74 research outputs found
CREWS - l'Ecritoire Analysis for the Implementation of a medical image database for mammography
International audienceIn this paper, we present our approach in order to implement a Medical Image Database (MIDB) for archiving mammograms and their related information in the Department of Radiology of the Necker Hospital (Paris). The aim of such a database is to help breast cancer screening in clinics, research and education. As implementation of such a MIDB requires the understanding of users' needs, we have analyzed requirements by using the Crews-l'Ecritoire (Cooperative REquirements With Scenarios) approach developed in our laboratory. This approach is based on the "Requirement Engineering" concept. It helps understanding users' needs using a semi-automatic analysis of textual scenarios, i.e. scenarios written in natural language. This approach mixes concepts of goals and of scenarios into the notion of "Requirement Chunk". Authored scenarios and goal discovery are guided by rules, which lead to a structured network of scenarios. Our analysis resulted in 58 Requirements Chunks gathering 72 authored scenarios and 300 goals which represent MIDB services requested by radiologists in the course of their daily practice
Validation of a new fully automated software for 2D digital mammographic breast density evaluation in predicting breast cancer risk.
We compared accuracy for breast cancer (BC) risk stratification of a new fully automated system (DenSeeMammo-DSM) for breast density (BD) assessment to a non-inferiority threshold based on radiologists' visual assessment. Pooled analysis was performed on 14,267 2D mammograms collected from women aged 48-55Â years who underwent BC screening within three studies: RETomo, Florence study and PROCAS. BD was expressed through clinical Breast Imaging Reporting and Data System (BI-RADS) density classification. Women in BI-RADS D category had a 2.6 (95% CI 1.5-4.4) and a 3.6 (95% CI 1.4-9.3) times higher risk of incident and interval cancer, respectively, than women in the two lowest BD categories. The ability of DSM to predict risk of incident cancer was non-inferior to radiologists' visual assessment as both point estimate and lower bound of 95% CI (AUC 0.589; 95% CI 0.580-0.597) were above the predefined visual assessment threshold (AUC 0.571). AUC for interval (AUC 0.631; 95% CI 0.623-0.639) cancers was even higher. BD assessed with new fully automated method is positively associated with BC risk and is not inferior to radiologists' visual assessment. It is an even stronger marker of interval cancer, confirming an appreciable masking effect of BD that reduces mammography sensitivity
Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract
This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40â74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered.
Teaching Points
âą US is an established tool for suspected cancers at all ages and also the method of choice under 40.
âą For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings.
âą High-risk women can be screened with US, especially when MRI cannot be performed.
âą Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams.
âą Breast US is inappropriate as a stand-alone screening method
Screening and diagnostic breast MRI:how do they impact surgical treatment? Insights from the MIPA study
Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p †0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key points: ⹠Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. ⹠The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). ⹠The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups
Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey.
UNLABELLED: EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40Â % for women aged 50-69Â years taking up the invitation while the probability of false-positive needle biopsy is <1Â % per round and overdiagnosis is only 1-10Â % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49Â years and 70-74Â years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69Â years; extension up to 73 or 75Â years, biennially, is a second priority, from 40-45 to 49Â years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged. KEY POINTS: âą EUSOBI and 30 national breast radiology bodies support screening mammography. âą A first priority is double-reading biennial mammography for women aged 50-69Â years. âą Extension to 73-75 and from 40-45 to 49Â years is also encouraged. âą Digital mammography (not film-screen or computer radiography) should be used. âą DBT is set to become "routine mammography" in the screening setting in the next future
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Personalized early detection and prevention of breast cancer: ENVISION consensus statement
Abstract: The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectivenessâimplementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas
Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract: We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as âhigh-riskâ or B3 lesions). Finally, seven frequently asked questions are answered
Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA).
Funder: Bayer AGFunder: UniversitĂ degli Studi di MilanoOBJECTIVES: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. METHODS: This observational study enrolled women aged 18-80Â years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. RESULTS: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancersââ„â20Â mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (pâ<â0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (pâ<â0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (pâ<â0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, pâ<â0.001). CONCLUSIONS: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. KEY POINTS: âą In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. âą The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. âą Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making
MR-Elastography for diagnosis and characterization of breast lesions
LâĂ©lastographie-IRM du sein (MRE) est une technique dâimagerie fonctionnelle non invasive utilisant les propriĂ©tĂ©s visco-Ă©lastiques des tissus et qui permet comme en Ă©lastographie-Ă©chographie dâĂ©valuer la rigiditĂ© dâune lĂ©sion. Il est Ă©galement possible, Ă la diffĂ©rence de lâĂ©lastographie-Ă©chographie, dâĂ©valuer le degrĂ© de viscositĂ© dâune lĂ©sion, et ainsi grĂące Ă la combinaison Ă©lasticitĂ©/viscositĂ©, comparĂ©e Ă lâanalyse des paramĂštres IRM classiques comme la morphologie ou la cinĂ©tique de rehaussement, dâamĂ©liorer la caractĂ©risation lĂ©sionnelle. TrĂšs peu dâĂ©tudes en Ă©lastographie-IRM du sein ont Ă©tĂ© menĂ©es Ă ce jour, essentiellement du fait dâune problĂ©matique instrumentale et de mise Ă disposition dâune antenne dĂ©diĂ©e sein Ă©quipĂ© dâun dispositif de gĂ©nĂ©ration des ondes de cisaillement dans le sein. Dans un premier temps, nous avons pu Ă©tablir et optimiser une sĂ©quence Ă©lasto-IRM du sein sur une sĂ©rie de 10 volontaires saines. Cette sĂ©quence basĂ©e sur un principe de sĂ©quence Spin Echo EPI-MRE 3D, a permis lâacquisition de 50 coupes en 10 minutes sur un sein, compatible avec la pratique clinique en IRM du sein. Une approche multifrĂ©quence Ă 37,5 Hz, 75 Hz et 112,5 Hz a Ă©tĂ© ensuite testĂ©e sur les trois derniĂšres volontaires puis transfĂ©rĂ©es Ă notre population de patientes. Cette sĂ©quence multifrĂ©quence permettait la continuitĂ© de diffusion des ondes dans le sein. 50 patientes prĂ©sentant des lĂ©sions indĂ©terminĂ©es ou suspectes du sein (37 cancers, 13 bĂ©nins) ont ensuite Ă©tĂ© incluses dans ce protocole et examinĂ©es par IRM du sein classique avec sĂ©quence supplĂ©mentaire Ă©lasto-IRM. Certaines patientes Ă©taient aussi examinĂ©es en Ă©lasto-Ă©chographie. Les donnĂ©es IRM morphologiques, dynamiques et de visco-Ă©lasticitĂ© IRM ont Ă©tĂ© corrĂ©lĂ©es Ă lâhistologie. Nous avons pu montrer que les paramĂštres visco-Ă©lastiques IRM Ă©taient fortement corrĂ©lĂ©s avec le score de malignitĂ© dâune lĂ©sion (Bi-RADS ACR) et avec le caractĂšre diffĂ©rentiel bĂ©nin/malin. Câest notamment le paramĂštre Gd qui reprĂ©sente lâĂ©lasticitĂ©, qui Ă©tait plus faible en cas de lĂ©sion suspecte BI-RADS 5. Le paramĂštre Gl Ă©tait plus Ă©levĂ© dans les lĂ©sions malignes par rapport aux lĂ©sions bĂ©nignes, avec un niveau de viscositĂ© statistiquement supĂ©rieur dans les lĂ©sions malignes. Le meilleur paramĂštre semble ĂȘtre le rapport y (Gl/Gd) qui Ă©tait aussi significativement Ă©levĂ© dans les lĂ©sions malignes par comparaison avec les lĂ©sions bĂ©nignes du sein, et qui a Ă©tĂ© analysĂ© comme un facteur indĂ©pendant. En pratique, lâajout de la sĂ©quence MRE Ă un examen IRM du sein classique a permis dans notre Ă©tude dâamĂ©liorer significativement la sensibilitĂ© de lâIRM (de 78 Ă 91 %) sans perte de spĂ©cificitĂ©, celle-ci Ă©tant initialement trĂšs bonne dans cette Ă©tude. Nous nâavons pas en revanche Ă©tabli de lien entre la fibrose, la quantification vasculaire ou la nĂ©crose pour expliquer ces phĂ©nomĂšnes de visco-Ă©lasticitĂ© des tumeurs. En conclusion, lâĂ©lasto-IRM peut sâavĂ©rer utile pour amĂ©liorer le diagnostic de lĂ©sions du sein en IRM. Une poursuite des travaux avec optimisation de la sĂ©quence pour quâelle puisse permettre lâanalyse des deux seins sera nĂ©cessaire pour sa diffusion en pratique clinique. Ce travail pourrait idĂ©alement se poursuivre sur une plus grande sĂ©rie de patientes.MR-elastography (MRE) is a non-invasive functional Imaging technique using tissue mechanical visco-elastic properties to evaluate tissue stifness. MRE is different from elasticity Imaging in ultrasound, as it is possible to evaluate tumour viscosity. Combining viscosity and elasticity may improve MRI accuracy, in comparison with classical morphological and kinetics criteria. Only very few studies are focused on breast MRE, because of low availability of dedicated breast coils with MRE devices. Firstly, we developed and optimized a breast MRE sequence on a population of 10 volunteers. This sequence is based on a Spin Echo EPI-MRE 3D, and it was possible to acquire 50 slices on one breast in 10 minutes, which is applicable in a clinical routine in breast MRI. Secondly, a multi-frequency approach 37,5 Hz, 75 Hz and 112,5 Hz has been evaluated on the last three volunteers, then transferred to our patientâs population. A continous diffusion of waves within the breast was possible with this multifrequency approach sequence. 50 patients presenting undetermined or suspicious breast lesions (37 cancers, 13 benign lesions) were included in this study and examined with a standard breast MRI and MRE sequence. Some patients were also examined with shear-wave ultrasound elastography (ARFI mode, Siemens Âź). Morphological, kinetic and visco-elastic MR parameters were correlated to pathology. We demonstrated that MR visco-elastic properties were strongly correlated with Bi-RADS ACR malignancy score of a breast lesion and with malignant and benign status. The best parameter was Gd (dynamic modulus), which corresponded to lesion stiffness. Gd was lower in case of BI-RADS 5 lesions. Gl parameter (Loss modulus) was higher in malignant lesions in comparison with benign lesions, with viscosity level statistically higher in malignant lesions. The best criterion was the ratio y (Gl/Gd), which was significantly higher in malignant lesions in comparison with benign lesions; ratio y was statistically an independent factor. In practice, addition of a MRE sequence to a standard breast MRI improved significantly breast MRI Sensitity (78 to 91 %) without reduction in specificity; Sp was anyway initially high in our study. Nevertheless, we didnât demonstrate a statistical correlation with fibrosis, vascular grading or necrosis with MRE parameters, to explain visco-elastic properties of breast tumours. In conclusion, MR-elastography may be useful to improve breast MRI accuracy. In future studies, MRE sequence may be optimized to allow a bilateral acquisition on both breasts, which would be useful in clinical practice. Future works could include higher number of patients to confirm our results
Elastographie-IRM pour le diagnostic et la caractérisation des lésions du sein
MR-elastography (MRE) is a non-invasive functional Imaging technique using tissue mechanical visco-elastic properties to evaluate tissue stifness. MRE is different from elasticity Imaging in ultrasound, as it is possible to evaluate tumour viscosity. Combining viscosity and elasticity may improve MRI accuracy, in comparison with classical morphological and kinetics criteria. Only very few studies are focused on breast MRE, because of low availability of dedicated breast coils with MRE devices. Firstly, we developed and optimized a breast MRE sequence on a population of 10 volunteers. This sequence is based on a Spin Echo EPI-MRE 3D, and it was possible to acquire 50 slices on one breast in 10 minutes, which is applicable in a clinical routine in breast MRI. Secondly, a multi-frequency approach 37,5 Hz, 75 Hz and 112,5 Hz has been evaluated on the last three volunteers, then transferred to our patientâs population. A continous diffusion of waves within the breast was possible with this multifrequency approach sequence. 50 patients presenting undetermined or suspicious breast lesions (37 cancers, 13 benign lesions) were included in this study and examined with a standard breast MRI and MRE sequence. Some patients were also examined with shear-wave ultrasound elastography (ARFI mode, Siemens Âź). Morphological, kinetic and visco-elastic MR parameters were correlated to pathology. We demonstrated that MR visco-elastic properties were strongly correlated with Bi-RADS ACR malignancy score of a breast lesion and with malignant and benign status. The best parameter was Gd (dynamic modulus), which corresponded to lesion stiffness. Gd was lower in case of BI-RADS 5 lesions. Gl parameter (Loss modulus) was higher in malignant