the segmentation accuracy. The former is quantified by the measure, where the greater the value, the better the contrast enhancement, whereas the latter is calculated by the Jaccard index, which should tend towards unity to indicate adequate segmentation. The experiments consider a data set with 500 breast ultrasound images. The results show that SACE outperforms its counterparts, where the median values for the measure are: SACE: 139.4, SEN: 68.2, HEQ: 64.1, CLAHE: 62.8, and FEN: 7.9. Considering the segmentation performance results, the SACE method presents the largest accuracy, where the median values for the Jaccard index are: SACE: 0.81, FEN: 0.80, CLAHE: 0.79, HEQ: 77, and SEN: 0.63. The SACE method performs well due to the combination of three elements: (1) the intensity variation map reduces intensity variations that could distort the real response of the mapping function, (2) the sigmoidal mapping function enhances the gray level range where the transition between lesion and background

Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy.

PubMed

Park, Ah Young; Son, Eun Ju; Kim, Jeong-Ah; Han, Kyunghwa; Youk, Ji Hyun

2015-12-01

To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (P<0.001). On multivariate analysis, the mean (Odds ratio [OR]=1.021, P=0.001), maximum (OR=1.015, P=0.008), and minimum (OR=1.028, P=0.001) elasticity values were independently associated with histologic underestimation. The patients' age, lesion size, and final assessment category on US of the upgrade group were higher than those of the non-upgrade group (P=0.046 for age; P=0.021 for lesion size; P=0.030 for US category), but these were not independent predictors of histologic underestimation on multivariate analysis. Breast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy.

PubMed

Li, Jie; Dershaw, D David; Lee, Carol H; Kaplan, Jennifer; Morris, Elizabeth A

2009-09-01

Follow-up MRI can be useful to confirm a benign diagnosis after MRI-guided breast biopsy. This retrospective study was undertaken to evaluate appropriate timing and imaging interpretation for the initial follow-up MRI when a benign, concordant histology is obtained using MRI-guided breast biopsy. Retrospective review was performed of 177 lesions visualized only by MRI in 172 women who underwent 9-gauge, vacuum-assisted core biopsy and marker placement with imaging-concordant benign histology. All underwent follow-up MRI within 12 months. Timing of the follow-up study, change in size, results of second biopsy if performed, and distance of localizing marker to the lesion on the follow-up study were recorded. At initial follow-up, 155 lesions were decreased or gone, 14 lesions were stable, and eight were enlarged. Seventeen (9.6%, 17/177) lesions underwent a second biopsy, including six enlarging, 10 stable, and one decreasing. Of these, four were malignant. Enlargement was seen in two carcinomas at 6 and 12 months. Two carcinomas, one stable at 2 months and another stable at 3 and 11 months, were rebiopsied because of suspicion of a missed lesion in the former and worrisome mammographic and sonographic changes in the latter. The distance of the marker from the lesion on follow-up did not correlate with biopsy accuracy. Follow-up MRI did not detect missed cancers because of lesion enlargement before 6 months after biopsy; two of four missed cancers were stable. The localizing marker can deploy away from the target despite successful sampling.

Comparison between fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in the diagnosis of breast lesions.

PubMed

Moschetta, M; Telegrafo, M; Carluccio, D A; Jablonska, J P; Rella, L; Serio, Gabriella; Carrozzo, M; Stabile Ianora, A A; Angelelli, G

2014-01-01

To compare the diagnostic accuracy of fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in patients with USdetected breast lesions. Between September 2011 and May 2013, 3469 consecutive breast US examinations were performed. 400 breast nodules were detected in 398 patients. 210 FNACs and 190 CNBs were performed. 183 out of 400 (46%) lesions were surgically removed within 30 days form diagnosis; in the remaining cases, a six month follow up US examination was performed. Sensitivity, specificity, diagnostic accuracy, positive predictive (PPV) and negative predictive (NPV) values were calculated for FNAC and CNB. 174 out of 400 (43%) malignant lesions were found while the remaining 226 resulted to be benign lesions. 166 out of 210 (79%) FNACs and 154 out of 190 (81%) CNBs provided diagnostic specimens. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 94%, 95%, 91% and 98% were found for FNAC, and values of 92%, 82%, 89%, 92% and 82% were obtained for CNB. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 97%, 96%, 96%, 97% and 96% were found for FNAC, and values of 97%, 96%, 96%, 97% and 96% were obtained for CNB. FNAC and CNB provide similar values of diagnostic accuracy.

Imaging features of carcinoid tumors metastatic to the breast.

PubMed

Glazebrook, Katrina N; Jones, Katie N; Dilaveri, Christina A; Perry, Kyle; Reynolds, Carol

2011-06-29

The objective of this study was to describe the imaging findings of carcinoid tumors metastatic to the breast, with pathologic and clinical correlations. We searched our surgical database for cases of pathologically proven carcinoid tumors metastatic to the breast from October 1, 2000, to May 31, 2010. Of the approximate 10,000 breast biopsies identified, 7000 had malignant findings. Ten cases of metastatic carcinoid (0.1% of all malignancies), all with imaging studies available for review, were included in the study. All patients were women and had their primary carcinoid in the gastrointestinal tract (n=9) or lung (n = 1). One patient presented with a palpable breast mass and no history of carcinoid tumor; an ileal carcinoid was discovered after the pathologic diagnosis of metastatic carcinoid was established. In the breast, tumors presented as solitary lesions in half the cases. Metastases to the breast typically presented as circumscribed masses mammographically and as hypoechoic circumscribed masses ultrasonographically; some showed increased through-transmission and increased vascularity with color Doppler evaluation. Five patients had octreotide scans; of these, 4 had increased focal activity in the region of metastasis within the breast. Six patients underwent computed tomography. Without contrast, nodular masses were observed; with contrast, the masses showed rapid enhancement during arterial phase imaging. Magnetic resonance imaging (n = 4) also showed rapid enhancement and washout kinetics after contrast administration. Recognition of carcinoid metastases to the breast in patients with known or occult primary carcinoid tumors is important to avoid unnecessary treatment for primary breast cancer.

Computerized detection of breast lesions in multi-centre and multi-instrument DCE-MR data using 3D principal component maps and template matching

NASA Astrophysics Data System (ADS)

Ertas, Gokhan; Doran, Simon; Leach, Martin O.

2011-12-01

In this study, we introduce a novel, robust and accurate computerized algorithm based on volumetric principal component maps and template matching that facilitates lesion detection on dynamic contrast-enhanced MR. The study dataset comprises 24 204 contrast-enhanced breast MR images corresponding to 4034 axial slices from 47 women in the UK multi-centre study of MRI screening for breast cancer and categorized as high risk. The scans analysed here were performed on six different models of scanner from three commercial vendors, sited in 13 clinics around the UK. 1952 slices from this dataset, containing 15 benign and 13 malignant lesions, were used for training. The remaining 2082 slices, with 14 benign and 12 malignant lesions, were used for test purposes. To prevent false positives being detected from other tissues and regions of the body, breast volumes are segmented from pre-contrast images using a fast semi-automated algorithm. Principal component analysis is applied to the centred intensity vectors formed from the dynamic contrast-enhanced T1-weighted images of the segmented breasts, followed by automatic thresholding to eliminate fatty tissues and slowly enhancing normal parenchyma and a convolution and filtering process to minimize artefacts from moderately enhanced normal parenchyma and blood vessels. Finally, suspicious lesions are identified through a volumetric sixfold neighbourhood connectivity search and calculation of two morphological features: volume and volumetric eccentricity, to exclude highly enhanced blood vessels, nipples and normal parenchyma and to localize lesions. This provides satisfactory lesion localization. For a detection sensitivity of 100%, the overall false-positive detection rate of the system is 1.02/lesion, 1.17/case and 0.08/slice, comparing favourably with previous studies. This approach may facilitate detection of lesions in multi-centre and multi-instrument dynamic contrast-enhanced breast MR data.

Uranus occults SAO158687. [stellar occultation and planetary parametric observation

NASA Technical Reports Server (NTRS)

Elliot, J. L.; Veverka, J.; Millis, R. L.

1977-01-01

Experience gained in obtaining atmospheric parameters, oblatenesses, and diameters of Jupiter and Mars from recent stellar occultations by these planets is used to predict what can be learned from the March 1977 occultation of the star SAO158687 by Uranus. The spectra of this star and Uranus are compared to indicate the relative instrument intensities of the two objects, the four passbands where the relative intensities are most nearly equal are listed, and expected photon fluxes from the star are computed on the assumption that it has UBVRI colors appropriate for a K5 main-sequence object. It is shown that low photon noise errors can be achieved by choosing appropriate passbands for observation, and the rms error expected for the Uranus temperature profiles obtained from the occultation light curves is calculated. It is suggested that observers of this occultation should record their data digitally for optimum time resolution.

The Occult Today: Why?

ERIC Educational Resources Information Center

Kessler, Gary E.

1975-01-01

Author offered some reflections on the "why" of the contemporary interest in the occult. He attempted to convince the reader that, if he or she has been surprised by the recent rise of occultism, sober reflection will dispell some fears and, perhaps, even convince him or her that occultism is not merely superstition. (Author/RK)

ULTRA-WIDE-FIELD FUNDUS AUTOFLUORESCENCE FINDINGS IN PATIENTS WITH ACUTE ZONAL OCCULT OUTER RETINOPATHY.

PubMed

Shifera, Amde Selassie; Pennesi, Mark E; Yang, Paul; Lin, Phoebe

2017-06-01

To determine whether ultra-wide-field fundus autofluorescence (UWFFAF) findings in acute zonal occult outer retinopathy correlated well with perimetry, optical coherence tomography, and electroretinography findings. Retrospective observational study on 16 eyes of 10 subjects with AZOOR seen at a single referral center from October 2012 to March 2015 who had UWFFAF performed. Chi-square analysis was performed to compare categorical variables, and Mann-Whitney U test used for comparisons of nonparametric continuous variables. All eyes examined within 3 months of symptom onset (five of the five eyes) had diffusely hyperautofluorescent areas on UWFFAF. The remaining eyes contained hypoautofluorescent lesions with hyperautofluorescent borders. In 11/16 (68.8%) eyes, UWFFAF showed the full extent of lesions that would not have been possible with standard fundus autofluorescence centered on the fovea. There were 3 patterns of spread: centrifugal spread (7/16, 43.8%), centripetal spread (5/16, 31.3%), and centrifugal + centripetal spread (4/16, 25.0%). The UWFFAF lesions corresponded well with perimetric, optical coherence tomography, and electroretinography abnormalities. The UWFFAF along with optical coherence tomography can be useful in the evaluation and monitoring of acute zonal occult outer retinopathy patients.

[Practical problems in breast screening. Columnar cell lesions including flat epithelial atypia and lobular neoplasia].

PubMed

Nährig, J

2008-11-01

Columnar cell lesions (CCL) and lobular neoplasia (LN) are encountered with increasing frequency in breast screening biopsies. CCLs are frequently associated with microcalcifications, whereas LN is an incidental finding in most cases. Flat epithelia atypia (FEA) the atypical variant of CLL, LN and atypical ductal hyperplasia (ADH) are frequently associated lesions. Molecular genetic studies of CCL, ductal carcinoma in situ (DCIS) and low grade invasive carcinomas revealed similar chromosomal alterations supporting the assumption that CCLs are neoplastic proliferations. The frequent association of FEA together with well differentiated invasive carcinomas provides further evidence of this concept. There is no internationally accepted classification of CCLs at present. CDH1-gene mutations are the cardinal feature of LN and invasive lobular carcinoma. In immunohistochemically CDH1-positive cases, alternative genetic alterations of the CDH1 pathway can lead to functional loss of CDH1. In our opinion morphologically and immunohistochemically hybrid lesions may represent this group of lobular lesions. Recent follow-up data suggest a higher rate of ipsilateral carcinomas in patients with previously diagnosed LN. It is currently an open question whether FEA and LN are members of a common family of intralobular proliferations, which are non-obligatory precursors of a low nuclear grade breast neoplasia family.

Manufacture and characterization of breast tissue phantoms for emulating benign lesions

NASA Astrophysics Data System (ADS)

Villamarín, J. A.; Rojas, M. A.; Potosi, O. M.; Narváez-Semanate, J. L.; Gaviria, C.

2017-11-01

Phantoms elaboration has turned a very important field of study during the last decades due to its applications in medicine. These objects are capable of emulating or mimicking acoustically biological tissues in which parameters like speed of sound (SOS) and attenuation are successfully attained. However, these materials are expensive depending on their characteristics (USD 460.00 - 6000.00) and is difficult to have precise measurements because of their composition. This paper presents the elaboration and characterization of low cost ( USD $25.00) breast phantoms which emulate histological normality and pathological conditions in order to support algorithm calibration procedures in imaging diagnosis. Quantitative ultrasound (QUS) was applied to estimate SOS and attenuation values for breast tissue (background) and benign lesions (fibroadenoma and cysts). Results showed values of the SOS and attenuation for the background between 1410 - 1450 m/s and 0.40 - 0.55 dB/cm at 1 MHz sampling frequency, respectively. On the other hand, the SOS obtained for the lesions ranges from 1350 to 1700 m/s and attenuation values between 0.50 - 1.80 dB/cm at 1 MHz. Finally, the fabricated phantoms allowed for obtaining ultrasonograms comparable with real ones whose acoustic parameters are in agree with those reported in the literature.

Studies in occultation astronomy

NASA Technical Reports Server (NTRS)

Veverka, J.

1980-01-01

Major scientific results are summarized for the following studies: (1) observations of the 8 April 1976 occultation of epsilon Geminorum by Mars; (2) studies in occultation techniques; and (3) the March 1974 occultation of Saturn by the Moon. A re-analysis of the 1974 lunar occultation of the Titan indicates that Titan is strongly limb darkened, with D approximately greater than 5800km; there is internal evidence in the data that Titan's atmosphere is inhomogeneous; and that observations are inconsistent with any sample homogeneous model atmosphere which matches the P (lambda) and Beta (lambda) observations of Titan.

A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology.

PubMed

Dauphine, Christine; Reicher, Joshua J; Reicher, Murray A; Gondusky, Christina; Khalkhali, Iraj; Kim, Michelle

2015-06-01

The purpose of this study was to evaluate the safety and performance of localizing nonpalpable breast lesions using radiofrequency identification technology. Twenty consecutive women requiring preoperative localization of a breast lesion were recruited. Subjects underwent placement of both a hook wire and a radiofrequency identification tag immediately before surgery. The radiofrequency identification tag was the primary method used by the operating surgeon to localize each lesion during excision, with the hook wire serving as backup in case of tag migration or failed localization. Successful localization with removal of the intended lesion was the primary outcome measured. Tag migration and postoperative infection were also noted to assess safety. Twenty patients underwent placement of a radiofrequency identification tag, 12 under ultrasound guidance and eight with stereotactic guidance. In all cases, the radiofrequency identification tag was successfully localized by the reader at the level of the skin before incision, and the intended lesion was removed along with the radiofrequency identification tag. There were no localization failures and no postoperative infections. Tag migration did not occur before incision, but in three cases, occurred as the lesion was being retracted with fingers to make the final cut along the deep surface of the specimen. In this initial clinical study, radiofrequency tags were safe and able to successfully localize nonpalpable breast lesions. Radiofrequency identification technology may represent an alternative method to hook wire localization.

Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology.

PubMed

Dessauvagie, Benjamin F; Lee, Andrew H S; Meehan, Katie; Nijhawan, Anju; Tan, Puay Hoon; Thomas, Jeremy; Tie, Bibiana; Treanor, Darren; Umar, Seemeen; Hanby, Andrew M; Millican-Slater, Rebecca

2018-02-13

Fibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses. Scanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved. Interobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a 'weak' mean kappa agreement between pathologists (k=0.36). 'Moderate' agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs. Accurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

1H-MRS evaluation of breast lesions by using total choline signal-to-noise ratio as an indicator of malignancy: a meta-analysis.

PubMed

Wang, Xin; Wang, Xiang Jiang; Song, Hui Sheng; Chen, Long Hua

2015-05-01

The aim of this study was to evaluate the diagnostic performance of the use of total choline signal-to-noise ratio (tCho SNR) criteria in MRS studies for benign/malignant discrimination of focal breast lesions. We conducted (1) a meta-analysis based on 10 studies including 480 malignant breast lesions and 312 benign breast lesions and (2) a subgroup meta-analysis of tCho SNR ≥ 2 as cutoff for malignancy based on 7 studies including 371 malignant breast lesions and 239 benign breast lesions. (1) The pooled sensitivity and specificity of proton MRS with tCho SNR were 0.74 (95 % CI 0.69-0.77) and 0.76 (95 % CI 0.71-0.81), respectively. The PLR and NLR were 3.67 (95 % CI 2.30-5.83) and 0.25 (95 % CI 0.14-0.42), respectively. From the fitted SROC, the AUC and Q* index were 0.89 and 0.82. Publication bias was present (t = 2.46, P = 0.039). (2) Meta-regression analysis suggested that neither threshold effect nor evaluated covariates including strength of field, pulse sequence, TR and TE were sources of heterogeneity (all P value >0.05). (3) Subgroup meta-analysis: The pooled sensitivity and specificity were 0.79 and 0.72, respectively. The PLR and NLR were 3.49 and 0.20, respectively. The AUC and Q* index were 0.92 and 0.85. The use of tCho SNR criteria in MRS studies was helpful for differentiation between malignant and benign breast lesions. However, pooled diagnostic measures might be overestimated due to publication bias. A tCho SNR ≥ 2 as cutoff for malignancy resulted in higher diagnostic accuracy.

Abbreviated Combined MR Protocol: A New Faster Strategy for Characterizing Breast Lesions.

PubMed

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2016-06-01

The use of an abbreviated magnetic resonance (MR) protocol has been recently proposed for cancer screening. The aim of our study is to evaluate the diagnostic accuracy of an abbreviated MR protocol combining short TI inversion recovery (STIR), turbo-spin-echo (TSE)-T2 sequences, a pre-contrast T1, and a single intermediate (3 minutes after contrast injection) post-contrast T1 sequence for characterizing breast lesions. A total of 470 patients underwent breast MR examination for screening, problem solving, or preoperative staging. Two experienced radiologists evaluated both standard and abbreviated protocols in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both protocols were calculated (with the histological findings and 6-month ultrasound follow-up as the reference standard) and compared with the McNemar test. The post-processing and interpretation times for the MR images were compared with the paired t test. In 177 of 470 (38%) patients, the MR sequences detected 185 breast lesions. Standard and abbreviated protocols obtained sensitivity, specificity, diagnostic accuracy, PPV, and NPV values respectively of 92%, 92%, 92%, 68%, and 98% and of 89%, 91%, 91%, 64%, and 98% with no statistically significant difference (P < .0001). The mean post-processing and interpretation time were, respectively, 7 ± 1 minutes and 6 ± 3.2 minutes for the standard protocol and 1 ± 1.2 minutes and 2 ± 1.2 minutes for the abbreviated protocol, with a statistically significant difference (P < .01). An abbreviated combined MR protocol represents a time-saving tool for radiologists and patients with the same diagnostic potential as the standard protocol in patients undergoing breast MRI for screening, problem solving, or preoperative staging. Copyright © 2016 Elsevier Inc. All rights reserved.

Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits.

PubMed

Houben, I P L; Van de Voorde, P; Jeukens, C R L P N; Wildberger, J E; Kooreman, L F; Smidt, M L; Lobbes, M B I

2017-09-01

Contrast-enhanced spectral mammography (CESM) is a reliable problem solving tool in the work-up of women recalled from breast cancer screening. We evaluated additional findings caused by CESM alone and outweighed them against the disadvantages of this technique. From December 2012 to December 2015, all women recalled from screening who underwent CESM were considered for this study. Radiation exposure and number of adverse contrast reactions were analysed. An experienced breast radiologist reviewed all exams and identified cases with lesions detected by CESM alone and scored their conspicuity. From these cases, data on breast density and final diagnosis were collected. For malignant cases, tumour grade and receptor characteristics were also collected. During this study, 839 women underwent CESM after a screening recall, in which five minor adverse contrast reactions were observed. Median radiation dose per exam was 6.0mGy (0.9-23.4mGy). Seventy CESM-only lesions were detected in 65 patients. Of these 70 lesions, 54.3% proved to be malignant, most commonly invasive ductal carcinomas. The remaining CESM-only lesions were benign, predominantly fibroadenomas. No complications were observed during biopsy of these lesions. Retrospectively, the majority of the lesions were either occult or a 'minimal sign' on low-energy CESM images or the screening mammogram. Using CESM as a work-up tool for women recalled from screening carries low risk for the patient, while additionally detected tumour foci might hold important clinical implications which need to be further studied in large, randomized controlled trials. Copyright © 2017 Elsevier B.V. All rights reserved.

Occultation studies of the Solar System

NASA Technical Reports Server (NTRS)

Millis, Robert L.

1987-01-01

The planetary occultation program began at Lowell Observatory in 1973 with a worldwide campaign to observe mutual occultations and eclipses of the Galilean Satellites. Then the temperature profile of the Martian atmosphere was measured from data taken during the occultation of epsilon Geminorum, the Rings of Uranus were discovered as they occulted SAO 158687, and the dimensions of Pallas were measured when that minor planet occulted SAO 85009. In 1979 the present grant was initiated, providing funds for portable photometric instrumentation used to observe occultations by asteroids as well as by Uranus and Neptune. Software for predicting occultations of catalog stars by asteroids, planets, and comets was written in 1983. Lowell currently provides most of the available predictions for asteroid occultations. Realizing in 1983 that the lack of a high-quality astrometric telescope dedicated to occultation work was limiting progress, an 18-inch, F/8 lens was acquired and adapted to an existing mounting at Lowell. Although acquisition of the lens and implementation of the new telescope has been accomplished primarily with non-grant funds, the instrument makes a major contribution to occultation research.

New Occultation Systems and the 2005 July 11 Charon Occultation

NASA Astrophysics Data System (ADS)

Young, L. A.; French, R. G.; Gregory, B.; Olkin, C. B.; Ruhland, C.; Shoemaker, K.; Young, E. F.

2005-08-01

Charon's density is an important input to models of its formation and internal structure. Estimates range from 1.59 to 1.83 g/cm3 (Olkin et al. 2003. Icarus 164, 254), with Charon's radius as the main source of uncertainty. Reported values of Charon's radius from mutual events range from 593±13 (Buie et al. 1992, Icarus 97, 211) to 621±21 km (Young & Binzel 1994, Icarus 108), while an occultation observed from a single site gives a lower limit on the radius of 601.5 km (Walker 1980 MNRAS 192, 47; Elliot & Young 1991, Icarus 89, 244). On 2005 July 11 UT (following this abstract submission date), Charon is predicted to occult the star C313.2. If successful, this event will be the first Charon occultation observed since 1980, and the first giving multiple chords across Charon's disk. This event is expected to measure Charon's radius to 1 km. Our team is observing from three telescopes in Chile, the 4.0-m Blanco and the 0.9-m telescopes at Cerro Tololo and the 4.2-m SOAR telescope at Cerro Pachon. At SOAR, we will be using the camera from our new PHOT systems (Portable High-speed Occultation Telescopes). The PHOT camera is a Princeton Instrument MicroMAX:512BFT from Roper Scientific, a 512×512 frame-transfer CCD with a readnoise of only 3 electrons at the 100 kHz digitization rate. The camera's exposures are triggered by a custom built, compact, stand-alone GPS-based pulse-train generator. A PHOT camera and pulse-train generator were used to observe the occultation of 2MASS 1275723153 by Pluto on 2005 June 15 UT from Sommers-Bausch Observatory in Boulder Colorado; preliminary analysis shows this was at best a grazing occultation from this site and a successful engineering run for the July 11 Charon occultation. The work was supported, in part, by NSF AST-0321338 (EFY) and NASA NNG-05GF05G (LAY).

On a fractional order calculus model in diffusion weighted breast imaging to differentiate between malignant and benign breast lesions detected on X-ray screening mammography

PubMed Central

Steudle, Franziska; Paech, Daniel; Mlynarska, Anna; Kuder, Tristan Anselm; Lederer, Wolfgang; Daniel, Heidi; Freitag, Martin; Delorme, Stefan; Schlemmer, Heinz-Peter; Laun, Frederik Bernd

2017-01-01

Objective To evaluate a fractional order calculus (FROC) model in diffusion weighted imaging to differentiate between malignant and benign breast lesions in breast cancer screening work-up using recently introduced parameters (βFROC, DFROC and μFROC). Materials and methods This retrospective analysis within a prospective IRB-approved study included 51 participants (mean 58.4 years) after written informed consent. All patients had suspicious screening mammograms and indication for biopsy. Prior to biopsy, full diagnostic contrast-enhanced MRI examination was acquired including diffusion-weighted-imaging (DWI, b = 0,100,750,1500 s/mm2). Conventional apparent diffusion coefficient Dapp and FROC parameters (βFROC, DFROC and μFROC) as suggested further indicators of diffusivity components were measured in benign and malignant lesions. Receiver operating characteristics (ROC) were calculated to evaluate the diagnostic performance of the parameters. Results 29/51 patients histopathologically revealed malignant lesions. The analysis revealed an AUC for Dapp of 0.89 (95% CI 0.80–0.98). For FROC derived parameters, AUC was 0.75 (0.60–0.89) for DFROC, 0.59 (0.43–0.75) for βFROC and 0.59 (0.42–0.77) for μFROC. Comparison of the AUC curves revealed a significantly higher AUC of Dapp compared to the FROC parameters DFROC (p = 0.009), βFROC (p = 0.003) and μFROC (p = 0.001). Conclusion In contrast to recent description in brain tumors, the apparent diffusion coefficient Dapp showed a significantly higher AUC than the recently proposed FROC parameters βFROC, DFROC and μFROC for differentiating between malignant and benign breast lesions. This might be related to the intrinsic high heterogeneity within breast tissue or to the lower maximal b-value used in our study. PMID:28453516

Fusion of digital breast tomosynthesis images via wavelet synthesis for improved lesion conspicuity

NASA Astrophysics Data System (ADS)

Hariharan, Harishwaran; Pomponiu, Victor; Zheng, Bin; Whiting, Bruce; Gur, David

2014-03-01

Full-field digital mammography (FFDM) is the most common screening procedure for detecting early breast cancer. However, due to complications such as overlapping breast tissue in projection images, the efficacy of FFDM reading is reduced. Recent studies have shown that digital breast tomosynthesis (DBT), in combination with FFDM, increases detection sensitivity considerably while decreasing false-positive, recall rates. There is a huge interest in creating diagnostically accurate 2-D interpretations from the DBT slices. Most of the 2-D syntheses rely on visualizing the maximum intensities (brightness) from each slice through different methods. We propose a wavelet based fusion method, where we focus on preserving holistic information from larger structures such as masses while adding high frequency information that is relevant and helpful for diagnosis. This method enables the spatial generation of a 2D image from a series of DBT images, each of which contains both smooth and coarse structures distributed in the wavelet domain. We believe that the wavelet-synthesized images, generated from their DBT image datasets, provide radiologists with improved lesion and micro-calcification conspicuity as compared with FFDM images. The potential impact of this fusion method is (1) Conception of a device-independent, data-driven modality that increases the conspicuity of lesions, thereby facilitating early detection and potentially reducing recall rates; (2) Reduction of the accompanying radiation dose to the patient.

Breast metastasis from cutaneous malignant melanoma mimicking a breast cancer.

PubMed

Maniglio, Marina; Capalbo, Emanuela; Viganò, Sara; Trecate, Giovanna; Scaperrotta, Gianfranco Paride; Panizza, Pietro

2015-06-25

Breast metastases are very uncommon, either from solid tumors or malignant melanoma. We present the case of a 42-year-old woman with a history of cutaneous melanoma of the shoulder excised 21 years ago. She presented with a palpable lump in the upper outer quadrant of the right breast. Ultrasound demonstrated a solid mass within a cystic lesion. A core biopsy was taken and first histology reported a poorly differentiated primary breast cancer suspected to be triple negative. MRI detected a satellite lesion in the same breast, a focus of suspected enhancement in the other breast, and the extramammary finding of an enhancing pulmonary lesion. Staging computed tomography detected widespread metastases to the lungs, brain, subcutaneous left shoulder, liver, pancreas, and hepatorenal recess. A core biopsy was taken from the left breast lesion and the previous slides were reviewed; histopathology and immunohistochemistry were in keeping with metastasis from melanoma. The possibility of a metastatic lesion to the breast should be taken into account in any patient presenting with a breast lump and a previous history of melanoma. Breast involvement cannot be considered an isolated finding, as it might be the first manifestation of widespread disease.

Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41.

PubMed

Hooley, Regina J; Greenberg, Kathryn L; Stackhouse, Rebecca M; Geisel, Jaime L; Butler, Reni S; Philpotts, Liane E

2012-10-01

To determine performance and utilization of screening breast ultrasonography (US) in women with dense breast tissue who underwent additional screening breast US in the 1st year since implementation of Connecticut Public Act 09-41 requiring radiologists to inform patients with heterogeneous or extremely dense breasts at mammography that they may benefit from such examination. Informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective review of 935 women with dense breasts at mammography who subsequently underwent handheld screening and whole-breast US from October 1, 2009, through September 30, 2010. Of 935 women, 614 (65.7%) were at low risk, 149 (15.9%) were at intermediate risk, and 87 (9.3%) were at high risk for breast cancer. Of the screening breast US examinations, in 701 (75.0%), results were classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 or 2; in 187 (20.0%), results were classified as BI-RADS category 3; and in 47 (5.0%), results were classified as BI-RADS category 4. Of 63 aspirations or biopsies recommended and performed in 53 patients, in nine, lesions were BI-RADS category 3, and in 54, lesions were BI-RADS category 4. Among 63 biopsies and aspirations, three lesions were malignant (all BI-RADS category 4, diagnosed with biopsy). All three cancers were smaller than 1 cm, were found in postmenopausal patients, and were solid masses. One cancer was found in each risk group. In 44 of 935 (4.7%) patients, examination results were false-positive. Overall positive predictive value (PPV) for biopsy or aspirations performed in patients with BI-RADS category 4 masses was 6.5% (three of 46; 95% confidence interval [CI]: 1.7%, 19%). Overall cancer detection rate was 3.2 cancers per 1000 women screened (three of 935; 95% CI: 0.8 cancers per 1000 women screened, 10 cancers per 1000 women screened). Technologist-performed handheld screening breast US offered to women in the general population

The Pinhole/Occulter Facility

NASA Technical Reports Server (NTRS)

Tandberg-Hanssen, E. A. (Editor); Hudson, H. S. (Editor); Dabbs, J. R. (Editor); Baity, W. A. (Editor)

1983-01-01

Scientific objectives and requirements are discussed for solar X-ray observations, coronagraph observations, studies of coronal particle acceleration, and cosmic X-ray observations. Improved sensitivity and resolution can be provided for these studies using the pinhole/occulter facility which consists of a self-deployed boom of 50 m length separating an occulter plane from a detector plane. The X-ray detectors and coronagraphic optics mounted on the detector plane are analogous to the focal plane instrumentation of an ordinary telescope except that they use the occulter only for providing a shadow pattern. The occulter plane is passive and has no electrical interface with the rest of the facility.

Measurement of stellar occultations

NASA Astrophysics Data System (ADS)

Eberle, Andreas

2008-09-01

Whenever an asteroid occults a star, we have the opportunity to study that asteroid in great detail. As frequently shown in the past, amateur astronomers1 have the necessary equipment to measure such events successfully2. Combined with the dense net of amateur observatories and online coordination tools3 for movable stations, they can create fine grids to detect even small bodies. The analysis of these events gives us the possibility to receive high precision astrometry data, to determine the asteroids size and shape (and therefore its albedo), and even to collect information on the star itself.4 While usually a set of several light curves is required to do so, a single recording5 of (10734) Wieck's occultation of HIP 22157 on 2008 Feb 08 was sufficient to retrieve the necessary data6. 1 Observation campaigns are organized by the International Occultation Timing Association (IOTA), http://www.iota-es.de/ 2 for results see e.g. euraster.net by E. Frappa, http://www.euraster.net/ 3 Occult Watcher by H. Pavlov, http://www.hristopavlov.net/OccultWatcher/OccultWatcher.html 4 see K. Miyashita's analysis of the observation of the occultation of TYC 1886-01206-1 by Kalliope and Linus, http://www005.upp.so-net.ne.jp/k miyash/occ02/kalliope/doublestar en.html 5 recording obtained by H. Michels, MPC Station Code 240 6 using Limovie by K. Miyashita

Comparison of conventional DCE-MRI and a novel golden-angle radial multicoil compressed sensing method for the evaluation of breast lesion conspicuity.

PubMed

Heacock, Laura; Gao, Yiming; Heller, Samantha L; Melsaether, Amy N; Babb, James S; Block, Tobias K; Otazo, Ricardo; Kim, Sungheon G; Moy, Linda

2017-06-01

To compare a novel multicoil compressed sensing technique with flexible temporal resolution, golden-angle radial sparse parallel (GRASP), to conventional fat-suppressed spoiled three-dimensional (3D) gradient-echo (volumetric interpolated breath-hold examination, VIBE) MRI in evaluating the conspicuity of benign and malignant breast lesions. Between March and August 2015, 121 women (24-84 years; mean, 49.7 years) with 180 biopsy-proven benign and malignant lesions were imaged consecutively at 3.0 Tesla in a dynamic contrast-enhanced (DCE) MRI exam using sagittal T1-weighted fat-suppressed 3D VIBE in this Health Insurance Portability and Accountability Act-compliant, retrospective study. Subjects underwent MRI-guided breast biopsy (mean, 13 days [1-95 days]) using GRASP DCE-MRI, a fat-suppressed radial "stack-of-stars" 3D FLASH sequence with golden-angle ordering. Three readers independently evaluated breast lesions on both sequences. Statistical analysis included mixed models with generalized estimating equations, kappa-weighted coefficients and Fisher's exact test. All lesions demonstrated good conspicuity on VIBE and GRASP sequences (4.28 ± 0.81 versus 3.65 ± 1.22), with no significant difference in lesion detection (P = 0.248). VIBE had slightly higher lesion conspicuity than GRASP for all lesions, with VIBE 12.6% (0.63/5.0) more conspicuous (P < 0.001). Masses and nonmass enhancement (NME) were more conspicuous on VIBE (P < 0.001), with a larger difference for NME (14.2% versus 9.4% more conspicuous). Malignant lesions were more conspicuous than benign lesions (P < 0.001) on both sequences. GRASP DCE-MRI, a multicoil compressed sensing technique with high spatial resolution and flexible temporal resolution, has near-comparable performance to conventional VIBE imaging for breast lesion evaluation. 3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;45:1746-1752. © 2016 International Society for Magnetic Resonance in Medicine.

Quantitative differentiation of breast lesions at 3T diffusion-weighted imaging (DWI) using the ratio of distributed diffusion coefficient (DDC).

PubMed

Ertas, Gokhan; Onaygil, Can; Akin, Yasin; Kaya, Handan; Aribal, Erkin

2016-12-01

To investigate the accuracy of diffusion coefficients and diffusion coefficient ratios of breast lesions and of glandular breast tissue from mono- and stretched-exponential models for quantitative diagnosis in diffusion-weighted magnetic resonance imaging (MRI). We analyzed pathologically confirmed 170 lesions (85 benign and 85 malignant) imaged using a 3.0T MR scanner. Small regions of interest (ROIs) focusing on the highest signal intensity for lesions and also for glandular tissue of contralateral breast were obtained. Apparent diffusion coefficient (ADC) and distributed diffusion coefficient (DDC) were estimated by performing nonlinear fittings using mono- and stretched-exponential models, respectively. Coefficient ratios were calculated by dividing the lesion coefficient by the glandular tissue coefficient. A stretched exponential model provides significantly better fits then the monoexponential model (P < 0.001): 65% of the better fits for glandular tissue and 71% of the better fits for lesion. High correlation was found in diffusion coefficients (0.99-0.81 and coefficient ratios (0.94) between the models. The highest diagnostic accuracy was found by the DDC ratio (area under the curve [AUC] = 0.93) when compared with lesion DDC, ADC ratio, and lesion ADC (AUC = 0.91, 0.90, 0.90) but with no statistically significant difference (P > 0.05). At optimal thresholds, the DDC ratio achieves 93% sensitivity, 80% specificity, and 87% overall diagnostic accuracy, while ADC ratio leads to 89% sensitivity, 78% specificity, and 83% overall diagnostic accuracy. The stretched exponential model fits better with signal intensity measurements from both lesion and glandular tissue ROIs. Although the DDC ratio estimated by using the model shows a higher diagnostic accuracy than the ADC ratio, lesion DDC, and ADC, it is not statistically significant. J. Magn. Reson. Imaging 2016;44:1633-1641. © 2016 International Society for Magnetic Resonance in Medicine.

Spherical Occulter Coronagraph Cubesat

NASA Technical Reports Server (NTRS)

Davila, Joseph M. (Inventor); Rabin, Douglas M. (Inventor); Reginald, Nelson (Inventor); Gong, Qian (Inventor); Shah, Neerav (Inventor); Chamberlin, Phillip C. (Inventor)

2018-01-01

The present invention relates to a space-based instrument which provides continuous coronal electron temperature and velocity images, for a predetermined period of time, thereby improving the understanding of coronal evolution and how the solar wind and Coronal Mass Ejection transients evolve from the low solar atmosphere through the heliosphere for an entire solar rotation. Specifically, the present invention relates to using a 6U spherical occulter coronagraph CubeSat, and a relative navigational system (RNS) that controls the position of the spacecraft relative to the occulting sphere. The present invention innovatively deploys a free-flying spherical occulter, and after deployment, the actively controlled CubeSat will provide an inertial formation flying with the spherical occulter and Sun.

[One day diagnosis for breast lesions: Medical and psychological assessment--EVADIASEIN study].

PubMed

Berman, A; Teig, B; Duracinsky, M; Gayet, M; Bellin, M-F; Guettier, C; Fernandez, H; Nazac, A

2016-01-01

Breast cancer is the most frequent feminine cancer in France and its incidence increases steadily. The time of access to medical care is an indicator of the quality of the treatments recommended by the Plan Cancer 2009-2013, as it influences the diagnosis and reduces psychological morbidity during the pre-diagnosis phase. The one-day diagnosis is a recently initiated concept, which offers to get the results of the biopsy on the day it is performed and facilitates the setting-up of therapeutic care with the surgeon met during the one-day medical consultations. The aim of this study is to evaluate the satisfaction of patients who benefited from a one-day breast lesion diagnosis, as well as confirm the decrease of time of access to medical treatment. This is an observational, non-interventional and single-centre study based on 27 patients who benefited from one-day breast lesions diagnosis over two years. The patients were only included who had a classified lesion ACR 4 or 5 and visible in the ultrasound. We analyzed the histological concordance between the biopsy and the definitive histology, the time of access to medical care, and the therapeutic treatments We analyzed the psychological impact of such an organization by sending to the patients a questionnaire including the Psychological Consequence Questionnaire (PCQ) and the Breast Cancer Anxiety Indicator (BCA) allowing to estimate the anxiety generated by the pre-diagnostic phase, the DC-Sat allowing to estimate the satisfaction of the consultation of announcement, as well as the same day diagnosis benefit. The patients were 59.8 years old in average [33-87]. The average time between the date of the mammography and the one-day diagnosis consultation (including the biopsy) was 15.0 days [0-60]. Fifty-seven percent of the patients considered this time as short. The average time between the biopsy date and the start of the treatment was 15.9 days [4-30]. The one-day diagnosis took an average of 1.6 days [1-5]. The

Evaluation of clinical breast examination and breast ultrasonography among pregnant women in Abakaliki, Nigeria

PubMed Central

Ezeonu, Paul Olisaemeka; Ajah, Leonard Ogbonna; Onoh, Robinson Chukwudi; Lawani, Lucky Osaheni; Enemuo, Vincent Chidi; Agwu, Uzoma MaryRose

2015-01-01

Background Breast cancer in pregnancy accounts for 2%–3% of all breast cancers. The increased vascularity and lymphatic drainage from the breast during pregnancy potentiate the metastatic spread of the cancer to the regional lymph nodes. However, the increased breast density in pregnancy makes it difficult to detect breast lesions early. Aim To evaluate and compare the detection rate of breast lesions using clinical breast examination (CBE) and breast ultrasonography among pregnant women. Methodology A cross-sectional comparative study involving antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, was conducted between March 3, 2014, and December 31, 2014. CBE and breast ultrasonography were done in the participants at booking and repeated at 6 weeks postpartum. Fine-needle aspiration cytology and histology were done in women with suspicious breast lesions on CBE or breast ultrasonography or both. Data analysis was both descriptive and inferential at the 95% confidence level using the Statistical Package for the Social Sciences (SPSS) software version 17.0. Test of significance was done using chi-square test. A P-value of less than or equal to 0.05 was considered statistically significant. Results A total of 320 pregnant women participated in the study. Of these, 267 (83.4%) were aware of breast cancer. Although more lesions were detected with breast ultrasonography than by CBE, there was no statistically significant difference between them (25 versus 17; P=0.26). The histology of the lesions revealed 21 benign lesions and 4 normal breast tissues. The sensitivity of breast ultrasonography was 95.2%, while that of CBE was 66.7%. The specificity, positive predictive value, and negative predictive value were similar between CBE and breast ultrasonography. Conclusion The detection rates of breast lesions by both CBE and breast ultrasonography were equivalent during pregnancy and 6 weeks postpartum, making CBE a convenient and very cost

Evaluation of shear wave elastography for differential diagnosis of breast lesions: A new qualitative analysis versus conventional quantitative analysis.

PubMed

Ren, Wei-Wei; Li, Xiao-Long; Wang, Dan; Liu, Bo-Ji; Zhao, Chong-Ke; Xu, Hui-Xiong

2018-04-13

To evaluate a special kind of ultrasound (US) shear wave elastography for differential diagnosis of breast lesions, using a new qualitative analysis (i.e. the elasticity score in the travel time map) compared with conventional quantitative analysis. From June 2014 to July 2015, 266 pathologically proven breast lesions were enrolled in this study. The maximum, mean, median, minimum, and standard deviation of shear wave speed (SWS) values (m/s) were assessed. The elasticity score, a new qualitative feature, was evaluated in the travel time map. The area under the receiver operating characteristic (AUROC) curves were plotted to evaluate the diagnostic performance of both qualitative and quantitative analyses for differentiation of breast lesions. Among all quantitative parameters, SWS-max showed the highest AUROC (0.805; 95% CI: 0.752, 0.851) compared with SWS-mean (0.786; 95% CI:0.732, 0.834; P = 0.094), SWS-median (0.775; 95% CI:0.720, 0.824; P = 0.046), SWS-min (0.675; 95% CI:0.615, 0.731; P = 0.000), and SWS-SD (0.768; 95% CI:0.712, 0.817; P = 0.074). The AUROC of qualitative analysis in this study obtained the best diagnostic performance (0.871; 95% CI: 0.825, 0.909, compared with the best parameter of SWS-max in quantitative analysis, P = 0.011). The new qualitative analysis of shear wave travel time showed the superior diagnostic performance in the differentiation of breast lesions in comparison with conventional quantitative analysis.

Retrospective analysis of the utility of multiparametric MRI for differentiating between benign and malignant breast lesions in women in China.

PubMed

Fan, Wei Xiong; Chen, Xiao Feng; Cheng, Feng Yan; Cheng, Ya Bao; Xu, Tai; Zhu, Wen Biao; Zhu, Xiao Lei; Li, Gui Jin; Li, Shuai

2018-01-01

We explored the utility of time-resolved angiography with interleaved stochastic trajectories dynamic contrast-enhanced magnetic resonance imaging (TWIST DCE-MRI), readout segmentation of long variable echo-trains diffusion-weighted magnetic resonance imaging- diffusion-weighted magnetic resonance imaging (RESOLVE-DWI), and echo-planar imaging- diffusion-weighted magnetic resonance imaging (EPI-DWI) for distinguishing between malignant and benign breast lesions.This retrospective analysis included female patients with breast lesions seen at a single center in China between January 2016 and April 2016. Patients were allocated to a benign or malignant group based on pathologic diagnosis. All patients received routine MRI, RESOLVE-DWI, EPI-DWI, and TWIST DCE-T1WI. Variables measured included quantitative parameters (K, Kep, and Ve), semiquantitative parameters (rate of contrast enhancement for contrast agent inflow [W-in], rate of contrast decay for contrast agent outflow [W-out], and time-to-peak enhancement after contrast agent injection [TTP]) and apparent diffusion coefficient (ADC) values for RESOLVE-DWI (ADCr) and EPI-DWI (ADCe). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the diagnostic utility of each parameter for differentiating malignant from benign breast lesions.A total of 87 patients were included (benign, n = 20; malignant, n = 67). Compared with the benign group, the malignant group had significantly higher K, Kep and W-in and significantly lower W-out, TTP, ADCe, and ADCr (all P < .05); Ve was not significantly different between groups. RESOLVE-DWI was superior to conventional EPI-DWI at illustrating lesion boundary and morphology, while ADCr was significantly lower than ADCe in all patients. Kep, W-out, ADCr, and ADCe showed the highest diagnostic efficiency (based on AUC value) for differentiating between benign and malignant lesions. Combining 3 parameters (Kep, W-out, and ADCr) had a higher diagnostic

Diagnostic power of diffuse reflectance spectroscopy for targeted detection of breast lesions with microcalcifications

PubMed Central

Soares, Jaqueline S.; Barman, Ishan; Dingari, Narahara Chari; Volynskaya, Zoya; Liu, Wendy; Klein, Nina; Plecha, Donna; Dasari, Ramachandra R.; Fitzmaurice, Maryann

2013-01-01

Microcalcifications geographically target the location of abnormalities within the breast and are of critical importance in breast cancer diagnosis. However, despite stereotactic guidance, core needle biopsy fails to retrieve microcalcifications in up to 15% of patients. Here, we introduce an approach based on diffuse reflectance spectroscopy for detection of microcalcifications that focuses on variations in optical absorption stemming from the calcified clusters and the associated cross-linking molecules. In this study, diffuse reflectance spectra are acquired ex vivo from 203 sites in fresh biopsy tissue cores from 23 patients undergoing stereotactic breast needle biopsies. By correlating the spectra with the corresponding radiographic and histologic assessment, we have developed a support vector machine-derived decision algorithm, which shows high diagnostic power (positive predictive value and negative predictive value of 97% and 88%, respectively) for diagnosis of lesions with microcalcifications. We further show that these results are robust and not due to any spurious correlations. We attribute our findings to the presence of proteins (such as elastin), and desmosine and isodesmosine cross-linkers in the microcalcifications. It is important to note that the performance of the diffuse reflectance decision algorithm is comparable to one derived from the corresponding Raman spectra, and the considerably higher intensity of the reflectance signal enables the detection of the targeted lesions in a fraction of the spectral acquisition time. Our findings create a unique landscape for spectroscopic validation of breast core needle biopsy for detection of microcalcifications that can substantially improve the likelihood of an adequate, diagnostic biopsy in the first attempt. PMID:23267090

Microglandular adenosis of the breast: a deceptive and still misterious benign lesion.

PubMed

Foschini, Maria P; Eusebi, Vincenzo

2018-06-24

Microglandular adenosis of the breast (MA), a benign glandular proliferation, was originally described about 35years ago. The lesion, is constituted by small glands all of the same size. Glands are lined by one layer of cuboidal epithelial cells encircled by basal lamina without any evidence of interposed myoepithelial elements. Cells are positive for low weight keratins and S-100 protein and negative for ER, PR and HER 2. Since then, in the years, several malignant lesions all showing microglandular architecture have been regarded either as a precursor or an equivalent manifestation of MA. The latter has been associated to a large number of malignancies that include DCIS, LCIS, ademyoepithelioma, high grade basal like carcinoma, adenoid cystic carcinoma, matrix producing carcinoma, invasive duct carcinoma NOS, spindle cell carcinoma, not to mention acinic cell carcinoma. None of the above tumors were identical to MA. Differences mainly rested not only on the specific structure of the small glands but also on the cytological composition and immunohistochemical features of different lesions. Here a review of the features of MA together with the differential diagnosis with lesions showing microglandular structure is discussed. MA shows similarities with a lesion named microglandular hamartoma/adenosis (MH) of the nasal cavity. The relation of the two similar lesions is discussed. Copyright © 2018. Published by Elsevier Inc.

