Autonomous Robotic System for Breast Biopsy With Deformation Compensation

Background Although breast magnetic resonance imaging (MRI) could help to identify occult lesions in breast cancer, its role in patient outcome has always been controversial. The current study aimed to evaluate the role of MRI in Asian breast cancer patients, especially young patients that might have dense breasts. Methods Patients with non-metastatic unilateral breast cancer who received surgery in our institute during 2007-2013 were retrospectively reviewed. The differences between groups were compared using Pearson's χ2 test.Loco-regional recurrence-free survival (LRRFS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method. Results A total of 13,681 patients were included into analysis, among which 5823 (42.6%) had pre-operative MRI. Of all patients, 39.7% were stage 0-I according to TNM system, 35.5% were stage II, 14.8% were stage III and 10.0% could not be staged. Patients with axillary lymph node metastasis were comparable in MRI and non-MRI groups (35.3% versus 35.6%, P=0.695). The percentile of patients receiving MRI increased from 7.3% in 2007 to 67.5% in 2013. Patients in the breast-conservative surgery (BCS) group were more likely to receive MRI compared with the mastectomy group (P<0.001). Age and menopausal status were also related with the choice of pre-operative MRI. When patients were grouped according to age, 56.7%, 48.9%, 43.6%, 37.0% and 27.1% patients in the ≤35, 36-45, 46-55, 56-65 and >65 years old group had MRI, respectively (P<0.001). When patients were grouped according to menopausal status, 37.8%, 48.8% and 27.3% patients in the post-menopausal group, pre-menopausal group and unknown menopausal status group had MRI, respectively (P<0.001). In survival analysis, the average follow-up time for the MRI group (N=5823) and non MRI group (N=7858) were 88.5 and 114.4 months, during which 238 (4.1%) and 464 (5.9%) breast cancer recurrences occurred, while 63 (1.1%) and 159 (2.0%) loco-reginal recurrences occurred. The estimated 5-year RFS for MRI group and non-MRI group were 90.1% and 90.0% (P=0.510). The 5-year LRR-free survival LRRFS for MRI group and non-MRI group were 96.7% and 97.3% (P=0.128). In subgroup analysis, 2376 patients received BCS, and 11,035 received mastectomy. Patient in the pre-operative MRI group did not have superior RFS or LRRFS compared with the non-MRI group, regardless of surgical management (BCS versus mastectomy). Then we restrained the analysis to patients who were ≤45 years old and treated with BCS. A total of 699 patients had pre-operative MRI, and 419 patients did not. The 5-year RFS for MRI group and non-MRI group were 95.8% versus 94.6% (P=0.231); the 5-year LRRFS for MRI group and non-MRI group were 99.8% and 97.1% (P=0.144). Conclusions There was an increasing trend of pre-operative MRI examination during 2007-2013, especially in young patients and patients treated with BCS. However, pre-operative MRI could not benefit breast cancer patients' survival by detecting occult lesions, even in young patients treated with BCS, who were considered to have dense breasts. Citation Format: Huang N, Chen J, Yang B, Quan C, Xue J, Huang X, Wu J. Pre-operative breast MRI would not benefit breast cancer patients' survival, even in young patients treated with breast-conservative surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-01.

What is the role of preoperative imaging for cochlear implants in adults with postlingual deafness?

The possibility to perform an early and repeatable assessment of imaging performance is fundamental in the design and development process of new ultrasound (US) probes. Particularly, a more realistic analysis with application-specific imaging targets can be extremely valuable to assess the expected performance of US probes in their potential clinical field of application. The experimental protocol presented in this work was purposely designed to provide an application-specific assessment procedure for newly-developed US probe prototypes based on Capacitive Micromachined Ultrasonic Transducer (CMUT) technology in relation to brain imaging. The protocol combines the use of a bovine brain fixed in formalin as the imaging target, which ensures both realism and repeatability of the described procedures, and of neuronavigation techniques borrowed from neurosurgery. The US probe is in fact connected to a motion tracking system which acquires position data and enables the superposition of US images to reference Magnetic Resonance (MR) images of the brain. This provides a means for human experts to perform a visual qualitative assessment of the US probe imaging performance and to compare acquisitions made with different probes. Moreover, the protocol relies on the use of a complete and open research and development system for US image acquisition, i.e. the Ultrasound Advanced Open Platform (ULA-OP) scanner. The manuscript describes in detail the instruments and procedures involved in the protocol, in particular forthe calibration, image acquisition and registration of US and MR images. The obtained results prove the effectiveness of the overall protocol presented, which is entirely open (within the limits of the instrumentation involved), repeatable, and covers the entire set of acquisition and processing activities for US images.

Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions.

Internal impingement: Findings on magnetic resonance imaging and arthroscopic evaluation

Contrary to practice guidelines, breast magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of women with breast cancer. While existing literature has found little benefit to MRI in most patients, potential downstream consequences associated with breast MRI are not well described. To describe patterns of preoperative breast MRI utilization in a health care system with universal insurance and its association with downstream investigations and clinical outcomes. This was a population-based retrospective cohort study using administrative heath care databases in Ontario, Canada (2012 population, 13.5 million) over 14 geographic regions were evaluated within the data set. Participants comprised 53 015 patients with primary operable breast cancer treated from 2003 to 2012. Use of preoperative breast MRI by year, geographic region, and breast cancer stage. Postdiagnosis imaging, biopsy, and short-term surgical outcomes were also evaluated between those who did and did not receive MRI. Overall, 14.8% of patients (7824 of 53 015) had a preoperative MRI. During the 10-year study period, MRI use increased across all stages by 8-fold (from 3% to 24%; P < .001 for trend). Factors associated with MRI use were younger age, higher socioeconomic status, higher Charlson comorbidity score, surgery performed in a teaching hospital, and fewer years of surgeon experience. Multivariate analyses showed that preoperative breast MRI was associated with higher likelihood of the following: postdiagnosis breast imaging (odds ratio [OR], 2.09; 95% CI, 1.92-2.28), postdiagnosis breast biopsies (OR, 1.74; 95% CI, 1.57-1.93), postdiagnosis imaging to assess for distant metastatic disease (OR, 1.51; 95% CI, 1.42-1.61), mastectomy (OR, 1.73; 95% CI, 1.62-1.85), contralateral prophylactic mastectomy (OR, 1.48; 95% CI, 1.23-1.77), and a greater than 30-day wait to surgery (OR, 2.52; 95% CI, 2.36-2.70) (all ORs are adjusted). Preoperative breast MRI use has increased substantially in routine clinical practice and is associated with a significant increase in ancillary investigations, wait time to surgery, mastectomies, and contralateral prophylactic mastectomies.

Abstract #1163 Background: Ductal carcinoma in situ (DCIS) accounts for about 20% of all female breast cancers and is now diagnosed 10 times more frequently than prior to the use of increased screening mammography. Although magnetic resonance imaging (MRI) has proven to be a useful imaging modality for invasive cancer, its role and impact in preoperative surgical planning for DCIS is unclear. Our aim is to determine if women diagnosed with pure DCIS on core-biopsy who have preoperative MRI are more likely to undergo mastectomy and sentinel lymph node biopsy (SLNB). Methods: Retrospective survey of women diagnosed with pure DCIS on stereotactic core biopsy between 2000-2007 at an academic tertiary referral center. All women underwent definitive surgical treatment for DCIS. Patient characteristics, surgical planning and surgical outcomes were compared between patients who underwent preoperative MRI and those without MRI. Continuous variables among the two groups were compared using the t-test. Differences in dichotomous variables between groups were compared using the chi-square test. Significance was determined if p&amp;lt;0.05. Results: Of 137 women diagnosed with DCIS, 39 underwent preoperative MRI. Mean age, DCIS size and grade, and presence of invasive cancer on surgical specimen were compared between the two groups. The only significant difference between the two groups was younger mean age in the group with preoperative MRI (51 vs 59 yrs, p=0.001). On univariate analysis, mastectomy and SLNB were more commonly employed in the MRI group. The mastectomy rate was 55% for women who had preoperative MRI and 17% for those who did not (p&amp;lt;0.0001). The SLNB rate was 46% for women had preoperative MRI and 23% for those who did not (p=0.009). Number of re-excisions, margin status and size were compared between the two groups. Preoperative MRI was not significantly associated with wider surgical margins or higher proportion of patients with negative margins. However, the mean number of re-excisions was lower in women who underwent preoperative MRI (0.7 vs. 1.2, p=0.003). The only independent factor associated with likelihood of preoperative MRI in the setting of DCIS was patient age. On multivariate analysis, use of SLNB was independently associated with mastectomy, DCIS size and DCIS grade (p=0.0001, p=0.011, p=0.024, respectively). In contrast, independent predictors of mastectomy were DCIS size and use of MRI (OR 5.1, 95% CI 2.0-13.2)). Conclusion: Women who underwent preoperative MRI for DCIS were younger and more likely to undergo mastectomy. However, women who had preoperative MRI required a lower number of re-excisions to obtain negative margins. Our study cannot address whether the strong association between preoperative MRI and mastectomy is a causal one. Nevertheless our data support a critical need for future studies to further define the benefit as well as consequences of the use of MRI for DCIS evaluation and treatment. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1163.

