Linda Moy, M.D.

Imaging features and management of high-risk lesions on contrast-enhanced dynamic breast MRI
Heller, Samantha L; Moy, Linda
2012 Feb;198(2):249-255, American journal of roentgenology
OBJECTIVE: Women at high risk for breast cancer and women with newly diagnosed breast cancer often undergo breast MRI. With the increasing availability of MRI-guided biopsy, high-risk lesions are not infrequently encountered. These high-risk lesions include atypical ductal hyperplasia, lobular carcinoma in situ, atypical lobular hyperplasia, papilloma, radial scar, and flat epithelial cell atypia. The management of these lesions is controversial and is often extended to high-risk lesions detected on mammography and ultrasound, with surgical excision usually recommended. The increasing use of MRI for suspicious lesions necessitates review of the imaging characteristics, frequency, and surgical outcome of high-risk lesions identified at MRI. This article addresses the frequency of high-risk lesions detected on breast MRI according to the current literature and discusses MRI features of high-risk lesions, including morphologic and enhancement kinetic characteristics. The surgical outcome for high-risk lesions identified at MRI-guided biopsy will be discussed. Finally, appropriate management guidelines for high-risk lesions identified on MRI-guided biopsy will be determined. CONCLUSION: To our knowledge, no studies to date show definitive and specific characteristics for high-risk lesions. Underestimation of malignancy on MRI-guided biopsy currently warrants surgical management for all high-risk lesions. There is a need for prospective larger power studies
— id: 150572, year: 2012, vol: 198, page: 249, stat: Journal Article,

Intravoxel incoherent motion imaging of tumor microenvironment in locally advanced breast cancer
Sigmund, E E; Cho, G Y; Kim, S; Finn, M; Moccaldi, M; Jensen, J H; Sodickson, D K; Goldberg, J D; Formenti, S; Moy, L
2011 May;65(5):1437-1447, Magnetic resonance in medicine
Diffusion-weighted imaging plays important roles in cancer diagnosis, monitoring, and treatment. Although most applications measure restricted diffusion by tumor cellularity, diffusion-weighted imaging is also sensitive to vascularity through the intravoxel incoherent motion effect. Hypervascularity can confound apparent diffusion coefficient measurements in breast cancer. We acquired multiple b-value diffusion-weighted imaging at 3 T in a cohort of breast cancer patients and performed biexponential intravoxel incoherent motion analysis to extract tissue diffusivity (D(t) ), perfusion fraction (f(p) ), and pseudodiffusivity (D(p) ). Results indicated significant differences between normal fibroglandular tissue and malignant lesions in apparent diffusion coefficient mean (+/-standard deviation) values (2.44 +/- 0.30 vs. 1.34 +/- 0.39 mum(2) /msec, P < 0.01) and D(t) (2.36 +/- 0.38 vs. 1.15 +/- 0.35 mum(2) /msec, P < 0.01). Lesion diffusion-weighted imaging signals demonstrated biexponential character in comparison to monoexponential normal tissue. There is some differentiation of lesion subtypes (invasive ductal carcinoma vs. other malignant lesions) with f(p) (10.5 +/- 5.0% vs. 6.9 +/- 2.9%, P = 0.06), but less so with D(t) (1.14 +/- 0.32 mum(2) /msec vs. 1.18 +/- 0.52 mum(2) /msec, P = 0.88) and D(p) (14.9 +/- 11.4 mum(2) /msec vs. 16.1 +/- 5.7 mum(2) /msec, P = 0.75). Comparison of intravoxel incoherent motion biomarkers with contrast enhancement suggests moderate correlations. These results suggest the potential of intravoxel incoherent motion vascular and cellular biomarkers for initial grading, progression monitoring, or treatment assessment of breast tumors. Magn Reson Med, 2011. (c) 2011 Wiley-Liss, Inc
— id: 131795, year: 2011, vol: 65, page: 1437, stat: Journal Article,

Optimizing 1.5-Tesla and 3-Tesla dynamic contrast-enhanced magnetic resonance imaging of the breasts
Chatterji, Manjil; Mercado, Cecilia L; Moy, Linda
2010 May;18(2):207-24, viii, Magnetic resonance imaging clinics of North America
The technical requirements for magnetic resonance imaging (MRI) of the breasts are challenging because high temporal and high spatial resolution are necessary. This article describes the necessary equipment and pulse sequences for performing a high-quality study. Although imaging at 3-Tesla (T) has a higher signal-to-noise ratio, the protocol needs to be modified from the 1.5-T system to provide optimal imaging. The article presents the requirements for performing breast MRI and discusses techniques to ensure high-quality examinations on 1.5-T and 3-T systems
— id: 109803, year: 2010, vol: 18, page: 207, stat: Journal Article,

Incidence of Pleomorphic and Classic Lobular Carcinoma In Situ in Percutaneous Biopsies of the Breast: An Institutional Review
Lee, J; Mercado, C; Hernandez, O; Moy, L; Toth, H
2010 MAY ;194(5):-, American journal of roentgenology
— id: 111947, year: 2010, vol: 194, page: , stat: Journal Article,

