title: Assessment of Functional Differences in Malignant and Benign Breast Lesions and Improvement of Diagnostic Accuracy by Using US-guided Diffuse Optical Tomography in Conjunction with Conventional US.
abstract: Purpose To investigate ultrasonography (US)-guided diffuse optical tomography to distinguish the functional differences of hemoglobin concentrations in a wide range of malignant and benign breast lesions and to improve breast cancer diagnosis in conjunction with conventional US. Materials and Methods The study protocol was approved by the institutional review boards and was HIPAA compliant. Written informed consent was obtained from all patients. Patients (288 women; mean age, 50 years; range, 17-94 years) who underwent US-guided biopsy were imaged with a handheld US and optical probe. The US-imaged lesion was used to guide reconstruction of light absorption maps at four wavelengths, and total hemoglobin (tHb), oxygenated hemoglobin (oxyHb), and deoxygenated hemoglobin (deoxyHb) were computed from the absorption maps. A threshold (80 μmol/L) was chosen on the basis of this study population. Two radiologists retrospectively evaluated US images on the basis of the US Breast Imaging Reporting and Data System lexicon, and a lesion was considered malignant when a score of 4C or 5 was given or a lesion had tHb greater than 80 μmol/L. A two-sample t test was used to calculate significance between groups, and Spearman ρ was computed between hemoglobin parameters and tumor pathologic grades. Results Three tumors were Tis, 37 were T1, 19 were T2-T4 carcinomas, and 233 were benign lesions. The mean maximum tHb, oxyHb, and deoxyHb of Tis-T1 and T2-T4 groups were 89.3 μmol/L ± 20.2 (standard deviation), 65.0 μmol/L ± 20.8, and 33.5 μmol/L ± 11.3, respectively, and 84.7 μmol/L ± 32.8, 57.1 μmol/L ± 19.8, and 34.7 μmol/L ± 18.9, respectively. The corresponding values of benign lesions were 54.1 μmol/L ± 23.5, 38.0 μmol/L ± 17.4, and 25.2 μmol/L ± 13.8, respectively. The mean maximum tHb, oxyHb, and deoxyHb were significantly higher in the malignant groups than the benign group (P <.001, <.001, and .041, respectively). For malignant lesions, the mean maximum tHb moderately correlated with tumor histologic grade and nuclear grade (ρ = 0.283 and 0.315, respectively). The mean maximum oxyHb moderately correlated with tumor nuclear grade (ρ = 0.267). When radiologists' US diagnosis and the tHb were used together, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.6%-100%, 77.3%-83.3%, 52.7%-59.4%, and 99.0%-100%, respectively, for the combined malignant group. Conclusion The tHb and oxyHb correlate with breast cancer pathologic grade and can be used as an adjunct to US to improve sensitivity and negative predictive value in breast cancer diagnosis. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Quing
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ricci
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Poornima
authors.initials: P
authors.lastname: Hegde
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Mark
authors.initials: M
authors.lastname: Kane
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Edward
authors.initials: E
authors.lastname: Cronin
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Alex
authors.initials: A
authors.lastname: Merkulov
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Behnoosh
authors.initials: B
authors.lastname: Tavakoli
authors.affiliation: From the Department of Electrical and Biomedical Engineering (Q.Z.) and Department of Electrical and Computer Engineering (Y.X., B.T.), University of Connecticut, 371 Fairfield Rd, U4157, Storrs, CT 06269; Departments of Pathology (A.R.) and Radiology (E.C.), Hartford Hospital, Hartford, Conn; and Department of Pathology (P.H.), Department of Radiology (M.K., A.M.), and Carole & Ray Neag Comprehensive Cancer Center (S.T.), University of Connecticut Health Center, Farmington, Conn.
authors.forename: Susan
authors.initials: S
authors.lastname: Tannenbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000000981:diagnostic imaging; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D041622:Tomography, Optical / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult