12:45am Tuesday 20 March 2018

Breast cancer: How advanced imaging technologies will help avoid unnecessary biopsies

Enhancing the diagnosis of breast cancer is the stated goal of a research team at the German Cancer Research Center (DKFZ) in Heidelberg. The scientists have combined an advanced method of diffusion-weighted MR imaging with intelligent image analysis methods to detect malignant changes in tissues. This method may help avoid many control biopsies following suspicious findings from mammography screening, the scientists have now demonstrated in a study that was supported by the Dietmar Hopp Foundation. This advancement holds promise for substantial improvements in the diagnosis of breast cancer.

Optimized diffusion-weighted MR imaging (MRI) of a suspicious lesion in a female breast © Bickelhaupt//DKFZ

Mammography is one of the key methods used in breast cancer screening. It is a special type of X-ray examination of the breast that can show changes in tissues. Each year, approximately 2.8 million women have a mammography as part of the breast cancer screening program in Germany. However, the results are not always easy to interpret. Therefore, about one in 20 women who undergo mammography screening can expect a suspicious finding. If further tests indicate a possibility of cancer, physicians usually recommend taking a tissue sample, or biopsy. “Nearly 35,000 women every year face this situation,” says Dr. Sebastian Bickelhaupt, a radiologist at the DKFZ. “However, in only about half of these cases is a malignant tumor actually found.”

Bickelhaupt and his colleagues have therefore optimized a method called diffusion-weighted MR imaging (MRI) for examining the female breast and combined it with intelligent computer-based image analysis methods. Diffusion-weighted MRI is a special technique that makes it possible to see the movement of water molecules in tissues and to observe it using a computer algorithm. Malignant tumors change the structure of tissues, thus causing changes in the movement patterns of water molecules. This link might be utilized in the early detection of breast cancer – without the necessity to take tissue samples or use contrast agents in the body. “Our goal is to obtain better noninvasive insight into the interior of the body and thus provide additional information about tissues for clinical evaluation by radiologists, along with the standard methods, which will continue to be relevant,” said Bickelhaupt.

Now the DKFZ researchers have demonstrated in a study that was supported by the Dietmar Hopp Foundation that optimized diffusion-weighted MRI in combination with intelligent image analysis methods does in fact allow reliable assessments of malignant changes in the breast. In their study, the researchers examined 222 women who were recommended to have a biopsy after a suspicious mammography finding. Prior to the biopsy, the researchers used their newly developed method to analyze the breast tissue of study participants.

Their results were very promising: The new method enabled them to reduce the number of false positive findings in the study group by 70 percent. The scientists were able to identify truly malignant changes in 60 cases out of 61. This sums up to an accuracy of 98 percent and is comparable with the reliability of MRI methods that use contrast agents.

“We use our own specially developed intelligent software to evaluate the images,” said Paul Jäger, a computer scientist who shares the initial authorship of the study with Bickelhaupt. “This makes the method largely independent of interpretation by individual physicians.” In this way, constant reliability of the method can be assured at different study centers.

In a next step, the method must prove its worth in larger multicenter studies before it can be used as a routine method in the clinic. The scientists are currently building the collaborations that are needed for these larger studies. “If our result is confirmed in future studies, we will have an additional diagnostic tool available that will enable us to further enhance the early detection of breast cancer,” Bickelhaupt said about the promise that the new method holds.

Sebastian Bickelhaupt, Paul Jaeger, Frederik Bernd Laun, Wolfgang Lederer, Heidi Daniel, Tristan Anselm Kuder, Lorenz Wuesthof, Daniel Paech, David Bonekamp, Alexander Radbruch, Stefan Delorme, Heinz-Peter Schlemmer, Franziska Steudle, Klaus H. Maier-Hein: Radiomics Based on Adapted Diffusion Kurtosis Imaging Helps to Clarify Most Mammographic Findings Suspected of Being Cancer. Radiology, 2018, DOI: 10.1148/radiol.2017170723

A picture is available for download:

Caption: Optimized diffusion-weighted MR imaging (MRI) of a suspicious lesion in a female breast

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The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institute in Germany. At DKFZ, more than 1,000 scientists investigate how cancer develops, identify cancer risk factors and endeavor to find new strategies to prevent people from getting cancer. They develop novel approaches to make tumor diagnosis more precise and treatment of cancer patients more successful. The staff of the Cancer Information Service (KID) offers information about the widespread disease of cancer for patients, their families, and the general public. Jointly with Heidelberg University Hospital, DKFZ has established the National Center for Tumor Diseases (NCT) Heidelberg, where promising approaches from cancer research are translated into the clinic. In the German Consortium for Translational Cancer Research (DKTK), one of six German Centers for Health Research, DKFZ maintains translational centers at seven university partnering sites. Combining excellent university hospitals with high-profile research at a Helmholtz Center is an important contribution to improving the chances of cancer patients. DKFZ is a member of the Helmholtz Association of National Research Centers, with ninety percent of its funding coming from the German Federal Ministry of Education and Research and the remaining ten percent from the State of Baden-Württemberg.



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