Sandra B Brennan

Memorial Sloan-Kettering Cancer Center, New York City, New York, United States

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Publications (14)192.36 Total impact

  • Sandra B Brennan
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    ABSTRACT: Magnetic resonance Imaging-guided breast biopsy is an essential component of breast imaging practices offering breast magnetic resonance imaging. Careful planning and preparation allow for an efficient and successful biopsy. Deliberate positioning and controlled compression are keys to a comfortable and cooperative patient. The biopsy is only complete once imaging-histologic correlation has been made by the radiologist.
    Techniques in vascular and interventional radiology 03/2014; 17(1):40-48.
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    ABSTRACT: To determine the frequency of cancelled stereotactic biopsy due to non-visualisation of calcifications, and assess associated features and outcome data. A retrospective review was performed on 1,874 patients scheduled for stereotactic-guided breast biopsy from 2009 to 2011. Medical records and imaging studies were reviewed. Of 1,874 stereotactic biopsies, 76 (4 %) were cancelled because of non-visualisation of calcifications. Prompt histological confirmation was obtained in 42/76 (55 %). In 28/76 (37 %) follow-up mammography was performed, and 7/28 subsequently underwent biopsy. Of 27 without biopsy, 21 (78 %) had follow-up. Nine cancers (9/49, 18 %) were found: 6 ductal carcinoma in situ (DCIS), 3 infiltrating ductal carcinoma (IDC). Of 54 patients with either biopsy or at least 2 years' follow-up, 9 (17 %) had cancer (95 % CI 8-29). Cancer was present in 7/42 (17 %, 95 % CI 7-31 %) lesions that had prompt histological confirmation (DCIS = 5, IDC = 2) and in 2/28 (7 %, 95 % CI 0.8-24 %) lesions referred for follow-up (DCIS = 1, IDC = 1). Neither calcification morphology (P = 0.2), patient age (P = 0.7), breast density (P = 1.0), personal history (P = 1.0) nor family history of breast cancer (P = 0.5) had a significant association with cancer. Calcifications not visualised on the stereotactic unit are not definitely benign and require surgical biopsy or follow-up. No patient or morphological features were predictive of cancer. • Half of cancelled stereotactic biopsies were due to non-visualisation of calcified foci. • This reflects the improved detection of calcifications by digital mammography. • Calcifications too faint for the stereotactic technique require alternative biopsy or follow-up • 17 % of patients with biopsy or at least 2 years' follow-up had cancer. • No patient/morphological features were found to aid selection for re-biopsy vs. follow-up.
    European Radiology 11/2013; · 4.34 Impact Factor
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    ABSTRACT: Triple-negative (TN) breast cancers, which are associated with a more aggressive clinical course and poorer prognosis, often present with benign imaging features on mammography and ultrasound. The purpose of this study was to compare the magnetic resonance imaging features of TN breast cancers with estrogen (ER) and progesterone (PR) positive, human epidermal growth factor receptor (HER2) negative cancers. Retrospective review identified 140 patients with TN breast cancer who underwent a preoperative breast MRI between 2003 and 2008. Comparison was made to 181 patients with ER+/PR+/HER2- cancer. Breast MRIs were independently reviewed by two radiologists blinded to the pathology. Discrepancies were resolved by a third radiologist. TN cancers presented with a larger tumor size (p = 0.002), higher histologic grade (<0.001), and were more likely to be unifocal (p = 0.018) compared with ER+/PR+/HER2- tumors. MRI features associated with TN tumors included mass enhancement (p = 0.026), areas of intratumoral high T2 signal intensity (p < 0.001), lobulated shape (p < 0.001), rim enhancement (p < 0.001), and smooth margins (p = 0.005). Among the TN tumors with marked necrosis, 26% showed a large central acellular zone of necrosis.
    The Breast Journal 09/2013; · 1.83 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI. Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT. Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P = 0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT. BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT. • Background parenchymal enhancement significantly decreases at breast MRI following oophorectomy. • Fibroglandular tissue significantly decreases on breast MRI following oophorectomy. • Decrease in background parenchymal enhancement is greater than in fibroglandular tissue. • Decrease in background parenchymal enhancement occurs earlier than in fibroglandular tissue.
    European Radiology 08/2013; · 4.34 Impact Factor
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    ABSTRACT: Imaging has become a pivotal component throughout a patient's encounter with cancer, from initial disease detection and characterization through treatment response assessment and posttreatment follow-up. Recent progress in imaging technology has presented new opportunities for improving clinical care. This article provides updates on the latest approaches to imaging of 5 common cancers: breast, lung, prostate, and colorectal cancers, and lymphoma. CA Cancer J Clin 2012. © 2012 American Cancer Society.
