Breast Imaging: Radiologic Pathologic Correlation

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Breast Imaging Radiologic Pathologic Correlation
Mitchell Schnall MD, PhD Professor of
Radiology University of Pennsylvania Network
Chair ACRIN
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Rad / Path Correlation

• Careful collaboration between radiology and
  pathology
• Cooperation of surgeon
• Method to index lesions/findings

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Image analysis Turning an image into data

• User extracted qualitative features
• User extracted quantitative features
• Semi automated
• Automated

Feature 1 Feature 2 Feature 3 . . .
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Abnormal enhancement descriptors

• focus
• mass
• non-mass

E. Morris, MSKCC
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Invasive Ductal Carcinoma Irregular/Spiculated
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FOCAL MASS ROUND/IRREGULAR/Rim Enhancing
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Ductal Enhancement DCIS
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Associated DCIS
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Fibroadenoma Internal Septations
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Fibroadenoma
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Fibroadenoma
Post-Contrast
T2
Central component is glandular, bright T2, and
enhances Peripheral component is hyalinized, low
T2 and does not enhance
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Multivariate model for Focal Mass
Model ROC Area Forward model 0.873 (0.871 to
0.875) Backward model 0.880 (0.877 to 0.884).
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Image meta-dataStandard Structure and Data
Elements
Patient level data
Image Exam level data
Image Finding level data
Time
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Modality 1 Time 1
Modality 2 Time 1
M1 Finding 2 Lesion 2
M1 Finding 1 Lesion 1
M2 Finding 2 Lesion 3

• M2 Finding 1
• Lesion 1
• Size
• Shape
• Location
• Intensity
• etc

Modality 1 Time 2
Path Lab Micro Proteomics
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PET association with Receptor Status
 
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Triple Neg
Non Triple Neg
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Triple Neg
Non Triple Neg
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Multimodaliy triple negative phenotype
 
 
 

• No spiculations on mammography
• No calcs on mammography
• Heterogeneous enhancement on MRI
• Well circumscribed on ultrasound
• Rim enhancement on MRI
• Elevated SUV on PET

 
 
 
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Not Triple Negative Cancer
Triple Negative (Basal) Cancer
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Not Triple Negative Cancer
Triple Negative (Basal) Cancer
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Efficacy of MRI and Mammography for Breast-Cancer
Screening in Women with a Familial or Genetic
Predisposition
Kriege et al, NEJM 351, 2004 p.427

• 1909 women, 50 breast cancers detected, 45
  Cancers detected by screening, 32 seen by MRI, 18
  detected by mammography. (ROC analysis Plt0.5)
• 13 cancers missed by MRI (8 seen on mammography)

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Ca
No Ca
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Interval cancer presentation
11/07
5/07
3/08
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Collaborators

• Emily Conant
• Susan Weinstein
• Susan Orel
• Abass Alavi
• Mark Rosen
• Sara Englander
• Larry Dougherty
• Hee Kwon Song
• Joel Karp
• Sandy Seghal

Andrew Maidment et al John Tomaszewski Mike
Feldman Ray Boston Peter Moate Brian
Czernicki Susan Domchek Angie DeMichele Marcia
Boraas Sandy Schwartz