The diagnostic performance of magnetic resonance imaging (MRI) in the evaluation of breast ultrasound non-mass lesions: a systematic review

Aim: The purpose of this study is to conduct a systematic review of the current knowledge regarding the diagnostic performance of MRI in the investigation of non-mass lesions of the breast. Method: Up to July 2022, PubMed, Scopus, Web of Science, and Embase were searched comprehensively. All studies examining the diagnostic performance of MRI in non-mass lesions were included except review articles, articles published in a language other than English, and case reports or series of cases. A literature review and data extraction were performed by two independent reviewers. A checklist for cross-sectional studies developed by the Joanna Briggs Institute (JBI) was used to assess sources of bias. Results: The systematic review included two studies. If any enhancement is present on MRI, most ultrasound NMLs will exhibit a non-mass-enhancement. We found that the distribution of non-mass enhancement lesions was primarily segmental and regional. The highest number of malignancies is associated with segmental distributions, since 81.8% of the cases with segmental enhancement were ductal carcinomas, specifically DCIS. Conclusion: Non-mass lesions of the US that do not enhance in MRI have a good prognosis. Breast cancer is very unlikely in these cases, so follow-up is acceptable unless there is a suspicion of malignancy on mammography. In cases where regional and segmental enhancement of NMLs occurs on CE-MRI, ductal carcinomas may be present, and a pathological examination is warranted

Computer-aided detection of breast lesions in DCE-MRI using region growing based on fuzzy C-means clustering and vesselness filter

Abstract A computer-aided detection (CAD) system is introduced in this paper for detection of breast lesions in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The proposed CAD system firstly compensates motion artifacts and segments the breast region. Then, the potential lesion voxels are detected and used as the initial seed points for the seeded region-growing algorithm. A new and robust region-growing algorithm incorporating with Fuzzy C-means (FCM) clustering and vesselness filter is proposed to segment any potential lesion regions. Subsequently, the false positive detections are reduced by applying a discrimination step. This is based on 3D morphological characteristics of the potential lesion regions and kinetic features which are fed to the support vector machine (SVM) classifier. The performance of the proposed CAD system is evaluated using the free-response operating characteristic (FROC) curve. We introduce our collected dataset that includes 76 DCE-MRI studies, 63 malignant and 107 benign lesions. The prepared dataset has been used to verify the accuracy of the proposed CAD system. At 5.29 false positives per case, the CAD system accurately detects 94% of the breast lesions

What Can Computed Tomography Scans of the Thorax Show after Breast Surgery?

Background: Postoperative breast abnormalities after breast conserving surgery or modified radical mastectomy are frequently overlooked and inaccurately assessed or reported using multidetector computed tomography (MDCT). These inaccurate results may have legal ramifications for the clinicians, cause patients avoidable anxiety, and lead to additional unnecessary diagnostic follow-up testing and costs. Methods: The patients with a history of breast cancer who had undergone breast-conserving surgery or modified radical mastectomy up to 6 months prior to undergoing a thoracic MDCT scan consented and enrolled in this study. These patients underwent a thoracic MDCT scan either because of respiratory or cardiac clinical symptoms or as part of breast cancer staging. Results: Forty women were included in this study. Different postoperative breast changes observed on thoracic MDCT scans including fibrous scar tissue, fat necrosis, seroma, abscess, hematoma, and recurrent and residual tumor were described. Conclusions: MDCT scans offer sufficient evidence in many postoperative cases to allow a confident diagnosis. General radiologists who review thoracic MDCT scans should know how to characterize breast lesions incidentally found on MDCT scans after breast surgeries. This information would enhance the value of the radiologist’s report for appropriate case management

Stereotactic Breast Core Needle Biopsy in a Tertiary Breast Center of Tehran University of Medical Sciences

Background: The purpose of this study was to evaluate the results of stereotactic breast core needle biopsy in a tertiary breast center of Tehran University of Medical Sciences. Methods: Patients who were candidates for mammography-guided stereotactic breast core biopsy from March 2011 to December 2013 were included in this study. Stereotactic biopsy was performed by a dedicated prone Hologic mammography unit employing an automatic biopsy device with a 14-gauge needle. Patients with malignant or premalignant biopsy results were followed up with surgical pathology reports and patients with benign core biopsy findings were followed up with mammograms. Results: Among the 150 patients who were included in the final analyses, 30 had malignant findings on stereotactic biopsy and 10 patients had a premalignant pathology result on stereotactic biopsy. The remaining 110 patients had benign results on histopathology; however, in 30 patients, wire localization and surgery of the same area were performed due to either discordant mammography-pathology findings or clinical suspicion of malignancy and in two of them, advancing pathologic grade was witnessed. A total of 80 patients with benign histopathologic results had follow-up mammograms and the follow-up period was between 12 months to 3 years. The sensitivity and specificity of stereotactic breast core biopsy in this study were 94% and 96%, respectively. Conclusions: Stereotactic breast core needle biopsy is an effective and safe method in evaluation of suspicious mammography-detected lesions but caution should be warranted when taking results into account, especially in mammography-pathology discordance and in patients with premalignant pathology reports

