Susanne Luftner-Nagel

Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography

Abstract. The goal of this prospective study was to compare a full-field digital mammography system (FFDM) to a conventional screen-film mammography system (SFM) for the detection and characterization of microcalcifications. Fifty-five patients with 57 isolated microcalcification clusters were examined using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, Wis.) and a SFM system (Senographe DMR, GE Medical Systems, Milwaukee, Wis.). A conventional screen-film mammogram and a digital contact mammogram were obtained of each cluster. The image quality and the number of calcification particles were evaluated, and a characterization (BI-RADS 1–5) of microcalcifications was given by four experienced readers. Histopathology revealed 16 benign lesions (sclerosing adenosis, dysplasia, hamartoma, radial scar) in 15 patients and 21 malignant tumors (in situ carcinoma, invasive carcinoma) in 20 patients. Twenty patients had benign changes verified by long-term follow-up. Image quality of FFDM was assessed as superior to SFM in more than 50% of the cases. The FFDM showed more calcifications in 41% of all cases. Sensitivity and specificity for FFDM vs SFM were 95.2 vs 91.9% and 41.4 vs 39.3%, respectively. Moreover, FFDM demonstrated a higher diagnostic accuracy (deviation: 0.86 BI-RADS steps) compared with FSM (deviation 0.93 BI-RADS steps). The FFDM system with a 100-µm pixel size provides better image quality than SFM in patients with mammographic microcalcifications. The FFDM has a higher sensitivity and a higher reliability in characterizing microcalcifications.

MRI of the breast in patients with metastatic disease of unknown primary

Abstract. The objective of this study was to assess the value of contrast-enhanced dynamic breast imaging in patients with carcinoma of unknown primary (CUP). Fourteen patients presenting with metastatic disease compatible with breast cancer (axillary lymph node metastasis: n = 6; supraclavicular lymph node metastasis: n = 1; bone metastasis: n = 3; liver metastasis: n = 3; lung metastasis: n = 1), who had no evidence of tumor in X-ray mammograms and ultrasound, underwent bilateral dynamic breast MR imaging. Suspicious lesions were localized preoperatively using a stereotactic device for MR-guided localization procedures. Magnetic resonance imaging revealed suspicious lesions in 9 of 14 patients. Histopathology revealed invasive carcinoma of the breast in 6 of these patients. Two enhancing lesions were fibroadenomas; one proved to be sclerosing adenosis. In 5 patients MR imaging showed no abnormality. Follow-ups performed up to 1 year after initial treatment revealed no breast cancers in these 5 patients. In patients with metastatic disease of unknown primary, MRI of the breast depicts the primary in a considerable number of cases with normal conventional evaluation.

Diagnostic potential of ultrafast contrast-enhanced MRI of the breast in hypervascularized lesions: are there advantages in comparison with standard dynamic MRI?

PURPOSE Our goal was to evaluate possible diagnostic advantages of ultrafast MRI of the breast in comparison with dynamic MRI. METHOD Thirty patients with 35 hypervascularized lesions were selected prospectively after undergoing standard dynamic MRI (temporal resolution 87 s). Patients underwent additional ultrafast imaging (temporal resolution 2 s). Onset, rate, and pattern of enhancement were analyzed. RESULTS Histopathology revealed 15 malignant and 20 benign lesions (3-40 mm). Enhancement pattern was centripetal in 2 benign and 4 malignant lesions, centrifugal in 5 and 3, and homogeneous in 13 and 8. The onset of lesion enhancement ranged from 3 to 13 s (parenchymal enhancement 4-14 s) and the rate of enhancement from 3 to 70%/s, both without any correlation to the histologic diagnosis. There was no significant difference between ultrafast and standard dynamic MRI. CONCLUSION Ultrafast MRI does not provide additional information in comparison with standard dynamic MRI.

A multipurpose phantom for quality assurance of contrast-enhanced MR imaging of the breast.

Abstract. A phantom consisting of four components was developed to simulate contrast-enhanced MR imaging of the breast. These components included the correlation between the signal intensity and the contrast medium concentration, the uniformity of signals within surface coils, artefacts due to opposed-phase imaging effects, spatial resolution and the acquisition of relevant signal-to-time curves. Repetitive measurements demonstrated an excellent reproduction of phantom imaging with a deviation in signal intensity of approximately 5 %. The presented phantom allows the optimization of examination protocols as well as the comparison of different examination techniques. Furthermore, it enables the routine quality monitoring of contrast-enhanced MR imaging of the breast.

The role of cone-beam breast-CT for breast cancer detection relative to breast density

ObjectivesTo 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.MethodsA 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.ResultsBreast 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.ConclusionsCompared 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.Key Points• 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).

Short first-pass MRI of the breast.

To reduce examination time and costs, a new concept for MRI of the breast is presented. This short first-pass MRI takes 4–5 minutes and could be applied to approximately three-quarters of all women.

