Enhancing Nonmass Lesions in the Breast: Evaluation with Proton ( 1 H) MR Spectroscopy 1

Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Radiology (Impact Factor: 6.87). 11/2007; 245(1):80-7. DOI: 10.1148/radiol.2451061639
Source: PubMed


To prospectively evaluate the sensitivity and specificity of proton (hydrogen 1 [1H]) magnetic resonance (MR) spectroscopy for diagnosing malignant enhancing nonmass lesions identified at breast MR imaging, with histologic examination as the reference standard.
In this HIPAA-compliant, institutional review board-approved study, in which all participants gave written informed consent, proton (1H) MR spectroscopy of the breast was performed in suspicious or biopsy-proved malignant lesions that were 1 cm or larger at MR imaging. Single-voxel proton (1H) MR spectroscopic data were collected. MR spectroscopic findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was 2 or greater and as negative in all other cases. MR spectroscopic results were then compared with histologic findings, and statistical analysis was performed.
In 32 women (median age, 48.5 years [range, 20-63 years]) with enhancing nonmass lesions, the median lesion size at MR imaging was 2.8 cm (range, 1.2-9.0 cm). At histologic analysis, 12 (37%) of 32 lesions were malignant and 20 (63%) were benign. Positive choline findings were present in 15 of 32 lesions, including all 12 (100%) cancers and three (15%) of 20 benign lesions, giving proton (1H) MR spectroscopy a sensitivity of 100% (95% confidence interval [CI]: 74%, 100%) and a specificity of 85% (95% CI: 62%, 97%) for detection of enhancing nonmass lesions. For 25 lesions with unknown histologic features, proton (1H) MR spectroscopy would have significantly (P<.01) increased the positive predictive value of biopsy from 20% to 63%. If biopsy had been performed for only those lesions with positive choline findings at proton (1H) MR spectroscopy, biopsy might have been avoided for 17 (68%) of 25 lesions, and no cancers would have been missed.
Proton (1H) MR spectroscopy had 100% sensitivity and 85% specificity for the detection of malignancy in enhancing nonmass lesions.

Download full-text


Available from: Sunitha B Thakur, Oct 07, 2015
  • Source
    • "For instance, using standard metabolomic methods, tumors generally display elevated levels of phospholipids, increased glycolytic capacity with increased utilization of glucose carbons to drive synthetic processes and high glutaminolytic function. Additionally, the use of metabolomic MR spectroscopy imaging as a diagnostic tool has been validated with the notable successes of choline and citrate in breast and prostate cancer, respectively [74-76]. There are also extensive data on the ability of this technology to accurately and non-invasively discriminate between the various types of intra-cranial tumors [77, 78]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anti-cancer clinical drug development is currently costly and slow with a high attrition rate. There is thus an urgent and unmet need to integrate pharmacodynamic biomarkers into early phase clinical trials in the framework provided by the "pharmacologic audit trail" in order to overcome this challenge. This review discusses the rationale, advantages and disadvantages, as well as the practical considerations of various tissue-based approaches to perform pharmacodynamic studies in early phase oncology clinical trials using case histories of molecular targeting agents such as PI3K, m-TOR, HSP90, HDAC and PARP inhibitors. These approaches include the use of normal "surrogate" tissues such as peripheral blood mononuclear cells, platelet-rich plasma, plucked hair follicles, skin biopsies, plasma-based endocrine assays, proteomics, metabolomics and circulating endothelial cells. In addition the review discusses the use of neoplastic tissues including tumor biopsies, circulating tumor DNA and tumor cells and metabolomic approaches. The utilization of these tissues and technology platforms to study biomarkers will help accelerate the development of molecularly targeted agents for the treatment of cancer.
    Full-text · Article · Sep 2012 · Current drug targets
  • Source
    • "One of the reasons for this is thought to be differences between the types of cancers that were the subject of the studies. Ductal carcinoma in situ (DCIS) accounted for 17% (2/12) of the cancers in the report by Bartella et al. [25] whereas they accounted for 89% (25/28) of the cancers in our study. The morphologic patterns of DCIS were variable on MRI and included a branching-ductal pattern and a scattered clumped pattern in cases with low tumor density at histology and confluent clustered rings in those with high tumor density at histology [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Proton MR spectroscopy of the mammary gland area is used to be considered in the realm of basic research, but as a result of the advances in MR techniques, it is now being performed in ordinary clinical practice. It is particularly noteworthy that useful clinical data are now being accumulated with 1.5T MR units, which are the standard units. We think that, at this point, it is very important to systematically review the techniques, clinical applications, and future prospects of proton MR spectroscopy. We have performed proton MR spectroscopy with a 1.5T MR unit in over 3000 cases at our hospital. In this paper, we will comment on the current status of proton MR spectroscopy of the breast, primarily in regard to differentiation between benign and malignant lesions and prediction of the efficacy of chemotherapy while describing the data obtained at our hospital.
    Full-text · Article · Sep 2010 · Journal of Oncology
  • Source
    • "MR spectroscopy has also been shown to have a high diagnostic value for non-mass-like enhancement lesions. If the MRS can be added into the image acquisition protocol, the diagnostic performance may be improved [48]. The signal to noise ratio of the choline peak (or the concentration if using a quantitative method) may be built into the diagnostic model in the CAD system. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate methods developed for the characterisation of the morphology and enhancement kinetic features of both mass and non-mass lesions, and to determine their diagnostic performance to differentiate between malignant and benign lesions that present as mass versus non-mass types. Quantitative analysis of morphological features and enhancement kinetic parameters of breast lesions were used to differentiate among four groups of lesions: 88 malignant (43 mass, 45 non-mass) and 28 benign (19 mass, 9 non-mass). The enhancement kinetics was measured and analysed to obtain transfer constant (K(trans)) and rate constant (k(ep)). For each mass eight shape/margin parameters and 10 enhancement texture features were obtained. For the lesions presenting as nonmass-like enhancement, only the texture parameters were obtained. An artificial neural network (ANN) was used to build the diagnostic model. For lesions presenting as mass, the four selected morphological features could reach an area under the ROC curve (AUC) of 0.87 in differentiating between malignant and benign lesions. The kinetic parameter (k(ep)) analysed from the hot spot of the tumour reached a comparable AUC of 0.88. The combined morphological and kinetic features improved the AUC to 0.93, with a sensitivity of 0.97 and a specificity of 0.80. For lesions presenting as non-mass-like enhancement, four texture features were selected by the ANN and achieved an AUC of 0.76. The kinetic parameter k(ep) from the hot spot only achieved an AUC of 0.59, with a low added diagnostic value. The results suggest that the quantitative diagnostic features can be used for developing automated breast CAD (computer-aided diagnosis) for mass lesions to achieve a high diagnostic performance, but more advanced algorithms are needed for diagnosis of lesions presenting as non-mass-like enhancement.
    Full-text · Article · Sep 2009 · European Radiology
Show more