Discovering associations between radiological features and COVID‐19 patients' deterioration

Abstract Background and Aims Data mining methods are effective and well‐known tools for developing predictive models and extracting useful information from various data of patients. The present study aimed to predict the severity of patients with COVID‐19 by applying the rule mining method using characteristics of medical images. Methods This retrospective study has analyzed the radiological data from 104 COVID‐19 hospitalized patients diagnosed with COVID‐19 in a hospital in Iran. A data set containing 75 binary features was generated. Apriori method is utilized for association rule mining on this data set. Only rules with confidence equal to one were generated. The performance of rules is calculated by support, coverage, and lift indexes. Results Ten rules were extracted with only X‐ray‐related features on cases referred to ICU. The Support and Coverage index of all of these rules was 0.087, and the Lift index of them was 1.58. Thirteen rules were extracted from only CT scan‐related features on cases referred to ICU. The CXR_Pleural effusion feature has appeared in all the rules. The CXR_Left upper zone feature appears in 9 rules out of 10. The Support and Coverage index of all rules was 0.15, and the Lift index of all rules was 1.63. the CT_Adjacent pleura thickening feature has appeared in all rules, and the CT_Right middle lobe appeared in 9 rules out of 13. Conclusion This study could reveal the application and efficacy of CXR and CT scan imaging modalities in predicting ICU admission to a major COVID‐19 infection via data mining methods. The findings of this study could help data scientists, radiologists, and clinicians in the future development and implementation of these methods in similar conditions and timely and appropriately save patients from adverse disease outcomes

Does MRI have added value in ultrasound-detected BIRADS-3 breast masses in candidates for assisted reproductive therapy?

Background: Ultrasound-detected breast lesions with probably benign features are a great challenge for clinicians, especially in breasts with dense composition. We aimed to investigate the finding of two radiologic modalities on these lesions. Methods: This retrospective cross-sectional study recruited patients including (1) candidates of assisted reproductive therapy (ART), (2) patients with prior high-risk lesions, and (3) the “suspected” BIRADS-3 masses referring to masses that US BIRADS-3 was not compatible with the clinical breast exam. The degree of agreement in diagnosing BIRADS-3 lesions between two modalities of magnetic resonance imaging (MRI) and ultrasonography (US), and comparison of the lesions in US and MRI were the study variables. Results: A total number of 123 lesions in 67 patients with a median age of 38 (IQR: 11, range: 17–67). In the examination by MRI, 107 (87.0 %) lesions were BIRADS-3 indicating the agreement level between these two modalities. The median size of the lesions in US was 9 mm (IQR: 5, range: 3–43) and 9 mm (IQR: 10, range: 4–46) in MRI. The measured size of the lesions between the two modalities was highly correlated (Spearman correlation coefficient: 0.889, P-value < 0.001). MRI evaluation revealed two cases of deep lesions which were missed in the US imaging. Conclusions: This study found relatively high agreement values between US and MRI in detecting BIRADS-3 breast lesions in candidates for ART or patients with prior high-risk lesions. Also, MRI could downgrade about one-tenth of the cases to a lower BIRADS level and resolved the need for closer follow-up

The role of Bi-exponential diffusion-weighted model (IVIM) in breast cancer differentiation and comparison of curve fitting methods

Objective:&nbsp;The current meta-analysis aimed to analyze all published results about the diagnostic performance of intravoxel incoherent motion (IVIM) to assess the differential diagnosis between malignant and benign breast cancer and comparison of curve fitting methods. Methods: PubMed and Embase databases were systematically searched to find relevant articles published until November2021 in English journals. Studies were evaluated in accordance with inclusion and exclusion standards. We evaluated study heterogeneity and publication bias. Using a bivariate model, aggregated summary values of sensitivity, specificity, and area under the curve were derived for each related parameters of the intravoxel incoherent motion (true diffusivity [D], pseudo-diffusivity [D*], perfusion fraction [f]).&nbsp; Subgroup analysis was employed to investigate the impact of various field strengths and b values. Results: From 25 eligible studies, 2391 lesions (1652 malignant and 653 benign) were included. Publication bias was evident for studies that evaluated parameters of the intravoxel incoherent motion (D, D*, and f). Significant heterogeneity (P 0.05) was present for all parameters. The pooled sensitivity, specificity and area under the curve for f was 0.78, 0.69, and 0.83, respectively. D* was 0.69, 0.63, and 0.72, respectively

