Margarita L. Zuley

A deep learning risk model that explicitly captures bilateral and longitudinal asymmetries detected on sequential mammograms outperformed existing models for breast cancer risk prediction.

Objective: To determine the contrast-enhanced mammography-guided biopsy (CEM-Bx) success rate for MRI-suspicious lesions lacking known tomosynthetic or sonographic correlate along with factors associated with biopsy success. Methods: From June 2022 to August 2023, this prospective IRB-approved study enrolled women with breast MRI lesions rated BI-RADS ≥4A for CEM-Bx. Ipsilateral contrast-enhanced mammography (CEM) was performed in the biopsy suite and correlated with MRI. For visible lesions, CEM-Bx was performed immediately after prebiopsy CEM. Success criteria included enhancing correlate visualization and biopsy completion with accurate lesion sampling. An MRI-guided biopsy was recommended for failures. The success rate was evaluated with the Wilson score interval. MRI lesion and patient characteristics (size, type [mass, focus, or nonmass enhancement], kinetics, breast density, body mass index, background parenchymal enhancement [BPE], radiologist CEM experience, radiologist MRI experience, and histopathology) were collected. Multivariable logistic regression was performed with backward feature selection. Results: Analysis included 152 women (mean age 53 ± 11 years) with 184 lesions. CEM-Bx was successful for 106/184 (57.6%; [95% CI, 50.0-65.0]) lesions with 24/106 (22.6%) malignant. Of 78 failures, 60 (76.9%) lacked enhancement on prebiopsy CEM, 14 (17.9%) were not visualized with the biopsy grid, and 4 (5.1%) were not accurately sampled; 14/78 (17.9%) failures proved malignant. Increasing lesion size (odds ratio [OR] = 1.03; [95% CI, 1.01-1.06]), more years of radiologist CEM experience (OR = 1.24; [95% CI, 1.01-1.49]), and lower BPE (OR = 0.68 [95% CI, 0.46-0.98]) were associated with success. Conclusion: Contrast-enhanced mammography biopsy can be a successful alternative to MRI-guided biopsy for MRI-detected lesions. MRI-guided biopsy should be pursued if CEM-Bx fails.

Among women eligible for supplemental MRI screening according to state insurance law, adding contrast-enhanced mammography to digital breast tomosynthesis significantly increased early breast cancer detection alongside a 13% increase in the false-positive rate.

PURPOSE: Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart. METHODS: Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point. RESULTS: In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups ( P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time. CONCLUSION: Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.

Observational cross-sectional data from a large academic screening practice show significant changes in false-positive rates and interpretation times during batch reading of digital breast tomosynthesis images.

In this prospective trial interim report, adding contrast-enhanced mammography to digital breast tomosynthesis increased breast cancer detection with limited increase in recalls in women with personal history of breast cancer.

PURPOSE: In the United States, a comprehensive national breast cancer registry (CR) does not exist. Thus, care and coverage decisions are based on data from population subsets, other countries, or models. We report a prototype real-world research data mart to assess mortality, morbidity, and costs for breast cancer diagnosis and treatment. METHODS: With institutional review board approval and Health Insurance Portability and Accountability Act (HIPPA) compliance, a multidisciplinary clinical and research data warehouse (RDW) expert group curated demographic, risk, imaging, pathology, treatment, and outcome data from the electronic health records (EHR), radiology (RIS), and CR for patients having breast imaging and/or a diagnosis of breast cancer in our institution from January 1, 2004, to December 31, 2020. Domains were defined by prebuilt views to extract data denormalized according to requirements from the existing RDW using an export, transform, load pattern. Data dictionaries were included. Structured query language was used for data cleaning. RESULTS: Five-hundred eighty-nine elements (EHR 311, RIS 211, and CR 67) were mapped to 27 domains; all, except one containing CR elements, had cancer and noncancer cohort views, resulting in a total of 53 views (average 12 elements/view; range, 4-67). EHR and RIS queries returned 497,218 patients with 2,967,364 imaging examinations and associated visit details. Cancer biology, treatment, and outcome details for 15,619 breast cancer cases were imported from the CR of our primary breast care facility for this prototype mart. CONCLUSION: Institutional real-world data marts enable comprehensive understanding of care outcomes within an organization. As clinical data sources become increasingly structured, such marts may be an important source for future interinstitution analysis and potentially an opportunity to create robust real-world results that could be used to support evidence-based national policy and care decisions for breast cancer.

Background Background parenchymal enhancement (BPE) at dynamic contrast-enhanced (DCE) MRI of cancer-free breasts increases the risk of developing breast cancer; implications of quantitative BPE in ipsilateral breasts with breast cancer are largely unexplored. Purpose To determine whether quantitative BPE measurements in one or both breasts could be used to predict recurrence risk in women with breast cancer, using the Oncotype DX recurrence score as the reference standard. Materials and Methods This HIPAA-compliant retrospective single-institution study included women diagnosed with breast cancer between January 2007 and January 2012 (development set) and between January 2012 and January 2017 (internal test set). Quantitative BPE was automatically computed using an in-house-developed computer algorithm in both breasts. Univariable logistic regression was used to examine the association of BPE with Oncotype DX recurrence score binarized into high-risk (recurrence score >25) and low- or intermediate-risk (recurrence score ≤25) categories. Models including BPE measures were assessed for their ability to distinguish patients with high risk versus those with low or intermediate risk and the actual recurrence outcome. Results The development set included 127 women (mean age, 58 years ± 10.2 [SD]; 33 with high risk and 94 with low or intermediate risk) with an actual local or distant recurrence rate of 15.7% (20 of 127) at a minimum 10 years of follow-up. The test set included 60 women (mean age, 57.8 years ± 11.6; 16 with high risk and 44 with low or intermediate risk). BPE measurements quantified in both breasts were associated with increased odds of a high-risk Oncotype DX recurrence score (odds ratio range, 1.27-1.66 [95% CI: 1.02, 2.56]; P < .001 to P = .04). Measures of BPE combined with tumor radiomics helped distinguish patients with a high-risk Oncotype DX recurrence score from those with a low- or intermediate-risk score, with an area under the receiver operating characteristic curve of 0.94 in the development set and 0.79 in the test set. For the combined models, the negative predictive values were 0.97 and 0.93 in predicting actual distant recurrence and local recurrence, respectively. Conclusion Ipsilateral and contralateral DCE MRI measures of BPE quantified in patients with breast cancer can help distinguish patients with high recurrence risk from those with low or intermediate recurrence risk, similar to Oncotype DX recurrence score. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Zhou and Rahbar in this issue.