Effect of gadolinium injection on diffusion-weighted imaging with background body signal suppression (DWIBS) imaging of breast lesions.

PubMed

Moschetta, Marco; Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

2014-12-01

Diffusion-weighted imaging with background body signal suppression (DWIBS) provides both qualitative and quantitative imaging of breast lesions and are usually performed before contrast material injection (CMI). This study aims to assess whether the administration of gadolinium significantly affects DWIBS imaging. 200 patients were prospectively evaluated by MRI with STIR, TSE-T2, pre-CMI DWIBS, contrast enhanced THRIVE-T1 and post-CMI DWIBS sequences. Pre and post-CMI DWIBS were analyzed searching for the presence of breast lesions and calculating the ADC value. ADC values of ≤1.44×10(-3) mm(2)/s were considered suspicious for malignancy. This analysis was then compared with the histological findings. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated for both sequences and represented by ROC analysis. Pre and post-CMI ADC values were compared by using the paired t test. In 150/200 (59%) patients, pre and post-CMI DWIBS indicated the presence of breast lesions, 53 (35%) with ADC values of >1.44×10(-3) mm(2)/s and 97 (65%) with ADC≤1.44×10(-3) mm(2)/s. Pre-CMI and post-DWIBS sequences obtained the same sensitivity, specificity, DA, PPV and NPV values of 97%, 83%, 89%, 79% and 98%. The mean ADC value of benign lesions was 1.831±0.18×10(-3) mm(2)/s before and 1.828±0.18×10(-3) mm(2)/s after CMI. The mean ADC value of the malignant lesions was 1.146±0.16×10(-3) mm(2)/s before and 1.144±0.16×10(-3) mm(2)/s after CMI. No significant difference was found between pre and post CMI ADC values (p>0.05). DWIBS imaging is not influenced by CMI. Breast MR protocol could be modified by placing DWIBS after dynamic contrast enhanced sequences in order to maximize patient cooperation. Copyright © 2014 Elsevier Inc. All rights reserved.

[Clinical assessment of occult infections in children].

PubMed

Sporisević, L; Bajraktarević, A; Begić, Z

2000-01-01

Children's occult infections are characterised presenting pathogenic bacteries in blood of children in age 3 to 36 months, but they are good general aspect and orderly immunologic status and they don't have signs of focal infection. Manifestation of occult infections determined: age of child, increasing bodies temperature, testsphysical observance and clinical-biochemistry tests. Prevalence of manifestation occult infections is 3-8%, but they manifest ni a form occult bacteremia, occult pneumonia nad occult urinary infection. Methodic, systematic admission and adequate clinical-biochemical monitoring, we minimise sequeles of occult infections. Risk of serious sequeles at occult infections is importantly decreasing by epidemiological changes that it rises by using vaccination against Haemophilus influenzae and Streptococcus pneumoniae is leading ethiological source. Many contraversal opinions are presented in glance of therapeutic strategy at children's occult infection. Future of solutions at many hesitations ni context diagnosis and therapy of occult infections is established in using recent detectional tests /pneumococcus PCR, plasmas tumor reaction, interleukin lâ/ and preventive intervetions activities /conjugated pneumococcus vaccination/.

Characterization of spatiotemporal changes for the classification of dynamic contrast-enhanced magnetic-resonance breast lesions.

PubMed

Milenković, Jana; Hertl, Kristijana; Košir, Andrej; Zibert, Janez; Tasič, Jurij Franc

2013-06-01

The early detection of breast cancer is one of the most important predictors in determining the prognosis for women with malignant tumours. Dynamic contrast-enhanced magnetic-resonance imaging (DCE-MRI) is an important imaging modality for detecting and interpreting the different breast lesions from a time sequence of images and has proved to be a very sensitive modality for breast-cancer diagnosis. However, DCE-MRI exhibits only a moderate specificity, thus leading to a high rate of false positives, resulting in unnecessary biopsies that are stressful and physically painful for the patient and lead to an increase in the cost of treatment. There is a strong medical need for a DCE-MRI computer-aided diagnosis tool that would offer a reliable support to the physician's decision providing a high level of sensitivity and specificity. In our study we investigated the possibility of increasing differentiation between the malignant and the benign lesions with respect to the spatial variation of the temporal enhancements of three parametric maps, i.e., the initial enhancement (IE) map, the post-initial enhancement (PIE) map and the signal enhancement ratio (SER) map, by introducing additional methods along with the grey-level co-occurrence matrix, i.e., a second-order statistical method already applied for quantifying the spatiotemporal variations. We introduced the grey-level run-length matrix and the grey-level difference matrix, representing two additional, second-order statistical methods, and the circular Gabor as a frequency-domain-based method. Each of the additional methods is for the first time applied to the DCE-MRI data to differentiate between the malignant and the benign breast lesions. We applied the least-square minimum-distance classifier (LSMD), logistic regression and least-squares support vector machine (LS-SVM) classifiers on a total of 115 (78 malignant and 37 benign) breast DCE-MRI cases. The performances were evaluated using ten experiments of a ten

21 CFR 864.6550 - Occult blood test.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Occult blood test. 864.6550 Section 864.6550 Food... DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6550 Occult blood test. (a) Identification. An occult blood test is a device used to detect occult blood in urine or feces. (Occult blood is...

21 CFR 864.6550 - Occult blood test.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Occult blood test. 864.6550 Section 864.6550 Food... DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6550 Occult blood test. (a) Identification. An occult blood test is a device used to detect occult blood in urine or feces. (Occult blood is...

21 CFR 864.6550 - Occult blood test.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Occult blood test. 864.6550 Section 864.6550 Food... DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6550 Occult blood test. (a) Identification. An occult blood test is a device used to detect occult blood in urine or feces. (Occult blood is...

21 CFR 864.6550 - Occult blood test.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Occult blood test. 864.6550 Section 864.6550 Food... DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6550 Occult blood test. (a) Identification. An occult blood test is a device used to detect occult blood in urine or feces. (Occult blood is...

21 CFR 864.6550 - Occult blood test.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Occult blood test. 864.6550 Section 864.6550 Food... DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6550 Occult blood test. (a) Identification. An occult blood test is a device used to detect occult blood in urine or feces. (Occult blood is...

Dwarfism, occult spinal dysraphism, and presacral myxopapillary ependymoma with an epidermoid cyst in a child.

PubMed

Tubbs, R S; Kelly, D R; Mroczek-Musulman, E C; Braune, K; Reddy, A; Georgeson, K; Grabb, P A; Oakes, W J

2005-03-01

The authors present a case of a child with dwarfism that was noted to be developmentally delayed. Imaging revealed atlantoaxial instability, occult spinal dysraphism, and a presacral mass. Histopathology of the presacral lesion was that of a myxopapillary ependymoma with epidermoid cyst. We believe this to be the first report in the extant medical literature of this constellation of findings in the same patient. However, there are rare reports indicating a possible association of occult spinal dysraphism and the simultaneous occurrence of spinal ependymomas. Further case reports are necessary to discern whether these pathological entities are true low rate associations that the clinician should consider in their evaluation of these patients.

Diagnostic challenges in clinical, radiological and histopathological tests regarding papillomatous lesions of the breast.

PubMed

Rasmussen, Birgitte Bruun; Balslev, Eva; Jarle Christensen, Ib; Lanng, Charlotte; Bak, Anne; Galatius, Hanne; Møller Talman, Maj-Lis; Sharghi Someh, Nahid; Vejborg, Ilse; Okholm, Mette

2018-05-22

Papillomas of the female breast is a relatively frequent lesion, and the majority are benign when excised. However, some may host malignant or premalignant areas. Consequently, it is a worldwide accepted principle to excise the lesion whenever diagnosed. However, this leads to a large number of patients having an unnecessary operation. The present study was designed to investigate whether we could find clinical, radiological and pathological factors in the preoperative, diagnostic setting that could identify patients hosting a benign papilloma in order to avoid operation. The patient material consisted of 260 patients, all with a preoperative diagnosis of a papillomatous process in core biopsy. The lesion was excised, and 71% had a benign lesion. The rest had lesions ranging from premalignant to malignant. In the clinical, radiological and histopathological investigations conducted, we were not able to identify factors that statistically significant could predict whether the lesion was benign or malignant. However, our data showed a higher prevalence of malignant and premalignant lesions for older patient, larger lesions, and lesions found at a longer distance from the papilla. We conclude that, since almost 30% of the patients in our study ended up with a premalignant or malignant diagnosis, where no statistically significant preoperative factors could indicate a benign outcome, operation is warranted in all patients with a preoperative diagnosis of a papillomatous lesion. Copyright © 2018 Elsevier Ltd. All rights reserved.

The diagnostic value of diffusion-weighted imaging and the apparent diffusion coefficient values in the differentiation of benign and malignant breast lesions.

PubMed

Çabuk, Gonca; Nass Duce, Meltem; Özgür, Anıl; Apaydın, Feramuz Demir; Polat, Ayşe; Orekici, Gülhan

2015-04-01

The goal of our study was to evaluate the diagnostic efficacy of diffusion-weighted imaging (DWI) in the differentiation of benign and malignant breast lesions. Between June 2012 and March 2013, 60 patients with 63 lesions (age range 29-70 years, mean age 48.6 years) were included in our study. All lesions, except complicated cysts and intra-mammary lymph nodes, were confirmed histopathologically. The patients were evaluated with a 1.5 Tesla MR scanner using dedicated bilateral breast coil. DWI images were obtained by echo planar imaging sequence and 'b' values were selected as 200, 600 and 1000 s/mm(2). Apparent diffusion coefficient (ADC) values of both breast lesions and the normal fibroglandular tissue of the contralateral breast were calculated and statistically compared using Shapiro-Wilk test, Student's t-test, Mann-Whitney U test, chi-square test and the receiver operating curve. Of 63 lesions, 22 were malignant and 41 were benign. In malignant lesions, the mean ADC values were 1.40 ± 0.41 × 10(-3) mm(2)/s for b = 200, 1.05 ± 0.28 × 10(-3) mm(2)/s for b = 600 and 0.91 ± 0.20 × 10(-3) mm(2)/s for b = 1000 and in benign lesions, the mean ADC values were 2.13 ± 0.85 × 10(-3) mm(2)/s for b = 200, 1.64 ± 0.47 × 10(-3) mm(2)/s for b = 600 and 1.40 ± 0.43 × 10(-3) mm(2)/s for b = 1000. The success of ADC values in differentiation of benign and malignant lesions was statistically significant (P = 0.0001). The threshold values were determined to be 1.50 × 10(-3) mm(2)/s for b = 200, 1.22 × 10(-3) mm(2)/s for b = 600 and 0.98 × 10(-3) mm(2)/s for b = 1000 (P < 0.05). DWI can be an effective radiological method in the differentiation of benign and malignant breast lesions. © 2015 The Royal Australian and New Zealand College of Radiologists.

Testing a dual-modality system that combines full-field digital mammography and automated breast ultrasound

PubMed Central

Vaughan, Christopher L; Douglas, Tania S; Said-Hartley, Qonita; Baasch, Roland V; Boonzaier, James A; Goemans, Brian C; Harverson, John; Mingay, Michael W; Omar, Shuaib; Smith, Raphael V; Venter, Nielen C; Wilson, Heidi S

2015-01-01

Purpose The aim of this study was to test a novel dual-modality imaging system that combines full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in a single platform. Our Aceso system, named after the Greek goddess of healing, was specifically designed for the early detection of cancer in women with dense breast tissue. Materials and Methods Aceso was first tested using two industry standards: a CDMAM phantom as endorsed by EUREF was used to assess the FFDM images; and the CIRS 040GSE ultrasound phantom was imaged to evaluate the quality of the ABUS images. In addition, 58 women participated in a clinical trial: 51 were healthy volunteers aged between 40 and 65, while 7 were patients referred by the breast clinic, 6 of whom had biopsy-proven breast cancer. Results The CDMAM tests showed that the FFDM results were “acceptable” but fell short of “achievable” which was attributed to the low dose used. The ABUS images had good depth penetration (80 mm) and adequate axial resolution (0.5 mm) but the lateral resolution of 2 mm was judged to be too coarse. In a 42-year old volunteer with extremely dense breast tissue, the ABUS modality detected a lesion (a benign cyst) that was mammographically occult in the FFDM image. For a 73-year old patient with fatty breasts, a malignant lesion was successfully detected and co-registered in the FFDM and ABUS images. On average, each woman spent less than 11 minutes in the acquisition room. Conclusions While there is room for improvement in the quality of both the FFDM and ABUS images, Aceso has demonstrated its ability to acquire clinically meaningful images for a range of women with varying breast densities and therefore has potential as a screening device. PMID:27133694

Preoperative magnetic resonance imaging characteristics of oval circumscribed fast enhancing lesions in patients with newly diagnosed breast cancer.

PubMed

Lee, Jong Yoon; Jang, Mijung; Kim, Sun Mi; Yun, Bo La; Jang, Ja Yoon; Ahn, Hye Shin

2018-05-01

The aim of this study was to investigate the follow-up results and characteristics of oval circumscribed lesions with fast initial enhancement on preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer.Preoperative data from consecutive patients newly diagnosed with breast cancer between 2010 and 2013 were retrospectively reviewed. Only MRI reports containing, "oval shape, circumscribed margin, and fast initial enhancement," were extracted and analyzed. Follow-up results and clinical and pathological findings were evaluated.A total of 430 oval circumscribed lesions with fast initial enhancement were included. Forty-eight lesions were pathologically confirmed at initial workup and 382 were followed up. Among the 48 lesions, 14 were found to have additional malignancy and 34 were benign. Among the 382 followed-up lesions, only 1 was subsequently confirmed to be malignant. There were no evident changes in any of the remaining lesions during follow-up. The overall rate of malignancy was 3.5% (15/430). When lesions exhibited delayed washout enhancing kinetics (P < .001), were located ipsilaterally (P = .007), and closer to the primary tumor (P = .012), the possibility of malignancy was high. High T2-weighted imaging signal intensity suggested benignity (P = .043).Although the probability of being diagnosed with malignancy during follow-up in this study was low (0.3%), this investigation revealed several preoperative MRI characteristics that should alert clinicians to the possibility of malignancy.

Fusion of classifiers for REIS-based detection of suspicious breast lesions

NASA Astrophysics Data System (ADS)

Lederman, Dror; Wang, Xingwei; Zheng, Bin; Sumkin, Jules H.; Tublin, Mitchell; Gur, David

2011-03-01

After developing a multi-probe resonance-frequency electrical impedance spectroscopy (REIS) system aimed at detecting women with breast abnormalities that may indicate a developing breast cancer, we have been conducting a prospective clinical study to explore the feasibility of applying this REIS system to classify younger women (< 50 years old) into two groups of "higher-than-average risk" and "average risk" of having or developing breast cancer. The system comprises one central probe placed in contact with the nipple, and six additional probes uniformly distributed along an outside circle to be placed in contact with six points on the outer breast skin surface. In this preliminary study, we selected an initial set of 174 examinations on participants that have completed REIS examinations and have clinical status verification. Among these, 66 examinations were recommended for biopsy due to findings of a highly suspicious breast lesion ("positives"), and 108 were determined as negative during imaging based procedures ("negatives"). A set of REIS-based features, extracted using a mirror-matched approach, was computed and fed into five machine learning classifiers. A genetic algorithm was used to select an optimal subset of features for each of the five classifiers. Three fusion rules, namely sum rule, weighted sum rule and weighted median rule, were used to combine the results of the classifiers. Performance evaluation was performed using a leave-one-case-out cross-validation method. The results indicated that REIS may provide a new technology to identify younger women with higher than average risk of having or developing breast cancer. Furthermore, it was shown that fusion rule, such as a weighted median fusion rule and a weighted sum fusion rule may improve performance as compared with the highest performing single classifier.

Diagnosis of sub-centimetre breast lesions: combining BI-RADS-US with strain elastography and contrast-enhanced ultrasound-a preliminary study in China.

PubMed

Xiao, Xiaoyun; Jiang, Qiongchao; Wu, Huan; Guan, Xiaofeng; Qin, Wei; Luo, Baoming

2017-06-01

To compare the diagnostic efficacies of B-mode ultrasound (US), strain elastography (SE), contrast-enhanced ultrasound (CEUS) and the combination of these modalities for breast lesions <1 cm in size. Between January 2013 and October 2015, 203 inpatients with 209 sub-centimetre breast lesions categorised as BI-RADS-US (Breast Imaging Reporting and Data System for Ultrasound) 3-5 were included. US, SE and CEUS were performed to evaluate each lesion. The diagnostic performances of different ultrasonic modalities were compared. The diagnostic efficacies of BI-RADS-US and our re-rating systems were also compared. The pathology findings were used as the reference standard. The specificities of US, SE and CEUS for tumour differentiation were 17.4 %, 56.2 % and 86.0 %, respectively (P < 0.05); and the sensitivities were 100 %, 93.2 % and 93.2 % for US, SE and CEUS, respectively (P < 0.05). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.867 for original BI-RADS-US, 0.882 for BI-RADS-US combined with only SE, 0.953 for BI-RADS-US combined with only CEUS and 0.924 for BI-RADS-US combined with both SE and CEUS. The best combination was BI-RADS-US combined with only CEUS. Evaluating sub-centimetre breast lesions with SE and CEUS could increase the diagnostic specificity while retaining high sensitivity compared with B-mode ultrasound. • Evaluating breast lesions with SE and CEUS could increase the diagnostic specificity • SE and CEUS offer alternatives to biopsy and possibly allow shorter-interval follow-ups • BI-RADS-US combined with CEUS exhibited the best diagnostic performance.

Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization.

PubMed

Oldrini, Guillaume; Fedida, Benjamin; Poujol, Julie; Felblinger, Jacques; Trop, Isabelle; Henrot, Philippe; Darai, Emile; Thomassin-Naggara, Isabelle

2017-10-01

To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity. Copyright © 2017 Elsevier B.V. All rights reserved.

Ultrafast dynamic contrast-enhanced mri of the breast using compressed sensing: breast cancer diagnosis based on separate visualization of breast arteries and veins.

PubMed

Onishi, Natsuko; Kataoka, Masako; Kanao, Shotaro; Sagawa, Hajime; Iima, Mami; Nickel, Marcel Dominik; Toi, Masakazu; Togashi, Kaori

2018-01-01

To evaluate the feasibility of ultrafast dynamic contrast-enhanced (UF-DCE) magnetic resonance imaging (MRI) with compressed sensing (CS) for the separate identification of breast arteries/veins and perform temporal evaluations of breast arteries and veins with a focus on the association with ipsilateral cancers. Our Institutional Review Board approved this study with retrospective design. Twenty-five female patients who underwent UF-DCE MRI at 3T were included. UF-DCE MRI consisting of 20 continuous frames was acquired using a prototype 3D gradient-echo volumetric interpolated breath-hold sequence including a CS reconstruction: temporal resolution, 3.65 sec/frame; spatial resolution, 0.9 × 1.3 × 2.5 mm. Two readers analyzed 19 maximum intensity projection images reconstructed from subtracted images, separately identified breast arteries/veins and the earliest frame in which they were respectively visualized, and calculated the time interval between arterial and venous visualization (A-V interval) for each breast. In total, 49 breasts including 31 lesions (breast cancer, 16; benign lesion, 15) were identified. In 39 of the 49 breasts (breasts with cancers, 16; breasts with benign lesions, 10; breasts with no lesions, 13), both breast arteries and veins were separately identified. The A-V intervals for breasts with cancers were significantly shorter than those for breasts with benign lesions (P = 0.043) and no lesions (P = 0.007). UF-DCE MRI using CS enables the separate identification of breast arteries/veins. Temporal evaluations calculating the time interval between arterial and venous visualization might be helpful in the differentiation of ipsilateral breast cancers from benign lesions. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:97-104. © 2017 International Society for Magnetic Resonance in Medicine.

On the reduction of occultation light curves. [stellar occultations by planets

NASA Technical Reports Server (NTRS)

Wasserman, L.; Veverka, J.

1973-01-01

The two basic methods of reducing occultation light curves - curve fitting and inversion - are reviewed and compared. It is shown that the curve fitting methods have severe problems of nonuniqueness. In addition, in the case of occultation curves dominated by spikes, it is not clear that such solutions are meaningful. The inversion method does not suffer from these drawbacks. Methods of deriving temperature profiles from refractivity profiles are then examined. It is shown that, although the temperature profiles are sensitive to small errors in the refractivity profile, accurate temperatures can be obtained, particularly at the deeper levels of the atmosphere. The ambiguities that arise when the occultation curve straddles the turbopause are briefly discussed.

Differentiation of malignant and benign breast lesions: Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging at 3.0 T.

PubMed

An, Yeong Yi; Kim, Sung Hun; Kang, Bong Joo

2017-01-01

To determine the added value of qualitative analysis as an adjunct to quantitative analysis for the discrimination of benign and malignant lesions in patients with breast cancer using diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI). A total of 99 patients with 144 lesions were reviewed from our prospectively collected database. DWI data were obtained using rs-EPI acquired at 3.0 T. The diagnostic performances of DWI in the qualitative, quantitative, and combination analyses were compared with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Additionally, the effect of lesion size on the diagnostic performance of the DWI combination analysis was evaluated. The strongest indicators of malignancy on DWI were a heterogeneous pattern (P = 0.005) and an apparent diffusion coefficient (ADC) value <1.0 × 10-3 mm2/sec (P = 0.002). The area under the curve (AUC) values for the qualitative analysis, quantitative analysis, and combination analysis on DWI were 0.732 (95% CI, 0.651-0.803), 0.780 (95% CI, 0.703-0.846), and 0.826 (95% CI, 0.754-0.885), respectively (P<0.0001). The AUC for the combination analysis on DWI was superior to that for DCE-MRI alone (0.651, P = 0.003) but inferior to that for DCE-MRI plus the ADC value (0.883, P = 0.03). For the DWI combination analysis, the sensitivity was significantly lower in the size ≤1 cm group than in the size >1 cm group (80% vs. 95.6%, P = 0.034). Qualitative analysis of tumor morphology was diagnostically applicable on DWI using rs-EPI. This qualitative analysis adds value to quantitative analyses for lesion characterization in patients with breast cancer.

18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques.

PubMed

Koolen, Bas B; Vrancken Peeters, Marie-Jeanne T F D; Aukema, Tjeerd S; Vogel, Wouter V; Oldenburg, Hester S A; van der Hage, Jos A; Hoefnagel, Cornelis A; Stokkel, Marcel P M; Loo, Claudette E; Rodenhuis, Sjoerd; Rutgers, Emiel J Th; Valdés Olmos, Renato A

2012-01-01

The aim of the present study was to investigate if 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) outperforms conventional imaging techniques for excluding distant metastases prior to neoadjuvant chemotherapy (NAC) treatment in patients with stage II and III breast cancer. Second, we assessed the clinical importance of false positive findings. One hundred and fifty four patients with stage II or III breast cancer, scheduled to receive NAC, underwent an 18F-FDG PET/CT scan and conventional imaging, consisting of bone scintigraphy, ultrasound of the liver, and chest radiography. Suspect additional lesions at staging examination were confirmed by biopsy and histopathology and/or additional imaging. Metastases that were detected within 6 months after the PET/CT scan were considered evidence of occult metastasis, missed by staging examination. Forty-two additional distant lesions were seen in 25 patients with PET/CT and could be confirmed in 20 (13%) of 154 patients. PET/CT was false positive for 8 additional lesions (19%) and misclassified the presence of metastatic disease in 5 (3%) of 154 patients. In 16 (80%) of 20 patients, additional lesions were exclusively seen with PET/CT, leading to a change in treatment in 13 (8%) of 154 patients. In 129 patients with a negative staging PET/CT, no metastases developed during the follow-up of 9.0 months. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the detection of additional distant lesions in patients with stage II or III breast cancer are 100, 96, 80, 100, and 97%, respectively. FDG PET/CT is superior to conventional imaging techniques in the detection of distant metastases in patients with untreated stage II or III breast cancer and is associated with a low false positive rate. PET/CT may be of additional value in the staging of breast cancer prior to NAC.

Papillary lesions of the breast: To excise or observe?

