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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: closed (18 February 2025) | Viewed by 3013

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Special Issue Editor

Dr. Luca Nicosia

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Guest Editor

1. Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy
2. Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
Interests: breast imaging; contrast enhanced mammography; breast MRI; radiomics
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Special Issue Information

Dear Colleagues,

Breast cancer continues to be the leading cause of cancer-related deaths among women globally. In our field, the integration of multimodal approaches signifies a pivotal advancement in the diagnostic management of breast cancer. Innovative diagnostic techniques, such as automated 3D breast ultrasonography (ABUS), digital breast tomosynthesis (DBT), contrast-enhanced spectral mammography (CESM), and diffusion-weighted imaging (DWI) sequences in Magnetic Resonance Imaging, are heralding new and promising opportunities. These advancements are particularly significant as personalized and precision medicine become increasingly important in healthcare.

Furthermore, the application of artificial intelligence and radiomics in breast imaging is rapidly growing, enhancing the potential for outstanding results while minimizing diagnostic errors. Interventional radiology has also seen remarkable progress in recent years. For example, excisional biopsy (VAE) for low-grade breast lesions offers a less invasive alternative to surgery for many patients, significantly improving their quality of life.

In light of these developments, this Special Issue aims to showcase and explore the latest advancements in breast imaging modalities. We also invite articles discussing novel applications of breast biopsy procedures, especially those utilizing vacuum-assisted techniques. We look forward to your contributions to this significant and evolving field.

Dr. Luca Nicosia
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

breast imaging
contrast-enhanced mammography
breast MRI
radiomics
clinical advances

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Published Papers (3 papers)

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Research

11 pages, 4539 KiB

Open AccessArticle

Diagnostic Performance of Kaiser Score for Characterization of Breast Lesions on Modified Abbreviated Breast MRI and Comparison with Full-Protocol Breast MRI

by Merve Erkan and Seray Gizem Gur Ozcan

J. Clin. Med. 2025, 14(1), 264; https://doi.org/10.3390/jcm14010264 - 5 Jan 2025

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Abstract

Background: This study aimed to evaluate the diagnostic performance of the Kaiser score (KS) on the modified abbreviated breast magnetic resonance imaging (AB-MRI) protocol for characterizing breast lesions by comparing it with full-protocol MRI (FP-MRI), using the histological data as the reference standard. Methods: Breast MRIs detecting histologically verified contrast-enhancing breast lesions were evaluated retrospectively. A modified AB-MRI protocol was created from the standard FP-MRI, which comprised axial fat-suppressed T2-weighted imaging (T2WI), pre-contrast T1-weighted imaging (T1WI), and first, second, and fourth post-contrast phases. Two radiologists reviewed both protocols, recording the KS for each detected lesion. Sensitivity, specificity, and positive and negative predictive values, as well as accuracy, were calculated for each protocol. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of the modified AB-MRI compared to the FP-MRI. Results: In total, 154 patients with 158 histopathologically proven lesions (107 malignant, 51 benign) were included. For the diagnostic performance of the KS for modified AB-MRI and FP-MRI, the sensitivity was 96.3% vs. 98.1%, the specificity was 78.4% vs. 74.5%, PPV was 90.4% vs. 89%, NPV was 90.9% vs. 95%, and the diagnostic accuracy was 90.5% vs. 90.5%. The area under the curve (AUC) obtained from the ROC curve analysis was 0.873 and 0.863 for modified AB-MRI and FP-MRI for reader 1, respectively, and 0.859 and 0.878 for modified AB-MRI and FP-MRI for reader 2, respectively, (p < 0.001). Conclusions: Our modified AB-MRI protocol revealed comparable results in terms of the diagnostic value of the KS in characterizing breast lesions compared to FP-MRI and reduced both scanning and interpretation time. Full article

(This article belongs to the Special Issue Advances in Breast Imaging)

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11 pages, 930 KiB

Open AccessArticle

Radiomics for Predicting Prognostic Factors in Breast Cancer: Insights from Contrast-Enhanced Mammography (CEM)

by Claudia Lucia Piccolo, Marina Sarli, Matteo Pileri, Manuela Tommasiello, Aurora Rofena, Valerio Guarrasi, Paolo Soda and Bruno Beomonte Zobel

J. Clin. Med. 2024, 13(21), 6486; https://doi.org/10.3390/jcm13216486 - 29 Oct 2024

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Abstract

Objectives: To evaluate the correlation between radiomic features extracted from contrast-enhanced mammography (CEM) tumor lesions and peritumoral background with prognostic factors in breast cancer (BC). Methods: In this retrospective, single-center study, 134 women with histologically confirmed breast cancer underwent CEM examination. Radiomic features were extracted from manually segmented lesions and lesion contours were automatically delineated using PyRadiomics. The extracted features were categorized into seven classes: First-order Features, Shape Features (2D), Gray Level Co-occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRLM), Gray Level Size Zone Matrix (GLSZM), and Neighboring Gray Tone Difference Matrix (NGTDM). Histological examination assessed tumor type, grade, receptor structure (ER, PgR, HER2), Ki67 index, and lymph node involvement. Pearson correlation and multivariate regression were applied to evaluate associations between radiomic features and prognostic factors. Results: Significant correlations were found between First-order Features and prognostic factors such as ER, PgR, and Ki67 (p < 0.05). GLCM-based texture features showed strong associations with Ki67 and HER2 (p < 0.01). Radiomic features from peritumoral regions, especially shape and GLSZM metrics, were significantly correlated with Ki67 and lymph node involvement. Conclusions: Radiomic analysis of both tumor and peritumoral regions offers significant insights into BC prognosis. These findings support the integration of radiomics into personalized diagnostic and therapeutic strategies, potentially improving clinical decision making in BC management. Full article