Contrast-enhanced cone-beam breast-CT (CBBCT): clinical performance compared to mammography and MRI

ObjectivesTo evaluate the diagnostic accuracy of contrast-enhanced (CE) cone-beam breast computed tomography (CBBCT) in dense breast tissue and compare it to non-contrast (NC) CBBCT, mammography (MG) and magnetic resonance imaging (MRI).MethodsThis prospective institutional review board-approved study included 41 women (52 breasts) with American College of Radiology (ACR) density types c or d and Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 assessments in MG or ultrasound (US). Imaging modalities were independently evaluated by two blinded readers.ResultsA total of 100 lesions (51 malignant, 6 high-risk, and 43 benign) were identified. For readers 1/2, respectively, and p values comparing CE-CBBCT to other modalities: diagnostic accuracy (AUC) for CE-CBBCT was 0.83/0.77, for MRI 0.88/0.89 (p = 0.2272/0.002), for NC-CBBCT 0.73/0.66 (p = 0.038/ 0.0186) and for MG 0.69/0.64 (p = 0.081/0.0207). CE-CBBCT sensitivity (0.88/0.78) was 37-39% higher in comparison to MG (0.49/0.41, p < 0.001 both) but inferior to MRI (0.98/0.96, p = 0.0253/0.0027). CE-CBBCT specificity (0.71/0.71) was numerically higher compared to MRI (0.61/0.69, p = 0.0956/0.7389).ConclusionsCBBCT diagnostic performance varied with the respective reader and experience. CE-CBBCT improved AUC and sensitivity in comparison to MG and NC-CBBCT, and was comparable to MRI in dense breast tissue. In tendency, specificity was higher for CE-CBBCT than MRI.Key Points• CE-CBBCT diagnostic accuracy (AUC) was comparable to MRI in dense breasts.• CE-CBBCT improved sensitivity and AUC in comparison to MG and NC-CBBCT.• CE-CBBCT has inferior sensitivity but higher specificity than MRI.• CE-CBBCT is a potential imaging alternative for patients with MRI contraindications.

The Value of Quality-Assured Magnetic Resonance Imaging of the Breast for the Early Detection of Breast Cancer in Asymptomatic Women

Purpose The aim of this study was to evaluate the exclusive performance of quality-assured high-resolution breast magnetic resonance imaging (MRI) for early detection of breast cancer in a population of asymptomatic women. Materials and Methods A total of 1189 MRI examinations performed in 789 asymptomatic women (mean age, 51.1 years) were evaluated. All examinations were performed using open bilateral surface coil, dedicated compression device, and high spatial resolution (matrix, 512 × 512). Digital mammography was available for all participants. Assessment included density types, artifact level, and Breast Imaging Reporting and Data System classification. Evaluation was performed by 2 readers. In addition, a computer-assisted diagnosis (CAD) system was used for image assessment. Results Breast MRI showed density types I and II in 87.6% and artifacts categories III and IV in 3.1%. Study included 32 carcinomas (8 ductal carcinoma in situ, 24 invasive tumors). Both readers detected 29 of 32 correctly (sensitivity 90.6%). The variation between the readers was low (reader 1: specificity, 94.4% and positive predictive value (PPV), 25.7%; reader 2: specificity, 97.6% and PPV, 34.1%). Sensitivity of CAD was 62.5% (specificity, 84.4%; PPV, 5.2%). Digital mammography detected 13 of 32 carcinomas (sensitivity, 56.3%; specificity, 98.4%; PPV, 32.1%). Conclusions The exclusive use of quality-assured breast MRI allows the early detection of breast cancer with a high sensitivity and specificity. The CAD analysis of MRI does not give additional information but shows results comparable with digital mammography.

Computer-Based Reading of Full-Field Digital Mammograms

Mammograms of 50 patients performed on a full-field digital mammography system were evaluated. The images were judged as hardcopy prints and on 2k x 2.5k high resolution monitors. 19 of the 50 patients had histologically proven carcinomas, the remainder showed no malignancies after a follow-up of 2 years. The mammograms were evaluated with respect to image quality, presence of masses and microcalcifications. All detected lesions were categorized according to the BI-RADS™ classification. Time was recorded. Postprocessing in softcopy evaluation (windowing and levelling, zooming, inversion) and additional views like spot views in both methods were also timed. Possible changes in the BI-RADS™ classification were included in the evaluation protocol. Diagnostic accuracy of the classification of the malignant lesions according to the BI-RADS™ categories showed no significant differences between soft- and hardcopy. More time was needed for the evaluation of the softcopies than for the hardcopies. Additional views were recommended in hardcopy more often than in softcopy evaluation (26 versus 21 for reader 1, 20 versus 18 for reader 2). Postprocessing was used in 9 cases by reader 1 and in all cases by reader 2 resulting in an further increase of the evaluation time. Furthermore softcopy reading enables radiographers to use the advantages of a digital system (e.g. CAD, teleradiology, PACS).