PubMed

Khan, Sidrah; Diaz, Adrian; Archer, Kellie J; Lehman, Rebecca R; Mullins, Tiffany; Cardenosa, Gilda; Bear, Harry D

2018-05-01

Papillary lesions of the breast range from benign to atypical to malignant. Although papillomas without frank cancer are benign, their management remains controversial. When a core needle biopsy of a lesion yields a diagnosis of intraductal papilloma with atypia, excision is generally recommended to rule out a concurrent malignant neoplasm. For intraductal papillomas without atypia, however, recommendations for excision versus observation are variable. The aims of this study are to evaluate the rate of concurrent malignancies for intraductal papilloma diagnosed on core needle biopsy and to assess the long-term risk of developing cancer after the diagnosis of a papillary lesion. This single institution retrospective study analyzed 259 patients that were diagnosed with intraductal papilloma (IDP) by core needle biopsy from 1995 to 2010. Patients were grouped by initial diagnosis into three groups (papilloma without atypia, papilloma with atypia, and papilloma with atypical duct hyperplasia or atypical lobular hyperplasia (ADH/ALH) and followed up for long-term outcomes. After a core needle biopsy showing IDP with atypia or IDP + ADH/ALH, surgical excision yielded a diagnosis of concomitant invasive or ductal in situ cancer in greater that 30% of cases. For intraductal papilloma without atypia, the likelihood of cancer was much lower. Moreover, even with excision, the finding of intraductal papilloma with atypia carries a significant risk of developing cancer long-term, and such patients should be followed carefully and perhaps should be considered for chemoprevention. © 2017 Wiley Periodicals, Inc.

Retrospective analysis of the utility of multiparametric MRI for differentiating between benign and malignant breast lesions in women in China

PubMed Central

Fan, Wei Xiong; Chen, Xiao Feng; Cheng, Feng Yan; Cheng, Ya Bao; Xu, Tai; Zhu, Wen Biao; Zhu, Xiao Lei; Li, Gui Jin; Li, Shuai

2018-01-01

Abstract We explored the utility of time-resolved angiography with interleaved stochastic trajectories dynamic contrast-enhanced magnetic resonance imaging (TWIST DCE-MRI), readout segmentation of long variable echo-trains diffusion-weighted magnetic resonance imaging- diffusion-weighted magnetic resonance imaging (RESOLVE-DWI), and echo-planar imaging- diffusion-weighted magnetic resonance imaging (EPI-DWI) for distinguishing between malignant and benign breast lesions. This retrospective analysis included female patients with breast lesions seen at a single center in China between January 2016 and April 2016. Patients were allocated to a benign or malignant group based on pathologic diagnosis. All patients received routine MRI, RESOLVE-DWI, EPI-DWI, and TWIST DCE-T1WI. Variables measured included quantitative parameters (Ktrans, Kep, and Ve), semiquantitative parameters (rate of contrast enhancement for contrast agent inflow [W-in], rate of contrast decay for contrast agent outflow [W-out], and time-to-peak enhancement after contrast agent injection [TTP]) and apparent diffusion coefficient (ADC) values for RESOLVE-DWI (ADCr) and EPI-DWI (ADCe). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the diagnostic utility of each parameter for differentiating malignant from benign breast lesions. A total of 87 patients were included (benign, n = 20; malignant, n = 67). Compared with the benign group, the malignant group had significantly higher Ktrans, Kep and W-in and significantly lower W-out, TTP, ADCe, and ADCr (all P < .05); Ve was not significantly different between groups. RESOLVE-DWI was superior to conventional EPI-DWI at illustrating lesion boundary and morphology, while ADCr was significantly lower than ADCe in all patients. Kep, W-out, ADCr, and ADCe showed the highest diagnostic efficiency (based on AUC value) for differentiating between benign and malignant lesions. Combining 3 parameters (Kep, W-out, and ADCr) had

Triton stellar occultation candidates - 1992-1994

NASA Technical Reports Server (NTRS)

Mcdonald, S. W.; Elliot, J. T.

1992-01-01

A search for Triton stellar occultation candidates for the period 1992-1994 has been completed with CCD strip-scanning observations. The search reached an R magnitude of about 17.4 and found 129 candidates within 1.5 arcsec of Triton's ephemeris during this period. Of these events, around 30 occultations are expected to be visible from the earth, indicating that a number of Triton occultation events should be visible from major observatories. Even the faintest of the present candidate events could produce useful occultation data if observed with a large enough telescope. The present astrometric accuracy is inadequate to identify which of these appulse events will produce occultations on the earth; further astrometry is needed to refine the predictions for positive occultation identification. To aid in selecting candidates for additional astrometric and photometric studies, finder charts and earth-based visibility charts for each event are included.

Progress on the occulter experiment at Princeton

NASA Astrophysics Data System (ADS)

Cady, Eric; Balasubramanian, Kunjithapatham; Carr, Michael; Dickie, Matthew; Echternach, Pierre; Groff, Tyler; Kasdin, Jeremy; Laftchiev, Christian; McElwain, Michael; Sirbu, Dan; Vanderbei, Robert; White, Victor

2009-08-01

An occulter is used in conjunction with a separate telescope to suppress the light of a distant star. To demonstrate the performance of this system, we are building an occulter experiment in the laboratory at Princeton. This experiment will use an etched silicon mask as the occulter, with some modifications to try to improve the performance. The occulter is illuminated by a diverging laser beam to reduce the aberrations from the optics before the occulter. We present the progress of this experiment and expectations for future work.

[Diagnostic efficiency of decline rate of signal intensity and apparent diffusion coefficient with different b values for differentiating benign and malignant breast lesions on diffusion-weighted 3.0T magnetic resonance imaging].

PubMed

Jiang, Jing; Liu, Wanhua; Ye, Yuanyuan; Wang, Rui; Li, Fengfang; Peng, Chengyu

2014-06-17

To investigate the diagnostic efficiency of decline rate of signal intensity and apparent diffusion coefficient with different b values for differentiating benign and malignant breast lesions on diffusion-weighted 3.0 T magnetic resonance imaging. A total of 152 patients with 162 confirmed histopathologically breast lesions (85 malignant and 77 benign) underwent 3.0 T diffusion-weighted magnetic resonance imaging. Four b values (0, 400, 800 and 1 000 s/mm²) were used. The signal intensity and ADC values of breast lesions were measured respectively. The signal intensity decline rate (SIDR) and apparent diffusion coefficient decline rate (ADCDR) were calculated respectively. SIDR = (signal intensity of lesions with low b value-signal intensity of lesions with high b value)/signal intensity of lesions with low b value, ADCDR = (ADC value of lesions with low b value-ADC value of lesions with high b value) /ADC value of lesions with low b value. The independent sample t-test was employed for statistical analyses and the receiver operating characteristic (ROC) curve for evaluating the diagnosis efficiency of SIDR and ADCDR values. Significant differences were observed in SIDR between benign and malignant breast lesions with b values of 0-400, 400-800 and 800-1 000 s/mm². The sensitivities of SIDR for differentiating benign and malignant breast lesions were 61.2%, 68.2% and 67.1%, the specificities 74.0%, 85.7% and 67.5%, the diagnosis accordance rates 67.3%, 76.5% and 67.3%, the positive predictive values 72.2%, 84.1% and 69.5% and the negative predictive values 63.3%, 71.0% and 65.0% respectively. Significant differences were observed in ADCDR between benign and malignant breast lesions with b values of 400-800 s/mm² and 800-1 000 s/mm². The sensitivities of SDR for differentiating benign and malignant breast lesions were 80.0% and 65.9%, the specificities 72.7% and 65.0%, the diagnostic accordance rates 76.5% and 65.4%, the positive predictive values 76.4% and 67

The differentiation of the character of solid lesions in the breast in the compression sonoelastography. Part II: Diagnostic value of BIRADS-US classification, Tsukuba score and FLR ratio.

PubMed

Dobruch-Sobczak, Katarzyna

2013-03-01

Sonoelastography is a dynamically developing method of ultrasound examination used to differentiate the character of focal lesions in the breasts. The aim of the Part II of the study is to determine the usefulness of sonoelastography in the differentiation diagnosis of focal breast lesions including the evaluation of the diagnostic value of Tsukuba score and FLR ratio in characterizing solid lesions in the breasts. Furthermore, the paper provides a comparison of classic B-mode imaging and sonoelastography. From January to July 2010 in the Ultrasound Department of the Cancer Centre, The Institute of Maria Skłodowska-Curie, 375 breast ultrasound examinations were conducted. The examined group included patients who in B-mode examinations presented indications for pathological verification. They were 80 women aged between 17 and 83 (mean age was 50) with 99 solid focal lesions in the breasts. All patients underwent: the interview, physical examination, B-mode ultrasound examination and elastography of the mammary glands and axillary fossae. The visualized lesions were evaluated according to BIRADS-US classification and Tsukuba score as well as FLR ratio was calculated. In all cases, the histopathological and/or cytological verification of the tested lesions was obtained. In the group of 80 patients, the examination revealed 39 malignant neoplastic lesions and 60 benign ones. The mean age of women with malignant neoplasms was 55.07 (SD = 10.54), and with benign lesions - 46.9 (SD = 15.47). In order to identify threshold values that distinguish benign lesions from malignant ones, a comparative analysis of statistical models based on BIRADS-US classification and Tsukuba score was conducted and the cut-off value for FLR was assumed. The sensitivity and specificity values for BIRADS-US 4/5 were 76.92% and 96.67% and for Tsukuba 3/4 - 64.1% and 98.33% respectively. The assumed FLR threshold value to differentiate between benign and malignant lesions in the breasts equaled 3

Optimization of Region of Interest Drawing for Quantitative Analysis: Differentiation Between Benign and Malignant Breast Lesions on Contrast-Enhanced Sonography.

PubMed

Nakata, Norio; Ohta, Tomoyuki; Nishioka, Makiko; Takeyama, Hiroshi; Toriumi, Yasuo; Kato, Kumiko; Nogi, Hiroko; Kamio, Makiko; Fukuda, Kunihiko

2015-11-01

This study was performed to evaluate the diagnostic utility of quantitative analysis of benign and malignant breast lesions using contrast-enhanced sonography. Contrast-enhanced sonography using the perflubutane-based contrast agent Sonazoid (Daiichi Sankyo, Tokyo, Japan) was performed in 94 pathologically proven palpable breast mass lesions, which could be depicted with B-mode sonography. Quantitative analyses using the time-intensity curve on contrast-enhanced sonography were performed in 5 region of interest (ROI) types (manually traced ROI and circular ROIs of 5, 10, 15, and 20 mm in diameter). The peak signal intensity, initial slope, time to peak, positive enhancement integral, and wash-out ratio were investigated in each ROI. There were significant differences between benign and malignant lesions in the time to peak (P < .05), initial slope (P < .001), and positive enhancement integral (P < .05) for the manual ROI. Significant differences were found between benign and malignant lesions in the time to peak (P < .05) for the 5-mm ROI; the time to peak (P < .05) and initial slope (P< .05) for the 10-mm ROI; absolute values of the peak signal intensity (P< .05), time to peak (P< .01), and initial slope (P< .005) for the 15-mm ROI; and the time to peak (P < .05) and initial slope (P < .05) for the 20-mm ROI. There were no statistically significant differences in any wash-out ratio values for the 5 ROI types. Kinetic analysis using contrast-enhanced sonography is useful for differentiation between benign and malignant breast lesions. © 2015 by the American Institute of Ultrasound in Medicine.

Radioactive Seed Localization Versus Wire Localization for Nonpalpable Breast Lesions: A Two-Year Initial Experience at a Large Community Hospital.

PubMed

Stelle, Lacey; Schoenheit, Taylor; Brubaker, Allison; Tang, Xiwei; Qu, Peiyong; Cradock, Kimberly; Higham, Anna

2018-01-01

Radioactive seed localization (RSL) is a safe and effective alternative to wire localization (WL) for nonpalpable breast lesions. While several large academic institutions currently utilize RSL, few community hospitals have adopted this technique. The aim of this study was to examine the experience of RSL versus WL at a large community hospital. A retrospective chart review of patients who underwent RSL or WL for breast-conserving surgery from 1 November 2013 to 31 November 2015. The total number of lesions examined was 382. RSL was utilized in 205 (54%) lesions, with 187 undergoing single RSL, while WL was used in 155 (40%) lesions, with 109 undergoing single WL; both techniques were used in 22 (6%) lesions. Pathology was benign in 142 (48%) lesions, with 93 RSLs and 49 WLs. For malignant lesions, mean specimen size was 36.3 g for single RSL and 35.9 g for single WL (p = 0.904). Re-excision for margin clearance was required for 16 (17%) malignant lesions in the RSL group and 10 (17%) in the WL group (p = 0.954). For malignant lesions, mean operating room time was 86 min for single RSL versus 70 min for single WL (p = 0.014). The use of RSL is a viable option in the community setting, with several benefits over WL. While operative times were slightly longer with RSL, there was no difference in specimen size or re-excision rate for malignant lesions.

A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision.

PubMed

Cox, Charles E; Russell, Scott; Prowler, Vanessa; Carter, Ebonie; Beard, Abby; Mehindru, Ankur; Blumencranz, Peter; Allen, Kathleen; Portillo, Michael; Whitworth, Pat; Funk, Kristi; Barone, Julie; Norton, Denise; Schroeder, Jerome; Police, Alice; Lin, Erin; Combs, Freddie; Schnabel, Freya; Toth, Hildegard; Lee, Jiyon; Anglin, Beth; Nguyen, Minh; Canavan, Lynn; Laidley, Alison; Warden, Mary Jane; Prati, Ronald; King, Jeff; Shivers, Steven C

2016-10-01

This study was a multicenter evaluation of the SAVI SCOUT(®) breast localization and surgical guidance system using micro-impulse radar technology for the removal of nonpalpable breast lesions. The study was designed to validate the results of a recent 50-patient pilot study in a larger multi-institution trial. The primary endpoints were the rates of successful reflector placement, localization, and removal. This multicenter, prospective trial enrolled patients scheduled to have excisional biopsy or breast-conserving surgery of a nonpalpable breast lesion. From March to November 2015, 154 patients were consented and evaluated by 20 radiologists and 16 surgeons at 11 participating centers. Patients had SCOUT(®) reflectors placed up to 7 days before surgery, and placement was confirmed by mammography or ultrasonography. Implanted reflectors were detected by the SCOUT(®) handpiece and console. Presence of the reflector in the excised surgical specimen was confirmed radiographically, and specimens were sent for routine pathology. SCOUT(®) reflectors were successfully placed in 153 of 154 patients. In one case, the reflector was placed at a distance from the target that required a wire to be placed. All 154 lesions and reflectors were successfully removed during surgery. For 101 patients with a preoperative diagnosis of cancer, 86 (85.1 %) had clear margins, and 17 (16.8 %) patients required margin reexcision. SCOUT(®) provides a reliable and effective alternative method for the localization and surgical excision of nonpalpable breast lesions using no wires or radioactive materials, with excellent patient, radiologist, and surgeon acceptance.

Analysis of 3D Subharmonic Ultrasound Signals from Patients with Known Breast Masses for Lesion Differentiation

DTIC Science & Technology

2012-10-01

separate image processing course were attended and this programming language will be used for the research component of this project. Subharmonic...4 5 BODY ...lesions. 5 BODY 5.1 Training Component The training component of this research has been split into breast imaging and image processing arms

Moderate Physical Activity Mediates the Association between White Matter Lesion Volume and Memory Recall in Breast Cancer Survivors.

PubMed

Cooke, Gillian E; Wetter, Nathan C; Banducci, Sarah E; Mackenzie, Michael J; Zuniga, Krystle E; Awick, Elizabeth A; Roberts, Sarah A; Sutton, Brad P; McAuley, Edward; Kramer, Arthur F

2016-01-01

Increased survival rates among breast cancer patients have drawn significant attention to consequences of both the presence of cancer, and the subsequent treatment-related impact on the brain. The incidence of breast cancer and the effects of treatment often result in alterations in the microstructure of white matter and impaired cognitive functioning. However, physical activity is proving to be a successful modifiable lifestyle factor in many studies that could prove beneficial to breast cancer survivors. This study investigates the link between white matter lesion volume, moderate physical activity, and cognition in breast cancer survivors following treatment compared to non-cancer age-matched controls. Results revealed that brain structure significantly predicted cognitive function via mediation of physical activity in breast cancer survivors. Overall, the study provided preliminary evidence suggesting moderate physical activity may help reduce the treatment related risks associated with breast cancer, including changes to WM integrity and cognitive impairment.

Several Well-observed Asteroidal Occultations in 2010

NASA Astrophysics Data System (ADS)

Timerson, Brad; Durech, J.; Abramson, H.; Brooks, J.; Caton, D.; Clark, D.; Conard, S.; Cooke, B.; Dunham, D. W.; Dunham, J.; Edberg, S.; Ellington, C.; Faircloth, J.; Herchak, S.; Iverson, E.; Jones, R.; Lucas, G.; Lyzenga, G.; Maley, P.; Martinez, L.; Menke, J.; Mroz, G.; Nolan, P.; Peterson, R.; Preston, S.; Rattley, G.; Ray, J.; Scheck, A.; Stamm, J.; Stanton, R.; Suggs, R.; Tatum, R.; Thomas, W.

2011-10-01

During 2010 IOTA observers in North America reported about 190 positive observations for 106 asteroid occultation events. For several asteroids, this included observations with multiple chords. For two events, an inversion model was available. An occultation by 16 Psyche on 2010 August 21 yielded a best-fit ellipse of 235.4 x 230.4 km. On 2010 December 24, an occultation by 93 Minerva produced a best-fit ellipse of 179.4 x 133.4 km. An occultation by 96 Aegle on 2010 October 29 yielded a best-fit ellipse of 124.9 x 88.0 km. An occultation by 105 Artemis on 2010 June 24 showed a best-fit ellipse of 125.0 x 92.0 km. An occultation by 375 Ursula on 2010 December 4 produced a best-fit ellipse of 125.0 km x 135.0 km. Of note are two events not summarized in this article. On 2010 August 31, an occultation by 695 Bella yielded a new double star. That event will be summarized in the JDSO. Finally, on 2010 April 6, an occultation of zeta Ophiuchi by 824 Anastasia was observed by 65 observers at 69 locations. Unfortunately a large shift in the path yielded only 4 chords. Results of that event, and all the events mentioned here, can be found on the North American Asteroidal Occultation Results web page.

Does variability in carotenoid composition and concentration in tissues of the breast and reproductive tract in women depend on type of lesion?

PubMed

Czeczuga-Semeniuk, E; Wołczyński, S

2008-01-01

Vitamin A takes part in many physiological and pathological processes in women's reproductive organs. The study objective was to compare the carotenoid content in benign and malignant lesions of the breast, ovary and uterus, and to demonstrate quantitative and qualitative similarities or differences between the study groups. Materials for analysis were physiological and pathological tissues of breast, ovary and uterus. The carotenoid pigments were isolated using column chromatography (CC), thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC). Sixteen carotenoids were identified in the study material, including those belonging to the provitamin A group. The most common were: beta-carotene, beta-cryptoxanthin, lutein, mutatoxanthin, violaxanthin, lutein epoxide and zeaxanthin. All the tissues subjected to analysis contained beta-carotene, 98% of the tissues had beta-cryptoxanthin, whereas alpha-carotene was detected in about 50% of breast tissue. No differences in carotenoid concentration were found between benign and malignant lesions in the examined tissues, apart from hydroxyechinenone, canthaxanthin, astaxanthin, lutein epoxide, antheraxanthin and neoxanthin. Similarly, no differences in concentration of the provitamin A carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, and echinenone) were found between benign and malignant lesions except hydroxyechinenone. The highest total content of carotenoids and the biggest spectrum of predominant carotenoids were found in the breast. Only in tissues of malignant lesions of the uterus, we observed statistically higher total content of carotenoids compared to remaining samples from the uterus (p<0.001) and more frequent isolation of some carotenoids (compared to benign lesions). The results of our study confirmed the presence of a high diversity of carotenoids in the physiologic, benign and malignant tissues of the breast and the reproductive tract in women. The differences

Stellar Occultation Studies of the Solar System

NASA Technical Reports Server (NTRS)

Elliot, James L.

1998-01-01

Earth-based observations of stellar occultations provide extremely high spatial resolution for bodies in the outer solar system, about 10,000 times better than that of traditional imaging observations. Stellar occultation data can be used to establish the structure of atmospheres and rings of solar system bodies at high spatial resolution. Airborne occultation observations are particularly effective, since the controlled mobility of the observing platform allows the observer to fly within the optimum part of the occultation shadow for most events that are visible from Earth. Airborne observations are carried out above any clouds and are nearly free of scintillation noise from the Earth's atmosphere. KAO occultation observations resulted in the first detection of gravity waves in the Martian atmosphere, discovery of the Uranian rings, the first detection of Pluto's atmosphere, the first Earth-based investigations of Triton's atmosphere, and the discovery of narrow jets from Chiron's nucleus. The first SOFIA occultation opportunity will be an investigation of Pluto's atmospheric structure in November, 2002, and will resolve a problem that has lingered since the KAO discovery observation fourteen years earlier. We plan to continue our successful airborne occultation program with the greatly enhanced capability provided by SOFIA. We propose here to replace our KAO occultation photometer with one having twice the throughput, half the noise, a somewhat wider wavelength range, four times the field of view, and ten times the frame rate to optimize its performance and to capitalize on the larger collecting area offered by SOFIA. It will also allow for simultaneous visible and IR occultation observations, greatly enriching the results that we can obtain from occultations. We call this new imaging occultation photometer HOPI (High-speed Occultation Photometer and Imager). HOPI will provide a signal-to-noise ratio two to four times that of our present photometer for a given

Predicted occultations by Uranus - 1981-1984

NASA Technical Reports Server (NTRS)

Klemola, A. R.; Mink, D. J.; Elliot, J. L.

1981-01-01

Predictions are presented for 11 occultations by and appulses to Uranus and its ring system for ten stars from 1981 through 1984. The brightest stars are occulted on April 26, 1981 (BD - 19 deg 4222) and on April 22, 1982 (Hyd - 20 deg 51699). The ring system occults the same star twice during March 1983 (Hyd - 21 deg 64352).

EDITORIAL: Optical mammography: Imaging and characterization of breast lesions by pulsed near-infrared laser light (OPTIMAMM)

NASA Astrophysics Data System (ADS)

Hebden, Jeremy C.; Rinneberg, Herbert

2005-06-01

The Commission of the European Union (EU) conceived its Fifth Framework Programme (FP5) to identify the priorities for the European Union's research, technological development and demonstration activities for the period 1998-2002. By encouraging collaborative research between groups in different member countries, FP5 was intended to help solve problems the EU is facing and respond to major socio-economic challenges. The programme focused on a number of objectives and areas combining technological, industrial, economic, social and cultural aspects. A specific call was made, under its `Quality of Life and Management of Living Resources' section, for proposals which aim to explore improvements in non-invasive methods of imaging for early diagnosis and clinical evaluation of disease. Among the projects successfully funded under the FP5 programme was one entitled `Optical mammography: Imaging and characterization of breast lesions by pulsed near-infrared laser light', known by its acronym OPTIMAMM. The project involved a consortium of nine partners, comprising ten applied science and clinical research groups based in six EU countries, with overall administration and management provided by the Physikalisch-Technische Bundesanstalt, Berlin, Germany. The broad aim of the OPTIMAMM project was to combine multi-disciplinary basic (physics, engineering, mathematics, computer science) and clinical (oncology, histology) research to assess the diagnostic potential of time-domain optical and photoacoustic mammography as novel, non-invasive imaging modalities for the detection and clinical evaluation of breast lesions. Funding for the project, at a total cost of about 1.67 MEuro, began in December 2000 for a period of three years, although a zero-cost extension was granted to enable the ongoing project activities to continue until the end of May 2004. The importance of developing new tools for the detection and diagnosis of breast disease is evident from the very high incidence and

Breast Lesions: Diagnosis Using Diffusion Weighted Imaging at 1.5T and 3.0T-Systematic Review and Meta-analysis.