lesions in comparison with benign lesions, with viscosity level statistically higher in malignant lesions. The best criterion was the ratio y (Gl/Gd), which was significantly higher in malignant lesions in comparison with benign lesions; ratio y was statistically an independent factor. In practice, addition of a MRE sequence to a standard breast MRI improved significantly breast MRI Sensitity (78 to 91 %) without reduction in specificity; Sp was anyway initially high in our study. Nevertheless, we didnât demonstrate a statistical correlation with fibrosis, vascular grading or necrosis with MRE parameters, to explain visco-elastic properties of breast tumours. In conclusion, MR-elastography may be useful to improve breast MRI accuracy. In future studies, MRE sequence may be optimized to allow a bilateral acquisition on both breasts, which would be useful in clinical practice. Future works could include higher number of patients to confirm our results.LâĂ©lastographie-IRM du sein (MRE) est une technique dâimagerie fonctionnelle non invasive utilisant les propriĂ©tĂ©s visco-Ă©lastiques des tissus et qui permet comme en Ă©lastographie-Ă©chographie dâĂ©valuer la rigiditĂ© dâune lĂ©sion. Il est Ă©galement possible, Ă la diffĂ©rence de lâĂ©lastographie-Ă©chographie, dâĂ©valuer le degrĂ© de viscositĂ© dâune lĂ©sion, et ainsi grĂące Ă la combinaison Ă©lasticitĂ©/viscositĂ©, comparĂ©e Ă lâanalyse des paramĂštres IRM classiques comme la morphologie ou la cinĂ©tique de rehaussement, dâamĂ©liorer la caractĂ©risation lĂ©sionnelle. TrĂšs peu dâĂ©tudes en Ă©lastographie-IRM du sein ont Ă©tĂ© menĂ©es Ă ce jour, essentiellement du fait dâune problĂ©matique instrumentale et de mise Ă disposition dâune antenne dĂ©diĂ©e sein Ă©quipĂ© dâun dispositif de gĂ©nĂ©ration des ondes de cisaillement dans le sein. Dans un premier temps, nous avons pu Ă©tablir et optimiser une sĂ©quence Ă©lasto-IRM du sein sur une sĂ©rie de 10 volontaires saines. Cette sĂ©quence basĂ©e sur un principe de sĂ©quence Spin Echo EPI-MRE 3D, a permis lâacquisition de 50 coupes en 10 minutes sur un sein, compatible avec la pratique clinique en IRM du sein. Une approche multifrĂ©quence Ă 37,5 Hz, 75 Hz et 112,5 Hz a Ă©tĂ© ensuite testĂ©e sur les trois derniĂšres volontaires puis transfĂ©rĂ©es Ă notre population de patientes. Cette sĂ©quence multifrĂ©quence permettait la continuitĂ© de diffusion des ondes dans le sein. 50 patientes prĂ©sentant des lĂ©sions indĂ©terminĂ©es ou suspectes du sein (37 cancers, 13 bĂ©nins) ont ensuite Ă©tĂ© incluses dans ce protocole et examinĂ©es par IRM du sein classique avec sĂ©quence supplĂ©mentaire Ă©lasto-IRM. Certaines patientes Ă©taient aussi examinĂ©es en Ă©lasto-Ă©chographie. Les donnĂ©es IRM morphologiques, dynamiques et de visco-Ă©lasticitĂ© IRM ont Ă©tĂ© corrĂ©lĂ©es Ă lâhistologie. Nous avons pu montrer que les paramĂštres visco-Ă©lastiques IRM Ă©taient fortement corrĂ©lĂ©s avec le score de malignitĂ© dâune lĂ©sion (Bi-RADS ACR) et avec le caractĂšre diffĂ©rentiel bĂ©nin/malin. Câest notamment le paramĂštre Gd qui reprĂ©sente lâĂ©lasticitĂ©, qui Ă©tait plus faible en cas de lĂ©sion suspecte BI-RADS 5. Le paramĂštre Gl Ă©tait plus Ă©levĂ© dans les lĂ©sions malignes par rapport aux lĂ©sions bĂ©nignes, avec un niveau de viscositĂ© statistiquement supĂ©rieur dans les lĂ©sions malignes. Le meilleur paramĂštre semble ĂȘtre le rapport y (Gl/Gd) qui Ă©tait aussi significativement Ă©levĂ© dans les lĂ©sions malignes par comparaison avec les lĂ©sions bĂ©nignes du sein, et qui a Ă©tĂ© analysĂ© comme un facteur indĂ©pendant. En pratique, lâajout de la sĂ©quence MRE Ă un examen IRM du sein classique a permis dans notre Ă©tude dâamĂ©liorer significativement la sensibilitĂ© de lâIRM (de 78 Ă 91 %) sans perte de spĂ©cificitĂ©, celle-ci Ă©tant initialement trĂšs bonne dans cette Ă©tude. Nous nâavons pas en revanche Ă©tabli de lien entre la fibrose, la quantification vasculaire ou la nĂ©crose pour expliquer ces phĂ©nomĂšnes de visco-Ă©lasticitĂ© des tumeurs. En conclusion, lâĂ©lasto-IRM peut sâavĂ©rer utile pour amĂ©liorer le diagnostic de lĂ©sions du sein en IRM. Une poursuite des travaux avec optimisation de la sĂ©quence pour quâelle puisse permettre lâanalyse des deux seins sera nĂ©cessaire pour sa diffusion en pratique clinique. Ce travail pourrait idĂ©alement se poursuivre sur une plus grande sĂ©rie de patientes
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