Our experience using synthesized mammography vs full field digital mammography in population-based screening

Background: Synthesized Mammogram (SM) from Digital Breast Tomosynthesis (DBT) images is introduced to replace the routine Full Field Digital Mammography (FFDM) to reduce radiation dose. Purpose: to compare the conspicuity of cancer related findings between SM and FFDM and combination of these methods with DBT Methods: The study was conducted in a tertiary breast imaging center, where 200 women referred for screening were enrolled in the study sequentially. Patients underwent FFDM and DBT simultaneously and a two-year follow-up was done. Data was evaluated for Breast Imaging Reporting and Data System (BI-RADS) score, breast density, mass lesions, calcification, and focal asymmetry by two expert breast radiologists. Comparison between different methods was made by Cohen Kappa test. Results: 22 patients with likely malignant findings went under biopsy. Taking histopathologic findings and two-year follow up as reference, the overall sensitivity and specificity for FFDM+DBT (86.1 and 88.9 respectively) and SM+DBT (86.1 and 88.2) didn’t show a meaningful difference. Comparing SM and FFDM, calcification in 20 subjects were overlooked on SM, but later detected when combined with DBT. Considering breast composition and BI-RADS categorization, an excellent agreement existed between the readers. Conclusion: Screening with SM+DBT shows comparable results with FFDM+DBT considering BI-RADS categorization of the patients. Although SM showed slightly inferior sensitivity compared to FFDM, after combining DBT with SM no malignant appearing calcification or mass lesion was missed

Following a patient with breast cysts using thermal imaging: case report

Background: Breast cancer is a common malignancy in which early breast cancer detection by the help of imaging can improve the treatment outcome. Thermography utilizes infrared beams which are fast, non-invasive, and non-contact and the output created images by this technique are flexible and useful to monitor the temperature of the human body. Case presentation: Our patient is a 25-year-old woman who was referred to Tehran's Imam Khomeini Hospital, Tehran University of Medical Sciences, in October 2014 and June 2017 to perform clinical examinations of breast cancer at the Invasive and New Radiology Research Center of Tehran. The results of the sonography for the left breast and bilateral axillary regions and sonography guided biopsy from the left axillary region indicated that:  it was consistent with the tangential prominence at 11-12 O’ clock in the left breast tissue and echo gene was found without any suspected findings. Then, using the non-contact infrared imaging camera VisIR 640 (Thermoteknix Systems Ltd, Cambridge, UK), the feasibility of thermography method in the patient's follow-up was investigated. Conclusion: Thermography can be used to detect abnormal areas in the breast tissue that may have cystic origin. The results indicated that the accuracy of the identification and matching of patient cysts in mammography and ultrasonography with the results of thermography in both periods of October 2014 and June 2017. Considering the results, it is noteworthy that the diagnostic clock of the breast cysts in the patient is consistent with the results of the clinical trials with the thermography. Moreover, in a 2 years intervals, the status of thermal morphology status of the cystic region did not considerably change which showed a relatively stable status

The comparison of clinical, laboratory, and radiological findings in immunocompromised and immunocompetent patients with COVID‐19: A case‐control study

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) causes coronavirus disease 2019 (COVID‐19) with significant morbidity and mortality. We reported and compared the clinical and para‐clinical findings of immunocompromised and immunocompetent COVID‐19 patients in a case‐control study at the Imam Khomeini hospital in Tehran, Iran. Methods In this study, 107 immunocompromised COVID‐19 patients were recruited as the case group, and 107 immunocompetent COVID‐19 patients as the control group. The participants were matched based on age and sex. The patients' information was retrieved from the hospital records in an information sheet. Associations between clinical and para‐clinical findings with the immune status were assessed using bivariate and multivariate analyses. Results The initial pulse rate and recovery time were significantly higher in immunocompromised patients (p < .05). Myalgia, nausea/vomiting, loss of appetite, headache, and dizziness were more frequently reported by the control group (p < .05). Regarding the prescribed medications' duration, Sofosbovir was used longer in the case group, while Ribavirin was used longer in the control groups (p < .05). The most common complication in the case group was acute respiratory distress syndrome, although no major complications were observed in the control group. According to the multivariate analysis, recovery time and Lopinavir/Ritonavir (Kaletra) prescription were significantly higher in the immunocompromised compared to the immunocompetent group. Conclusion Recovery time was significantly longer in the immunocompromised compared to the immunocompetent group, which emphasizes the necessity of prolonged care in these high‐risk patients. Also, it is recommended to investigate the effect of novel therapeutic interventions to reduce the recovery time in addition to improving the prognosis of immunodeficient patients with COVID‐19