Calcification in breast lesions: pathologists’ perspective

Tse, Gary M.; Tan, Puay Hoon; Pang, A; Tang, Alice Py; Cheung, H. T. Andrew

doi:10.1136/jcp.2006.046201

Cited by 76 publications

(62 citation statements)

References 40 publications

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“…Similar to what we observed in the dog, the incidence of calcification in human DCIS ranges between 42% and 72% (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Up to 90% of DCIS lesions in human are detected on the basis of mammograpically visible microcalcifications (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). All canine DCISs were associated with comedo-type carcinoma and contained microcalcification and, interestingly, were mammographically detected.…”

Section: Discussionsupporting

confidence: 68%

“…Typical benign calcifications in human are similar to that we have seen in the dog and are large, smooth, popcorn-like, round, dense, and scattered over a large area. These lesions in human do not need further investigations or close follow-up (26,34). About 47% of malignant tumors in this study showed microcalcification.…”

Section: Discussionmentioning

confidence: 80%

“…Usually, suspicious microcalcifications vary in size and shape and form clusters in linear or segmental patterns that signify that the tissue may be malignant whereas benign calcifications or macrocalcification tend to be large with round or oval shape and scattered in the breast (34)(35)(36). Thus, calcifications are considered to be one of the most important diagnostic markers of both benign and malignant lesions (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Correlation of mammographic features with histopathology, in this study, revealed that calcifications were present in 54% of canine mammary cases.…”

Section: Discussionmentioning

confidence: 99%

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Mammography and Ultrasound Imaging of Preinvasive and Invasive Canine Spontaneous Mammary Cancer and Their Similarities to Human Breast Cancer

Mohammed¹,

Meloni²,

Parpaglia³

et al. 2011

Cancer Prevention Research

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Understanding the evolution of proliferative breast disease such as atypical hyperplasia and carcinoma in situ is essential for clinical management of women diagnosed with these lesions. Therefore, an animal model that faithfully represents human breast disease in every aspect from spontaneity of dysplasia onset, histopathologic features, and genetics to clinical outcome is needed. Previously, we studied canine spontaneous atypical hyperplasia and ductal carcinoma in situ (low, intermediate, and high grade) and reported their similarities to human lesions in histopathologic and molecular features as well as prevalence. To further validate the resemblance of these lesions to humans, we examined their mammographic and sonographic characteristics in comparison with those of human's as well as the potential of the human Breast Imaging Reporting and Data System (BI-RADS) to predict canine disease. Nonlesional, benign, and malignant mammary glands of dogs presented to Sassari Veterinary Hospital were imaged using mammography and ultrasonography. The images where then analyzed and statistically correlated with histopathologic findings and to their similarities to humans. Our results showed that canine mammary preinvasive lesions, benign, and malignant tumors have mammographic abnormalities, including the presence, pattern, and distribution of macrocalcification and microcalcification, similar to their human counterparts. BI-RADS categorization is an accurate predictor of mammary malignancy in canine, with 90% sensitivity and 82.8% specificity. The similarities of mammographic images and the ability of BI-RADS to predict canine mammary malignances with high specificity and sensitivity further confirm and strengthen the value of dog as a model to study human breast premalignancies for the development of prognostic biomarkers.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Mammography and Ultrasound Imaging of Preinvasive and Invasive Canine Spontaneous Mammary Cancer and Their Similarities to Human Breast Cancer

Mohammed¹,

Meloni²,

Parpaglia³

et al. 2011

Cancer Prevention Research

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“…The presence of microcalcifications indicating HER2 overexpression could be explained by the fact that DCIS, which may be a component of invasive cancer, is frequently HER2-positive and often shows microcalcifications (108)(109)(110). Alternatively, poorly differentiated tumors more often show central necrosis and rapid growth, resulting in deposition of microcalcifications along the ductal structures, and the finding could thus also be a reflection of the more aggressive nature of HER2-positive invasive cancers (109). Correlation between the presence of a mass (significant on ultrasound but also corroborated by the mammography and MRI findings) and decreased chance of HER2 overexpression is also likely a reflection of DCIS (less often presenting as a mass and more frequently HER2-positive; ref.…”

Section: Discussionmentioning

confidence: 99%

Imaging Features of HER2 Overexpression in Breast Cancer: A Systematic Review and Meta-analysis

