Comparison of radiation dose between 2D digital stereotactic versus digital breast tomosynthesis-guided breast biopsies.

RATIONALE AND OBJECTIVE: Use of digital breast tomosynthesis (DBT) in breast imaging has necessitated DBT-guided biopsy, however, a single DBT acquisition may result in a greater radiation dose than a single DM acquisition. Our objective was to compare the number of images acquired and the resulting radiation dose of DBT versus DM-guided breast biopsies. METHOD: All biopsies performed on our DM unit from 8/2016 to 1/2017 and on our DM-DBT unit from 8/2017 to 1/2018 were retrospectively reviewed. The number of image acquisitions, average glandular dose (AGD) per acquisition and per procedure were computed and stratified by guidance modality and lesion type. RESULTS: 25 DM-guided biopsies were performed on the DM-only unit, 58 biopsies were performed with DM guidance on the dual unit (DM-DU) and 29 were performed with DBT. The average number of images acquisitions was 10.9 for DM-only unit biopsies, 9.3 images for DM-DU biopsies and 4.3 images for DBT-guided biopsies. Mean procedure AGD for DM-only unit biopsies was 28.77 mGy, versus 22.06 mGy for DM-DU and 10.18 mGy for DBT biopsies. Mean procedure AGD for biopsied calcification-only lesions was 22.3 mGy for DM-DU versus 10.7 mGy for DBT guidance (p < 0.001), with an average of 8.1 images per procedure for DM-DU versus 4.2 for DBT. CONCLUSION: Fewer image acquisitions were obtained with DBT compared with DM guidance, therefore, the overall dose of DBT-guided procedures was less. The dose reduction obtained with DBT is possible across all lesion types, even for calcification-only lesions.

Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone.

AIM: To compare the utility of breast magnetic resonance imaging (MRI) in determining the extent of disease in patients with newly diagnosed breast cancer detected on combination digital breast tomosynthesis (DBT) versus digital screening mammography (DM). MATERIALS AND METHODS: Review of 24,563 DBT-screened patients and 10,751 DM-screened patients was performed. Two hundred and thirty-five DBT patients underwent subsequent MRI examinations; 82 to determine extent of disease after newly diagnosed breast cancer. Eighty-three DM patients underwent subsequent MRI examinations; 23 to determine extent of disease. MRI examinations performed to assess disease extent were considered true positives if additional disease was discovered in the contralateral breast or >2 cm away from the index malignancy. Differences in cancer subtypes and MRI outcomes between the DM and DBT cohorts were compared using chi-squared tests and post-hoc Bonferroni-adjusted tests for equal proportions. RESULTS: No differences in cancer subtype findings were observed between the two cohorts; however, MRI outcomes were found to differ between the DBT and DM cohorts (p=0.024). Specifically, the DBT cohort had significantly (p=0.013) fewer true-positive findings (7/82, 8.5%) than did the DM cohort (7/23; 30%), whereas the false-positive rate was similar between the cohorts (not statistically significant). When stratifying by breast density, this difference in true-positive rates was primarily observed when evaluating women with non-dense breasts (p=0.001). CONCLUSION: In both the DM- and DBT-screened populations with new cancer diagnoses, MRI is able to detect additional cancer; however, in those patients who have DBT screen-detected cancers the positive impact of preoperative MRI is diminished, particularly in those women with non-dense breasts.

A microsatellite analysis of five Colonial Spanish horse populations of the southeastern United States.

