Giuliana Moffa

Background: Digital breast tomosynthesis (DBT) is a valuable imaging modality for breast cancer detection; however, its interpretation remains time-consuming and subject to inter-reader variability. This study aimed to develop and evaluate two deep learning (DL) models based on transfer learning for the binary classification of breast lesions (benign vs. malignant) using DBT images to support clinical decision-making and risk stratification. Methods: In this retrospective monocentric study, 184 patients with histologically or clinically confirmed benign (107 cases, 41.8%) or malignant (77 cases, 58.2%) breast lesions were included. Each case underwent DBT with a single lesion manually segmented for radiomic analysis. Two convolutional neural network (CNN) architectures—ResNet50 and DenseNet201—were trained using transfer learning from ImageNet weights. A 10-fold cross-validation strategy with ensemble voting was applied. Model performance was evaluated through ROC–AUC, accuracy, sensitivity, specificity, PPV, and NPV. Results: The ResNet50 model outperformed DenseNet201 across most metrics. On the internal testing set, ResNet50 achieved a ROC–AUC of 63%, accuracy of 60%, sensitivity of 39%, and specificity of 75%. The DenseNet201 model yielded a lower ROC–AUC of 55%, accuracy of 55%, and sensitivity of 24%. Both models demonstrated relatively high specificity, indicating potential utility in ruling out malignancy, though sensitivity remained suboptimal. Conclusions: This study demonstrates the feasibility of using transfer learning-based DL models for lesion classification on DBT. While the overall performance was moderate, the results highlight both the potential and current limitations of AI in breast imaging. Further studies and approaches are warranted to enhance model robustness and clinical applicability.

Purpose This retrospective study aimed to evaluate the relationship between BPE on CEM and breast density, age and menopausal status. Material and methods Our analysis included all women eligible for CEM as a second-level examination in the diagnostic phase in a 12-month period. CEM were performed on a dedicated low-dose digital mammography unit after the injection of 1.5 ml/kg body weight Iohexol 350 mgI/ml. Both breast composition and BPE were assessed independently by two breast radiologists according to the CEM supplement to the 2013 ACR BI-RADS Mammography. A two-stage ordered probit regression model was fitted to evaluate the relationship between BPE and the other factors considered. Results 49 patients were included (median age = 55 years, 28.6% premenopausal and 71.4% postmenopausal). Breast composition was classified as ACR BI-RADS a in 4.1%, ACR BI-RADS b in 36.7%, ACR BI-RADS c in 46.9%, and ACR BI-RADS d in 12.2% of cases, by both Readers. A BPE 1 category was assigned in 53.1–55.1% of patients (by Reader 1 and 2, respectively), BPE 2 in 22.4%, BPE 3 in 18.4–12.2%, and BPE 4 in 6.1–10.2%. Higher breast density was strongly associated with higher levels of BPE, while BPE was not directly associated with age, both in fertile and postmenopausal patients. No significant differences were observed between the two Readers. Conclusion Increased BPE is associated with a well-established breast cancer risk factor as high breast density, while it was not directly dependent on the other non-modifiable factors considered.

The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic–pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.

Cryoablation is a minimally invasive technique currently employed in breast cancer care, that uses freeze and thaw cycles to treat benign breast lesions, small breast cancers or focal sites of metastatic disease in patients not eligible for surgery. The final goal of this procedure is to destroy breast cancer cells using extreme cold. In addition, several studies have shown that this technique seems to have an enhancing effect on the immune response, especially by increasing the expression of tumor neoantigens specific to tumor cells, which are then attacked and destroyed. Exploiting this effect, cryoablation in combination with immunotherapy could be the key to treating early-stage breast cancers or patients who are unsuitable for surgery. According to some recent studies, there are other potential tools that could be used to enhance the therapeutic effect of cryoablation, such as FE3O4 nanoparticles or the manipulation of aquaporin expression. The aim of this narrative review is to summarize the current evidence regarding the use, indications, advantages and disadvantages of cryoablation in the treatment of breast cancer.

Background: Ductal carcinoma in situ (DCIS) is often reclassified as invasive cancer in the final pathology report of the surgical specimen. It is of significant clinical relevance to acknowledge the possibility of underestimating invasive disease when utilizing preoperative biopsies for a DCIS diagnosis. In cases where such histologic upgrades occur, it is imperative to consider them in the preoperative planning process, including the potential inclusion of sentinel lymph node biopsy due to the risk of axillary lymph node metastasis. Purpose: To assess the capability of breast multiparametric magnetic resonance imaging (MP-MRI) in differentiating between pure DCIS and microinvasive carcinoma (MIC). Material and Methods: Between January 2018 and November 2022, this retrospective study enrolled patients with biopsy-proven DCIS who had undergone preoperative breast MP-MRI. We assessed various MP-MRI features, including size, morphology, margins, internal enhancement pattern, extent of disease, presence of peritumoral edema, time-intensity curve value, diffusion restriction, and ADC value. Subsequently, a logistic regression analysis was conducted to explore the association of these features with the pathological outcome. Results: Of 129 patients with biopsy-proven DCIS, 36 had foci of micro-infiltration on surgical specimens and eight were diagnosed with invasive ductal carcinoma (IDC). The presence of micro-infiltration foci was significantly associated with several MP-MRI features, including tumor size ( P −3 mm²/s ( P = 0.004). Conclusion: Breast MP-MRI has the potential to predict the presence of micro-infiltration foci in biopsy-proven DCIS and may serve as a valuable tool for guiding therapeutic planning.

The aim of this prospective study was to compare the diagnostic performance of contrast-enhanced mammography (CEM) versus digital mammography (DM) combined with breast ultrasound (BUS) in women with dense breasts. Between March 2021 and February 2022, patients eligible for CEM with the breast composition category ACR BI-RADS c–d at DM and an abnormal finding (BI-RADS 3-4-5) at DM and/or BUS were considered. During CEM, a nonionic iodinated contrast agent (Iohexol 350 mg I/mL, 1.5 mL/kg) was power-injected intravenously. Images were evaluated independently by two breast radiologists. Findings classified as BI-RADS 1–3 were considered benign, while BI-RADS 4–5 were considered malignant. In case of discrepancies, the higher category was considered for DM+BUS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, using histology/≥12-month follow-up as gold standards. In total, 51 patients with 65 breast lesions were included. 59 (90.7%) abnormal findings were detected at DM+BUS, and 65 (100%) at CEM. The inter-reader agreement was excellent (Cohen’s k = 0.87 for DM+BUS and 0.97 for CEM). CEM showed a 93.5% sensitivity (vs. 90.3% for DM+BUS), a 79.4–82.4% specificity (vs. 32.4–35.5% for DM+BUS) (McNemar p = 0.006), a 80.6–82.9% PPV (vs. 54.9–56.0% for DM+BUS), a 93.1–93.3% NPV (vs. 78.6–80.0% for DM+BUS), and a 86.1–87.7% accuracy (vs. 60.0–61.5% for DM+BUS). The AUC was higher for CEM than for DM+BUS (0.865 vs. 0.613 for Reader 1, and 0.880 vs. 0.628, for Reader 2) (p < 0.001). In conclusion, CEM had a better diagnostic performance than DM and BUS alone and combined together in patients with dense breasts.

Pregnancy-associated breast cancer (PABC) is commonly defined as a breast cancer occurring during pregnancy, throughout 1 year postpartum, or during lactation. Despite being a rare circumstance, PABC is one of the most common types of malignancies occurring during pregnancy and lactation, with growing incidence in developed countries, due both to decreasing age at onset of breast cancer and to increasing maternal age. Diagnosis and management of malignancy in the prenatal and postnatal settings are challenging for practitioners, as the structural and functional changes that the breast undergoes may be misleading for both the radiologist and the clinician. Furthermore, safety concerns for the mother and child, as well as psychological aspects in this unique and delicate condition, need to be constantly considered. In this comprehensive review, clinical, diagnostic, and therapeutic aspects of PABC (including surgery, chemotherapy and other systemic treatments, and radiotherapy) are presented and fully discussed, based on medical literature, current international clinical guidelines, and systematic practice.

The aim of this study was to combine breast MRI-derived biomarkers with clinical-pathological parameters to identify patients who truly need an Oncotype DX Breast Recurrence Score^® (ODXRS) genomic assay, currently used to predict the benefit of adjuvant chemotherapy in ER-positive/HER2-negative early breast cancer, with the ultimate goal of customizing therapeutic decisions while reducing healthcare costs. Patients who underwent a preoperative multiparametric MRI of the breast and ODXRS tumor profiling were retrospectively included in this study. Imaging sets were evaluated independently by two breast radiologists and classified according to the 2013 American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) lexicon. In a second step of the study, a combined oncologic and radiologic assessment based on clinical-pathological and radiological data was performed, in order to identify patients who may need adjuvant chemotherapy. Results were correlated with risk levels expressed by ODXRS, using the decision made on the basis of the ODXRS test as a gold standard. The χ² test was used to evaluate associations between categorical variables, and significant ones were further investigated using logistic regression analyses. A total of 58 luminal-like, early-stage breast cancers were included. A positive correlation was found between ODXRS and tumor size (p = 0.003), staging (p = 0.001) and grading (p = 0.005), and between BI-RADS categories and ODXRS (p < 0.05 for both readers), the latter being confirmed at multivariate regression analysis. Moreover, BI-RADS categories proved to be positive predictors of the therapeutic decision taken after performing an ODXRS assay. A statistically significant association was also found between the therapeutic decision based on the ODXRS and the results of combined onco-radiologic assessment (p < 0.001). Our study suggests that there is a correlation between BI-RADS categories at MRI and ODXRS and that a combined onco-radiological assessment may predict the decision made on the basis of the results of ODXRS genomic test.

Purpose Nowadays, surgical excision is no longer justified for all B3 lesions and a minimally-invasive therapeutic treatment has been encouraged. The aim of this study was to evaluate the feasibility and the therapeutic efficacy of ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of selected breast lesions of uncertain malignant potential (B3). Material and methods From July 2018 to December 2019, 11/48 breast lesions classified as B3 after ultrasound-guided core needle biopsy were treated with US-VAE in our Institution. Inclusion criteria were: B3 nodules ultrasonographically detectable for which VAE is recommended by international guidelines², size ranging between 5 and 25 mm, circumscribed margins, and lesion position at least 5 mm from the skin and the nipple. A radiological follow-up to evaluate the completeness of excision, the presence of post-procedural hematoma or of residual disease/recurrence was performed after 10 and 30 days and 6 and 12 months. 12-month ultrasound was considered the gold standard. All patients were asked to complete a satisfaction survey and a full assessment of the costs of US-VAE was performed. Results Complete excision was achieved in 81.8% of US-VAE. No lesions were upgraded to carcinoma and no patients had to undergo surgery. No complications occurred during or after US-VAE. All patients were satisfied with the procedure and the cosmetic result (100%). US-VAE cost approximately 422 Euros per procedure. Conclusion US-VAE has proven to be an optimal tool for the therapeutic excision of selected B3 lesions, with high success rate, good patient compliance and considerable money savings compared to surgery. This technique has the potential to reduce unnecessary surgery and healthcare costs.