    CA A Cancer Journal for Clinicians 10/2012; · 153.46 Impact Factor
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    ABSTRACT: The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade. For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated. Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p = 0.6). Postmenopausal status (p = 0.04) and histologic size of less than 0.2 cm (p = 0.04) had a significant association with the cancer upgrade rate. Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted.
    American Journal of Roentgenology 10/2012; 199(4):W512-9. · 2.90 Impact Factor
  • European Journal of Radiology 09/2012; 81:S10. · 2.51 Impact Factor
  • Radiology 05/2012; 263(2):618. · 6.34 Impact Factor
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    ABSTRACT: To determine the rate of canceled magnetic resonance (MR) imaging-guided breast biopsies due to nonvisualization of the lesion and to assess associated features and outcome data for these cases. With the approval of the institutional review board, a HIPAA-compliant retrospective review, in which the requirement for informed consent was waived, was performed for 907 patients scheduled for MR imaging-guided breast biopsy from 2004 to 2008. In 70 patients, MR imaging biopsy was canceled due to lesion nonvisualization. Medical records and imaging studies were reviewed to identify patient, parenchymal, lesion features and outcome data. Statistical analysis was performed with the Fisher exact test. The 95% confidence interval (CI) was calculated. Cancellation of MR-guided biopsy due to lesion nonvisualization occurred in 8% (70 of 907) of patients and in 8% (74 of 911) of lesions. Factors associated with a significantly higher cancellation rate included marked and moderate versus mild and minimal background parenchymal enhancement (38 of 316 [12%] vs 32 of 591 [5%], P = .001), extremely and heterogeneously dense versus scattered fibroglandular densities and fatty parenchymal volume (64 of 712 [9%] vs six of 195 [3%], P = .006), and lesions 1 cm or less in size (52 of 520 [10%] vs 22 of 391 [6%], P = .02).The rate of cancellation per year was highest in the first year, with a decrease in subsequent years (14 of 102 [14%] vs 56 of 805 [7%], P = .025). A significantly lower rate was found in women with synchronous breast cancer (nine of 240 [4%] vs 61 of 667 [9%], P = .007), and a significantly higher rate was found in women with a history of cancer (35 of 315 [11%] vs 35 of 592 [6%], P = .01). Among 58 women who had MR imaging follow-up, no cancers were identified. Among three women who underwent mastectomy after cancellation, one had ductal carcinoma in situ in the same quadrant as the MR-depicted lesion. The cancer detection rate among 61 women who underwent either MR imaging or pathologic follow-up was 2% (one of 61) (95% CI: 0.4%, 9%). MR imaging-guided breast biopsy was canceled due to lesion nonvisualization in 8% of the patients. Although the cancer detection rate among the lesions for which biopsy was canceled is low (95% CI: 0%, 9%), short-term follow-up MR imaging is prudent.
    Radiology 08/2011; 261(1):92-9. · 6.34 Impact Factor
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    ABSTRACT: To compare total choline concentrations ([Cho]) and water-to-fat (W/F) ratios of subtypes of malignant lesions, benign lesions, and normal breast parenchyma and determine their usefulness in breast cancer diagnosis. Reference standard was histology. In this HIPPA compliant study, proton MRS was performed on 93 patients with suspicious lesions (>1 cm) who underwent MRI-guided interventional procedures, and on 27 prospectively accrued women enrolled for screening MRI. (W/F) and [Cho] values were calculated using MRS data. Among 88 MRS-evaluable histologically-confirmed lesions, 40 invasive ductal carcinoma (IDC); 10 invasive lobular carcinoma (ILC); 4 ductal carcinoma in situ (DCIS); 3 invasive mammary carcinoma (IMC); 31 benign. No significant difference observed in (W/F) between benign lesions and normal breast tissue. The area under curve (AUC) of receiver operating characteristic (ROC) curves for discriminating the malignant group from the benign group were 0.97, 0.72, and 0.99 using [Cho], (W/F) and their combination as biomarkers, respectively. (W/F) performs significantly (P < 0.0001;AUC = 0.96) better than [Cho] (AUC = 0.52) in differentiating IDC and ILC lesions. Although [Cho] and (W/F) are good biomarkers for differentiating malignancy, [Cho] is a better marker. Combining both can further improve diagnostic accuracy. IDC and ILC lesions have similar [Cho] levels but are discriminated using (W/F) values.