The domestic horse (Equus caballus) was re-introduced to the Americas by Spanish explorers. Although horses from other parts of Europe were subsequently introduced, some New World populations maintain characteristics ascribed to their Spanish heritage. The southeastern United States has a history of Spanish invasion and settlement, and this influence on local feral horse populations includes two feral-recaptured breeds: the Florida Cracker and the Marsh Tacky, both of which are classified as Colonial Spanish horses. The feral Banker horses found on islands off the coast of North Carolina, which include, among others, the Shackleford Banks, the Corolla and the Ocracoke, are also Colonial Spanish horses. Herein we analyse 15 microsatellite loci from 532 feral and 2583 domestic horses in order to compare the genetic variation of these five Colonial Spanish Horse populations to 40 modern horse breeds. We find that the Corolla horse has very low heterozygosity and that both the Corolla and Ocracoke populations have a low mean number of alleles. We also find that the Florida Cracker population has a heterozygosity deficit. In addition, we find evidence of similarity of the Shackleford Banks, Marsh Tacky and Florida Cracker populations to New World Iberian horse breeds, while the origins of the other two populations are less clear.

Genetic analysis of the Venezuelan Criollo horse.

Various horse populations in the Americas have an origin in Spain; they are remnants of the first livestock introduced to the continent early in the colonial period (16th and 17th centuries). We evaluated genetic variability within the Venezuelan Criollo horse and its relationship with other horse breeds. We observed high levels of genetic diversity within the Criollo breed. Significant population differentiation was observed between all South American breeds. The Venezuelan Criollo horse showed high levels of genetic diversity, and from a conservation standpoint, there is no immediate danger of losing variation unless there is a large drop in population size.

Incidence of the mask phenotype M264V mutation in Labrador Retrievers.

The introduction of SNP (Single Nucleotide Polymorphism) chips allows for the rapid typing of multiple markers for many individuals at one time. Our lab routinely types dogs using a custom designed combined panel of SNPs for parentage verification and a number of genes for diagnostic tests using an OpenArray platform manufactured by BioTrove (Woburn, MA, USA). By utilizing the same SNP panel across a wide array of canine breeds it is possible to detect trait-associated SNPs in breeds not thought to carry those traits. We genotyped 245 Labrador Retrievers on the canine SNP chip and found 13 animals heterozygous for the M264V mutation associated with autosomal dominant mask trait, and one animal homozygous for this trait. The color genotypes for these animals were further examined. In standard colored Labradors (black, chocolate, and yellow), the mask phenotype would never be distinguishable. As illustrated by this example, we feel this SNP panel is a valuable method for discovering traits not known to exist in a breed.

Dual-energy contrast-enhanced digital breast tomosynthesis--a feasibility study.

Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel modality for imaging breast lesion morphology and vascularity. The purpose of this study is to assess the feasibility of dual-energy subtraction as a technique for CE-DBT (a temporal subtraction CE-DBT technique has been described previously). As CE-DBT evolves, exploration of alternative image acquisition techniques will contribute to its optimisation. Evaluation of dual-energy CE-DBT was conducted with Institutional Review Board (IRB) approval from our institution and in compliance with federal Health Insurance Portability and Accountability Act (HIPAA) guidelines. A 55-year old patient with a known malignancy in the right breast underwent imaging with MRI and CE-DBT. CE-DBT was performed in the medial lateral oblique view with a DBT system, which was modified under IRB approval to allow high-energy image acquisition with a 0.25 mm Cu filter. Image acquisition occurred via both temporal and dual-energy subtraction CE-DBT. Between the pre- and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1.0 ml kg(-1)) was administered, followed by a 60 ml saline flush. The contrast agent and saline were administrated manually at a rate of approximately 2 ml s(-1). Images were reconstructed using filtered-back projection and transmitted to a clinical PACS workstation. Dual-energy CE-DBT was shown to be clinically feasible. In our index case, the dual-energy technique was able to provide morphology and kinetic information about the known malignancy. This information was qualitatively concordant with that of CE-MRI. Compared with the temporal subtraction CE-DBT technique, dual-energy CE-DBT appears less susceptible to motion artefacts.

Y-chromosome analysis of ancient Hungarian and two modern Hungarian-speaking populations from the Carpathian Basin.

