TY - JOUR
T1 - MRI of the Lactating Breast
T2 - Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features
AU - Nissan, Noam
AU - Sorin, Vera
AU - Bauer, Ethan
AU - Anaby, Debbie
AU - Samoocha, David
AU - Yagil, Yael
AU - Faermann, Renata
AU - Halshtok-Neiman, Osnat
AU - Shalmon, Anat
AU - Gotlieb, Michael
AU - Sklair-Levy, Miri
N1 - Publisher Copyright:
© 2021 The Association of University Radiologists
PY - 2022/9
Y1 - 2022/9
N2 - Rationale and Objectives: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. Materials and Methods: The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups’ trends and differences between the lactating and cancer cohorts were statistically assessed. Results: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001). Conclusion: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.
AB - Rationale and Objectives: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. Materials and Methods: The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups’ trends and differences between the lactating and cancer cohorts were statistically assessed. Results: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001). Conclusion: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.
KW - BPE
KW - CAD MRI
KW - DWI
KW - MRI lactation
KW - PABC
KW - pregnancy-associated breast cancer
UR - http://www.scopus.com/inward/record.url?scp=85120405401&partnerID=8YFLogxK
U2 - 10.1016/j.acra.2021.11.003
DO - 10.1016/j.acra.2021.11.003
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 34857455
AN - SCOPUS:85120405401
SN - 1076-6332
VL - 29
SP - 1332
EP - 1341
JO - Academic Radiology
JF - Academic Radiology
IS - 9
ER -