PubMed

Shi, Ruo-Yang; Yao, Qiu-Ying; Wu, Lian-Ming; Xu, Jian-Rong

2018-06-01

We compared the diagnostic performance of diffusion weighted imaging (DWI) acquired with 1.5T and 3.0T magnetic resonance (MR) units in differentiating malignant breast lesions from benign ones. A comprehensive search of the PubMed and Embase databases was performed for studies reported from January 1, 2000 to February 19, 2016. The quality of the included studies was assessed. Statistical analysis included pooling of diagnostic sensitivity and specificity and assessing data inhomogeneity and publication bias. A total of 61 studies were included after a full-text review. These included 4778 patients and 5205 breast lesions. The overall sensitivity and specificity were 90% (95% confidence interval [CI], 88%-92%) and 86% (95% CI, 82%-89%), respectively. The pooled diagnostic odds ratio was 53 (95% CI, 37-74). For breast cancer versus benign lesions, the area under the curve was 0.94 (95% CI, 0.92-0.96). For the 44 studies that used a 1.5T MR unit, the pooled sensitivity and specificity were 91% (95% CI, 89%-92%) and 86% (95% CI, 81%-90%), respectively. For the 17 studies that used a 3.0T MR unit, the pooled sensitivity and specificity were 88% (95% CI, 83%-91%) and 84% (95% CI, 0.78-0.89), respectively. Publication bias and significant heterogeneity were observed; however, no threshold was found among the 61 studies. No significant difference was found in the sensitivity or specificity between the subgroups. The results of the comparison between the subgroups that had used either a 1.5T or 3.0T MR unit suggest that the diagnostic accuracy for breast cancer compared with benign lesions is not significantly different. Copyright © 2017 Elsevier Inc. All rights reserved.

Radio occultation experiments with INAF-IRA radiotelescopes.

NASA Astrophysics Data System (ADS)

Pluchino, S.; Schillirò, F.; Salerno, E.; Pupillo, G.

The Radio Occultation research program performed at the Medicina and Noto Radioastronomical Stations of the Istituto Nazionale di Astrofisica (INAF) - Istituto di Radioastronomia (IRA) includes observations of spacecraft by satellite and satellite by satellite events. The Lunar Radio Occultation (LRO) part of the program consists in collecting data of the lunar Total Electron Content (TEC), at different limb longitudes and at different time, in order to study long term variation of the Moon's ionosphere. The LRO program started at Medicina in September 2006 with the observation of the European probe SMART-1 during its impact on the lunar soil. It proceeded in 2007 with the observation of the lunar occultations of Saturn and Venus, and with the observation of Mars in 2008. On this occasion the probes Cassini, Venus Express, Mars Express, Mars Reconaissance Orbiter and Mars Odissey were respectively occulted by the moon. On Dec 1st 2008 a Venus lunar occultation occurred. On that occasion we performed the first Italian-VLBI (I-VLBI) tracking experiment by detecting the carrier signals coming from the Venus Express (VEX) spacecraft with both the IRA radiotelescopes together with the Matera antenna of the Italian Space Agency. The second part of the radio occultation program includes the observation of satellite by satellite occultation events, as well as mutual occultations of Jupiter satellites. These events are referred to as mutual phenomena (PHEMU). These observations are aimed to measure the radio flux variation during the occultation and to derive surface spatial characteristics such as Io's hot spots. In this work preliminary results of the Radio Occultation program will be presented.

Design of optimal collimation for dedicated molecular breast imaging systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weinmann, Amanda L.; Hruska, Carrie B.; O'Connor, Michael K.

2009-03-15

Molecular breast imaging (MBI) is a functional imaging technique that uses specialized small field-of-view gamma cameras to detect the preferential uptake of a radiotracer in breast lesions. MBI has potential to be a useful adjunct method to screening mammography for the detection of occult breast cancer. However, a current limitation of MBI is the high radiation dose (a factor of 7-10 times that of screening mammography) associated with current technology. The purpose of this study was to optimize the gamma camera collimation with the aim of improving sensitivity while retaining adequate resolution for the detection of sub-10-mm lesions. Square-hole collimatorsmore » with holes matched to the pixilated cadmium zinc telluride detector elements of the MBI system were designed. Data from MBI patient studies and parameters of existing dual-head MBI systems were used to guide the range of desired collimator resolutions, source-to-collimator distances, pixel sizes, and collimator materials that were examined. General equations describing collimator performance for a conventional gamma camera were used in the design process along with several important adjustments to account for the specialized imaging geometry of the MBI system. Both theoretical calculations and a Monte Carlo model were used to measure the geometric efficiency (or sensitivity) and resolution of each designed collimator. Results showed that through optimal collimation, collimator sensitivity could be improved by factors of 1.5-3.2, while maintaining a collimator resolution of either {<=}5 or {<=}7.5 mm at a distance of 3 cm from the collimator face. These gains in collimator sensitivity permit an inversely proportional drop in the required dose to perform MBI.« less

Moderate Physical Activity Mediates the Association between White Matter Lesion Volume and Memory Recall in Breast Cancer Survivors

PubMed Central

Cooke, Gillian E.; Wetter, Nathan C.; Banducci, Sarah E.; Mackenzie, Michael J.; Zuniga, Krystle E.; Awick, Elizabeth A.; Roberts, Sarah A.; Sutton, Brad P.; McAuley, Edward; Kramer, Arthur F.

2016-01-01

Increased survival rates among breast cancer patients have drawn significant attention to consequences of both the presence of cancer, and the subsequent treatment-related impact on the brain. The incidence of breast cancer and the effects of treatment often result in alterations in the microstructure of white matter and impaired cognitive functioning. However, physical activity is proving to be a successful modifiable lifestyle factor in many studies that could prove beneficial to breast cancer survivors. This study investigates the link between white matter lesion volume, moderate physical activity, and cognition in breast cancer survivors following treatment compared to non-cancer age-matched controls. Results revealed that brain structure significantly predicted cognitive function via mediation of physical activity in breast cancer survivors. Overall, the study provided preliminary evidence suggesting moderate physical activity may help reduce the treatment related risks associated with breast cancer, including changes to WM integrity and cognitive impairment. PMID:26915025

Efficacy and cost-effectiveness of stereotactic vacuum-assisted core biopsy of nonpalpable breast lesions: analysis of 602 biopsies performed over 5 years.

PubMed

Luparia, A; Durando, M; Campanino, P; Regini, E; Lucarelli, D; Talenti, A; Mattone, G; Mariscotti, G; Sapino, A; Gandini, G

2011-04-01

The authors sought to evaluate the diagnostic accuracy and cost-effectiveness of vacuum-assisted core biopsy (VACB) in comparison with diagnostic surgical excision for characterisation of nonpalpable breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) categories R3 and R4. From January 2004 to December 2008, we conducted 602 stereotactic, 11-gauge, VACB procedures on 243 nonpalpable breast lesions categorised as BI-RADS R3, 346 categorised as BI-RADS R4 and 13 categorised as BI-RADS R5. We calculated the diagnostic accuracy and cost savings of VACB by subtracting the cost of the stereotactic biopsy from that of the diagnostic surgical procedure. A total of 56% of the lesions were benign and required no further assessment. Lesions of uncertain malignant potential (B3) (23.6%) were debated at multidisciplinary meetings, and diagnostic surgical biopsy was recommended for 83.1% of them. All malignant lesions (B4 and B5) underwent surgical excision. VACB had a sensitivity of 94.9%, specificity of 98.3% and diagnostic accuracy of 97.7%. The cost savings per VACB procedure were 464.00 euro; by obviating 335 surgical biopsies, the overall cost savings was 155,440.00 euro over 5 years. VACB proved to have high diagnostic accuracy for characterising abnormalities at low to intermediate risk of malignancy and obviated surgical excision in about half of the cases, allowing for considerable cost savings.

Not all occult papillary carcinomas are minimal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Allo, M.D.; Christianson, W.; Koivunen, D.

1988-12-01

Occult papillary carcinomas are characterized as small papillary tumors of less than 1.5 cm in maximum diameter, with or without bulky metastatic deposits in cervical nodes. The primary lesion is usually not palpable, and although the clinical behavior usually follows a benign course, tumors with unfavorable histologic features (invasiveness, multifocality) or extrathyroidal disease or a combination of both may not do so. In this report six cases are presented to illustrate this entity. No patient had a history of irradiation to the head or neck. All had primary lesions smaller than 1.5 cm. None had a palpable nodule or abnormalmore » thyroid scan results, and the diagnosis of thyroid cancer was based on cervical lymph node or lung biopsy specimens, which revealed papillary thyroid cancer. All of the patients underwent total or near-total thyroidectomies and were found to have small, invasive papillary lesions with additional metastases to cervical nodes noted at the time of thyroidectomy. Adjunctive treatment consisted of a 5 mCi iodine-131 scan, ablative iodine-131 therapy, and suppression with L-thyroxine. Although distant metastasis to lung or other organs is uncommon and the mortality rate is low (as in larger papillary cancers), these invasive lesions--despite their small size--have a high propensity for recurrence and should be considered to behave more like encapsulated papillary tumors with extrathyroidal extension than like their small, unencapsulated intrathyroidal counterparts.« less

Multimodality imaging and state-of-art GPU technology in discriminating benign from malignant breast lesions on real time decision support system

NASA Astrophysics Data System (ADS)

Kostopoulos, S.; Sidiropoulos, K.; Glotsos, D.; Dimitropoulos, N.; Kalatzis, I.; Asvestas, P.; Cavouras, D.

2014-03-01

The aim of this study was to design a pattern recognition system for assisting the diagnosis of breast lesions, using image information from Ultrasound (US) and Digital Mammography (DM) imaging modalities. State-of-art computer technology was employed based on commercial Graphics Processing Unit (GPU) cards and parallel programming. An experienced radiologist outlined breast lesions on both US and DM images from 59 patients employing a custom designed computer software application. Textural features were extracted from each lesion and were used to design the pattern recognition system. Several classifiers were tested for highest performance in discriminating benign from malignant lesions. Classifiers were also combined into ensemble schemes for further improvement of the system's classification accuracy. Following the pattern recognition system optimization, the final system was designed employing the Probabilistic Neural Network classifier (PNN) on the GPU card (GeForce 580GTX) using CUDA programming framework and C++ programming language. The use of such state-of-art technology renders the system capable of redesigning itself on site once additional verified US and DM data are collected. Mixture of US and DM features optimized performance with over 90% accuracy in correctly classifying the lesions.

Breast 3 T-MR imaging: indication for stereotactic vacuum-assisted breast biopsy.

PubMed

Yamamoto, Nobuko; Yoshizako, Takeshi; Yoshikawa, Kazuaki; Itakura, Masayuki; Maruyama, Riruke; Kitagaki, Hajime

2014-01-01

The purpose of this study was to assess indications for stereotactic vacuum-assisted breast biopsy (SVAB) evaluated by breast 3 T-magnetic resonance (3 T-MR) imaging in patients showing suspicious microcalcifications on mammography and negative ultrasound (US) findings. Fifty-five patients with 55 breast lesions showing suspicious microcalcifications on mammography and negative US findings underwent preoperative 3 T-MR examination including dynamic MR imaging. All patients underwent SVAB within 1 month of MR imaging. The pathological diagnosis of each breast lesion was made by examining tissues obtained by SVAB or radical/partial mastectomy. 3 T-MR imaging findings were evaluated by using the American College of Radiology Breast Imaging Reporting and Data System Atlas (BI-RADS-MRI) and then were correlated with the histopathological findings. When BI-RADS 4 and 5 MR imaging lesions were assumed to be malignant, the usefulness of 3 T-MR imaging was evaluated for diagnosis of impalpable breast lesions by SVAB among lesions with microcalcification detected by mammography and negative US findings. There were 21 malignant lesions, including 5 invasive ductal carcinomas, 16 lesions of ductal carcinoma in situ (DCIS). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 3 T-MR imaging for deciding the indications for SVAB was 90.5%, 97.1%, 95.0%, 94.3%, and 94.5%, respectively. The one-false negative case was a DCIS with small enhancing lesions (0.5 mm). The one false-positive case was ductal adenoma with a linear ductal pattern of enhancement. 3 T-MR imaging may be useful for deciding the indications for SVAB in patients who have breast lesions with microcalcification that are impalpable and are detected by mammography and negative US findings. However, our findings should be considered preliminary and further prospective investigation is required.

Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions.

PubMed

Kucukkaya, Fikret; Aribal, Erkin; Tureli, Derya; Altas, Hilal; Kaya, Handan

2016-01-01

The objective of this study was to evaluate the accuracy of the volume navigation technique for combining real-time ultrasound and contrast-enhanced MRI (CE-MRI) of breast lesions. Thirty-eight women with single breast lesions underwent 3-T MRI. A 3.5-minute CE-MRI sequence was used, as was a flexible body coil. Patients underwent imaging in the supine position, with three markers placed on their breasts. Real-time sonographic images were coregistered to the preloaded breast CE-MRI volume by coupling skin markers, with the use of an electromagnetic transmitter positioned next to the subjects. The transmitter detected the spatial positions of the two electromagnetic sensors mounted on the transducer bracket. After this fusion process in 3D space was completed, divergences in the location of the center of each lesion on CE-MRI and ultrasound images were analyzed. The mean lesion size was 17.4 mm on ultrasound and 17.9 mm on MRI, whereas the mean (± SD) misalignment of the lesion centers on CE-MRI and ultrasound was 3.9 ± 2.5 mm on the x-axis (mediolateral view), 3.6 ± 2.7 mm on the y-axis (anteroposterior view), and 4.3 ± 2.6 mm on the z-axis (craniocaudal view). No lesion had a misalignment greater than 10 mm on any of three axes. The accuracy of volume navigation was independent of patient age and the lesion size, location, and histopathologic findings (p > 0.05). Intermediate lesions, which had a depth of center of 11-20 mm on ultrasound had a mean misalignment of 2.6 ± 1.9 mm, compared with 5.5 ± 2.2 mm for deep lesions, which had a depth of center greater than 20 mm (p = 0.049). The volume navigation technique is an accurate method for coregistration of CE-MRI and sonographic images, enabling lesion localization within a limited volume.

Papular skin lesions: Clue to a recurrence of breast cancer on fine needle non-aspiration cytology (FNNAC)

PubMed Central

Afrose, Ruquiya; Akram, Mohammad; Siddiqui, Shahid Ali

2015-01-01

Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice. A high index of suspicion is required to diagnose these lesions, as these lesions can mimic benign skin lesions and clinical findings may be subtle. Fine needle aspiration cytology (FNAC) is commonly employed for diagnosing these skin lesions. However, it is often difficult to aspirate adequate material from small papular lesions. In these clinical situations, fine needle non-aspiration cytology (FNNAC) is proposed as an alternative procedure. FNNAC eliminates the negative suction pressure employed in FNAC and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material. We report here a case in which FNNAC was used in place of FNAC in diagnosing papular skin lesions. This procedure was carried out in a treated patient of carcinoma breast who was on regular follow-up and presented to us with a 20-day history of papular skin lesions over the chest and back. This article enlightens the clinicians about the utility of FNNAC, which is a relatively uncommon procedure. PMID:25948954

Papular skin lesions: Clue to a recurrence of breast cancer on fine needle non-aspiration cytology (FNNAC).

PubMed

Afrose, Ruquiya; Akram, Mohammad; Siddiqui, Shahid Ali

2015-01-01

Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice. A high index of suspicion is required to diagnose these lesions, as these lesions can mimic benign skin lesions and clinical findings may be subtle. Fine needle aspiration cytology (FNAC) is commonly employed for diagnosing these skin lesions. However, it is often difficult to aspirate adequate material from small papular lesions. In these clinical situations, fine needle non-aspiration cytology (FNNAC) is proposed as an alternative procedure. FNNAC eliminates the negative suction pressure employed in FNAC and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material. We report here a case in which FNNAC was used in place of FNAC in diagnosing papular skin lesions. This procedure was carried out in a treated patient of carcinoma breast who was on regular follow-up and presented to us with a 20-day history of papular skin lesions over the chest and back. This article enlightens the clinicians about the utility of FNNAC, which is a relatively uncommon procedure.

[Progress in research of occult hepatitis B virus infection].

PubMed

Huang, X Y; Shi, Q F; Huang, T

2017-05-10

Occult hepatitis B virus infection is a worldwide public health problem, which seriously affects the clinical diagnosis of hepatitis B and threatens the safety of blood transfusion. The concept of occult hepatitis B virus infection, the pathogenesis of occult hepatitis B virus infection, the prevalence of occult hepatitis B virus infection in different groups, including healthy population and different patients, and the possibility of transmission were summarized. The prevalence of occult hepatitis B virus infection was found in healthy population and different patients, and there is possibility of occult hepatitis B virus infection to be transmitted through blood transfusion. The paper provides a comprehensive introduction of the pathogenesis and prevalence of occult hepatitis B virus infection. More attention should be paid to occult hepatitis B virus infection.

New perspectives in occult hepatitis C virus infection

PubMed Central

Carreño, Vicente; Bartolomé, Javier; Castillo, Inmaculada; Quiroga, Juan Antonio

2012-01-01

Occult hepatitis C virus (HCV) infection, defined as the presence of HCV RNA in liver and in peripheral blood mononuclear cells (PBMCs) in the absence of detectable viral RNA in serum by standard assays, can be found in anti-HCV positive patients with normal serum levels of liver enzymes and in anti-HCV negative patients with persistently elevated liver enzymes of unknown etiology. Occult HCV infection is distributed worldwide and all HCV genotypes seem to be involved in this infection. Occult hepatitis C has been found not only in anti-HCV positive subjects with normal values of liver enzymes or in chronic hepatitis of unknown origin but also in several groups at risk for HCV infection such as hemodialysis patients or family members of patients with occult HCV. This occult infection has been reported also in healthy populations without evidence of liver disease. Occult HCV infection seems to be less aggressive than chronic hepatitis C although patients affected by occult HCV may develop liver cirrhosis and even hepatocellular carcinoma. Thus, anti-HCV negative patients with occult HCV may benefit from antiviral therapy with pegylated-interferon plus ribavirin. The persistence of very low levels of HCV RNA in serum and in PBMCs, along with the maintenance of specific T-cell responses against HCV-antigens observed during a long-term follow-up of patients with occult hepatitis C, indicate that occult HCV is a persistent infection that is not spontaneously eradicated. This is an updated report on diagnosis, epidemiology and clinical implications of occult HCV with special emphasis on anti-HCV negative cases. PMID:22736911

Stellar occultation studies of the solar system

NASA Technical Reports Server (NTRS)

Elliot, J. L.

1979-01-01

The paper covers the principles, observational procedures, and results relating to occultations of stars by solar system bodies other than the moon. Physical processes involved in occultations are presented including (1) extinction by ring material, (2) differential refraction by a planetary atmosphere, (3) extinction by a planetary atmosphere, and (4) Fresnel diffraction by sharp edges. It is noted that from a sufficient number of immersion and emersion timings of a stellar occultation, the radius and ellipticity of the occulting body can be accurately determined. From an occultation by a planet having an atmosphere, temperature, pressure, and number density profiles can be obtained along with information about the composition of the atmosphere and the extinction.

Method of Modeling and Simulation of Shaped External Occulters

NASA Technical Reports Server (NTRS)

Lyon, Richard G. (Inventor); Clampin, Mark (Inventor); Petrone, Peter, III (Inventor)

2016-01-01

The present invention relates to modeling an external occulter including: providing at least one processor executing program code to implement a simulation system, the program code including: providing an external occulter having a plurality of petals, the occulter being coupled to a telescope; and propagating light from the occulter to a telescope aperture of the telescope by scalar Fresnel propagation, by: obtaining an incident field strength at a predetermined wavelength at an occulter surface; obtaining a field propagation from the occulter to the telescope aperture using a Fresnel integral; modeling a celestial object at differing field angles by shifting a location of a shadow cast by the occulter on the telescope aperture; calculating an intensity of the occulter shadow on the telescope aperture; and applying a telescope aperture mask to a field of the occulter shadow, and propagating the light to a focal plane of the telescope via FFT techniques.

Occult Participation: Its Impact on Adolescent Development.

ERIC Educational Resources Information Center

Tennant-Clark, Cynthia M.; And Others

1989-01-01

Investigated relationship between occult participation, substance abuse, and level of self-esteem among 25 clinical (alcohol or drug treatment) and 25 nonclinical adolescents. Results indicated that adolescent substance abuse and occult participation were significantly related. Found significant differences between high versus low occult groups…

Robustness of radiomic breast features of benign lesions and luminal A cancers across MR magnet strengths

NASA Astrophysics Data System (ADS)

Whitney, Heather M.; Drukker, Karen; Edwards, Alexandra; Papaioannou, John; Giger, Maryellen L.

2018-02-01

Radiomics features extracted from breast lesion images have shown potential in diagnosis and prognosis of breast cancer. As clinical institutions transition from 1.5 T to 3.0 T magnetic resonance imaging (MRI), it is helpful to identify robust features across these field strengths. In this study, dynamic contrast-enhanced MR images were acquired retrospectively under IRB/HIPAA compliance, yielding 738 cases: 241 and 124 benign lesions imaged at 1.5 T and 3.0 T and 231 and 142 luminal A cancers imaged at 1.5 T and 3.0 T, respectively. Lesions were segmented using a fuzzy C-means method. Extracted radiomic values for each group of lesions by cancer status and field strength of acquisition were compared using a Kolmogorov-Smirnov test for the null hypothesis that two groups being compared came from the same distribution, with p-values being corrected for multiple comparisons by the Holm-Bonferroni method. Two shape features, one texture feature, and three enhancement variance kinetics features were found to be potentially robust. All potentially robust features had areas under the receiver operating characteristic curve (AUC) statistically greater than 0.5 in the task of distinguishing between lesion types (range of means 0.57-0.78). The significant difference in voxel size between field strength of acquisition limits the ability to affirm more features as robust or not robust according to field strength alone, and inhomogeneities in static field strength and radiofrequency field could also have affected the assessment of kinetic curve features as robust or not. Vendor-specific image scaling could have also been a factor. These findings will contribute to the development of radiomic signatures that use features identified as robust across field strength.

The Northrop Grumman External Occulter Testbed: Preliminary Results

NASA Astrophysics Data System (ADS)

Lo, Amy; Glassman, T.; Lillie, C.

2007-05-01

We have built a subscale testbed to demonstrate and validate the performance of the New Worlds Observer (NWO), a terrestrial planet finder external-occulter mission concept. The external occulter concept allows observations of nearby exo-Earths using two spacecraft: one carrying an occulter that is tens of meters in diameter and the other carrying a generic space telescope. The occulter is completely opaque, resembling a flower, with petals having a hypergaussian profile that enable 10-10 intensity suppression of stars that potentially harbor terrestrial planets. The baseline flight NWO system has a 30 meter occulter flying 30,000 km in front of a 4 meter class telescope. Testing the flight configuration on the ground is not feasible, so we have matched the Fresnel number of the flight configuration ( 10) using a subscale occulter. Our testbed consists of an 80 meter length evacuated tube, with a high precision occulter in the center of the tube. The occulter is 4 cm in diameter, manufactured with ¼ micron metrological accuracy and less than 2 micron tip truncation. This mimics a 30 meter occulter with millimeter figure accuracy and less than centimeter tip truncation. Our testbed is an evolving experiment, and we report here the first, preliminary, results using a single wavelength laser (532 nm) as the source.

Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases.

PubMed

Vigano, Luca; Di Tommaso, Luca; Mimmo, Antonio; Sollai, Mauro; Cimino, Matteo; Donadon, Matteo; Roncalli, Massimo; Torzilli, Guido

2018-06-07

Patients with numerous colorectal liver metastases (CLM) have high risk of early recurrence after liver resection (LR). The presence of intrahepatic occult microscopic metastases missed by imaging has been hypothesized, but it has never been assessed by pathology analyses. All patients with > 10 CLM who underwent LR between September 2015 and September 2016 were considered. A large sample of liver without evidence of disease ("healthy liver") was taken from the resected specimen and sent to the pathologist. One mm-thick sections were analyzed. Any metastasis, undetected by preoperative and intraoperative imaging, but identified by the pathologist was classified as occult microscopic metastasis. Ten patients were prospectively enrolled (median number of CLM n = 15). In a per-lesion analysis, the sensitivity of computed tomography and magnetic resonance imaging was 91 and 98% respectively. The pathology examination confirmed all the CLM. All patients had an adequate sample of "healthy liver" (median number of examined blocks per sample n = 14 [5-33]). No occult microscopic metastases were detected. After a median follow-up of 15 months, 5 patients were disease-free. Recurrence was hepatic and bilobar in all patients. Clinically relevant occult microscopic disease in patients with numerous CLM is excluded. These results support the indication to resection in such patients and exclude the need for de principe major hepatectomy to increase the completeness of surgery. © 2018 S. Karger AG, Basel.