The Hungarian population belongs linguistically to the Finno-Ugric branch of the Uralic family. The Tat C allele is an interesting marker in the Finno-Ugric context, distributed in all the Finno-Ugric-speaking populations, except for Hungarians. This question arises whether the ancestral Hungarians, who settled in the Carpathian Basin, harbored this polymorphism or not. 100 men from modern Hungary, 97 Szeklers (a Hungarian-speaking population from Transylvania), and 4 archaeologically Hungarian bone samples from the 10(th) century were studied for this polymorphism. Among the modern individuals, only one Szekler carries the Tat C allele, whereas out of the four skeletal remains, two possess the allele. The latter finding, even allowing for the low sample number, appears to indicate a Siberian lineage of the invading Hungarians, which later has largely disappeared. The two modern Hungarian-speaking populations, based on 22 Y-chromosomal binary markers, share similar components described for other Europeans, except for the presence of the haplogroup P*(xM173) in Szekler samples, which may reflect a Central Asian connection, and high frequency of haplogroup J in both Szeklers and Hungarians. MDS analysis based on haplogroup frequency values, confirms that modern Hungarian and Szekler populations are genetically closely related, and similar to populations from Central Europe and the Balkans.

Diffuse boundary extraction of breast masses on ultrasound by leak plugging.

We propose a semiautomated seeded boundary extraction algorithm that delineates diffuse region boundaries by finding and plugging their leaks. The algorithm not only extracts boundaries that are partially diffuse, but in the process finds and quantifies those parts of the boundary that are diffuse, computing local sharpness measurements for possible use in computer-aided diagnosis. The method treats a manually drawn seed region as a wellspring of pixel "fluid" that flows from the seed out towards the boundary. At indistinct or porous sections of the boundary, the growing region will leak into surrounding tissue. By changing the size of structuring elements used for growing, the algorithm changes leak properties. Since larger elements cannot leak as far from the seed, they produce compact, less detailed boundary approximations; conversely, growing from smaller elements results in less constrained boundaries with more local detail. This implementation of the leak plugging algorithm decrements the radius of structuring disks and then compares the regions grown from them as they increase in both area and boundary detail. Leaks are identified if the outflows between grown regions are large compared to the areas of the disks. The boundary is plugged by masking out leaked pixels, and the process continues until one-pixel-radius resolution. When tested against manual delineation on scans of 40 benign masses and 40 malignant tumors, the plugged boundaries overlapped and correlated well in area with manual tracings, with mean overlap of 0.69 and area correlation R2 of 0.86, but the algorithm's results were more reproducible.

Blinded review of retrospectively visible unreported breast cancers: an eye-position analysis.

PURPOSE: To determine whether unreported retrospectively identified cancers on mammograms receive prolonged visual attention and can be reliably detected in a blinded review. MATERIALS AND METHODS: Four experienced mammographers performed a blinded review of a test set of 20 retrospective cases where the cancer was not detected until the next mammographic evaluation, 10 prospective cases where the cancer was initially detected, and 10 cancer-free cases. Two views were digitized and displayed on a workstation. The experiment consisted of an initial impression, during which eye position was monitored, and a final impression, during which viewers zoomed on regions of interest and localized suspicious lesions. Eye-position data were analyzed to determine whether retrospectively visible cancers attracted attention to the same degree as prospectively visible cancers. The initial impression used 1,000 msec as the eye-fixation dwell criterion for detecting a lesion. RESULTS: Initially, 70% of retrospective cancers and 50% of prospective cancers did not attract prolonged visual attention. In prospective cases, detailed examination significantly improved the mean receiver operating characteristic area, from.73 to.88 (P <.01), but in retrospective cases, the mean receiver operating characteristic area barely increased, from.60 to.68, due to a high true-positive-to-false-positive ratio. CONCLUSION: At blinded review, detection of retrospectively visible cancers was significantly inferior to that of prospective cancers. It cannot be assumed that retrospectively identified cancers are intrinsically detectable, because they do not draw prolonged visual attention during visual search for breast cancers.