(This article belongs to the Special Issue Advances in Breast Imaging)

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Figure 1
The diagram shows the multivariate analysis results examining the correlation between features extracted from lesion contour segmentation and prognostic factors, evaluated on the CC projection. The asterisks denote levels of statistical significance (p < 0.05, p < 0.01, p < 0.001), and the intensity of the color indicates the strength of the correlation, with darker shades representing stronger correlations. Full article ">Figure 2
The diagram shows the multivariate analysis results examining the correlation between features extracted from lesion contour segmentation and prognostic factors, evaluated on the MLO projection. The asterisks denote levels of statistical significance (p < 0.05, p < 0.01, p < 0.001), and the intensity of the color indicates the strength of the correlation, with darker shades representing stronger correlations. Full article ">Figure 3
The diagram shows the multivariate analysis results examining the correlation between features extracted from lesion contour segmentation and prognostic factors, evaluated on both the CC and MLO projections. The asterisks denote levels of statistical significance (p < 0.05, p < 0.01, p < 0.001), and the intensity of the color indicates the strength of the correlation, with darker shades representing stronger correlations. Full article ">

13 pages, 1296 KiB

Open AccessArticle

Treatment of Capsular Contracture in Previously Irradiated Breasts Implants and Expanders with the Use of Porcine Acellular Dermal Matrices: Outcomes and Complications

by Andrea Vittorio Emanuele Lisa, Riccardo Carbonaro, Manuela Bottoni, Giulia Colombo, Marika Gentilucci, Valeriano Vinci, Edvin Ostapenko, Luca Nicosia, Francesca De Lorenzi and Mario Rietjens

J. Clin. Med. 2024, 13(18), 5653; https://doi.org/10.3390/jcm13185653 - 23 Sep 2024

Viewed by 1038

Abstract

Background: Radiation therapy is a crucial component of breast cancer treatment. However, it is well known to increase the risk of unsatisfactory cosmetic outcomes and higher complication rates. The aim of this study is to provide further insight into the use of acellular dermal matrices (ADMs) for the prevention of capsular contracture. Materials and Methods: This single-center, retrospective study analyzed irradiated patients who underwent post-mastectomy, ADM-assisted implant reconstructions. Of the 60 patients included, 26 underwent expander-to-implant substitution after radiotherapy (Group A), while 34 required implant replacement due to capsular contracture following radiotherapy (Group B). The primary objective was to evaluate the effectiveness of ADMs in reducing reconstructive failures, complications, and capsular contracture after breast irradiation. Results: We recorded a total of 15 complications and four implant losses. Reconstructive failures were attributed to implant exposure in two cases, full-thickness skin necrosis in one case, and severe Baker grade IV contracture in one case. Both Group A and Group B showed a significant decrease in postoperative Baker grades. US follow-up was used to demonstrate ADM integration with host tissues over time. Conclusions: Based on our findings, the use of ADM in selected cases appears to be a viable option for treating and preventing capsular contracture in irradiated breasts. This approach is associated with relatively low complication rates, a low rate of reconstructive failure, and satisfactory cosmetic outcomes and can be applied both in breast reconstructed with implants and with expanders. Full article

(This article belongs to the Special Issue Advances in Breast Imaging)

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Figure 1
(A) Preoperative photograph of a 56-year-old patient who declined autologous breast reconstruction and was included in group B. History of right skin reducing mastectomy and DTI reconstruction, followed by radiotherapy, then affected by capsular contraction and implant dislocation. Patient underwent capsulotomy and anterior capsulectomy, implant exchange and ADM positioning. (B) Postoperative photograph at one-year follow-up of a 56-year-old patient who declined autologous breast reconstruction and was included in group B. Full article ">Figure 2
(A) Preoperative photograph of a 50-year-old patient included in group A. History of left nipple sparing mastectomy and tissue expander reconstruction followed by adjuvant radiotherapy. During expander-to-implant substitution after anterior capsulectomy and capsulotomy we applied ADM in order to increase soft tissue coverage and prevent capsular contraction development. (B) Postoperative photograph of 50-year-old patient included in group A at one-year follow-up. Full article ">Figure 3
(A) Preoperative photograph of 49-year-old patient included in group B. History of bilateral DTI breast reconstruction followed by left breast adjuvant radiotherapy. Patient referred to our hospital for left Baker grade IV capsular contraction with functional symptoms. Underwent anterior capsulectomy, bilateral implant exchange and left ADM positioning to reduce capsular contraction and related symptoms. (B) Postoperative photograph of 49-year-old patient included in group B at one-year follow-up. Full article ">

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