Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI

Abstract Background Prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NACT) may influence planned surgical approaches in the breast and axilla. The aim of this project is to assess the value of interim shear wave elastography (SWE), ultrasound (US) and magnetic resonance imaging (MRI) after 3 cycles in predicting pCR. Methods 64 patients receiving NACT had baseline and interim US, SWE and MRI examinations. The mean lesion stiffness at SWE, US and MRI diameter was measured at both time points. We compared four parameters with pCR status: a) Interim mean stiffness ≤ or &gt; 50 kPa; b) Percentage stiffness reduction; c) Percentage US diameter reduction and d) Interim MRI response using RECIST criteria. The Chi square test was used to assess significance. Results Interim stiffness of ≤ or &gt; 50 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of &gt; 50 kPa, (p &lt; 0.0001) (sensitivity 59 %, specificity 91 %, PPV 71 %, NPV 86 % and diagnostic accuracy 83 %). Percentage reduction in stiffness was the next best parameter (sensitivity 59 %, specificity 85 %, p &lt; 0.0004) followed by reduction in MRI diameter of &gt; 30 % (sensitivity 50 % and specificity 79 %, p = 0.03) and % reduction in US diameter (sensitivity 47 %, specificity 81 %, p = 0.03). Similar results were obtained from ROC analysis. Conclusion SWE stiffness of breast cancers after 3 cycles of NACT and changes in stiffness from baseline are strongly associated with pCR after 6 cycles.</jats:p

Development of an automated detection algorithm for patient motion blur in digital mammograms

The purpose is to develop and validate an automated method for detecting image unsharpness caused by patient motion blur in digital mammograms. The goal is that such a tool would facilitate immediate re-taking of blurred images, which has the potential to reduce the number of recalled examinations, and to ensure that sharp, high-quality mammograms are presented for reading. To meet this goal, an automated method was developed based on interpretation of the normalized image Wiener Spectrum. A preliminary algorithm was developed using 25 cases acquired using a single vendor system, read by two expert readers identifying the presence of blur, location, and severity. A predictive blur severity score was established using multivariate modeling, which had an adjusted coefficient of determination, R2 =0.63±0.02, for linear regression against the average reader-scored blur severity. A heatmap of the relative blur magnitude showed good correspondence with reader sketches of blur location, with a Spearman rank correlation of 0.70 between the algorithmestimated area fraction with blur and the maximum of the blur area fraction categories of the two readers. Given these promising results, the algorithm-estimated blur severity score and heatmap are proposed to be used to aid observer interpretation. The use of this automated blur analysis approach, ideally with feedback during an exam, could lead to a reduction in repeat appointments for technical reasons, saving time, cost, potential anxiety, and improving image quality for accurate diagnosis.</p

Contrast-enhanced digital breast tomosynthesis and breast MRI to monitor response to neoadjuvant chemotherapy:Patient tolerance and preference

OBJECTIVE: Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography and tomosynthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques.METHODS: Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE-DBT and MRI following pre-treatment and end-of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with Wilcoxon signed rank test and McNemar test for related samples using SPSS v. 25.RESULTS: 18 patients were enrolled in the pilot study. Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE-DBT with no difference between pre-treatment and end-of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE-DBT. However, more breast pain was experienced during CE-DBT when measured on both VAS (p = 0.011) and categorical scale (p = 0.021).CONCLUSION: Our paper suggests that patients prefer CE-DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques.ADVANCES IN KNOWLEDGE: Contrast mammographic techniques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of contrast-enhanced spectral mammography, this is the first study to directly explore patient preference for CE-DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE-DBT despite the relatively long breast compression.</p

Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer?

Shear wave elastography (SWE) shows promise as an adjunct to greyscale ultrasound examination in assessing breast masses. In breast cancer, higher lesion stiffness on SWE has been shown to be associated with features of poor prognosis. The purpose of this study was to assess whether lesion stiffness at SWE is an independent predictor of lymph node involvement. Patients with invasive breast cancer treated by primary surgery, who had undergone SWE examination were eligible. Data were retrospectively analysed from 396 consecutive patients. The mean stiffness values were obtained using the Aixplorer(®) ultrasound machine from SuperSonic Imagine Ltd. Measurements were taken from a region of interest positioned over the stiffest part of the abnormality. The average of the mean stiffness value obtained from each of two orthogonal image planes was used for analysis. Associations between lymph node involvement and mean lesion stiffness, invasive cancer size, histologic grade, tumour type, ER expression, HER-2 status and vascular invasion were assessed using univariate and multivariate logistic regression. At univariate analysis, invasive size, histologic grade, HER-2 status, vascular invasion, tumour type and mean stiffness were significantly associated with nodal involvement. Nodal involvement rates ranged from 7 % for tumours with mean stiffness <50 kPa to 41 % for tumours with a mean stiffness of >150 kPa. At multivariate analysis, invasive size, tumour type, vascular invasion, and mean stiffness maintained independent significance. Mean stiffness at SWE is an independent predictor of lymph node metastasis and thus can confer prognostic information additional to that provided by conventional preoperative tumour assessment and staging

