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Electromagnetic Breast Imaging: Results of a Pilot Study in Women with Abnormal Mammograms¹

¹ From the Departments of Radiology (S.P.P., C.A.K.), Pathology (W.A.W.), and Obstetrics and Gynecology (S.K.S.), Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, HB 7999, Lebanon, NH 03756; Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH (J.J.G., T.D.T.); Norris Cotton Cancer Center, Lebanon, NH (T.D.T.); and Thayer School of Engineering, Dartmouth College, Hanover, NH (B.W.P., P.M.M., A.H., K.D.P.). Received February 14, 2006; revision requested April 18; revision received June 16; accepted July 7; final version accepted September 27. Supported by National Institutes of Health grant P01-CA80139 awarded by the National Cancer Institute. Address correspondence to S.P.P. (e-mail: Steven.P.Poplack{at}Hitchcock.org).

View larger version (68K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Corresponding craniocaudal mammographic views (top row) and coronal EM images (bottom row) of three invasive ductal cancers (arrows) in three subjects. Left: An 11-mm invasive ductal cancer seen as a 1-cm oval mass on the right craniocaudal mammogram and as a white focus (with a peak conductivity value of 1.5 siemens per meter) in the upper outer quadrant on the corresponding coronal EIS conductivity image of the right breast. Middle: An 8-mm invasive ductal cancer identified as focal asymmetry on the left craniocaudal mammogram and as a lighter gray focus (with a peak conductivity of 0.8 siemens per meter) in the upper outer quadrant on the corresponding coronal MIS conductivity image of the left breast. Right: A 35-mm invasive ductal cancer seen as bilobed asymmetry with architectural distortion on the left craniocaudal mammogram and as a black focus (with a peak hemoglobin value of 40 µm) in the lower central left breast on the corresponding coronal NIR hemoglobin image.

View larger version (36K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Bar charts of the mean imaged property contrast ratios for EIS conductivity and permittivity (top), MIS conductivity and permittivity (middle), and NIR total hemoglobin concentration (bottom) according to diagnostic group. Vertical lines represent the 95% confidence interval, and mean numeric value is inside each box. Standard error is indicated by the corresponding vertical bar. Unadjusted P values for each group comparison from the analysis of variance of means across the diagnostic categories appear above bars. Cancers have the highest mean contrast ratios relative to benign breast abnormalities and normal control subjects for most of the imaged properties and are significantly different across group comparisons for MIS conductivity in lesions greater than 1 cm and for NIR total hemoglobin concentration (in the ROI of ipsilateral breast to contralateral breast background ratio).

View larger version (28K): [in this window] [in a new window] [Download PPT slide]   Figure 3: ROC (top row) and PPV plots (bottom row) for the EM modalities for EIS conductivity (far left), MIS conductivity (left), NIR total hemoglobin (right) contrast ratios, and those for all three modalities combined (far right). Comparison groups for the ROC analyses were based on cancers in BI-RADS category 4 or 5 for subjects in the abnormal group versus the normal control subjects (BI-RADS category 1). Dotted horizontal lines in each PPV plot show the percentage of cancers among the subjects with BI-RADS 4 or 5 classification in the examination sets analyzed for each modality. EIS shows good sensitivity to breast abnormality but relatively poor specificity, whereas MIS and NIR are more diagnostically specific and improve the PPV of mammography considerably in the subjects in the abnormal group pool. The multimodal index shows some diagnostic improvement over the best single-modality performance. Numbers in parentheses after AUC values are the 95% confidence intervals. AUC = area under the ROC curve, HbT = total hemoglobin, = conductivity.