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Preoperative magnetic resonance imaging (MRI) is increasingly used in the workup of breast cancer patients and could lead to changes in surgical management. It is unclear how the information gained from MRI studies affects surgical decision making and influences clinical outcomes. These issues are addressed in this review. PubMed database searches were performed to retrieve and analyze respective original research and review articles on preoperative MRI in the evaluation of breast cancer patients. Preoperative MRI is a highly sensitive but nonspecific method that leads to changes in surgical management with increased numbers of more extended surgical interventions. It appears that a relatively large proportion of MRI-driven changes in surgical management result in overtreatment without conclusively proven beneficial effects on such clinical outcomes as decrease in reoperation rates or improved patient survival. Thus, routine use of supplementary preoperative breast MRI should be discouraged until compelling evidence of its effectiveness is available.

Purpose To retrospectively investigate the relationship between the kinetic features of breast cancer assessed with computer-aided diagnosis (CAD) at preoperative magnetic resonance (MR) imaging and disease-free survival in patients with primary operable invasive breast cancer. Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. The authors identified 329 consecutive women (mean age, 52.9 years; age range, 32-88 years) with newly diagnosed invasive breast cancer who had undergone preoperative MR imaging and surgery between January 2012 and February 2013. All MR images were retrospectively reviewed by using a commercially available CAD system, and the following kinetic parameters were noted for each lesion: peak enhancement (highest pixel signal intensity in the first series obtained after administration of contrast material), angio-volume (total volume of the enhancing lesion), and delayed enhancement profiles (the proportions of washout, plateau, and persistently enhancing component within a tumor). Cox proportional hazards modeling was used to identify the relationship between CAD-generated kinetics and disease-free survival after adjusting for clinical-pathologic variables. Results A total of 36 recurrences developed at a median follow-up of 50 months (range, 15-55 months). CAD-measured peak enhancement at preoperative MR imaging enabled differentiation between patients with and patients without recurrence (area under the receiver operating characteristic curve = 0.728; 95% confidence interval [CI]: 0.676, 0.775; P < .001). Multivariate Cox analysis showed that a higher peak enhancement (hazard ratio [HR] = 1.001; 95% CI: 1.000, 1.002; P = .004), a higher washout component (HR = 1.029; 95% CI: 1.005, 1.054; P = .017), and lymphovascular invasion at histopathologic examination (HR = 3.011; 95% CI: 1.302, 6.962; P = .010) were associated with poorer disease-free survival. Conclusion Higher values of CAD-measured peak enhancement and washout component at preoperative MR imaging were significantly associated with poorer disease-free survival of patients with primary operable breast cancer. © RSNA, 2017.

Characteristics of clinically node negative breast cancer patients needing preoperative MRI

The purpose of this study was to assess and compare the diagnostic performances of preoperative ultrasonography (US) and magnetic resonance imaging (MRI) in predicting extrathyroidal extension (ETE) in patients with papillary thyroid carcinoma (PTC). This retrospective study was approved by our institutional review board. Preoperative US and MRI were performed on 225 patients who underwent surgery for PTC between May 2014 and December 2018. The US and MRI features of ETE of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and MRI, including their sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for ETE, and their accuracy in predicting ETE were analyzed. Higher sensitivity and NPV in predicting minimal ETE were observed in US (87.5% and 76.2%, respectively) compared with MRI (71.3% and 61.7%, respectively) (p = 0.006 and p = 0.046, respectively). Meanwhile, MRI (85.4%) showed higher sensitivity than US (66.7%) in assessing extensive ETE (p = 0.005). MRI also showed significantly higher specificity and PPV than US in assessing overall ETE (p = 0.025 and p = 0.025, respectively). Preoperative US should be used as the first line in predicting minimal ETE, and MRI should be added in extensive ETE assessment. Compared with US, MRI had higher specificity and PPV in detecting the overall ETE of PTC.

Breast Magnetic Resonance Imaging for Preoperative Evaluation of Breast Cancer: A Systematic Review and Meta-Analysis.

The Effectiveness of MR Imaging in the Assessment of Invasive Lobular Carcinoma of the Breast

The effects of magnetic resonance imaging (MRI)-compatible ultrasound (US) probes on MRI monitoring were evaluated. It was found that MRI-compatible US probes with backing material containing 100 ppm ferrite, did not disturb MR monitoring except within a few mm radius from the US probe's position. MRI temperature monitoring of an excised swine liver irradiated with a high-intensity focused US beam from an MRI-compatible therapeutic transducer with US image guidance was then performed, and the potential usefulness of such a therapeutic system in minimally invasive therapy was demonstrated.