Nachiko Uchiyama

Diagnostic Usefulness of Synthetic MMG SMMG with DBT Digital Breast Tomosynthesis for Clinical Setting in Breast Cancer Screening

We evaluated the diagnostic performance of a novel image processing technique of synthetic MMG SMMG as 2D-like visualization approach with and without DBT slice images DBT compared with that of 2D MMG MMG alone. With one-view MMG and DBT, the radiation doses, utilizing the ACR phantom 156, were 1.20i¾?mGy and 1.80i¾?mGy. The number of the cases was 108. MMG, SMMG, and DBT slice images were evaluated independently by 4 readers utilizing ROC analysis and diagnostic performance. SMMG plus DBT demonstrated higher area under the curve AUC and superior diagnostic accuracy with sensitivity, specificity, and NPV compared with SMMG and MMG alone pi¾?<i¾?0.05. In addition, a 40i¾?% decrease of radiation dose with SMMG plus DBT compared with MMG plus DBT as the current setting will enable us to apply a two-view SMMG plus DBT in breast cancer screening instead of MMG.

Assessing Radiologist Performance and Microcalcifications Visualization Using Combined 3D Rotating Mammogram (RM) and Digital Breast Tomosynthesis (DBT)

We evaluated the diagnostic performance of a novel 3D visualization approach (rotating mammogram, RM) in combination with DBT compared with that of FFDM and DBT alone.. FFDM, DBT alone and DBT images plus reconstructed RM from 110 breasts (34 cases of breast cancer and 76 normal breasts) were evaluated and rated independently by 6 readers. DBT plus RM demonstrated superior diagnostic accuracy compared to FFDM (p<0.05) and a small improvement in performance compared to DBT alone. Visualization of microcalcifications was significantly better on RM than DBT (p<0.05) for all 14 microcalcification-dominant cancer lesions. Adjunction of RM to DBT will offer the benefit of increased diagnostic accuracy and contribute to more accurate assessment of DBT alone.

Clinical Efficacy of Novel Image Processing Techniques in the Framework of Filtered Back Projection (FBP) with Digital Breast Tomosynthesis (DBT)

Digital breast tomosynthesis (DBT) slices are reconstructed from projections acquired within a limited angular range. Out-of-plane artifacts are inevitable in reconstructed DBT images. In this study, we evaluated novel image processing techniques in the framework of filtered backprojection (FBP) and compared the results with reconstruction using a previously used FBP method. The novel FBP reconstruction has an adapted filter kernel, uses unbinned projections, performs an adaptive collapsing scheme and statistical artifact reduction, and applies iterative filtering in the image domain. Fifty-four image pairs were evaluated by three experienced radiologists. The images were compared on a 7-point scale (-3, -2, -1, 0, +1, +2, and +3) according to the following five categories: (1) visibility of noise, (2) diagnostic certainty regarding masses, (3) diagnostic certainty regarding microcalcifications, (4) visibility of structures in the pectoral muscle, and (5) overall image quality. The results showed a statistically significant superiority of the novel FBP reconstruction in comparison with standard FBP (p < 0.05). In particular, the improvement of the diagnostic certainty related to microcalcifications with the novel FBP is noteworthy.

Diagnostic impact of adjunction of digital breast tomosynthesis (DBT) to full field digital mammography (FFDM) and in comparison with full field digital mammography (FFDM)

According to recent reports, DBT is a useful diagnostic procedure compared to 2D mammography. In this paper, we evaluated the diagnostic impact of adjunction of DBT to FFDM and in comparison with FFDM only, in accordance with pathological findings and breast density. 303 women, having 333 lesions, (age 29-84, mean age 54.0 years old) that were recruited for this study gave informed consent. The results indicated that adjunction of DBT to FFDM was superior to FFDM only, regarding diagnostic performance.

Optimization of Digital Breast Tomosynthesis (DBT) for Breast Cancer Diagnosis

Recent papers have reported the usefulness of DBT as the latest diagnostic modality for breast cancer [1]-[6]. In this chapter, the author describes clinical evaluation of the usefulness regarding DBT with reference to other diagnostic modalities such as Full Field Digital Mammography (FFDM), contrast-enhanced (CE) MRI, contrast-enhanced (CE) CT, and ultrasound (US) in accordance with preliminary experiences in breast cancer diagnosis.

How can image quality affect the detection performance of breast CAD (computer aided detection) in FFDM (full field digital mammography)? – a comparative study with two different FFDM systems-

This study was conducted to retrospectively evaluate the variation of CAD performance utilizing two different FFDM systems in normal clinical cases.

Preliminary experiences of DBT (digital breast tomosynthesis) and hybrid 18F-FDG-PET/MR (PETMR) for neoadjuvant chemotherapy (NAC) cases in breast cancer.