Breast tissue density quantification via digitized mammograms.

Studies reported in the literature indicate that breast cancer risk is associated with mammographic densities. An objective, repeatable, and a quantitative measure of risk derived from mammographic densities will be of considerable use in recommending alternative screening paradigms and/or preventive measures. However, image processing efforts toward this goal seem to be sparse in the literature, and automatic and efficient methods do not seem to exist. In this paper, we describe and validate an automatic and reproducible method to segment dense tissue regions from fat within breasts from digitized mammograms using scale-based fuzzy connectivity methods. Different measures for characterizing mammographic density are computed from the segmented regions and their robustness in terms of their linear correlation across two different projections--cranio-caudal and medio-lateral-oblique--are studied. The accuracy of the method is studied by computing the area of mismatch of segmented dense regions using the proposed method and using manual outlining. A comparison between the mammographic density parameter taking into account the original intensities and that just considering the segmented area indicates that the former may have some advantages over the latter.

Cyclosporin A-induced fibroadenomas of the breast: report of five cases.

Five female patients undergoing cyclosporin A therapy had newly developed breast masses. Masses were bilateral in three of the five patients and palpable in four patients. The imaging findings were suggestive of fibroadenomas, and biopsy results were used to confirm the diagnosis. With the development of new breast lesions in patients after transplantation surgery, the diagnosis of cyclosporin A-induced fibroadenomas should be considered.

Diabetic mastopathy in men: imaging findings in two patients.

The classic imaging findings of diabetic mastopathy, an uncommon entity manifesting in patients with a history of long-standing insulin-dependent diabetes mellitus, have been reported in the literature in women but not, to the authors' knowledge, in men. Two men with diabetic mastopathy presented with palpable breast masses. The clinical histories of the men in whom this condition was diagnosed were similar to those reported for women with the condition. The mammographic findings in both men, at presentation, were suggestive of gynecomastia.

Interreader variability and predictive value of US descriptions of solid breast masses: pilot study.

RATIONALE AND OBJECTIVES: This study evaluated the specificity of ultrasound (US) characteristics of solid breast lesions and the interreader variability in their interpretation. MATERIALS AND METHODS: In 61 patients, 70 sonographically visible solid masses, scheduled for biopsy because of findings from conventional imaging, were prospectively and sequentially accrued for evaluation. Three readers interpreted the sonograms and described the solid masses in terms of established US characteristics. The specificity and positive predictive value (PPV) for each characteristic were calculated by comparing US findings with biopsy findings, and interreader variability was evaluated. Five assessment categories were developed to guide recommendations for patient care. The relative performance of each reader was assessed by measuring the PPV for each assessment category and by measuring the area under the receiver operating characteristic curve. RESULTS: The specificity and PPV were calculated for all characteristics and for each reader. The average specificities of the three readers for the most frequently used six characteristics were as follows: spiculation, 97%+/-5 (standard deviation); taller than wide, 91%+/-4; central shadowing, 77%+/-1; markedly hypoechoic, 86%+/-5; duct extension, 95%+/-5; and microlobulation, 84%+/-3 (overall average specificity, 88.5%). The average PPVs for categories II-V were 5%, 10%, 63%, and 94%, respectively. The readers' interpretations were similar and correlated well. CONCLUSION: The proposed US recommendation system is an accurate predictor of histologic findings. A sonographic classification lexicon should prove valuable.

The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience.

