- Diagnostic Radiology
Professor - University Medical Line, Radiology
Member, Stanford Cancer Institute
Board Certification: American Board of Radiology, Diagnostic Radiology (1993)
Residency: Yale New Haven Medical Center Radiology Residency (1993) CT
Internship: Steward Carney Hospital (1989) MA
Medical Education: Boston University School of Medicine (1988) MA
Early Assessment Window for Predicting Breast Cancer Neoadjuvant Therapy using Biomarkers, Ultrasound, and Diffuse Optical Tomography.
Breast cancer research and treatment
PURPOSE: The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer responseto neoadjuvant therapy (NAT).METHODS: This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P<0.05 considered statistically significant. Logistic regression was used for ROC analysis.RESULTS: Thirty-eight patients (mean age=47, range 24-71years) successfully completed the study, including 15 HER2+of which 11 were ER+; 12 ER+or PR+/HER2-, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC=0.941 (95% CI 0.869-1.0). Similarly an AUC of 0.910 (95% CI 0.810-1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC=0.974 (95% CI 0.933-1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status.CONCLUSION: The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle.CLINICAL TRIAL REGISTRATION NUMBER: NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 , Registration time: September 7, 2016.
View details for DOI 10.1007/s10549-021-06239-y
View details for PubMedID 33970392
The impact of adjunctive tomosynthesis on screening mammography outcomes in two widely diverse radiology practices.
The breast journal
To determine the effect of adjunctive digital breast tomosynthesis screening on dissimilar mammography practices. We compared the outcomes of breast cancer screening with digital mammography versus digital mammography combined with tomosynthesis in two independent breast imaging practices from June 1, 2015, to May 31, 2016. Institution one was a hospital-based academic practice of breast imaging specialists and institution two was a community-based practice with academic affiliation served by general radiologists. Screening mammography was linked to subsequent diagnostic imaging and pathology. Subject characteristics and performance metrics were compared via t test for continuous variables and the chi-square test for categorical variables. A two-sided z test was performed to test modality differences for assessment and pathology subtype. Of the 54 638 women, 54% (n = 29 295) were from institution one and 55% (n = 30 013) underwent digital mammography alone. Women undergoing mammography with tomosynthesis were older (60.8 years vs 56.9 years, P < .001) and had slightly less dense breast composition (P = .001). Performance metrics varied substantially between institutions. At both institutions the biopsy rate, positive predictive value of screening (PPV1 ), and invasive cancer detection rate increased significantly with adjunctive tomosynthesis. At institution one, the biopsy rate increased from 1.4% to 1.9%, the PPV1 from 6.0% to 8.2%, and the invasive cancer detection rate from 3.4 to 4.9/1000 women screened. At institution two, the respective increases were from 0.7% to 1.0%, 5.5% to 11.0%, and 2.3% to 4.1/1000. Tomosynthesis recalled asymmetry less and mass more and resulted in fewer BI-RADS 1 and 2 assessments than screening with mammography alone. Adjunctive tomosynthesis appears to have a consistent impact on breast cancer screening performance metrics despite marked variation in breast imaging practice. Combined tomosynthesis screening has a significantly higher PPV1 , leads to a greater number of biopsies, and detects more invasive cancer than screening with digital mammography.
View details for DOI 10.1111/tbj.14121
View details for PubMedID 33274490