Triton stellar occultation candidates: 1995-1999

NASA Technical Reports Server (NTRS)

Mcdonald, S. W.; Elliot, J. L.

1995-01-01

We have completed a search for candidates for stellar occultations by Triton over the years 1995-1999. CCd strip scan images provided star positions in the relevant sky area to a depth of about 17.5 R magnitude. Over this time period, we find that Triton passes within 1.0 arcsec of 75 stars. Appulses with geocentric minimum separations of less than 0.35 arcsec will result in stellar occultations, but further astrometry and photometry is necessary to refine individual predictions for identification of actual occultations. Finder charts are included to aid in further studies and prediction refinement. The two most promising potential occultations, Tr176 and Tr180, occur in 1997.

Evaluation of T1/T2 ratios in a pilot study as a potential biomarker of biopsy: proven benign and malignant breast lesions in correlation with histopathological disease stage.

PubMed

Malikova, Marina A; Tkacz, Jaroslaw N; Slanetz, Priscilla J; Guo, Chao-Yu; Aakil, Adam; Jara, Hernan

2017-08-01

Early breast cancer detection is important for intervention and prognosis. Advances in treatment and outcome require diagnostic tools with highly positive predictive value. To study the potential role of quantitative MRI (qMRI) using T1/T2 ratios to differentiate benign from malignant breast lesions. A cross-sectional study of 69 women with 69 known or suspicious breast lesions were scanned with mixed-turbo spin echo pulse sequence. Patients were grouped according to histopathological assessment of disease stage: untreated malignant tumor, treated malignancy and benign disease. Elevated T1/T2 means were observed for biopsy-proven malignant lesions and for malignant lesions treated prior to qMRI with chemotherapy and/or radiation, as compared with benign lesions. The qMRI-obtained T1/T2 ratios correlated with histopathology. Analysis revealed correlation between elevated T1/T2 ratio and disease stage. This could provide valuable complementary information on tissue properties as an additional diagnostic tool.

Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography (SWE) in solid breast masses.

PubMed

Skerl, K; Vinnicombe, S; Giannotti, E; Thomson, K; Evans, A

2015-12-01

To evaluate the influence of the region of interest (ROI) size and lesion diameter on the diagnostic performance of 2D shear wave elastography (SWE) of solid breast lesions. A study group of 206 consecutive patients (age range 21-92 years) with 210 solid breast lesions (70 benign, 140 malignant) who underwent core biopsy or surgical excision was evaluated. Lesions were divided into small (diameter <15 mm, n=112) and large lesions (diameter ≥15 mm, n=98). An ROI with a diameter of 1, 2, and 3 mm was positioned over the stiffest part of the lesion. The maximum elasticity (Emax), mean elasticity (Emean) and standard deviation (SD) for each ROI size were compared to the pathological outcome. Statistical analysis was undertaken using the chi-square test and receiver operating characteristic (ROC) analysis. The ROI size used has a significant impact on the performance of Emean and SD but not on Emax. Youden's indices show a correlation with the ROI size and lesion size: generally, the benign/malignant threshold is lower with increasing ROI size but higher with increasing lesion size. No single SWE parameter has superior performance. Lesion size and ROI size influence diagnostic performance. Copyright © 2015. Published by Elsevier Ltd.

Exploring the Solar System with Stellar Occultations

NASA Technical Reports Server (NTRS)

Elliot, J. L.; Dunham, E. W.

1984-01-01

By recording the light intensity as a function of time when a planet occults a relatively bright star, the thermal structure of the upper atmosphere of the planet can be probed. The main feature of stellar occultation observations is their high spatial resolution, typically several thousand times better than the resolution achievable with ground-based imaging. Five stellar occultations have been observed. The main results of these observations are summarized. Stellar occultations have been observed on Uranus, Mars, Pallas, Neptune and the Jovian Ring.

Occult hemorrhage in children with severe ITP.

PubMed

Flores, Adolfo; Buchanan, George R

2016-03-01

Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients ≤ 18 years of age and a platelet count ≤ 10,000/mm(3) . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm(3) . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P < 0.0005). CNS microbleeding in the superficial cortex of the left frontal lobe was identified in one child with occult bleeding in the urinary tract. There was no relationship between occult hemorrhage and bleeding manifestations on physical examination. Occult hemorrhage was not a harbinger of subsequent bleeding. Our findings suggest that occult hemorrhage occurs with greater frequency than overt bleeding in children with severe ITP. CNS microbleeding is a potential risk in this patient population. Assessment of brain microbleeds and microscopic hematuria in this patient population require additional study. © 2015 Wiley Periodicals, Inc.

Flat epithelial atypia is a common subtype of B3 breast lesions and is associated with noninvasive cancer but not with invasive cancer in final excision histology.

PubMed

Noske, Aurelia; Pahl, Stefan; Fallenberg, Eva; Richter-Ehrenstein, Christiane; Buckendahl, Ann-Christin; Weichert, Wilko; Schneider, Achim; Dietel, Manfred; Denkert, Carsten

2010-04-01

The biological behavior and the optimal management of benign breast lesions with uncertain malignant potential, the so-called B3 lesions, found in breast needle core biopsies is still under debate. We addressed this study to compare histologic findings in B3 needle core biopsies with final excision specimens to determine associated rates of malignancy. Consecutive needle core biopsies were performed in a 3-year period (January 1, 2006-December 31, 2008). Biopsies were image-guided (31 by ultrasound, 85 stereotactic vacuum-assisted, 6 unknown) for evaluation of breast abnormalities. We reviewed 122 needle core biopsies with B3 lesions of 91 symptomatic patients and 31 screen-detected women and compared the B3 histologic subtypes with the final excision histology. A total of 1845 needle core biopsies were performed and B3 lesions comprised 6.6% of all B categories. The most common histologic subtype in biopsies was flat epithelia atypia in 35.2%, followed by papillary lesions in 21% and atypical ductal hyperplasia in 20%. Reports on excision specimens were available in 66% (81 patients). Final excision histology was benign in 73 (90.2%) and malignant in 8 (9.8%) patients (2 invasive cancer, 6 ductal carcinoma in situ). Of all B3 subtypes, atypical ductal hyperplasia and flat epithelial atypia were associated with malignancy, whereas only atypical ductal hyperplasia was accompanied by invasive cancer. Of all lesions, flat epithelial atypia was most frequently found in excision specimens (18%). In our study, flat epithelial atypia and atypical ductal hyperplasia are common lesions of the B3 category in needle core biopsies of the breast. Both lesions are associated with malignancy, whereas only atypical ductal hyperplasia was related to invasive cancer. We conclude that an excision biopsy after diagnosis of flat epithelial atypia is recommended depending on clinical and radiologic findings. Copyright 2010 Elsevier Inc.

Spectral embedding based active contour (SEAC) for lesion segmentation on breast dynamic contrast enhanced magnetic resonance imaging.

PubMed

Agner, Shannon C; Xu, Jun; Madabhushi, Anant

2013-03-01

Segmentation of breast lesions on dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) is the first step in lesion diagnosis in a computer-aided diagnosis framework. Because manual segmentation of such lesions is both time consuming and highly susceptible to human error and issues of reproducibility, an automated lesion segmentation method is highly desirable. Traditional automated image segmentation methods such as boundary-based active contour (AC) models require a strong gradient at the lesion boundary. Even when region-based terms are introduced to an AC model, grayscale image intensities often do not allow for clear definition of foreground and background region statistics. Thus, there is a need to find alternative image representations that might provide (1) strong gradients at the margin of the object of interest (OOI); and (2) larger separation between intensity distributions and region statistics for the foreground and background, which are necessary to halt evolution of the AC model upon reaching the border of the OOI. In this paper, the authors introduce a spectral embedding (SE) based AC (SEAC) for lesion segmentation on breast DCE-MRI. SE, a nonlinear dimensionality reduction scheme, is applied to the DCE time series in a voxelwise fashion to reduce several time point images to a single parametric image where every voxel is characterized by the three dominant eigenvectors. This parametric eigenvector image (PrEIm) representation allows for better capture of image region statistics and stronger gradients for use with a hybrid AC model, which is driven by both boundary and region information. They compare SEAC to ACs that employ fuzzy c-means (FCM) and principal component analysis (PCA) as alternative image representations. Segmentation performance was evaluated by boundary and region metrics as well as comparing lesion classification using morphological features from SEAC, PCA+AC, and FCM+AC. On a cohort of 50 breast DCE-MRI studies, Pr

Earlier detection of breast cancer by surveillance of women at familial risk.

PubMed

Tilanus-Linthorst, M M; Bartels, C C; Obdeijn, A I; Oudkerk, M

2000-03-01

A positive family history increases the risk for breast cancer which oft en occurs at a much younger age than in the general population. We stud ied whether surveillance of these women resulted in the detection of bre ast cancer in an earlier stage than in symptomatic patients with a famil y history. Between January 1994 and April 1998, 294 women with 15-25% r isk (moderate), mean age:43.3 (22-75) years, were screened with a yearly physical examination and mammography from 5 years before the youngest ag e of onset in the family and 384 women with >25% risk (high) for breast cancer, mean age: 42.9 (20-74) years were screened with a physical examination every 6 months and yearly mammography. From September 1995 breast magnetic resonance imaging (MRI) was also carried out for 109 high risk women where mammography showed over 50% density. 26 breast cancers detected under surveillance were significantly more often found in an early T1N0 stage than the 24 breast cancers in patients with a family history referred in that period because of symptoms: 81 versus 46% (P=0.018). Patients under surveillance were also less frequently node-positive than the symptomatic group: 19 versus 42% (P=0.12). 20 patients with a family history referred by our national screening programme in that period had 21 breast cancers detected, 81% in stage T1N0 and 5% node-positive, which was comparable to the results in our national screening programme T1N0 66%, N+ 24% resulting in a 30% reduction in mortality. The incidence in women under surveillance was 10.1 per 1000 in the 'high' risk group and 13.3 per 1000 in the 'moderate' risk group. Expected incidence in an average risk population aged 40-50 years is 1.5, expected if the group consisted of only gene carriers 15 per 1000. 23% of the breast cancers in the surveillance group were detected at physical examination, but occult at mammography. 38% were detected at mammography and clinically occult. Breast MRI (in the subgroup) detected 3 occult

Optical performance of the New Worlds Occulter

NASA Astrophysics Data System (ADS)

Arenberg, Jonathan W.; Lo, Amy S.; Glassman, Tiffany M.; Cash, Webster

2007-04-01

The New Worlds Observer (NWO) is a multiple spacecraft mission that is capable of detecting and characterizing extra-solar planets and planetary systems. NWO consists of an external occulter and a generic space telescope, flying in tandem. The external occulter has specific requirements on its shape and size, while the telescope needs no special modification beyond that required to do high-quality astrophysical observations. The occulter is a petal-shaped, opaque screen that creates a high-suppression shadow large enough to accommodate the telescope. This article reports on the optical performance of the novel New Worlds occulter design. It also introduces two new aspects of its optical performance which enhance the detectability of extra-solar planets. We also include a brief discussion of the buildability and the tolerances of the occulter. It is also shown that an occulter design can be found for any set of science requirements. We show that NWO is a viable mission concept for the study of extra-solar planets. To cite this article: J.W. Arenberg et al., C. R. Physique 8 (2007).

Experiment D005: Star occultation navigation

NASA Technical Reports Server (NTRS)

Silva, R. M.; Jorris, T. R.; Vallerie, E. M., III

1971-01-01

The usefulness of star occultation measurements for space navigation and the determination of a horizon density profile which could be used to update atmospheric models for horizon-based measurement systems were studied. The time of occultation of a known star by a celestial body, as seen by an orbiting observer, determines a cylinder of position, the axis of which is the line through the star and the body center, and the radius of which is equal to the occulting-body radius. The dimming percentage, with respect to the altitude of this grazing ray from the star to the observer, is a percentage altitude for occultation. That is, the star can be assumed to be occulted when it reaches a predetermined percentage of its unattenuated value. The procedure used was to measure this attenuation with respect to time to determine the usefulness of the measurements for autonomous space navigation. In this experiment, the crewmembers had to accomplish star acquisition, identification, calibration, and tracking. Instrumentation was required only for measurement of the relative intensity of the star as it set into the atmosphere.

Two-dimensional shear wave elastography of breast lesions: Comparison of two different systems.

PubMed

Ren, Wei-Wei; Li, Xiao-Long; He, Ya-Ping; Li, Dan-Dan; Wang, Dan; Zhao, Chong-Ke; Bo, Xiao-Wan; Liu, Bo-Ji; Yue, Wen-Wen; Xu, Hui-Xiong

2017-01-01

To evaluate the diagnostic performance of two different shear wave elastography (SWE) techniques in distinguishing malignant breast lesions from benign ones. From March 2016 to May 2016, a total of 153 breast lesions (mean diameter, 16.8 mm±10.5; range 4.1-90.0 mm) in 153 patients (mean age, 46.4 years±15.1; age range 20-86 years) were separately performed by two different SWE techniques (i.e. T-SWE, Aplio500, Toshiba Medical System, Tochigi, Japan; and S-SWE, the Aixplorer US system, SuperSonic Imagine, Provence, France). The maximum (Emax), mean (Emean) and standard deviation (ESD) of elasticity modulus values in T-SWE and S-SWE were analyzed. All the lesions were confirmed by ultrasound (US)-guided core needle biopsy (n = 26), surgery (n = 122), or both (n = 5), with pathological results as the gold standard. The areas under the receiver operating characteristic curves (AUROCs) were calculated. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were calculated to assess the diagnostic performance between T-SWE and S-SWE. Operator consistency was also evaluated. Among the 153 lesions, 41 (26.8%) were malignant and 112 (73.2%) were benign. Emax (T-SWE: 40.10±37.14 kPa vs. 118.78±34.41 kPa; S-SWE: 41.22±22.54 kPa vs. 134.77±60.51 kPa), Emean (T-SWE: 19.75±16.31 kPa vs. 52.93±25.75 kPa; S-SWE: 20.95±10.98 kPa vs. 55.95±22.42 kPa) and ESD (T-SWE: 9.00±8.55 kPa vs. 38.44±12.30 kPa; S-SWE: 8.17±6.14 kPa vs. 29.34±13.88 kPa) showed statistical differences in distinguishing malignant lesions from benign ones both in T-SWE and S-SWE (all p < 0.05). In T-SWE, the diagnostic performance of ESD was the highest (AUROC = 0.958), followed by Emax (AUROC = 0.909; p = 0.001 in comparison with ESD) and Emean (AUROC = 0.892; p < 0.001 in comparison with ESD), while in S-SWE, the diagnostic performance of Emax was the highest (AUROC = 0.967), followed

Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3).

PubMed

Gruber, R; Jaromi, S; Rudas, M; Pfarl, G; Riedl, C C; Flöry, D; Graf, O; Sickles, E A; Helbich, T H

2013-03-01

To determine the accuracy of a probably benign assessment of non-palpable breast lesions (BI-RADS category 3) at mammography and/or ultrasound with immediate histological work-up. Stereotactic or ultrasound guided core needle breast biopsy (NBB) was performed to evaluate 288 lesions, which were prospectively assessed as BI-RADS category 3. Imaging findings included 195 masses, 73 calcification cases, 16 focal asymmetries, and four architectural distortion cases. After NBB, patients underwent either open surgical biopsy (OSB) (n=204) or mammographic follow-up (n=84) for at least 24 months. Histological results of NBB were compared with those of OSB. Three of the 288 lesions (1.0%) proved to be malignant at histological work-up, two of them were ductal carcinoma in situ (DCIS) and one of them was an invasive carcinoma. NBB revealed invasive carcinoma in 1/288 (0.35%) and atypical ductal hyperplasia (ADH) in 13/288 (4.5%) lesions. OSB revealed DCIS in 2/204 (1%) and invasive carcinoma in 1/204 (0.5%) lesions. The two DCIS were underestimated as ADH by NBB. The remaining 285 (99%) lesions proved to be benign at OSB or remained stable during follow-up. Confirmed by tissue diagnosis, the low likelihood of malignancy of prospectively assessed probably benign lesions is below the 2% threshold established for BI-RADS category 3. Imaging follow-up is a safe and effective alternative to immediate histological work-up for such lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Evaluation for Occult Fractures in Injured Children

PubMed Central

French, Benjamin; Song, Lihai; Feudtner, Chris

2015-01-01

OBJECTIVES: To examine variation across US hospitals in evaluation for occult fractures in (1) children <2 years old diagnosed with physical abuse and (2) infants <1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. METHODS: We performed a retrospective study in children <2 years old with a diagnosis of physical abuse and in infants <1 year old with non-motor vehicle crash–related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013. We examined across-hospital variation and identified child- and hospital-level factors associated with evaluation for occult fractures. RESULTS: Evaluations for occult fractures were performed in 48% of the 2502 children with an abuse diagnosis, in 51% of the 1574 infants with traumatic brain injury, and in 53% of the 859 infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all 3 groups. Occult fracture evaluations were more likely to be performed at teaching hospitals than at nonteaching hospitals (all P < .001). The hospital-level annual volume of young, injured children was associated with the probability of occult fracture evaluation, such that hospitals treating more young, injured patients were more likely to evaluate for occult fractures (all P < .001). CONCLUSIONS: Substantial variation in evaluation for occult fractures among young children with a diagnosis of abuse or injuries associated with a high likelihood of abuse highlights opportunities for quality improvement in this vulnerable population. PMID:26169425

Evaluation for Occult Fractures in Injured Children.

PubMed

Wood, Joanne N; French, Benjamin; Song, Lihai; Feudtner, Chris

2015-08-01

To examine variation across US hospitals in evaluation for occult fractures in (1) children <2 years old diagnosed with physical abuse and (2) infants <1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. We performed a retrospective study in children <2 years old with a diagnosis of physical abuse and in infants <1 year old with non-motor vehicle crash-related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013. We examined across-hospital variation and identified child- and hospital-level factors associated with evaluation for occult fractures. Evaluations for occult fractures were performed in 48% of the 2502 children with an abuse diagnosis, in 51% of the 1574 infants with traumatic brain injury, and in 53% of the 859 infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all 3 groups. Occult fracture evaluations were more likely to be performed at teaching hospitals than at nonteaching hospitals (all P < .001). The hospital-level annual volume of young, injured children was associated with the probability of occult fracture evaluation, such that hospitals treating more young, injured patients were more likely to evaluate for occult fractures (all P < .001). Substantial variation in evaluation for occult fractures among young children with a diagnosis of abuse or injuries associated with a high likelihood of abuse highlights opportunities for quality improvement in this vulnerable population. Copyright © 2015 by the American Academy of Pediatrics.

Molecular Mechanisms Underlying Occult Hepatitis B Virus Infection

PubMed Central

Samal, Jasmine; Kandpal, Manish

2012-01-01

Summary: Chronic hepatitis B virus (HBV) infection is a complex clinical entity frequently associated with cirrhosis and hepatocellular carcinoma (HCC). The persistence of HBV genomes in the absence of detectable surface antigenemia is termed occult HBV infection. Mutations in the surface gene rendering HBsAg undetectable by commercial assays and inhibition of HBV by suppression of viral replication and viral proteins represent two fundamentally different mechanisms that lead to occult HBV infections. The molecular mechanisms underlying occult HBV infections, including recently identified mechanisms associated with the suppression of HBV replication and inhibition of HBV proteins, are reviewed in detail. The availability of highly sensitive molecular methods has led to increased detection of occult HBV infections in various clinical settings. The clinical relevance of occult HBV infection and the utility of appropriate diagnostic methods to detect occult HBV infection are discussed. The need for specific guidelines on the diagnosis and management of occult HBV infection is being increasingly recognized; the aspects of mechanistic studies that warrant further investigation are discussed in the final section. PMID:22232374

ASTEROID SIZING BY RADIOGALAXY OCCULTATION AT 5 GHZ

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lehtinen, K.; Muinonen, K.; Poutanen, M.

Stellar occultations by asteroids observed at visual wavelengths have been an important tool for studying the size and shape of asteroids and for revising the orbital parameters of asteroids. At radio frequencies, a shadow of an asteroid on the Earth is dominated by diffraction effects. Here, we show, for the first time, that a single observation of an occultation of a compact radio source at a frequency of 5 GHz can be used to derive the effective size of the occulting object and to derive the distance between the observer and the center of the occultation path on the Earth.more » The derived diameter of the occulting object, asteroid (115) Thyra, is 75 ± 6 km. The observed occultation profile shows features that cannot be explained by diffraction of a single asteroid.« less

Image Analysis of the 2012 Pluto (Near) Occultation

DTIC Science & Technology

2013-09-01

Image Analysis of the 2012 Pluto (Near) Occultation Keith T. Knox Air Force Research Laboratory ABSTRACT Imagery was gathered at the AMOS...observatory on the 3.6-meter telescope for the expected occultation of a star by the dwarf planet, Pluto , on 29 June 2012. The imagery was taken at...5 Hz for 40 minutes before and after the expected time of occultation. The initial analysis of the photometry indicated that Pluto did not occult

Diffusion-weighted imaging of breast lesions: Region-of-interest placement and different ADC parameters influence apparent diffusion coefficient values.

PubMed

Bickel, Hubert; Pinker, Katja; Polanec, Stephan; Magometschnigg, Heinrich; Wengert, Georg; Spick, Claudio; Bogner, Wolfgang; Bago-Horvath, Zsuzsanna; Helbich, Thomas H; Baltzer, Pascal

2017-05-01

To investigate the influence of region-of-interest (ROI) placement and different apparent diffusion coefficient (ADC) parameters on ADC values, diagnostic performance, reproducibility and measurement time in breast tumours. In this IRB-approved, retrospective study, 149 histopathologically proven breast tumours (109 malignant, 40 benign) in 147 women (mean age 53.2) were investigated. Three radiologists independently measured minimum, mean and maximum ADC, each using three ROI placement approaches:1 - small 2D-ROI, 2 - large 2D-ROI and 3 - 3D-ROI covering the whole lesion. One reader performed all measurements twice. Median ADC values, diagnostic performance, reproducibility, and measurement time were calculated and compared between all combinations of ROI placement approaches and ADC parameters. Median ADC values differed significantly between the ROI placement approaches (p < .001). Minimum ADC showed the best diagnostic performance (AUC .928-.956), followed by mean ADC obtained from 2D ROIs (.926-.94). Minimum and mean ADC showed high intra- (ICC .85-.94) and inter-reader reproducibility (ICC .74-.94). Median measurement time was significantly shorter for the 2D ROIs (p < .001). ROI placement significantly influences ADC values measured in breast tumours. Minimum and mean ADC acquired from 2D-ROIs are useful for the differentiation of benign and malignant breast lesions, and are highly reproducible, with rapid measurement. • Region of interest placement significantly influences apparent diffusion coefficient of breast tumours. • Minimum and mean apparent diffusion coefficient perform best and are reproducible. • 2D regions of interest perform best and provide rapid measurement times.

Sampling probability distributions of lesions in mammograms

NASA Astrophysics Data System (ADS)

Looney, P.; Warren, L. M.; Dance, D. R.; Young, K. C.

2015-03-01

One approach to image perception studies in mammography using virtual clinical trials involves the insertion of simulated lesions into normal mammograms. To facilitate this, a method has been developed that allows for sampling of lesion positions across the cranio-caudal and medio-lateral radiographic projections in accordance with measured distributions of real lesion locations. 6825 mammograms from our mammography image database were segmented to find the breast outline. The outlines were averaged and smoothed to produce an average outline for each laterality and radiographic projection. Lesions in 3304 mammograms with malignant findings were mapped on to a standardised breast image corresponding to the average breast outline using piecewise affine transforms. A four dimensional probability distribution function was found from the lesion locations in the cranio-caudal and medio-lateral radiographic projections for calcification and noncalcification lesions. Lesion locations sampled from this probability distribution function were mapped on to individual mammograms using a piecewise affine transform which transforms the average outline to the outline of the breast in the mammogram. The four dimensional probability distribution function was validated by comparing it to the two dimensional distributions found by considering each radiographic projection and laterality independently. The correlation of the location of the lesions sampled from the four dimensional probability distribution function across radiographic projections was shown to match the correlation of the locations of the original mapped lesion locations. The current system has been implemented as a web-service on a server using the Python Django framework. The server performs the sampling, performs the mapping and returns the results in a javascript object notation format.

