Optical Imaging of Breast Cancer Using Hemodynamic Changes Induced by Valsalva Maneuver

Abstract

Purpose: To investigate whether changes in hemodynamics induced by Valsalva maneuver can be exploited for detecting and characterizing breast lesions by optical mammography.

Materials and Methods: 30 women underwent optical imaging of the breast using a DYNOT 232 system and performing Valsalva maneuvers prior to biopsy. Changes in light absorption due to changes in oxyhemoglobin and deoxyhemoglobin concentrations were recorded volumetrically and in a time-resolved manner. The parameters full width at half maximum (FWHM), time to ten (TTT), and peak amplitude (PA) of the reconstructed concentration time curves yielded color-coded maps of the breast which were separately evaluated by two experienced readers for detection rate, degree of visibility, and detection of additional lesions. ROC analysis was performed with the evaluation results.

Results: 10 patients were excluded from analysis due to artifacts or inadequately performed Valsalva maneuver. The resulting 20 patients showed a clear increase in oxygenated and deoxygenated hemoglobin concentration after the onset of the Valsalva maneuver. ROC analysis yielded AUC values (0.393 – 0.779) that did not differ from random probabilities. The highest AUC values were obtained for FWHM (AUC: 0.779, detection rates [60 – 70 %], identification of additional lesions [55 – 70 %]). PA analysis had the highest detection rate (70 – 90 %) but also the highest identification of false-positive additional lesions (80 – 90 %). The concordance rates of the two readers for malignant lesions were satisfactory (0.524 – 1.0).

Conclusion: Our study revealed susceptibility to artifacts and a large number of false-positive additional lesions, suggesting that the evaluation of hemodynamic changes after Valsalva maneuver by optical imaging is not a promising method.

Zusammenfassung

Ziel: Zu überprüfen, inwieweit die optische Mammografie eine durch ein Valsalva-Manöver induzierte Veränderung der Hämodynamik zur Läsionsdetektion und Charakterisierung nutzen kann.

Material und Methoden: 30 Patientinnen unterzogen sich vor Brustbiopsie einer optischen Untersuchung mit Valsalva-Manöver am Tomografen DYNOT 232. Die Konzentrationsänderungen von Oxyhämoglobin und Deoxyhämoglobin wurden dreidimensional zeitaufgelöst rekonstruiert. Die Parameter „full width at half maximum“ (FWHM), „time to ten“ (TTT) und „peak amplitude“ (PA) aus den zeitaufgelösten Kurvenverläufen wurden farblich kodiert grafisch dargestellt. Die errechneten Bilder wurden von 2 erfahrenen Auswertern getrennt bezüglich Detektionsrate, Grad der Sichtbarkeit und dem Auftreten von Zusatzläsionen evaluiert und eine ROC-Analyse durchgeführt.

Ergebnisse: 10 Patientinnen waren aufgrund von Artefakten oder nicht regelrechten Valsava-Manövern nicht auswertbar. Die ROC-Analyse zeigte AUC-Werte (0,393 – 0,779) die sich nicht von der Zufallswahrscheinlichkeit unterschieden. Die höchsten AUC-Werte ergab das FWHM-Model (AUC: 0,779, Detektions- [60 – 70 %] und Zusatzläsionsraten [55 – 70 %]). Das PA-Modell zeigte zwar die höchsten Detektions- (70 – 90 %) aber auch die höchsten Zusatzläsionsraten (80 – 90 %). Die Konkordanzraten beider Auswerter bei malignen Läsionen waren zufriedenstellend (0,524 – 1,0).

Schlussfolgerung: Die Artefaktanfälligkeit und die zahlreichen falsch positiven Zusatzläsionen lassen in unserer Studie die optische Beurteilung der Hämodynamik mittels Valsalva-Manöver als nicht vielversprechend erscheinen.

Key words

breast - optical imaging - hemodynamic changes

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