    Journal of Magnetic Resonance Imaging 04/2011; 33(4):855-63. · 2.57 Impact Factor
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    ABSTRACT: Background parenchymal enhancement on breast MRI refers to normal enhancement of the patient's fibroglandular tissue. The aim of this study was to determine the effect of background parenchymal enhancement on short-interval follow-up, biopsy, and cancer detection rate on baseline screening MRI in a high-risk group. Two hundred fifty baseline high-risk screening MRI examinations were reviewed. For each, the background parenchymal enhancement pattern was recorded (minimal, ≤ 25%; mild, 26-50%; moderate, 51-75%; and marked, > 75%), as were BI-RADS category, biopsy rate, and final pathology result. Results were compared for each enhancement category. Of the 250 MRI examinations, 24.8% showed minimal enhancement; 34%, mild; 24%, moderate; and 17.2%, marked enhancement. Women with minimal enhancement had a significantly higher number of BI-RADS categories 1 and 2 examinations (64.5%) than women with mild (38.8%), moderate (40%), or marked (25.6%) enhancement. The BI-RADS category 3 rate was 43.6% overall and was significantly lower for women with minimal enhancement (27.4% vs 47.1% for women with mild, 45.0% for women with moderate, and 58.1% for women with marked enhancement). At follow-up, 86.2% of the BI-RADS 3 lesions were converted to BI-RADS category 1 or 2 and 13.8% were converted to BI-RADS 4, with a malignancy rate of 0.9% for lesions undergoing short-interval follow-up. There was no significant difference in biopsy rate or cancer detection rate among enhancement categories. Mild, moderate, and marked background parenchymal enhancement is associated with a significantly lower rate of BI-RADS categories 1 and 2 assessments and a significantly higher rate of BI-RADS category 3 assessments than minimal enhancement. There was no significant difference in biopsy rate or cancer detection rate among the enhancement categories.
    American Journal of Roentgenology 01/2011; 196(1):218-24. · 2.90 Impact Factor
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    ABSTRACT: The purpose of this article is to determine the cancer detection and biopsy rate among women who have breast MRI screening solely on the basis of a personal history of breast cancer. This retrospective review of 1,699 breast MRI examinations performed from 1999 to 2001 yielded 144 women with prior breast cancer but no family history who commenced breast MRI screening during that time. Minimal breast cancer was defined as ductal carcinoma in situ (DCIS) or node-negative invasive breast cancer < 1 cm in size. Of 144 women, 44 (31% [95% CI, 15-29%]) underwent biopsies prompted by MRI examination. Biopsies revealed malignancies in 17 women (12% [95% CI, 7-18%]) and benign findings only in 27 women (19% [95% CI, 13-26%]). Of the 17 women in whom cancer was detected, seven also had benign biopsy results. In total, 18 malignancies were found. One woman had two metachronous cancers. MRI screening resulted in a total of 61 biopsies, with a positive predictive value (PPV) of 39% (95% CI, 27-53%). The malignancies found included 17 carcinomas and one myxoid liposarcoma. Of the 17 cancers, 12 (71%) were invasive, five (29%) were DCIS, and 10 (59%) were minimal breast cancers. Of 17 cancers, 10 were detected by MRI only. The 10 cancers detected by MRI only, versus seven cancers later found by other means, were more likely to be DCIS (4/10 [40%] vs 1/7 [14%]; p = 0.25) or minimal breast cancers (7/10 [70%] vs 3/7 [43%]; p = 0.26). We found that breast MRI screening of women with only a personal history of breast cancer was clinically valuable finding malignancies in 12%, with a reasonable biopsy rate (PPV, 39%).
    American Journal of Roentgenology 08/2010; 195(2):510-6. · 2.90 Impact Factor
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    ABSTRACT: Hodgkin lymphoma is one of the most curable cancers because of its sensitivity to both radiation and several chemotherapy agents. Radical radiotherapy alone provided curative therapy for patients who had Hodgkin lymphoma as early as six decades ago. Yet, the radiation field included normal organs, such as breast tissue, thyroid, and coronary arteries, which were at risk for long-term complications. Dedicated imaging approaches have been developed to evaluate late radiation effects on these structures.
    Radiologic Clinics of North America 04/2008; 46(2):419-30, x. · 1.95 Impact Factor
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    ABSTRACT: PURPOSE/AIM 1. To review the techniques of MR image–guided biopsy and wire localization 2. To discuss the reasons for failure of MR image–guided interventional procedures CONTENT ORGANIZATION 1. Introduction (a review of the literature will be presented with failure rates and causes) 2. Review advantages, disadvantages and techniques of MR image–guided wire localization and biopsy 3. Detail the possible reasons for failure of MR image–guided tissue sampling procedures 4. Discuss ways to minimize technical failure 5. Conclusion 6. Bibliography SUMMARY 1. MR guided wire localization and core biopsy are accurate techniques for histological characterization of enhancing breast lesions not seen with mammographic or sonographic modalities, however, failure of sampling is subsequently documented in a small percentage of cases. 2. Many limitations of these procedures have become evident and published which will be discussed. 3. Awareness of the causes of procedure failure will improve the sucess rate of MR sampling techniques.
    Radiological Society of North America 2007 Scientific Assembly and Annual Meeting;