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Sylvia H Heywang-Köbrunner

Publications and source records attributed to Sylvia H Heywang-Köbrunner.

11 recordsLinked to original sources
PubMed2006

Diagnostic architectural and dynamic features at breast MR imaging: multicenter study.

PURPOSE: To prospectively determine the prevalence and predictive value of three-dimensional (3D) and dynamic breast magnetic resonance (MR) imaging and contrast material kinetic features alone and as part of predictive diagnostic models. MATERIALS AND METHODS: The study protocol was approved by the institutional review board or ethics committees of all participating institutions, and informed consent was obtained from all participants. Although study data collection was performed before HIPAA went into effect, standards that would be compliant with HIPAA were adhered to. Data from the International Breast MR Consortium trial 6883 were used in the analysis. Women underwent 3D (minimum spatial resolution, 0.7 x 1.4 x 3 mm; minimal temporal resolution, 4 minutes) and dynamic two-dimensional (temporal resolution, 15 seconds) MR imaging examinations. Readers rated enhancement shape, enhancement distribution, border architecture, enhancement intensity, presence of rim enhancement or internal septations, and the shape of the contrast material kinetic curve. Regression was performed for each feature individually and after adjustment for associated mammographic findings. Multivariate models were also constructed from multiple architectural and dynamic features. Areas under the receiver operating characteristic curve (Az values) were estimated for all models. RESULTS: There were 995 lesions in 854 women (mean age, 53 years +/- 12 [standard deviation]; range, 18-80 years) for whom pathology data were available. The absence of enhancement was associated with an 88% negative predictive value for cancer. Qualitative characterization of the dynamic enhancement pattern was associated with an Az value of 0.66 across all lesion architectures. Focal mass margins (Az = 0.76) and signal intensity (Az = 0.70) were highly predictive imaging features. Multivariate models were constructed with an Az value of 0.880. CONCLUSION: Architectural and dynamic features are important in breast MR imaging interpretation. Multivariate models involving feature assessment have a diagnostic accuracy superior to that of qualitative characterization of the dynamic enhancement pattern.

Adolescent↗
PubMed2005

MRI detection of distinct incidental cancer in women with primary breast cancer studied in IBMC 6883.

BACKGROUND: Prior single institution studies suggest MRI may improve the assessment of the extent of cancer within the breast, and thus reduce the risk of leaving macroscopic disease in the breast following breast conservation therapy. We report on the rate of MRI and mammography detection of foci of distinct incidental cancer in a prospective, multi center trial involving 426 women with confirmed breast cancer at 15 institutions in the US, Canada, and Germany. METHODS: Women underwent mammography and MRI prior to biopsy of the suspicious index lesion. Additional incidental lesions (IL) greater than 2 cm from the index lesion that were detected by mammography and MRI were noted and characterized. Biopsy recommendations were associated with ILs given an assessment of suspicious or highly suspicous (BiRads 4 and 5). These assessments were considered a positive test. RESULTS: MRI had a significantly higher yield of confirmed cancer ILs than mammography (0.18 (95%CI: 0.142-0.214) for MRI versus 0.072 (95%CI: 0.050-0.100) for mammography). The cancer ILs detected by MRI alone appeared to be similar to those detected by mammography with respect to size and histology. The percentage of biopsies of ILs that resulted in a cancer diagnosis was similar between the modalities (MRI 0.72(95%CI: 0.6-0.81); Mammography 0.85 (95%CI: 0.62-0.96)). CONCLUSIONS: These results suggest that consideration needs to be given regarding the integration of breast MRI into the pretreatment evaluation of women seeking breast conservation therapy.

Biopsy↗
PubMed2004

Magnetic resonance imaging of the breast prior to biopsy.

CONTEXT: Breast magnetic resonance imaging (MRI) has been shown to have high sensitivity for cancer detection and is increasingly used following mammography to evaluate suspicious breast lesions. OBJECTIVE: To determine the accuracy of breast MRI in conjunction with mammography for the detection of breast cancer in patients with suspicious mammographic or clinical findings. DESIGN, SETTING, AND PATIENTS: Prospective multicenter investigation of the International Breast MR Consortium conducted at 14 university hospitals in North America and Europe from June 2, 1998, through October 31, 2001, of 821 patients referred for breast biopsy for American College of Radiology category 4 or 5 mammographic assessment or suspicious clinical or ultrasound finding. INTERVENTIONS: MRI examinations performed prior to breast biopsy; MRI results were interpreted at each site, which were blinded to pathological results. MAIN OUTCOME MEASURES: Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of breast MRI. RESULTS: Among the 821 patients, there were 404 malignant index lesions, of which 63 were ductal carcinoma in situ (DCIS) and 341 were invasive carcinoma. Of the 417 nonmalignant index lesions, 366 were benign, 47 showed atypical histology, and 4 were lobular carcinoma in situ. The AUC pooled over all institutions was 0.88 (95% confidence interval [CI], 0.86-0.91). MRI correctly detected cancer in 356 of 404 cancer cases (DCIS or invasive cancer), resulting in a sensitivity of 88.1% (95% CI, 84.6%-91.1%), and correctly identified as negative for cancer 281 of 417 cases without cancer, resulting in a specificity of 67.7% (95% CI, 62.7%-71.9%). MRI performance was not significantly affected by mammographic breast density, tumor histology, or menopausal status. The positive predictive values for 356 of 492 patients was 72.4% (95% CI, 68.2%-76.3%) and of mammography for 367 of 695 patients was 52.8% (95% CI, 49.0%-56.6%) (P<.005). Dynamic MRI did not improve the AUC compared with 3-dimensional MRI alone, but the specificity of a washout pattern for 123 of 136 patients without cancer was 90.4% (95% CI, 84%-95%). CONCLUSIONS: Breast MRI has high sensitivity but only moderate specificity independent of breast density, tumor type, and menopausal status. Although the positive predictive value of MRI is greater than mammography, MRI does not obviate the need for subsequent tissue sampling in this setting.

