Rassegna della letteratura: gennaio/marzo 2020
Epidemiologia, prevenzione, diagnosi e screening
A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer.
Xiang W, Rao H, Zhou L – Thorac Cancer. 2020 Mar 31.
Background: To identify the performance of contrast-enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) for breast cancer diagnosis by pooling the open published data.
Methods: A systematic review of studies relevant to CESM and MRI in the diagnosis of breast cancer were screened in the electronic databases of Pubmed, EMBASE, the Cochrane Library, Web of Science, Google scholar and CNKI. The methodical quality of the included publications was evaluated by the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). The diagnostic sensitivity, specificity and area under the ROC curve (AUC) were pooled and the true positive (TP), false positive (FP), false negative (FN) and true negative (TN) of the original studies were calculated.
Results: A total of 13 diagnostic publications were identified and included in the meta-analysis. Of those included, five were retrospective studies and the remaining eight were prospective work. The combined data indicating the pooled sensitivity and specificity of CESM and MRI were 0.97 (95% CI: 0.95-0.98), 0.66 (95% CI: 0.59-0.71), 0.97 (95% CI: 0.95-0.98),and 0.52 (95% CI: 0.46-0.58), respectively. The pooled +LR and -LR for CESM were 2.70 (95% CI: 1.57-4.65), 0.06 (95% CI: 0.04-0.09), and 2.01 (95% CI: 1.78-2.26), 0.08 (95% CI: 0.05-0.11) for MRI, respectively. For the diagnostic odds ratio (DOR), the pooled results of CESM and MRI were 60.15 (95% CI: 24.72-146.37) and 31.34 (95% CI: 19.61-50.08), respectively. The AUC of the symmetric receiver operating characteristic curve (SROC) was 0.9794 and 0.9157 for CESM and MRI, respectively, calculated using the Moses model in the diagnosis of breast cancer.
Conclusions: Both CESM and MRI are effective methods for the detection of breast cancer with high diagnostic sensitivity. The diagnostic performance of CESM appears to be more effective than MRI.
Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening.
Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J et Al – Radiologia. 2020 Mar 30.
Screening plays an important role in women with a high risk of breast cancer. Given this population’s high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.
Confusion and Anxiety Following Breast Density Notification: Fact or Fiction?
Dench EK, Darcey EC, Keogh L et Al. – Clin Med. 2020 Mar 30;9(4).
In the absence of evidence-based screening recommendations for women with dense breasts, it is important to know if breast density notification increases women’s anxiety. This study describes psychological reactions and future screening intentions of women attending a public mammographic screening program in Western Australia. Two-thirds of notified women indicated that knowing their breast density made them feel informed, 21% described feeling anxious, and 23% confused. Of the notified women who reported anxiety, 96% intended to re-screen when due (compared to 91% of all notified women and 93% of controls; p = 0.007 and p < 0.001, respectively). In summary, reported anxiety (following breast density notification) appears to increase women’s intentions for future screening, not the reverse.
European women’s perceptions of the implementation and organisation of risk-based breast cancer screening and prevention: a qualitative study.
Rainey L, van der Waal D, Jervaeus A et Al. – BMC Cancer. 2020 Mar 24;20(1):247.
Background: Increased knowledge of breast cancer risk factors has meant that we are currently exploring risk-based screening, i.e. determining screening strategies based on women’s varying levels of risk. This also enables risk management through primary prevention strategies, e.g. a lifestyle programme or risk-reducing medication. However, future implementation of risk-based screening and prevention will warrant significant changes in current practice and policy. The present study explores women’s perceptions of the implementation and organisation of risk-based breast cancer screening and prevention to optimise acceptability and uptake
Methods: A total of 143women eligible for breast cancer screening in the Netherlands, the United Kingdom, and Sweden participated in focus group discussions. The focus group discussions were transcribed verbatim and the qualitative data was analysed using thematic analysis:
Results: Women from all three countries generally agreed on the overall proceedings, e.g. a risk assessment after which the risk estimate is communicated via letter (for below average and average risk) or consultation (for moderate and high risk). However, discrepancies in information needs, preferred risk communication format and risk counselling professional were identified between countries. Additionally, a need to educate healthcare professionals on all aspects of the risk-based screening and prevention programme was established.