BACKGROUND: Advances in the diagnosis and treatment of breast carcinoma have led to a multidisciplinary approach to management for patients with breast carcinoma. To assess the effect of this approach, the authors performed an evaluation for a cohort of patients examined in a multidisciplinary breast cancer center. METHODS: An analysis was performed for the records of 75 consecutive women with 77 breast lesions examined in consultation in a multidisciplinary breast cancer center between January and June 1998. Each patient's case was evaluated by a panel consisting of a medical oncologist, surgical oncologist, radiation oncologist, pathologist, diagnostic radiologist, and, when indicated, plastic surgeon. A comprehensive history and physical examination was performed, and the relevant mammograms, pathology slides, and medical records were reviewed. Treatment recommendations made before this evaluation were compared with the consensus recommendations made by the panel. RESULTS: For the 75 patients, the multidisciplinary panel disagreed with the treatment recommendations from the outside physicians in 32 cases (43%), and agreed in 41 cases (55%). Two patients (3%) had no treatment recommendation before consultation. For the 32 patients with a disagreement, the treatment recommendations were breast-conservation treatment instead of mastectomy (n = 13; 41%) or reexcision (n = 2; 6%); further workup instead of immediate definitive treatment (n = 10; 31%); treatment based on major change in diagnosis on pathology review (n = 3; 9%); addition of postmastectomy radiation treatment (n = 3; 9%); or addition of hormonal therapy (n = 1; 3%). CONCLUSIONS: The multidisciplinary breast cancer evaluation program provided an integrated program in which individual patients were evaluated by a team of physicians and led to a change in treatment recommendation for 43% (32 of 75) of the patients examined. This multidisciplinary program provided important second opinions for many patients with breast carcinoma.

Update on digital mammography.

On January 28, 2000, the U.S. Food and Drug Administration (FDA) approved the first full-field digital mammography unit for clinical use. The approval occurred approximately ten years after a National Cancer Institute (NCI) expert panel determined that, of all emergent technologies, digital mammography held the greatest potential for improving breast cancer detection [1,2]. Currently, four types of digital mammographic systems are under clinical evaluation. This article will review the information from the early clinical trials on digital mammography and will attempt to define the potential impact of digital mammography on the clinical practice of breast imaging.

Spectrum of US findings in pediatric and adolescent patients with palpable breast masses.

Palpable breast masses arising in pediatric and adolescent patients are uncommon. A careful physical examination should be performed first, followed by an ultrasonographic evaluation when a suspect mass is present. In this study population, palpable findings were all due to benign causes, which is concordant with the literature. Benign causes included gynecomastia, cyst, fibroadenoma, lymph node, galactocele, duct ectasia, and infection. Though extremely rare, breast malignancies do occur in the pediatric and adolescent population.

Image processing algorithms for digital mammography: a pictorial essay.

Digital mammography systems allow manipulation of fine differences in image contrast by means of image processing algorithms. Different display algorithms have advantages and disadvantages for the specific tasks required in breast imaging-diagnosis and screening. Manual intensity windowing can produce digital mammograms very similar to standard screen-film mammograms but is limited by its operator dependence. Histogram-based intensity windowing improves the conspicuity of the lesion edge, but there is loss of detail outside the dense parts of the image. Mixture-model intensity windowing enhances the visibility of lesion borders against the fatty background, but the mixed parenchymal densities abutting the lesion may be lost. Contrast-limited adaptive histogram equalization can also provide subtle edge information but might degrade performance in the screening setting by enhancing the visibility of nuisance information. Unsharp masking enhances the sharpness of the borders of mass lesions, but this algorithm may make even an indistinct mass appear more circumscribed. Peripheral equalization displays lesion details well and preserves the peripheral information in the surrounding breast, but there may be flattening of image contrast in the nonperipheral portions of the image. Trex processing allows visualization of both lesion detail and breast edge information but reduces image contrast.

Optical imaging as an adjunct to sonograph in differentiating benign from malignant breast lesions.

