Prospective assessment of adjunctive ultrasound-guided diffuse optical tomography in women undergoing breast biopsy: Impact on BI-RADS assessments. Issue 145 (December 2021)

• Record Type: Journal Article
• Authors: Poplack, Steven P.; Young, Catherine A.; Hagemann, Ian S.; Luo, Jingqin; Herman, Cheryl R.; Wiele, Kimberly; Li, Shuying; Zeng, Yifeng; Covington, Matthew F.; Zhu, Quing
• Is Part Of: European journal of radiology. Issue 145(2021)
• Publication Date: 2021-12
• Subjects: Breast cancer -- Breast ultrasound -- Diffuse optical tomography -- Optical imaging -- Predictive value; HbT average maximum total Hemoglobin concentration -- DOT Diffuse Optical Tomography -- CI conventional imaging; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.110029
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: US-guided DOT may reduce (23.5%) benign breast biopsies without missing cancers. HbT is significantly higher in cancer compared to benign lesions. HbT = 78.5 µM achieved sensitivity 80% (12/15) and specificity 89% (41/46). Qualitative HbT ring distribution may independently predict malignancy. Abstract: Purpose: To assess the impact of adjunctive ultrasound guided diffuse optical tomography (US-guided DOT) on BI-RADS assessment in women undergoing US-guided breast biopsy. Method: This prospective study enrolled women referred for US-guided breast biopsy between 3/5/2019 and 3/19/2020. Participants underwent US-guided DOT immediately before biopsy. The US-guided DOT acquisition generated average maximum total hemoglobin (HbT) spatial maps and quantitative HbT values. Four radiologists blinded to histopathology assessed conventional imaging (CI) to assign a CI BI-RADS assessment and then integrated DOT information in assigning a CI&DOT BI-RADS assessment. HbT was compared between benign and malignant lesions using an ANOVA test and Tukey's test. Benign biopsies were tabulated, deeming BI-RADS ≥ 4A as positive. Reader agreement was assessed. Results: Among 61 included women (mean age 48 years), biopsy demonstrated 15 (24.6%) malignant and 46 (75.4%) benign lesions. Mean HbT was 55.3 ± 22.6 µM in benign lesions versus 85.4 ± 15.6 µM in cancers (p < .001). HbT threshold of 78.5 µM achieved sensitivity 80% (12/15) and specificity 89% (41/46) for malignancy. Across readers and patients, 197 pairs of CI BI-RADS and CI&DOT BI-RADS assessments were assigned. Adjunctive US-guided DOT achieved a net decrease in 23.5% (31/132) of suspicious (CI BI-RADS ≥ 4A) assessments of benign lesions (34 correct downgrades and 3 incorrect upgrades). 38.3% (31/81) of 4A assessments were appropriately downgraded. No cancer was downgraded to a non-actionable assessment. Interreader agreement analysis demonstrated kappa = 0.48–0.53 for CI BI-RADS and kappa = 0.28–0.44 for CI&DOT BI-RADS. Conclusions: Integration of US-guided DOT information achieved a 23.5% reduction in suspicious BI-RADS assessments for benign lesions. Larger studies are warranted, with attention to improved reader agreement.