Publications (39) View all
-
Article: Pilot Study of Quantitative Analysis of Background Enhancement on Breast MR Images: Association with Menstrual Cycle and Mammographic Breast Density.
[show abstract] [hide abstract]
ABSTRACT: Purpose:To perform semiautomated quantitative analysis of the background enhancement (BE) in a cohort of patients with newly diagnosed breast cancer and to correlate it with mammographic breast density and menstrual cycle.Materials and Methods:Informed consent was waived after the research ethics board approved this study. Results of 177 consecutive preoperative breast magnetic resonance (MR) examinations performed from February to December 2009 were reviewed; 147 female patients (median age, 48 years; range, 26-86 years) were included. Ordinal values of BE and breast density were described by two independent readers by using the Breast Imaging Reporting and Data System lexicon. The BE coefficient (BEC) was calculated thus: (SI(2) · 100/SI(1)) - 100, where SI is signal intensity, SI(2) is the SI enhancement measured in the largest anteroposterior dimension in the axial plane 1 minute after the contrast agent injection, and SI(1)is the SI before contrast agent injection. BEC was used for the quantitative analysis of BE. Menstrual cycle status was based on the last menstrual period. The Wilcoxon rank-sum or Kruskal-Wallis test was used to compare quantitative assessment groups. Cohen weighted κ was used to evaluate agreement.Results:Of 147 patients, 68 (46%) were premenopausal and 79 (54%) were postmenopausal. The quantitative BEC was associated with the menstrual status (BEC in premenopausal women, 31.48 ± 20.68 [standard deviation]; BEC in postmenopausal women, 25.65 ± 16.74; P = .02). The percentage of overall BE was higher when the MR imaging was performed in women in the inadequate phase of the cycle (<35 days, not 7-14 days; mean BEC, 35.7) compared with women in the postmenopausal group (P = .001). Premenopausal women had significantly higher BEC when compared with postmenopausal women (P = .03). There was no significant difference in the percentage of BE between breast density groups.Conclusion:Premenopausal women with breast cancer, and specifically women in the inadequate phase of the cycle, presented with higher quantitative BE than postmenopausal women. No association was found between BE and breast density.© RSNA, 2013.Radiology 02/2013; · 5.73 Impact Factor -
Article: LETTER TO THE EDITOR.
Menopause (New York, N.Y.) 01/2013; · 3.08 Impact Factor -
Article: Incidence of Breast Cancer in Patients with Pure Flat Epithelial Atypia Diagnosed at Core-Needle Biopsy of the Breast.
[show abstract] [hide abstract]
ABSTRACT: PURPOSE: to determine the frequency of malignancy in subsequent breast excisions following core-needle biopsy (CNB) diagnosis of pure flat epithelial atypia (pFEA) and to evaluate the imaging features of the associated tumors. MATERIALS AND METHODS: Retrospective review of 8,996 image-guided CNB (2002-2010) identified 115 cases of FEA not associated with other atypia. Patients with history of breast cancer or radiation therapy were excluded. One hundred four cases (women) with pFEA (mean age 51 years, range 29-77 years) were reviewed. Stereotactic CNB was performed in 79 (76 %) cases and ultrasound (US)-guided CNB in 25 (24 %) cases. In 99 cases 14G needles were used, and 10G vacuum-assisted devices were used in 5 cases. Ninety-four patients had subsequent excision. Ten patients declined excision, and imaging follow-up (mean of 36 months) is available. The upgrade rate of pFEA was defined as the number of patients diagnosed with invasive carcinoma (IC) or carcinoma in situ (CIS) divided by the total number of patients. RESULTS: 10 of 104 (9.6 %) patients were diagnosed with cancer: 9 presented as calcifications (89 % fine pleomorphic and amorphous) and 1 case as a mammographically occult mass. The size of calcifications was not statistically significant (P = 0.358). Five cases had ductal carcinoma in situ (DCIS) and five cases had IC (ductal and lobular) presenting as amorphous and pleomorphic calcifications. CONCLUSIONS: The upgrade rate of pFEA in our series was 9.6 %. The presence of 4.8 % of invasive cancers is substantial and warrants continuing management with surgical excision in all cases.Annals of Surgical Oncology 10/2012; · 4.17 Impact Factor -
Article: Added cancer yield of breast magnetic resonance imaging screening in women with a prior history of chest radiation therapy.
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Recommendation for breast magnetic resonance imaging (MRI) screening for women with a prior history of chest radiation is currently based on expert opinion, because existing data are very scant. The objective of this study was to evaluate added cancer yield of screening breast MRI in this population. METHODS: A retrospective review identified 98 women with a prior history of chest radiation therapy who had screening mammography and screening MRI performed at the authors' institution between January 2004 and July 2010. Medical records of these patients and results of 558 screening studies (296 mammograms and 262 MRI) were reviewed. Sensitivity, specificity, positive predictive value, negative predictive value, and added cancer yield were calculated. RESULTS: Malignancy was diagnosed in 13 patients, invasive cancer was diagnosed in 10 patients, and ductal carcinomas in situ was diagnosed in 3 patients. The median latency from completion of radiation to detection of the breast cancer was 18 years (range, 8-37 years). Of the 13 cancers, 12 (92%) were detected by MRI, and 9 (69%) by mammography. For mammography, the sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 98%, 82%, and 95%, respectively; and, for MRI, these values were 92%, 94%, 71%, and 99%, respectively. In 4 of 98 patients, cancer was diagnosed on MRI only, resulting in an incremental cancer detection rate of 4.1% (95% confidence interval, 1.6%-10%). CONCLUSIONS: The current results indicated that MRI is a useful adjunct modality for screening high-risk women who have a prior history of chest radiation therapy, resulting in a 4.1% (4 of 98 women) added cancer detection rate. The authors concluded that both MRI and mammography should be used to screen women in this high-risk group. Cancer 2012. © 2012 American Cancer Society.Cancer 09/2012; · 4.77 Impact Factor -
Article: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?
[show abstract] [hide abstract]
ABSTRACT: ObjectivesTo evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. MethodsRetrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. ResultsOf 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. ConclusionsImaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision. KeywordsVacuum-assisted breast biopsy–Breast MRI–MRI-guided breast biopsy–High-risk breast lesions–UnderestimationEuropean Radiology 04/2012; 21(3):582-589. · 3.22 Impact Factor