Detectability of BI-RADS category 3 or higher breast lesions and reading time on mammography: comparison between 5-MP and 8-MP LCD monitors.

PubMed

Yabuuchi, Hidetake; Kawanami, Satoshi; Kamitani, Takeshi; Matsumura, Tomomi; Yamasaki, Yuzo; Morishita, Junji; Honda, Hiroshi

2017-04-01

Background Five-megapixel (MP) displays are recommended as soft copy devices for digital mammogram. An 8-MP liquid crystal display (LCD) (two 4-MP displays within one display) might offer the advantage of being able to view biplane mammography more easily than the dual planes of 5-MP LCDs. Purpose To compare detectability of Breast Imaging Reporting and Data System (BI-RADS) category 3 or higher lesions and reading time on mammography between 5- MP and 8-MP LCDs. Material and Methods The mammograms of 240 breasts of 120 patients including 60 breasts with BI-RADS category 3 or higher lesions and 180 breasts with normal or category 2 lesions were enrolled. All bilateral mammograms were displayed on bifacial 5-MP LCDs or an 8-MP LCD (two 4-MP displays within one display). Six radiologists assessed 240 breasts on each display. The observations were analyzed using receiver operating characteristic (ROC) analysis. A jack-knife method was used for statistical analysis. We employed a paired t-test to determine whether any significant differences existed in the reading time between two different displays. A P value < 0.05 was considered significant. Results The mean areas under the ROC curve obtained using 5-MP and 8-MP LCDs were 0.925 and 0.915, respectively, and there was no significant difference ( P = 0.46). There was also no significant difference in the reading time between two types of displays (57.8 min. vs. 51.5 min, P = 0.39). Conclusion The detectability of BI-RADS category 3 or higher lesions and reading time using an 8-MP LCD were comparable to those using a 5-MP LCD.

The diagnostic performance of leak-plugging automated segmentation versus manual tracing of breast lesions on ultrasound images.

PubMed

Xiong, Hui; Sultan, Laith R; Cary, Theodore W; Schultz, Susan M; Bouzghar, Ghizlane; Sehgal, Chandra M

2017-05-01

To assess the diagnostic performance of a leak-plugging segmentation method that we have developed for delineating breast masses on ultrasound images. Fifty-two biopsy-proven breast lesion images were analyzed by three observers using the leak-plugging and manual segmentation methods. From each segmentation method, grayscale and morphological features were extracted and classified as malignant or benign by logistic regression analysis. The performance of leak-plugging and manual segmentations was compared by: size of the lesion, overlap area ( O a ) between the margins, and area under the ROC curves ( A z ). The lesion size from leak-plugging segmentation correlated closely with that from manual tracing ( R 2 of 0.91). O a was higher for leak plugging, 0.92 ± 0.01 and 0.86 ± 0.06 for benign and malignant masses, respectively, compared to 0.80 ± 0.04 and 0.73 ± 0.02 for manual tracings. Overall O a between leak-plugging and manual segmentations was 0.79 ± 0.14 for benign and 0.73 ± 0.14 for malignant lesions. A z for leak plugging was consistently higher (0.910 ± 0.003) compared to 0.888 ± 0.012 for manual tracings. The coefficient of variation of A z between three observers was 0.29% for leak plugging compared to 1.3% for manual tracings. The diagnostic performance, size measurements, and observer variability for automated leak-plugging segmentations were either comparable to or better than those of manual tracings.

Breast cancer screening and problem solving using mammography, ultrasound, and magnetic resonance imaging.

PubMed

Hooley, Regina J; Andrejeva, Liva; Scoutt, Leslie M

2011-03-01

Although mammography is the mainstay of early breast cancer detection, it has known limitations, particularly in women with dense breasts. As a result, additional imaging modalities, including ultrasound and contrast-enhanced magnetic resonance imaging, are also being used to supplement mammography in the early detection of occult breast cancer. This article reviews the indications and efficacy of mammography, ultrasound, and magnetic resonance imaging as both screening and diagnostic tools.

Occult pneumomediastinum in blunt chest trauma: clinical significance.

PubMed

Rezende-Neto, J B; Hoffmann, J; Al Mahroos, M; Tien, H; Hsee, L C; Spencer Netto, F; Speers, V; Rizoli, S B

2010-01-01

Thoracic injuries are potentially responsible for 25% of all trauma deaths. Chest X-ray is commonly used to screen patients with chest injury. However, the use of computed tomography (CT) scan for primary screening is increasing, particularly for blunt trauma. CT scans are more sensitive than chest X-ray in detecting intra-thoracic abnormalities such as pneumothoraces and pneumomediastinums. Pneumomediastinum detected by chest X-ray or "overt pneumomediastinum", raises the concern of possible aerodigestive tract injuries. In contrast, there is scarce information on the clinical significance of pneumomediastinum diagnosed by CT scan only or "occult pneumomediastinum". Therefore we investigated the clinical consequences of occult pneumomediastinum in our blunt trauma population. A 2-year retrospective chart review of all blunt chest trauma patients with initial chest CT scan admitted to a level I trauma centre. Data extracted from the medical records include; demographics, occult, overt, or no pneumomediastinum, the presence of intra-thoracic aerodigestive tract injuries (trachea, bronchus, and/or esophagus), mechanism and severity of injury, endotracheal intubation, chest thoracostomy, operations and radiological reports by an attending radiologist. All patients with intra-thoracic aerodigestive tract injuries from 1994 to 2004 were also investigated. Of 897 patients who met the inclusion criteria 839 (93.5%) had no pneumomediastinum. Five patients (0.6%) had overt pneumomediastinum and 53 patients (5.9%) had occult pneumomediastinum. Patients with occult pneumomediastinum had significantly higher ISS and AIS chest (p<0.0001) than patients with no pneumomediastinum. A chest thoracostomy tube was more common (p<0.0001) in patients with occult pneumomediastinum (47.2%) than patients with no pneumomediastinum (10.4%), as well as occult pneumothorax. None of the patients with occult pneumomediastinum had aerodigestive tract injuries (95%CI 0-0.06). Follow up CT scan of

Automated analysis of non-mass-enhancing lesions in breast MRI based on morphological, kinetic, and spatio-temporal moments and joint segmentation-motion compensation technique

NASA Astrophysics Data System (ADS)

Hoffmann, Sebastian; Shutler, Jamie D.; Lobbes, Marc; Burgeth, Bernhard; Meyer-Bäse, Anke

2013-12-01

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) represents an established method for the detection and diagnosis of breast lesions. While mass-like enhancing lesions can be easily categorized according to the Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon, a majority of diagnostically challenging lesions, the so called non-mass-like enhancing lesions, remain both qualitatively as well as quantitatively difficult to analyze. Thus, the evaluation of kinetic and/or morphological characteristics of non-masses represents a challenging task for an automated analysis and is of crucial importance for advancing current computer-aided diagnosis (CAD) systems. Compared to the well-characterized mass-enhancing lesions, non-masses have no well-defined and blurred tumor borders and a kinetic behavior that is not easily generalizable and thus discriminative for malignant and benign non-masses. To overcome these difficulties and pave the way for novel CAD systems for non-masses, we will evaluate several kinetic and morphological descriptors separately and a novel technique, the Zernike velocity moments, to capture the joint spatio-temporal behavior of these lesions, and additionally consider the impact of non-rigid motion compensation on a correct diagnosis.

Mammographic appearances of male breast disease.

PubMed

Appelbaum, A H; Evans, G F; Levy, K R; Amirkhan, R H; Schumpert, T D

1999-01-01

Various male breast diseases have characteristic mammographic appearances that can be correlated with their pathologic diagnoses. Male breast cancer is usually subareolar and eccentric to the nipple. Margins of the lesions are more frequently well defined, and calcifications are rarer and coarser than those occurring in female breast cancer. Gynecomastia usually appears as a fan-shaped density emanating from the nipple, gradually blending into surrounding fat. It may have prominent extensions into surrounding fat and, in some cases, an appearance similar to that of a heterogeneously dense female breast. Although there are characteristic mammographic features that allow breast cancer in men to be recognized, there is substantial overlap between these features and the mammographic appearance of benign nodular lesions. The mammographic appearance of gynecomastia is not similar to that of male breast cancer, but in rare cases, it can mask malignancy. Gynecomastia can be mimicked by chronic inflammation. All mammographically lucent lesions of the male breast appear to be benign, similar to such lesions in the female breast.

Occult urolithiasis in asymptomatic primary hyperparathyroidism.

PubMed

Tay, Yu-Kwang Donovan; Liu, Minghao; Bandeira, Leonardo; Bucovsky, Mariana; Lee, James A; Silverberg, Shonni J; Walker, Marcella D

2018-05-01

Recent international guidelines suggest renal imaging to detect occult urolithiasis in all patients with asymptomatic primary hyperparathyroidism (PHPT), but data regarding their prevalence and associated risk factors are limited. We evaluated the prevalence and risk factors for occult urolithiasis. Cross-sectional analysis of 96 asymptomatic PHPT patients from a university hospital in the United States with and without occult nephrolithiasis. Occult urolithiasis was identified in 21% of patients. Stone formers had 47% higher 24-hour urinary calcium excretion (p = 0.002). Although available in only a subset of patients (n = 28), activated vitamin D [1,25(OH) 2 D] was 29% higher (p = 0.02) in stone formers. There was no difference in demographics, BMI, calcium or vitamin D intake, other biochemistries, renal function, BMD, or fractures. Receiver operating characteristic curves indicated that urinary calcium excretion and 1,25(OH) 2 D had an area under the curve of 0.724 (p = 0.003) and 0.750 (p = 0.04), respectively. A urinary calcium threshold of >211mg/day provided a sensitivity of 84.2% and a specificity of 55.3% while a 1,25(OH) 2 D threshold of >91pg/mL provided a sensitivity and specificity of 62.5% and 90.0% respectively for the presence of stones. Occult urolithiasis is present in about one-fifth of patients with asymptomatic PHPT and is associated with higher urinary calcium and 1,25(OH) 2 D. Given that most patients will not have occult urolithiasis, targeted imaging in those most likely to have occult stones rather than screening all asymptomatic PHPT patients may be useful. The higher sensitivity of urinary calcium versus 1,25(OH) 2 D suggests screening those with higher urinary calcium may be an appropriate approach.

Magnetic resonance imaging-guided core needle breast biopsies resulting in high-risk histopathologic findings: upstage frequency and lesion characteristics.

PubMed

Weinfurtner, R Jared; Patel, Bhavika; Laronga, Christine; Lee, Marie C; Falcon, Shannon L; Mooney, Blaise P; Yue, Binglin; Drukteinis, Jennifer S

2015-06-01

Analysis of magnetic resonance imaging-guided breast biopsies yielding high-risk histopathologic features at a single institution found an overall upstage rate to malignancy of 14% at surgical excision. All upstaged lesions were associated with atypical ductal hyperplasia. Flat epithelial atypia and atypical lobular hyperplasia alone or with lobular carcinoma in situ were not associated with an upstage to malignancy. The purpose of the present study w as to determine the malignancy upstage rates and imaging features of high-risk histopathologic findings resulting from magnetic resonance imaging (MRI)-guided core needle breast biopsies. These features include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), flat epithelial atypia (FEA), and lobular carcinoma in situ (LCIS). A retrospective medical record review was performed on all MRI-guided core needle breast biopsies at a single institution from June 1, 2007 to December 1, 2013 to select biopsies yielding high-risk histopathologic findings. The patient demographics, MRI lesion characteristics, and histopathologic features at biopsy and surgical excision were analyzed. A total of 257 MRI-guided biopsies had been performed, and 50 yielded high-risk histopathologic features (19%). Biopsy site and surgical excision site correlation was confirmed in 29 of 50 cases. Four of 29 lesions (14%) were upstaged: 1 case to invasive ductal carcinoma and 3 cases to ductal carcinoma in situ. ADH alone had an overall upstage rate of 7% (1 of 14), mixed ADH/ALH a rate of 75% (3 of 4), ALH alone or with LCIS a rate of 0% (0 of 7), and FEA a rate of 0% (0 of 4). Only mixed ADH/ALH had a statistically significant upstage rate to malignancy compared with the other high-risk histopathologic subtypes combined. No specific imaging characteristics on MRI were associated with an upstage to malignancy on the statistical analysis. MRI-guided breast biopsies yielding high-risk histopathologic features were associated with

Progress on an external occulter testbed at flight Fresnel numbers

NASA Astrophysics Data System (ADS)

Kim, Yunjong; Sirbu, Dan; Galvin, Michael; Kasdin, N. Jeremy; Vanderbei, Robert J.

2016-01-01

An external occulter is a spacecraft flown along the line-of-sight of a space telescope to suppress starlight and enable high-contrast direct imaging of exoplanets. Laboratory verification of occulter designs is necessary to validate the optical models used to design and predict occulter performance. At Princeton, we have designed and built a testbed that allows verification of scaled occulter designs whose suppressed shadow is mathematically identical to that of space occulters. The occulter testbed uses 78 m optical propagation distance to realize the flight Fresnel numbers. We will use an etched silicon mask as the occulter. The occulter is illuminated by a diverging laser beam to reduce the aberrations from the optics before the occulter. Here, we present first light result of a sample design operating at a flight Fresnel number and the mechanical design of the testbed. We compare the experimental results with simulations that predict the ultimate contrast performance.

Earth rotation derived from occultation records

NASA Astrophysics Data System (ADS)

Sôma, Mitsuru; Tanikawa, Kiyotaka

2016-04-01

We determined the values of the Earth's rotation parameter, ΔT = T T - UT, around AD 500 after confirming that the value of the tidal acceleration, dot{n}, of the lunar motion remained unchanged during the period between ancient times and the present. For determining of ΔT, we used contemporaneous occultations of planets by the Moon. In general, occultation records are not useful. However, there are some records that give us a stringent condition for the range of ΔT. Records of the lunar occultations in AD 503 and AD 513 are such examples. In order to assure the usefulness of this occultation data, we used contemporaneous annular and total solar eclipses, which have not been used in the preceding work. This is the first work in which the lunar occultation data have been used as primary data to determine the value of ΔT together with auxiliary contemporaneous annular and total solar eclipses. Our ΔT value is less than a smoothed value (Stephenson 1997) by at least 450 s. The result is consistent with our earlier results obtained from solar eclipses.

Evolving paradigms in multifocal breast cancer.

PubMed

Salgado, Roberto; Aftimos, Philippe; Sotiriou, Christos; Desmedt, Christine

2015-04-01

The 7th edition of the TNM defines multifocal breast cancer as multiple simultaneous ipsilateral and synchronous breast cancer lesions, provided they are macroscopically distinct and measurable using current traditional pathological and clinical tools. According to the College of American Pathologists (CAP), the characterization of only the largest lesion is considered sufficient, unless the grade and/or histology are different between the lesions. Here, we review three potentially clinically relevant aspects of multifocal breast cancers: first, the importance of a different intrinsic breast cancer subtype of the various lesions; second, the emerging awareness of inter-lesion heterogeneity; and last but not least, the potential introduction of bias in clinical trials due to the unrecognized biological diversity of these cancers. Although the current strategy to assess the lesion with the largest diameter has clearly its advantages in terms of costs and feasibility, this recommendation may not be sustainable in time and might need to be adapted to be compliant with new evolving paradigms in breast cancer. Copyright © 2014 Elsevier Ltd. All rights reserved.

Association of preS/S Mutations with Occult Hepatitis B Virus (HBV) Infection in South Korea: Transmission Potential of Distinct Occult HBV Variants

PubMed Central

Kim, Hong; Kim, Bum-Joon

2015-01-01

Occult hepatitis B virus infection (HBV) is characterized by HBV DNA positivity but HBV surface antigen (HBsAg) negativity. Occult HBV infection is associated with a risk of HBV transmission through blood transfusion, hemodialysis, and liver transplantation. Furthermore, occult HBV infection contributes to the development of cirrhosis and hepatocellular carcinoma. We recently reported the characteristic molecular features of mutations in the preS/S regions among Korean individuals with occult infections caused by HBV genotype C2; the variants of preS and S related to severe liver diseases among chronically infected patients were also responsible for the majority of HBV occult infections. We also reported that HBsAg variants from occult-infected Korean individuals exhibit lower HBsAg secretion capacity but not reduced HBV DNA levels. In addition, these variants exhibit increased ROS-inducing capacity compared with the wild-type strain, linking HBV occult infections to liver cell damage. Taken together, our previous reports suggest the transmission potential of distinct HBV occult infection-related variants in South Korea. PMID:26084041

Association of preS/S Mutations with Occult Hepatitis B Virus (HBV) Infection in South Korea: Transmission Potential of Distinct Occult HBV Variants.

PubMed

Kim, Hong; Kim, Bum-Joon

2015-06-15

Occult hepatitis B virus infection (HBV) is characterized by HBV DNA positivity but HBV surface antigen (HBsAg) negativity. Occult HBV infection is associated with a risk of HBV transmission through blood transfusion, hemodialysis, and liver transplantation. Furthermore, occult HBV infection contributes to the development of cirrhosis and hepatocellular carcinoma. We recently reported the characteristic molecular features of mutations in the preS/S regions among Korean individuals with occult infections caused by HBV genotype C2; the variants of preS and S related to severe liver diseases among chronically infected patients were also responsible for the majority of HBV occult infections. We also reported that HBsAg variants from occult-infected Korean individuals exhibit lower HBsAg secretion capacity but not reduced HBV DNA levels. In addition, these variants exhibit increased ROS-inducing capacity compared with the wild-type strain, linking HBV occult infections to liver cell damage. Taken together, our previous reports suggest the transmission potential of distinct HBV occult infection-related variants in South Korea.

Increased expression of brother of the regulator of imprinted sites in peripheral blood neutrophils is associated with both benign and malignant breast lesions.

PubMed

El-Sharkawy, Nahla M; Radwan, Wafaa M; Essa, Enas S; Kandeel, Eman Z; Abd El-Fattah, Eman K; Kandil, Samia H; Kamel, Azza M

2017-09-01

BORIS, a paralog of the multifunctional CCCTC-binding factor (CTCF) gene is restricted to testis and normally not present in females. It is aberrantly activated in various human cancers including cancer breast. Using immunohistochemistry, western blot and/or RT-PCR, significantly higher levels of BORIS expression were reported in the neutrophils of cancer breast patients. We hypothesized that Flow Cytometry might be a better technique for objective quantitative evaluation of BORIS in neutrophils and we wanted to investigate if BORIS would discriminate between benign and malignant breast lesions. The study included 85 females; 52 breast cancer, 13 benign breast lesions and 20 age-matched healthy controls. BORIS expression in the neutrophils was detected by Flow Cytometry. High level of BORIS was detected in all malignant (64.4 ± 16.6%) and benign cases (67 ± 12.3), mean florescent intensity ratio (MFIR) of 7.2 ± 4.1 and 7 ± 3.5, median 5.8 and 6.6%; and staining index (SI) 8.3 ± 3.9 and 8.2 ± 3.4, median 7.6 and 7.9 respectively vs.13.4 ± 11.5% MFI 1.8 ± 0.7, median1.6 and SI 2.6 ± 0.69, median 2.5 for the control. BORIS level was comparable in the malignant and benign group (P = 0.934) and significantly higher than control (P = 0.0001). There was no correlation between neutrophil BORIS expression and ER/PR status, HER-2/neu expression or tumor stage or size. Increased BORIS expression in peripheral blood neutrophils is associated with both benign and malignant breast lesions; apparently, increased proliferation of breast tissue is the determining factor. This excludes BORIS as a tumor marker but it does not jeopardize its value as a potential therapeutic target. © 2016 International Clinical Cytometry Society. © 2016 International Clinical Cytometry Society.

Three-dimensional shear wave elastography for differentiation of breast lesions: An initial study with quantitative analysis using three orthogonal planes.

PubMed

Wang, Qiao

2018-05-25

To prospectively evaluate the diagnostic performance of three-dimensional (3D) shear wave elastography (SWE) for breast lesions with quantitative stiffness information from transverse, sagittal and coronal planes. Conventional ultrasound (US), two-dimensional (2D)-SWE and 3D-SWE were performed for 122 consecutive patients with 122 breast lesions before biopsy or surgical excision. Maximum elasticity values of Young's modulus (Emax) were recorded on 2D-SWE and three planes of 3D-SWE. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of US, 2D-SWE and 3D-SWE were evaluated. Two combined sets (i.e., BI-RADS and 2D-SWE; BI-RADS and 3D-SWE) were compared in AUC. Observer consistency was also evaluated. On 3D-SWE, the AUC and sensitivity of sagittal plane were significantly higher than those of transverse and coronal planes (both P < 0.05). Compared with BI-RADS alone, both combined sets had significantly (P < 0.05) higher AUCs and specificities, whereas, the two combined sets showed no significant difference in AUC (P > 0.05). However, the combined set of BI-RADS and sagittal plane of 3D-SWE had significantly higher sensitivity than the combined set of BI-RADS and 2D-SWE. The sagittal plane shows the best diagnostic performance among 3D-SWE. The combination of BI-RADS and 3D-SWE is a useful tool for predicting breast malignant lesions in comparison with BI-RADS alone.

Increasing cancer detection yield of breast MRI using a new CAD scheme of mammograms

NASA Astrophysics Data System (ADS)

Tan, Maxine; Aghaei, Faranak; Hollingsworth, Alan B.; Stough, Rebecca G.; Liu, Hong; Zheng, Bin

2016-03-01

Although breast MRI is the most sensitive imaging modality to detect early breast cancer, its cancer detection yield in breast cancer screening is quite low (< 3 to 4% even for the small group of high-risk women) to date. The purpose of this preliminary study is to test the potential of developing and applying a new computer-aided detection (CAD) scheme of digital mammograms to identify women at high risk of harboring mammography-occult breast cancers, which can be detected by breast MRI. For this purpose, we retrospectively assembled a dataset involving 30 women who had both mammography and breast MRI screening examinations. All mammograms were interpreted as negative, while 5 cancers were detected using breast MRI. We developed a CAD scheme of mammograms, which include a new quantitative mammographic image feature analysis based risk model, to stratify women into two groups with high and low risk of harboring mammography-occult cancer. Among 30 women, 9 were classified into the high risk group by CAD scheme, which included all 5 women who had cancer detected by breast MRI. All 21 low risk women remained negative on the breast MRI examinations. The cancer detection yield of breast MRI applying to this dataset substantially increased from 16.7% (5/30) to 55.6% (5/9), while eliminating 84% (21/25) unnecessary breast MRI screenings. The study demonstrated the potential of applying a new CAD scheme to significantly increase cancer detection yield of breast MRI, while simultaneously reducing the number of negative MRIs in breast cancer screening.

Probing Titan's atmosphere with a stellar occultation

NASA Technical Reports Server (NTRS)

Hubbard, W. B.

1991-01-01

The 3 July, 1989 occultation of 28 Sgr by Titan is discussed. The star was readily detectable throughout the occultation, reaching a minimum normalized flux of about 0.05. The occultation probed Titan's atmosphere in a region not studied by the Voyager spacecraft. The region is important for the aerobraking of Titan entry probes, and direct information about its properties is important for the Cassini mission. Occultation data (normalized stellar flux vs universal time) is shown in chart form for NASA supported stations, along with data from a collaborating group at the Wise observatory in Israel. Strong scintillation data of the star is noticeable in the data records, and provides information on waves/turbulence in Titan's high atmosphere.

Flat epithelial atypia of the breast.

PubMed

Nasser, Selim M

2009-01-01

"Flat epithelial atypia" is the adopted term by the WHO working group on breast tumor referring to an early neoplastic breast lesion affecting the terminal duct-lobular units. Pathologists have described this lesion under a variety of names including columnar cell lesions and low-grade clinging carcinoma in situ. It is usually encountered on breast biopsies performed for mammographically-identified microcalcifications. Because of its relatively frequent association with carcinomas, its recognition in biopsy specimens is important. This review will focus on the histopathologic features, differential diagnosis, biologic potential, clinical significance and management of this lesion.

Textural analysis of early-phase spatiotemporal changes in contrast enhancement of breast lesions imaged with an ultrafast DCE-MRI protocol.

PubMed

Milenković, Jana; Dalmış, Mehmet Ufuk; Žgajnar, Janez; Platel, Bram

2017-09-01

New ultrafast view-sharing sequences have enabled breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to be performed at high spatial and temporal resolution. The aim of this study is to evaluate the diagnostic potential of textural features that quantify the spatiotemporal changes of the contrast-agent uptake in computer-aided diagnosis of malignant and benign breast lesions imaged with high spatial and temporal resolution DCE-MRI. The proposed approach is based on the textural analysis quantifying the spatial variation of six dynamic features of the early-phase contrast-agent uptake of a lesion's largest cross-sectional area. The textural analysis is performed by means of the second-order gray-level co-occurrence matrix, gray-level run-length matrix and gray-level difference matrix. This yields 35 textural features to quantify the spatial variation of each of the six dynamic features, providing a feature set of 210 features in total. The proposed feature set is evaluated based on receiver operating characteristic (ROC) curve analysis in a cross-validation scheme for random forests (RF) and two support vector machine classifiers, with linear and radial basis function (RBF) kernel. Evaluation is done on a dataset with 154 breast lesions (83 malignant and 71 benign) and compared to a previous approach based on 3D morphological features and the average and standard deviation of the same dynamic features over the entire lesion volume as well as their average for the smaller region of the strongest uptake rate. The area under the ROC curve (AUC) obtained by the proposed approach with the RF classifier was 0.8997, which was significantly higher (P = 0.0198) than the performance achieved by the previous approach (AUC = 0.8704) on the same dataset. Similarly, the proposed approach obtained a significantly higher result for both SVM classifiers with RBF (P = 0.0096) and linear kernel (P = 0.0417) obtaining AUC of 0.8876 and 0.8548, respectively

Io hot spots - Infrared photometry of satellite occultations

NASA Technical Reports Server (NTRS)

Goguen, J. D.; Matson, D. L.; Sinton, W. M.; Howell, R. R.; Dyck, H. M.

1988-01-01

Io's active hot spots, which are presently mapped on the basis of IR photometry of this moon's occultation by other Gallilean satellites, are obtained with greatest spatial resolution near the sub-earth point. A model is developed for the occultation lightcurves, and its fitting to the data defines the apparent path of the occulting satellite relative to Io; the mean error in apparent relative position of occulting satellites is of the order of 178 km. A heretofore unknown, 20-km diameter hot spot is noted on Io's leading hemisphere.

Strong scintillations during atmospheric occultations Theoretical intensity spectra. [radio scattering during spacecraft occultations by planetary atmospheres

NASA Technical Reports Server (NTRS)

Hinson, D. P.

1986-01-01

Each of the two Voyager spacecraft launched in 1977 has completed a reconnaissance of the Jovian and Saturnian systems. In connection with occultation experiments, strong scintillations were observed. Further theoretical work is required before these scintillations can be interpreted. The present study is, therefore, concerned with the derivation of a theory for strong scattering during atmospheric occultation experiments, taking into account as fundamental quantity of interest the spatial spectrum (or spectral density) of intensity fluctuations. Attention is given to a theory for intensity spectra, and numerical calculations. The new formula derived for Phi-i accounts for strong scattering of electromagnetic waves during atmospheric occultations.

OCCULT-ORSER complete conversational user-language translator

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.; Young, K.

1981-01-01

Translator program (OCCULT) assists non-computer-oriented users in setting up and submitting jobs for complex ORSER system. ORSER is collection of image processing programs for analyzing remotely sensed data. OCCULT is designed for those who would like to use ORSER but cannot justify acquiring and maintaining necessary proficiency in Remote Job Entry Language, Job Control Language, and control-card formats. OCCULT is written in FORTRAN IV and OS Assembler for interactive execution.

Sizes, Shapes, and Satellites of Asteroids from Occultations

NASA Astrophysics Data System (ADS)

Waring Dunham, David; Herald, David Russell; Preston, Steve; Timerson, Bradley; Maley, Paul; Frappa, Eric; Hayamizu, Tsutomu; Talbot, John; Poro, Atila

2015-08-01

For 40 years, the sizes and shapes of dozens of asteroids have been determined from observations of asteroidal occultations. Some of the first evidence for satellites of asteroids was obtained from the early efforts; now, the orbits and sizes of some satellites discovered by other means have been refined from occultation observations. Also, several close binary stars have been discovered, and the angular diameters of some stars have been measured from analysis of these observations. The International Occultation Timing Association (IOTA) coordinates this activity worldwide, from predicting and publicizing the events, to accurately timing the occultations from as many stations as possible, and publishing and archiving the observations.The release of the Hipparcos and Tycho catalogs in 1997, from ESA’s Hipparcos space mission, revolutionized asteroidal occultation work, increasing the routine accuracy of the predictions and the annual number of observations by an order of magnitude. IOTA developed an efficient procedure for predicting the occultations using a combination of new star catalogs, based on Hipparcos and new star catalogs, generated mainly at the U. S. Naval Observatory (USNO), and new observations of asteroids relative to the improved astrometric nets mainly from USNO’s Flagstaff Astrometric Scanning Transit Telescope and JPL’s Table Mountain Observatory. In addition, many IOTA observers now use inexpensive low-light-level video cameras and specially built GPS video time inserters to accurately time the events. This automation has also allowed some observers to deploy multiple remote video stations across occultation paths. Then, one observer can record several “chords” across the asteroid. The cameras are sensitive enough that easily-hidden telescopes, many of which can be packed in standard air travel suitcases, can be used for many of the predicted occultations. IOTA’s network of regional coordinators collect and reduce the observations

Shear wave elastography in the diagnosis of breast non-mass lesions: factors associated with false negative and false positive results.

PubMed

Park, So Yoon; Choi, Ji Soo; Han, Boo-Kyung; Ko, Eun Young; Ko, Eun Sook

2017-09-01

To investigate factors related to false shear wave elastography (SWE) results for breast non-mass lesions (NMLs) detected by B-mode US. This retrospective study enrolled 152 NMLs detected by B-mode US and later pathologically confirmed (79 malignant, 73 benign). All lesions underwent B-mode US and SWE. Quantitative (mean elasticity [E mean ]) and qualitative (maximum stiffness colour) SWE parameters were assessed, and 'E mean  > 85.1 kPa' or 'stiff colour (green to red)' determined malignancy. Final SWE results were matched to pathology results. Multivariate logistic regression analysis identified factors associated with false SWE results for diagnosis of breast NMLs. Associated calcifications (E mean : odds ratio [OR] = 7.60, P < 0.01; maximum stiffness colour: OR = 6.30, P = 0.02), in situ cancer compared to invasive cancer (maximum stiffness colour: OR = 5.29, P = 0.02), and lesion size (E mean : OR = 0.90, P < 0.01; maximum stiffness colour: OR = 0.91, P = 0.01) were significantly associated with false negative SWE results for malignant NMLs. Distance from the nipple (E mean : OR = 0.84, P = 0.03; maximum stiffness colour: OR = 0.93, P = 0.04) was significantly associated with false positive SWE results for benign NMLs. Presence of associated calcifications, absence of the invasive component, and smaller lesion size for malignant NMLs and shorter distance from the nipple for benign NMLs are factors significantly associated with false SWE results. • Calcification and size are associated with false negative SWE in malignant NMLs. • In situ cancer is associated with false negative SWE in malignant NMLs. • Distance from the nipple is associated with false positive SWE in benign NMLs. • These factors need consideration when performing SWE on breast NMLs.

Applying a new unequally weighted feature fusion method to improve CAD performance of classifying breast lesions

NASA Astrophysics Data System (ADS)

Zargari Khuzani, Abolfazl; Danala, Gopichandh; Heidari, Morteza; Du, Yue; Mashhadi, Najmeh; Qiu, Yuchen; Zheng, Bin

2018-02-01

Higher recall rates are a major challenge in mammography screening. Thus, developing computer-aided diagnosis (CAD) scheme to classify between malignant and benign breast lesions can play an important role to improve efficacy of mammography screening. Objective of this study is to develop and test a unique image feature fusion framework to improve performance in classifying suspicious mass-like breast lesions depicting on mammograms. The image dataset consists of 302 suspicious masses detected on both craniocaudal and mediolateral-oblique view images. Amongst them, 151 were malignant and 151 were benign. The study consists of following 3 image processing and feature analysis steps. First, an adaptive region growing segmentation algorithm was used to automatically segment mass regions. Second, a set of 70 image features related to spatial and frequency characteristics of mass regions were initially computed. Third, a generalized linear regression model (GLM) based machine learning classifier combined with a bat optimization algorithm was used to optimally fuse the selected image features based on predefined assessment performance index. An area under ROC curve (AUC) with was used as a performance assessment index. Applying CAD scheme to the testing dataset, AUC was 0.75+/-0.04, which was significantly higher than using a single best feature (AUC=0.69+/-0.05) or the classifier with equally weighted features (AUC=0.73+/-0.05). This study demonstrated that comparing to the conventional equal-weighted approach, using an unequal-weighted feature fusion approach had potential to significantly improve accuracy in classifying between malignant and benign breast masses.

A hybrid deep learning approach to predict malignancy of breast lesions using mammograms

NASA Astrophysics Data System (ADS)

Wang, Yunzhi; Heidari, Morteza; Mirniaharikandehei, Seyedehnafiseh; Gong, Jing; Qian, Wei; Qiu, Yuchen; Zheng, Bin

2018-03-01

Applying deep learning technology to medical imaging informatics field has been recently attracting extensive research interest. However, the limited medical image dataset size often reduces performance and robustness of the deep learning based computer-aided detection and/or diagnosis (CAD) schemes. In attempt to address this technical challenge, this study aims to develop and evaluate a new hybrid deep learning based CAD approach to predict likelihood of a breast lesion detected on mammogram being malignant. In this approach, a deep Convolutional Neural Network (CNN) was firstly pre-trained using the ImageNet dataset and serve as a feature extractor. A pseudo-color Region of Interest (ROI) method was used to generate ROIs with RGB channels from the mammographic images as the input to the pre-trained deep network. The transferred CNN features from different layers of the CNN were then obtained and a linear support vector machine (SVM) was trained for the prediction task. By applying to a dataset involving 301 suspicious breast lesions and using a leave-one-case-out validation method, the areas under the ROC curves (AUC) = 0.762 and 0.792 using the traditional CAD scheme and the proposed deep learning based CAD scheme, respectively. An ensemble classifier that combines the classification scores generated by the two schemes yielded an improved AUC value of 0.813. The study results demonstrated feasibility and potentially improved performance of applying a new hybrid deep learning approach to develop CAD scheme using a relatively small dataset of medical images.

The role of cone-beam breast-CT for breast cancer detection relative to breast density.

PubMed

Wienbeck, Susanne; Uhlig, Johannes; Luftner-Nagel, Susanne; Zapf, Antonia; Surov, Alexey; von Fintel, Eva; Stahnke, Vera; Lotz, Joachim; Fischer, Uwe

2017-12-01

To evaluate the impact of breast density on the diagnostic accuracy of non-contrast cone-beam breast computed tomography (CBBCT) in comparison to mammography for the detection of breast masses. A retrospective study was conducted from August 2015 to July 2016. Fifty-nine patients (65 breasts, 112 lesions) with BI-RADS, 5th edition 4 or 5 assessment in mammography and/or ultrasound of the breast received an additional non-contrast CBBCT. Independent double blind reading by two radiologists was performed for mammography and CBBCT imaging. Sensitivity, specificity and AUC were compared between the modalities. Breast lesions were histologically examined in 85 of 112 lesions (76%). The overall sensitivity for CBBCT (reader 1: 91%, reader 2: 88%) was higher than in mammography (both: 68%, p<0.001), and also for the high-density group (p<0.05). The specificity and AUC was higher for mammography in comparison to CBBCT (p<0.05 and p<0.001). The interobserver agreement (ICC) between the readers was 90% (95% CI: 86-93%) for mammography and 87% (95% CI: 82-91%) for CBBCT. Compared with two-view mammography, non-contrast CBBCT has higher sensitivity, lower specificity, and lower AUC for breast mass detection in both high and low density breasts. • Overall sensitivity for non-contrast CBBCT ranged between 88%-91%. • Sensitivity was higher for CBBCT than mammography in both density types (p<0.001). • Specificity was higher for mammography than CBBCT in both density types (p<0.05). • AUC was larger for mammography than CBBCT in both density types (p<0.001).

The occult submucous cleft palate.

PubMed

Kaplan, E N

1975-10-01

We have studied 41 patients with classic submucous cleft and 32 cases with occult submucous cleft. Both groups have the same anatomic abnormality that leads to velar dysfunction-the insertion of the palate muscles onto the hard palate rather than onto the midline soft palate raphe. However, the occult submucous cleft palate does not have the classic triad of bifid uvula, hard palate bony notch, and furrow in the midline of the soft palate. Characteristic facial features, cephalmetric x-rays, and cine voice studies can help make a presumptive diagnosis of occult submucous cleft palate. Surgical management includes a diagnostic palate exploration to identify muscle configuration followed by levator muscle sling reconstruction, palate pushback, and pharyngeal flap. Excellent speech results are obtained except with patients having palate paresis.

Incidence of inflammatory breast cancer in patients with clinical inflammatory breast symptoms

PubMed Central

Pons, Kelly; Mabille, Mylène; Abd alsamad, Issam; Mitri, Rana; Skalli, Dounia; Haddad, Bassam

2017-01-01

Background To describe a large cohort of women with non-puerperal inflammatory breast and to identify characteristics of inflammatory breast cancer. Methods All patients consulting for inflammatory breast syndrome in the breast unit of our tertiary University hospital between September 2013 and December 2015 were prospectively included. We excluded women who were pregnant or in the postpartum period. Patients underwent systematic clinical examination and imaging (breast ultrasonography and mammography). A biopsy was performed if the clinician suspected a malignant lesion of the breast. Clinicopathologic and radiologic data were registered. Statistics were performed using R (3.0.2 version) software. Results Among the 76 patients screened and included, 38 (50%) had a malignant lesion at final diagnosis, 21 (27.6%) were diagnosed with infectious disease and 17 (22.4%) with inflammatory disease of the breast. When compared to patients with benign disease, patients with a malignant lesion were significantly older (p = 0.022, CI95% 1.78–14.7), had a significantly bigger palpable mass (p<0.001, CI 95% 22.8–58.9), were more likely to have skin thickening (p = 0.05) and had more suspicious lymph nodes at clinical examination (p<0.001, CI 95% 2.72–65.3). Precise limits on ultrasonography were significantly associated with benign lesions. The presence of a mass (p = 0.04), micro calcifications (p = 0.04) or of focal asymmetry (p<0.001, CI95% 1.3–618) on mammography was significantly associated with malignant disease. Conclusion Inflammatory breast cancer was common in our cohort of women consulting for inflammatory breast syndrome. Identifying these patients with high-risk malignancy is crucial in the management of an inflammatory breast. PMID:29261724

Columnar cell lesions without atypia initially diagnosed on breast needle biopsies: is imaging follow-up enough?

PubMed

Seo, Mirinae; Chang, Jung Min; Kim, Won Hwa; Park, In-Ae; Lee, Su Hyun; Cho, Nariya; Moon, Woo Kyung

2013-10-01

The purpose of this study was to evaluate the underestimation rate and predictive factor of underestimation of columnar cell lesions (CCLs) without atypia diagnosed through breast core needle biopsies (CNBs). From January 2007 through December 2011, 141 CCLs without atypia, including columnar cell change and columnar cell hyperplasia, were diagnosed in 138 women by CNB. Excisional (n = 16) or imaging follow-up (n = 125) findings were available in all cases. On a per-lesion basis, the underestimation rate and predictive factor of underestimation were evaluated. Among the 16 surgically excised lesions, there were two malignancies (one ductal carcinoma in situ and one invasive ductal carcinoma) and one lobular carcinoma in situ. Overall, the pooled underestimation rate of malignancy was 1.4% (2/141). With regard to lesion variables, the mean lesion size was significantly larger in the underestimation group of CCLs (p = 0.007). Fine pleomorphic morphology of microcalcifications (p < 0.001), the distribution of the microcalcifications (p = 0.007), BI-RADS final assessment (p = 0.001), and imaging-pathologic correlation (p < 0.001) were significantly associated with underestimation. Multivariate analysis showed that fine pleomorphic morphology of microcalcifications (p < 0.0001) was an independent predictor of underestimation in 58 lesions with microcalcifications on mammography. The overall underestimation rate of malignancy was 1.4%. Imaging follow-up is reasonable for CCLs without atypia at CNB, especially in small lesions with less suspicious imaging findings. Fine pleomorphic microcalcifications and higher BI-RADS category might be helpful in the prediction of underestimation of a high-risk lesion or malignancy.

[Sentinel lymph node metastasis in patients with ductal breast carcinoma in situ].

PubMed

Ruvalcaba-Limón, Eva; de Jesús Garduño-Raya, María; Bautista-Piña, Verónica; Trejo-Martínez, Claudia; Maffuz-Aziz, Antonio; Rodríguez-Cuevas, Sergio

2014-01-01

Sentinel lymph node biopsy in patients with ductal carcinoma in situ still controversial, with positive lymph node in range of 1.4-12.5% due occult invasive breast carcinoma in surgical specimen. To know the frequency of sentimel node metastases in patients with ductal carcinoma in situ, identify differences between positive and negative cases. Retrospective study of patients with ductal carcinoma in situ treated with sentinel lymph node biopsy because mastectomy indication, palpable tumor, radiological lesion = 5 cm, non-favorable breast-tumor relation and/or patients whom surgery could affect lymphatic flow drainage. Of 168 in situ carcinomas, 50 cases with ductal carcinoma in situ and sentinel lymph node biopsy were included, with a mean age of 51.6 years, 30 (60%) asymptomatic. The most common symptoms were palpable nodule (18%), nipple discharge (12%), or both (8%). Microcalcifications were common (72%), comedonecrosis pattern (62%), grade-2 histology (44%), and 28% negative hormonal receptors. Four (8%) cases had intra-operatory positive sentinel lymph node and one patient at final histo-pathological study (60% micrometastases, 40% macrometastases), all with invasive carcinoma in surgical specimen. Patients with intra-operatory positive sentinel lymph node where younger (44.5 vs 51 years), with more palpable tumors (50% vs 23.1%), and bigger (3.5 vs 2 cm), more comedonecrosis pattern (75% vs 60.8%), more indifferent tumors (75% vs 39.1%), and less cases with hormonal receptors (50% vs 73.9%), compared with negative sentinel lymph node cases, all these differences without statistic significance. One of each 12 patients with ductal carcinoma in situ had affection in sentinel lymph node, so we recommend continue doing this procedure to avoid second surgeries due the presence of occult invasive carcinoma.

Study of the technique of stellar occultation

NASA Technical Reports Server (NTRS)

Hays, P. B.; Graves, M. E.; Roble, R. G.; Shah, A. N.

1973-01-01

The results are reported of a study of the stellar occultation technique for measuring the composition of the atmosphere. The intensity of starlight was monitored during the occultation using the Wisconsin stellar ultraviolet photometers aboard the Orbiting Astronomical Observatory (OAO-A2). A schematic diagram of an occultation is shown where the change in intensity at a given wavelength is illustrated. The vertical projection of the attenuation region is typically 60 km deep for molecular oxygen and 30 km deep for ozone. Intensity profiles obtained during various occultations were analyzed by first determining the tangential columm density of the absorbing gases, and then Abel inverting the column densities to obtain the number density profile. Errors are associated with each step in the inversion scheme and have been considered as an integral part of this study.

Diagnostic value of (99m)Tc-3PRGD2 scintimammography for differentiation of malignant from benign breast lesions: Comparison of visual and semi-quantitative analysis.

PubMed

Chen, Qianqian; Xie, Qian; Zhao, Min; Chen, Bin; Gao, Shi; Zhang, Haishan; Xing, Hua; Ma, Qingjie

2015-01-01

To compare the diagnostic value of visual and semi-quantitative analysis of technetium-99m-poly-ethylene glycol, 4-arginine-glycine-aspartic acid ((99m)Tc-3PRGD2) scintimammography (SMG) for better differentiation of benign from malignant breast masses, and also investigate the incremental role of semi-quantitative index of SMG. A total of 72 patients with breast lesions were included in the study. Technetium-99m-3PRGD2 SMG was performed with single photon emission computed tomography (SPET) at 60 min after intravenous injection of 749 ± 86MBq of the radiotracer. Images were evaluated by visual interpretation and semi-quantitative indices of tumor to non-tumor (T/N) ratios, which were compared with pathology results. Receiver operating characteristics (ROC) curve analyses were performed to determine the optimal visual grade, to calculate cut-off values of semi-quantitative indices, and to compare visual and semi-quantitative diagnostic values. Among the 72 patients, 89 lesions were confirmed by histopathology after fine needle aspiration biopsy or surgery, 48 malignant and 41 benign lesions. The mean T/N ratio of (99m)Tc-3PRGD2 SMG in malignant lesions was significantly higher than that in benign lesions (P<0.05). When grade 2 of the disease was used as cut-off value for the detection of primary breast cancer, the sensitivity, specificity and accuracy were 81.3%, 70.7%, and 76.4%, respectively. When a T/N ratio of 2.01 was used as cut-off value, the sensitivity, specificity and accuracy were 79.2%, 75.6%, and 77.5%, respectively. According to ROC analysis, the area under the curve for semi-quantitative analysis was higher than that for visual analysis, but the statistical difference was not significant (P=0.372). Compared with visual analysis or semi-quantitative analysis alone, the sensitivity, specificity and accuracy of visual analysis combined with semi-quantitative analysis in diagnosing primary breast cancer were higher, being: 87.5%, 82.9%, and 85

An effective approach of lesion segmentation within the breast ultrasound image based on the cellular automata principle.

PubMed

Liu, Yan; Cheng, H D; Huang, Jianhua; Zhang, Yingtao; Tang, Xianglong

2012-10-01

In this paper, a novel lesion segmentation within breast ultrasound (BUS) image based on the cellular automata principle is proposed. Its energy transition function is formulated based on global image information difference and local image information difference using different energy transfer strategies. First, an energy decrease strategy is used for modeling the spatial relation information of pixels. For modeling global image information difference, a seed information comparison function is developed using an energy preserve strategy. Then, a texture information comparison function is proposed for considering local image difference in different regions, which is helpful for handling blurry boundaries. Moreover, two neighborhood systems (von Neumann and Moore neighborhood systems) are integrated as the evolution environment, and a similarity-based criterion is used for suppressing noise and reducing computation complexity. The proposed method was applied to 205 clinical BUS images for studying its characteristic and functionality, and several overlapping area error metrics and statistical evaluation methods are utilized for evaluating its performance. The experimental results demonstrate that the proposed method can handle BUS images with blurry boundaries and low contrast well and can segment breast lesions accurately and effectively.

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions.

PubMed

Fernández-García, P; Marco-Doménech, S F; Lizán-Tudela, L; Ibáñez-Gual, M V; Navarro-Ballester, A; Casanovas-Feliu, E

To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Right upper-quadrant pain in a patient with drug abuse, secondary syphilis and occult hepatitis B virus.

PubMed

Fielding, Cory M; Angulo, Paul

2014-01-01

To describe the etiology of hepatitis and identify occult hepatitis B virus (HBV) infection. A 40-year-old man presented with severe abdominal pain and jaundice, a history of acute HBV infection that had cleared as well as the use of acetaminophen, methamphetamine, buprenorphine and marijuana. He admitted to having had unprotected sex with multiple partners of both genders. A thorough skin examination revealed papulosquamous lesions on his penis, scrotum, upper and lower extremities and feet. Transaminases and bilirubin were elevated. His rapid plasma reagin was reactive, and hepatitis serologies showed occult HBV. Liver biopsy showed severe hepatitis, but the stains for hepatitis B surface antigen and hepatitis B core antigen were negative. The pathological findings were highly indicative of drug-induced hepatitis without evidence of chronic hepatitis, reactivation of HBV or syphilitic hepatitis. With supportive management and abstinence from drugs, his condition improved. This case describes a patient with multiple potential causes for hepatitis and highlights the importance of obtaining a detailed social history. Further, one should consider the presence of occult HBV and recognize the serologic pattern. © 2014 S. Karger AG, Basel.