Elias

Adams

Wisner

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [ 18 F]fluorodeoxyglucose positron emission tomography studies through February 2013. Of 68 imaging features that could be pooled (85 articles, 23,255 cancers; random-effects meta-analysis), 11 significantly related to HER2 overexpression. Results based on five or more studies and robustness in subgroup analyses were as follows: the presence of microcalcifications on mammography [pooled odds ratio (pOR), 3.14; 95% confidence interval (CI), 2.46-4.00] or ultrasound (mass-associated pOR, 2.95; 95% CI, 2.34-3.71), branching or fine linear microcalcifications (pOR, 2.11; 95% CI, 1.07-4.14) or extremely dense breasts on mammography (pOR, 1.37; 95% CI, 1.07-1.76), and washout (pOR, 1.57; 95% CI, 1.11-2.21) or fast initial kinetics (pOR, 2.60; 95% CI, 1.43-4.73) on MRI all increased the chance of HER2 overexpression. Maximum [ 18 F]fluorodeoxyglucose standardized uptake value (SUV max ) was higher upon HER2 overexpression (pooled mean difference, þ0.76; 95% CI, 0.10-1.42). These results show that several imaging features relate to HER2 overexpression, lending credibility to the hypothesis that imaging phenotype reflects cancer behavior. This implies prognostic relevance, which is especially relevant as imaging is readily available during diagnostic work-up. Cancer Epidemiol Biomarkers Prev; 23(8); 1464-83. Ó2014 AACR.

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“…The size of each contrast element is 25 mm 2 , which is in the range of sizes for calcifications of fibroadenoma and fat necrosis. 34 Iodine is relevant for contrast-enhanced imaging to detect angiogenesis in tumors. 24 Although the size of tumors and calcifications that indicate malignancy can be smaller than 25 mm 2 , the focus of this investigation is on the initial test of the theory and its performance given the chosen attenuation functions.…”

Section: Iic Measurement Phantomsmentioning

confidence: 99%

Least squares parameter estimation methods for material decomposition with energy discriminating detectors

Lê

Molloi

2010

Medical Physics

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Purpose: Energy resolving detectors provide more than one spectral measurement in one image acquisition. The purpose of this study is to investigate, with simulation, the ability to decompose four materials using energy discriminating detectors and least squares minimization techniques. Methods: Three least squares parameter estimation decomposition techniques were investigated for four-material breast imaging tasks in the image domain. The first technique treats the voxel as if it consisted of fractions of all the materials. The second method assumes that a voxel primarily contains one material and divides the decomposition process into segmentation and quantification tasks. The third is similar to the second method but a calibration was used. The simulated computed tomography ͑CT͒ system consisted of an 80 kVp spectrum and a CdZnTe ͑CZT͒ detector that could resolve the x-ray spectrum into five energy bins. A postmortem breast specimen was imaged with flat panel CT to provide a model for the digital phantoms. Hydroxyapatite ͑HA͒ ͑50, 150, 250, 350, 450, and 550 mg/ml͒ and iodine ͑4, 12, 20, 28, 36, and 44 mg/ml͒ contrast elements were embedded into the glandular region of the phantoms. Calibration phantoms consisted of a 30/70 glandular-toadipose tissue ratio with embedded HA ͑100, 200, 300, 400, and 500 mg/ml͒ and iodine ͑5, 15, 25, 35, and 45 mg/ml͒. The x-ray transport process was simulated where the Beer-Lambert law, Poisson process, and CZT absorption efficiency were applied. Qualitative and quantitative evaluations of the decomposition techniques were performed and compared. The effect of breast size was also investigated. Results: The first technique decomposed iodine adequately but failed for other materials. The second method separated the materials but was unable to quantify the materials. With the addition of a calibration, the third technique provided good separation and quantification of hydroxyapatite, iodine, glandular, and adipose tissues. Quantification with this technique was accurate with errors of 9.83% and 6.61% for HA and iodine, respectively. Calibration at one point ͑one breast size͒ showed increased errors as the mismatch in breast diameters between calibration and measurement increased. A four-point calibration successfully decomposed breast diameter spanning the entire range from 8 to 20 cm. For a 14 cm breast, errors were reduced from 5.44% to 1.75% and from 6.17% to 3.27% with the multipoint calibration for HA and iodine, respectively. Conclusions:The results of the simulation study showed that a CT system based on CZT detectors in conjunction with least squares minimization technique can be used to decompose four materials. The calibrated least squares parameter estimation decomposition technique performed the best, separating and accurately quantifying the concentrations of hydroxyapatite and iodine.

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Calcification in breast lesions: pathologists’ perspective

Cited by 76 publications

References 40 publications

Mammography and Ultrasound Imaging of Preinvasive and Invasive Canine Spontaneous Mammary Cancer and Their Similarities to Human Breast Cancer

Mammography and Ultrasound Imaging of Preinvasive and Invasive Canine Spontaneous Mammary Cancer and Their Similarities to Human Breast Cancer

Imaging Features of HER2 Overexpression in Breast Cancer: A Systematic Review and Meta-analysis

Least squares parameter estimation methods for material decomposition with energy discriminating detectors

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