The Dynamic Optical Breast Imaging in the Preoperative Workflow of Women with Suspicious or Malignant Breast Lesions: Development of a New Comprehensive Score
Purpose. To determine the diagnostic accuracy of DOBIComfortScan in patients with Breast Imaging Reporting suspect breast lesions (BI-RADS) 4-5 breast lesions. Materials and Methods. One-hundred and thirteen patients underwent DOBIComfortScan examination before surgery. Twelve parameters were taken into consideration to define DOBI findings. Results. Twenty-seven radical mastectomies, 47 quadrantectomies and 39 wide excisions, were performed. Overall, 65 invasive cancer, 9 in situ carcinoma and 39 nonmalignant lesions, were observed. Ten out of 12 considered parameters resulted significantly in association with histology at discriminant analysis. A summation score of 30.5 resulted to be the best cut off at ROC analysis, giving a sensitivity and specificity of 80% and 87%, respectively, and a positive predictive value of 92.2%. Finally the following DOBI-BI-RADS model was developed: malignant score); possibly malignant ( score); benign but the possibility of malignancy cannot be excluded ( score); benign ( score). Conclusion. definition of other parameters permits to improve the accuracy of this procedure. Further studies are warranted to define the potential role of DOBIComfortScan in breast cancer imaging. 1. Introduction Breast cancer is the most frequent female malignancy in developed countries. In Italy almost 40,000 new cases were diagnosed in 2010, with more than 7,000 deaths [1]. There is a general agreement about the correlation between tumor size and survival; therefore, a delay in diagnosis may negatively affect the prognosis [2]. Mammography screening has played an important role in the reduction of breast cancer mortality that has been observed in the past two decades, although in a recent report it has been stated that the improvements in treatment and in the efficiency of healthcare systems might be plausible explanations for that [3]. In any case, mammography cannot be considered an ideal tool to achieve early diagnosis. Indeed, the density of the breast in younger women can represent a major obstacle for the detection of small tumors; moreover, mammography has limited indication in women with breast implants [4, 5]. Breast MRI has become an essential diagnostic procedure in high-risk women, but it cannot be considered an ideal tool for large scale screenings [6]. The use of transillumination of the breast dates back to the 1920s, when it was proposed to investigate breast cancer [7]. However, the low sensitivity and specificity of transillumination limited its clinical use. With progress in photonic technologies and mathematic modeling
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