Conclusions: Women’s insights identified the need for country-specific standardised protocols regarding the assessment and communication of risk, and the provision of heterogeneous screening and prevention recommendations, monitoring the principle of solidarity in healthcare policy.
Breast Mammographic Density: Stromal Implications on Breast Cancer Detection and Therapy.
Fernández-Nogueira P, Mancino M, J et Al. – Clin Med. 2020 Mar 12;9(3).
Current evidences state clear that both normal development of breast tissue as well as its malignant progression need many-sided local and systemic communications between epithelial cells and stromal components. During development, the stroma, through remarkably regulated contextual signals, affects the fate of the different mammary cells regarding their specification and differentiation. Likewise, the stroma can generate tumour environments that facilitate the neoplastic growth of the breast carcinoma. Mammographic density has been described as a risk factor in the development of breast cancer and is ascribed to modifications in the composition of breast tissue, including both stromal and glandular compartments. Thus, stroma composition can dramatically affect the progression of breast cancer but also its early detection since it is mainly responsible for the differences in mammographic density among individuals. This review highlights both the pathological and biological evidences for a pivotal role of the breast stroma in mammographic density, with particular emphasis on dense and malignant stromas, their clinical meaning and potential therapeutic implications for breast cancer patients.
Preoperative MRI Improves Surgical Planning and Outcomes for Ductal Carcinoma in Situ.
Pinker K Radiology. 2020 Mar 17:200076.
Physical activity level and age contribute to functioning problems in patients with breast cancer-related lymphedema: a multicentre cross-sectional study.
De Vrieze T, Gebruers N, Nevelsteen I – Support Care Cancer. 2020 Mar 19.
Relationship Between Metabolic Syndrome and Postmenopausal Breast Cancer.
Ekinci O, Eren T, Kurtoglu Yakici M, Gapbarov A – Cir Esp. 2020 Mar 17.
The prognostic significance of immune microenvironment in breast ductal carcinoma in situ.
Toss MS, Abidi A, Lesche D, Joseph C, – Br J Cancer. 2020 Mar 17.
Trends and Projections in Breast Cancer Mortality among four Asian countries (1990-2017): Evidence from five Stochastic Mortality Models.
Mubarik S, Wang F, Fawad M et Al – Sci Rep. 2020 Mar 25;10(1):5480.
Prognostic Significance of Metastatic Lymph Nodes Ratio (MLNR) Combined with Protein-Tyrosine Phosphatase H1 (PTPH1) Expression in Operable Breast Invasive Ductal Carcinoma.
Ma S, Lv Y, Ma R. Cancer Manag Res. 2020 Mar 13;12:1895-1901
Performance in Breast Cancer Screening Using Digital Breast Tomosynthesis vsDigital Mammography.
Sprague BL, Coley RY, Kerlikowske K et Al – JAMA Netw Open. 2020 Mar 2;3(3):e201759.
Does minimum follow-up time post-diagnosis matter? An assessment of changing loss of life expectancy for people with cancer in Western Australia from 1982 to 2016.
Wright CM, Moorin RE. Cancer Epidemiol. 2020 Mar 27;66
MRI-guided vacuum-assisted breast biopsy: experience of a single tertiary referral cancer centre and prospects for the future.
Penco S, Rotili A, Pesapane F, Trentin C. – Med Oncol. 2020 Mar 27;37(5):36.
The association between breast cancer risk factors and background parenchymal enhancement at dynamic contrast-enhanced breast MRI.
Hellgren R, Saracco A, Strand F, Eriksson M. et Al – Acta Radiol. 2020 Mar 26:284185120911583.