Twenty-six patients with 27 invasive breast cancers were enrolled and MMG+DBT, US, and PETMR were obtained before and after NAC. The clinical response to chemotherapy was classified into the following categories, based on the RECIST and pathological response was classified in accordance with JBCS. Among Grade 3 (n=7), MMG+DBT demonstrated as CR by 71.4% and as PR by 28.6%. Among PR lesions, estimated pathological response was Grade 2 (n=2). PETMR demonstrated as PR by 57.1% and as CR by 42.9%. Among PR lesions, estimated pathological response was Grade 2 (n=4). FDG uptake was positive before and negative after NAC with all primary lesions. Among Grades 1b-2 (n=15), MMG +DBT demonstrated as PR by 76.3% (n=11) and four as CR by 26.7% (n=4). Among PR lesions, estimated pathological response were Grade 1b (n=5) and Grade 2 (n=6). PETMR demonstrated as PR by 80.0% and as CR by 20.0%. Among PR lesions, estimated pathological response were Grade 1b (n=3) and Grade 2 (n=9). After NAC, FDG uptake was positive in primary lesions by 20.0% (n=3). Among Grade 0-1a (n=5), MMG+DBT demonstrated as SD by 60.0 % and as PR by 40.0%. Among PR lesions, estimated pathological response were Grade 1b (n=1) and Grade 2 (n=1). PETMR demonstrated as SD by 40.0 % and as PR by 60.0%. Among PR lesions, estimated pathological response were Grade 1b (n=2) and Grade 2 (n=1). After NAC, FDG uptake was positive in primary lesions by 80.0% (n=4).

Usefulness of digital breast tomosynthesis (DBT) in evaluation of pathological response after neoadjuvant chemotherapy (NAC) for breast cancer.

119 Background: Digital breast tomosynthesis (DBT) has been developed recently and it provides an advantage in detection of breast masses compared to 2D mammography (MMG) since it allows to separate the tissue layers and to noticeably reduce occlusions caused by overlapping anatomical structures. Neoadjuvant chemotherapy (NAC) has been used increasingly for the treatment of breast cancer. The imaging methods that have been used until now to assess tumor response to NAC have serious limitations. Attaining pathological complete response (pCR) is the most important predictor of long-term survival in patients receiving NAC. We assessed the radiological findings and capability of DBT to predict response to NAC in comparison with 2D MMG. METHODS 33 woman (mean age, 47.3 y.o.) having 36 lesions were recruited. Image utilizing adjunction of DBT to 2D MMG were taken for diagnosis from January, 2010 to March, 2015. Pathological subtypes were IDC (n = 34), ILC (n = 1), and IMPC (n = 1). Pathological responses of the lesions to NAC were Grade1 (n = 16), Grade2 (n = 11), and Grade3 (n = 9). The clinical image data sets were acquired with a DBT system (MAMMOMAT Inspiration, Siemens, Germany).For each patient, CC and MLO views were taken for diagnosis. With one-view 2D MMG and DBT, those radiation dose, utilizing the ACR phantom 156, were 1.20mGy and 1.80mGy. RESULTS The clinical response to NAC was classified into the following categories: 1) Fairly Response (FR): reduction in size of the tumor by more than 70% including Complete Response (CR), 2) Partial Response (PR): reduction in size of the tumor by 30% or more but less than 70%, 3) Stable disease (SD): reduction in size of the tumor by less than 30%. DBT findings of pathological Grade2-3 cases were all suggested FR (28/28, 100.0%) Grade3 cases were all suggested CR (9/9,100.0%). Regarding the Grade1b cases, all lesions were suggested PR (8/8, 100.0%). Regarding the Grade1a cases, 3 out of 8 (36.5%) lesions were suggested CR, and 2 out of 8 (25%) lesions suggested PR, and 3 out of 8 lesions suggested SD. CONCLUSIONS DBT will contribute to improved diagnosis accuracy with regard to NAC response to breast cancer in comparison with 2D MMG.

Usefulness of a Combination DBT (Digital Breast Tomosynthesis) and Automated Volume Analysis of Dynamic Contrast-Enhanced Breast (DCEB) MRI in Evaluation of Response to Neoadjuvant Chemotherapy (NAC)

We evaluated the usefulness of DBT and automated volume analysis with DCEB MRI to assess its potential role in estimating viable tumor volume in pre-and pos-t NAC images in response to treatment in comparison with FFDM and US. Twenty women having 21 lesions, in total were recruited for this study.The diagnostic procedures were performed within one month prior to surgery. FFDM, DBT, US and DCEB MRI were performed on each of the patients before and after NAC. The imaging data was analyzed by a medical workstation dedicated to breast MRI imaging. Utilizing the dynamic contrast images from 1st to 4th phase, volume statistics with VOI (volume of interest) and the volume was automatically calculated and evaluated as to the efficacy of NAC. DBT has the advantage of providing macroscopic pathological fidings in total without utitiling contrast medium. On the other hand, DCEB MRI has the advantage of providing numerical and detailed vascularity details of viable areas. In accordance with the results, a combination of DBT and automated volume analysis of DCEB MRI will contribute to more accurate diagnosis in the assessment of pathological response to NAC.

Usefulness of adjunction of digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in evaluation of pathological response after neoadjuvant chemotherapy (NAC) for breast cancer

We assessed the radiological findings and capability of DBT in adjunction to FFDM to predict response to NAC in comparison with other diagnostic modalities. 25 women (ages 29-73, mean age, 53.0 years old) having 26 lesions were recruited for this study and gave informed consent. In accordance with this preliminary study, the adjunction of DBT to FFDM combined with other diagnostic modalities will contribute to more accurate assessment of pathological response to NAC.