Adult↗
PubMed2004

Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study.

BACKGROUND: Vacuum-assisted breast biopsy (VAB) can replace surgical biopsy for the diagnosis of breast carcinoma. The authors evaluated the accuracy and clinical utility of VAB in a multicenter setting using a strict quality assurance protocol. METHODS: In the current study, VABs were performed successfully for 2874 patients at 5 sites. Benign lesions were verified by follow-up. Surgery was recommended for malignant and borderline lesions. VAB was performed on patients with lesions rated as highly suspicious (6%), intermediate to suspicious (85%), or probably benign (9%). Fifty-eight percent of the lesions were < 10 mm and 70% had microcalcifications. RESULTS: The authors identified 7% of patients with invasive carcinomas, 15% with ductal carcinomas in situ (DCIS), 5% with atypical ductal hyperplasias (ADH), and 0.6% with lobular carcinomas in situ. The results of the VAB necessitated an upgrade of 24% of patients with ADH to DCIS or DCIS and invasive carcinoma. Twelve percent of patients with DCIS proved to have invasive carcinoma. Seventy-three percent of the patients had benign lesions. Only 1 false-negative result was encountered (negative predictive value, 99.95%). Minor side effects were reported to occur in 1.4% of patients and 0.1% of patients required a subsequent intervention. Scarring relevant for mammography was rare among patients (i.e., 0.3% of patients had relevant scarring). CONCLUSIONS: Quality-assured VAB was found to be highly reliable. VAB effectively identified patients with benign lesions and assisted therapeutic decisions. Most important, only a single case of malignancy was missed. A close interdisciplinary approach assured optimal results.

Biopsy↗
PubMed2002

Axillary lymph node metastases: a statistical analysis of various parameters in MRI with USPIO.

PURPOSE: To assess the value of plain vs. iron oxide-enhanced MRI vs. the combined study (plain + postcontrast) based on qualitative and quantitative parameters of three pulse sequences. MATERIALS AND METHODS: Data from two sites were acquired using the same technique; therefore, this data could be pooled. T1W-SE, T2W-FSE, and 3D-PSIF were used before and 24-36 hours after MRI with ultra small particles of iron oxide (USPIO) was performed. A total of 52 lymph nodes (LNs) in nine patients (25 benign, 27 malignant) were evaluated by two readers who were visually and quantitatively blinded to the histology. Combinations of the following diagnostic parameters were compared using logistic regression analysis: the short-axis diameter of the LN, the signal distribution of the LN on postcontrast agent MRI (homogeneous or heterogeneous), and qualitatively and quantitatively determined signal changes of the LN following administration of contrast agent in the three evaluated sequences. RESULTS: Using pre- and postcontrast data, the optimized accuracy based on the statistically most significant parameters (LN diameter > 6 mm, visual assessment of signal change on T2W-SE) was 87% (81% sensitivity, 92% specificity). Precontrast data alone yielded 75% accuracy (63% sensitivity, 86% specificity). Postcontrast data alone yielded 75% accuracy (56% sensitivity, 96% specificity). CONCLUSION: Based on our results, USPIO-MRI improved the diagnosis of metastatic axillary LNs compared with precontrast MRI alone. Both pre- and postcontrast studies are needed. T1W-SE and T2W-PSIF did not yield significant additional information. This study may help to further improve the technique of USPIO imaging.

Axilla↗
PubMed2002

Preservation of histopathologic assessment by use of a special technique for tissue inactivation by radiofrequency.

Thermoinactivation is under investigation as a new method of cancer treatment. Prior histopathologic verification has been indispensable. Our experiments show that thermoinactivation is in principle possible without destroying histopathologic morphology, if the temperature stays within certain limits. It could thus become applicable already before diagnostic biopsy, which might be used to avoid any potential spread during biopsy and before definitive surgery.

Biopsy↗
PubMedDate not supplied

Suppression of unspecific enhancement on breast magnetic resonance imaging (MRI) by antiestrogen medication.

AIMS AND BACKGROUND: The value of breast MRI may be impaired by unspecific enhancement. This may leave patients with difficult-to-assess breast tissue with an uncertain diagnosis. We examined whether this unspecific enhancement (which is mostly due to proliferative or hyperplastic changes of benign breast tissue) may be suppressed by antiestrogen medication. METHODS: In a trial of treatment, 10 peri- or postmenopausal patients who exhibited diffuse and/or focal enhancement on breast MRI before tamoxifen medication agreed to undergo a short-term tamoxifen treatment. MRI monitoring was performed 2, 4 and 8 weeks after onset of antiestrogen therapy (tamoxifen, 30 mg per day). RESULTS: Six patients showed a significant decrease of enhancement. Unchanged (n = 3) or increased (n = 1) enhancement was seen in 4 patients. One of the three patients with unchanged enhancement proved to have diffuse lobular carcinoma in situ. CONCLUSIONS: Part of the unspecific enhancement seen on breast MRI can probably be suppressed by short-term antiestrogen medication.

Adult↗