The role of near infrared (NIR) diffusive light imaging as an adjunct to ultrasound in differentiating benign from malignant lesions was evaluated in 27 mammography patients with infiltrating ductal carcinomas, apocrine metaplasia, fibroadenomas, radial scar and ductal hyperplasia, cysts, and normal tissues. Conventional ultrasound/mammography images were graded based on BI-RADS assessment categories. The spatial NIR measurements were made at wavelengths of 750 and 830 nm. Functional images, such as relative changes of deoxyhemoglobin (deoxyHb) and total blood concentration, were estimated from the dual wavelength measurements. Maximum relative deoxyHb and blood concentration changes were measured, and spatial correlation of masses in relative deoxyHb and blood concentration images for each breast were calculated. For the five biopsy proven benign lesions, ultrasound/mammography diagnoses were suspicious for malignancy (four cases) and highly suspicious for malignancy (one case). Four lesions showed less than 1.0 V maximum deoxyHb and less than 1.5 V maximum blood concentration levels on average and spatial image correlation showed no correlated masses in both deoxyHb and blood concentration images. For the four biopsy proven malignant lesions, ultrasound/mammography diagnoses were highly suspicious for malignancy. Maximum deoxyHb and blood concentration changes were greater than 2.9 V on average except one lesion which showed smaller deoxyHb signal (maximum 0.85 V) but the deoxyHb mass and blood concentration mass were highly correlated.

Radiologists' preferences for digital mammographic display. The International Digital Mammography Development Group.

PURPOSE: To determine the preferences of radiologists among eight different image processing algorithms applied to digital mammograms obtained for screening and diagnostic imaging tasks. MATERIALS AND METHODS: Twenty-eight images representing histologically proved masses or calcifications were obtained by using three clinically available digital mammographic units. Images were processed and printed on film by using manual intensity windowing, histogram-based intensity windowing, mixture model intensity windowing, peripheral equalization, multiscale image contrast amplification (MUSICA), contrast-limited adaptive histogram equalization, Trex processing, and unsharp masking. Twelve radiologists compared the processed digital images with screen-film mammograms obtained in the same patient for breast cancer screening and breast lesion diagnosis. RESULTS: For the screening task, screen-film mammograms were preferred to all digital presentations, but the acceptability of images processed with Trex and MUSICA algorithms were not significantly different. All printed digital images were preferred to screen-film radiographs in the diagnosis of masses; mammograms processed with unsharp masking were significantly preferred. For the diagnosis of calcifications, no processed digital mammogram was preferred to screen-film mammograms. CONCLUSION: When digital mammograms were preferred to screen-film mammograms, radiologists selected different digital processing algorithms for each of three mammographic reading tasks and for different lesion types. Soft-copy display will eventually allow radiologists to select among these options more easily.

Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications.

Seventy-four biopsy proven breast masses were imaged by color and power Doppler imaging to evaluate vascular pattern of malignant and benign breast masses. The images were analyzed for vascularity. The measurements were made over the entire mass as well as regionally at its core, at its periphery, and in the tissue surrounding it. The surgical specimens were analyzed for microvessel density. The diagnostic performance of Doppler sonographic vascularity indices was evaluated by receiver operating characteristic analysis. The malignant masses were 14 to 54% more vascular than the benign masses. Both types of masses were more vascular by ultrasonography than the tissue surrounding them. Whereas benign masses were 2.2 times more vascular than the surrounding tissue, the malignant masses were 5.0 times more vascular. In a subset of patients the regional vascularity at the core, periphery, and surrounding tissue by Doppler imaging exhibited a strong correlation (R2 > 0.9) with the corresponding histologic microvessel density measurements. Although the malignant masses exhibited a strong gradient in vascularity, core > periphery > surrounding tissue, the benign masses had relatively uniform distribution of vascularity. The area under the receiver operating characteristic curve (A(Z)) for the Doppler indices ranged from 0.56 +/- 0.07 to 0.65 +/- 0.07. A nonlinear analysis including age-specific values of Doppler indices improved the diagnostic performance to A(Z) = 0.85 +/- 0.06. In conclusion, quantitative Doppler imaging when used in combination with a nonlinear rule-based approach has the potential for differentiating between malignant and benign masses.