Application of the Rasch measurement framework to mammography positioning data

This work was supported by the School of Medicine Research Investment Fund at the University of St Andrews, and by charitable donations from Mrs Fiona Edwards (no grant numbers).The purpose of this article is to provide raw data and measure-validation data pertaining to a co-submission to published in European Journal of Radiology and entitled: Development and validation of a novel measure of adverse patient positioning in mammography. This Data in Brief article serves not only to provide greater detail than its companion article but also as an educational worked example of the Rasch measurement framework. Rasch measurement is a form of modern psychometric technique and our articles provide the first known example of its use in the evaluation of clinical radiological image quality. The data consist of observations of mammographic images, selected relevant patient and examination data, and validation indices produced by subjecting the primary data to Rasch analysis. An expert observer generated the primary data by reviewing mammographic images to judge the presence or absence of a set of features developed through theory and consultation with other experts. The validation data were generated through Rasch analysis, performed using Winsteps® software, which mathematically models the probability of having a correct response (or a present feature in this dataset) to an item in a given measurement instrument (e.g. questionnaire), as a function of the participant's ability/position on the underlying construct under study. The data can be reused by anyone wishing to learn and practice psychometric validation techniques. They can also form a basis for researchers wishing to build on our preliminary measure for the assessment of mammographic clinical image quality.Publisher PDFPeer reviewe

Contrast-enhanced digital breast tomosythesis and breast MRI to monitor response to neoadjuvant chemotherapy : patient tolerance and preference

OBJECTIVE: Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel imaging technique, combining contrast-enhanced spectral mammography and tomosynthesis. This may offer an alternative imaging technique to breast MRI for monitoring of response to neoadjuvant chemotherapy. This paper addresses patient experience and preference regarding the two techniques. METHODS: Conducted as part of a prospective pilot study; patients were asked to complete questionnaires pertaining to their experience of CE-DBT and MRI following pre-treatment and end-of-treatment imaging. Questionnaires consisted of eight questions answered on a categorical scale, two using a visual analogue scale (VAS), and a question to indicate preference of imaging technique. Statistical analysis was performed with Wilcoxon signed rank test and McNemar test for related samples using SPSS v. 25. RESULTS: 18 patients were enrolled in the pilot study. Matched CE-DBT and MRI questionnaires were completed after 22 patient episodes. Patient preference was indicated after 31 patient episodes. Overall, on 77% of occasions patients preferred CE-DBT with no difference between pre-treatment and end-of-treatment imaging. Overall experience (p = 0.008), non-breast pain (p = 0.046), anxiety measured using VAS (p = 0.003), and feeling of being put at ease by staff (p = 0.023) was better for CE-DBT. However, more breast pain was experienced during CE-DBT when measured on both VAS (p = 0.011) and categorical scale (p = 0.021). CONCLUSION: Our paper suggests that patients prefer CE-DBT to MRI, adding further evidence in favour of contrast-enhanced mammographic techniques. ADVANCES IN KNOWLEDGE: Contrast mammographic techniques offer an alternative, more accessible imaging technique to breast MRI. Whilst other studies have addressed patient experience of contrast-enhanced spectral mammography, this is the first study to directly explore patient preference for CE-DBT over MRI in the setting of neoadjuvant chemotherapy, finding that overall, patients preferred CE-DBT despite the relatively long breast compression.Peer reviewe

Women's experiences of mammography : fresh insights and novel measures

Introduction: Breast cancer is an important health problem with nearly 56,000 new invasive cases yearly in the UK. It is therefore the subject of a screening programme with mammography as the test. Screening programme effectiveness depends partly on acceptability of the test but mammography is not always acceptable to patients. This work aimed to improve upon current understandings of the impact of pain in mammography, and of the examination experience more broadly. Objectives: 1. To determine the relationship between mammography pain and repeat participation in breast screening; 2. To explore the contemporary experience of mammography in depth, from both patient and practitioner perspectives; 3. To develop and validate measures of patient experience in mammography. Methods: 1. A systematic review; 2. a qualitative interview study with Framework data management and thematic analysis; 3. an instrument development and measuring and modelling study incorporating the Rasch model. Findings: Painful mammography was the reason given by 11-46% of non-reattenders. Meta-analysis of a subset of studies showed a relative risk of non-reattendance after pain of 1.34 [95% CI 0.94-1.91]. Qualitative findings emphasised the importance of compassionate care and highlighted challenges practitioners face in providing it. Measures of adverse positioning and compassionate care in mammography were developed and validated, although further refinements are needed. Additional measures included general service quality and pain predisposition. In preliminary statistical analyses, mammography pain was associated with score on the pain predisposition measure. Compassionate care score was associated with general service quality score and showed some variation by mammographer. Conclusions/recommendations: Improved information and support interventions are required for women attending mammography for the first time and/or with high scores on the pain predisposition measure. An educational intervention to optimise compassionate care in mammography should be developed and tested, using a refined version of the compassionate care measure. The adverse positioning measure should be expanded and further validated."This work was supported by: • The National Awareness and Early Detection Initiative (NAEDI), reference C29002/A12256. NAEDI was a consortium under the auspices of the National Cancer Research Institute (NCRI). Partners were Cancer Research UK, Department of Health (England), Economic and Social Research Council, Health & Social Care R&D Division, Public Health Agency (Northern Ireland), National Institute for Social Care and Health Research (Wales) and the Scottish Government. • The College of Radiographers Industry Partnership Scheme (CoRIPS), grant number 095 • The University of St Andrews School of Medicine Research Investment Fund • Charitable donations from fundraising by Mrs Fiona Edwards." -- Fundin