Invasive Micropapillary Carcinoma: Radiographic Features in 18 Patients With This Unusual Variant
Mercado, C; Guth, A; Mercado, C; Moy, L; Lee, J; Toth, H; Cangiarella, J
2010 MAY ;194(5):-, American journal of roentgenology
— id: 111948, year: 2010, vol: 194, page: , stat: Journal Article,

Breast MRI. Preface
Mercado, Cecilia L; Moy, Linda
2010 May;18(2):xiii-xiii, Magnetic resonance imaging clinics of North America
— id: 109802, year: 2010, vol: 18, page: xiii, stat: Journal Article,

Role of fusion of prone FDG-PET and magnetic resonance imaging of the breasts in the evaluation of breast cancer
Moy, Linda; Noz, Marilyn E; Maguire, Gerald Q Jr; Melsaether, Amy; Deans, Abby E; Murphy-Walcott, Antoinette D; Ponzo, Fabio
2010 Jul;16(4):369-376, Breast journal
The purpose of this study is to report further about the statistically significant results from a prospective study, which suggests that fusion of prone F-18 Fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) breast scans increases the positive predictive value (PPV) and specificity for patients in whom the MR outcome alone would be nonspecific. Thirty-six women (mean age, 43 years; range, 24-65 years) with 90 lesions detected on MR consented to undergo a FDG-PET scan. Two blinded readers evaluated the MR and the computer tomography (CT) attenuation-corrected prone FDG-PET scans side-by-side, then after the volumes were superimposed (fused). A semiautomatic, landmark-based program was used to perform nonrigid fusion. Pathology and radiologic follow-up were used as the reference standard. The sensitivity, specificity, PPV, negative predictive value (NPV), and accuracy (with 95% confidence intervals) for MR alone, FDG-PET alone, and fused MR and FDG-PET were calculated. The median lesion size measured from the MR was 2.5 cm (range, 0.5-10 cm). Histologically, 56 lesions were malignant, and 15 were benign. Nineteen lesions were benign after 20-47 months of clinical and radiologic surveillance. The sensitivity of MR alone was 95%, FDG-PET alone was 57%, and fusion was 83%. The increase in PPV from 77% in MR alone to 98% when fused and the increase in specificity from 53% to 97% were statistically significant (p < 0.05). The false-negative rate on FDG-PET alone was 26.7%, and after fusion this number was reduced to 9%. FDG-PET and MR fusions were helpful in selecting which lesion to biopsy, especially in women with multiple suspicious MR breast lesions
— id: 111347, year: 2010, vol: 16, page: 369, stat: Journal Article,

Learning From Crowds
Raykar, Vikas C.; Yu, Shipeng; Zhao, Linda H.; Valadez, Gerardo Hermosillo; Florin, Charles; Bogoni, Luca; Moy, Linda
2010 APR ;11(1):1297-1322, Journal of machine learning research : JMLR
For many supervised learning tasks it may be infeasible (or very expensive) to obtain objective and reliable labels. Instead, we can collect subjective (possibly noisy) labels from multiple experts or annotators. In practice, there is a substantial amount of disagreement among the annotators, and hence it is of great practical interest to address conventional supervised learning problems in this scenario. In this paper we describe a probabilistic approach for supervised learning when we have multiple annotators providing (possibly noisy) labels but no absolute gold standard. The proposed algorithm evaluates the different experts and also gives an estimate of the actual hidden labels. Experimental results indicate that the proposed method is superior to the commonly used majority voting baseline
— id: 113919, year: 2010, vol: 11, page: 1297, stat: Journal Article,

Microinvasive ductal carcinoma in situ: Clinical presentation, imaging features, pathologic findings, and outcome
Vieira, Cristina C; Mercado, Cecilia L; Cangiarella, Joan F; Moy, Linda; Toth, Hildegard K; Guth, Amber A
2010 Jan;73(1):102-107, European journal of radiology
OBJECTIVE: The purpose of our study was to describe the clinical features, imaging characteristics, pathologic findings and outcome of microinvasive ductal carcinoma in situ (DCISM). MATERIALS AND METHODS: The records of 21 women diagnosed with microinvasive ductal carcinoma in situ (DCISM) from November 1993 to September 2006 were retrospectively reviewed. The clinical presentation, imaging and histopathologic features, and clinical follow-up were reviewed. RESULTS: The 21 lesions all occurred in women with a mean age of 56 years (range, 27-79 years). Clinical findings were present in ten (48%): 10 with palpable masses, four with associated nipple discharge. Mean lesion size was 21mm (range, 9-65mm). The lesion size in 62% was 15mm or smaller. Mammographic findings were calcifications only in nine (43%) and an associated or other finding in nine (43%) [mass (n=7), asymmetry (n=1), architectural distortion (n=1)]. Three lesions were mammographically occult. Sonographic findings available in 11 lesions showed a solid hypoechoic mass in 10 cases (eight irregular in shape, one round, one oval). One lesion was not seen on sonography. On histopathologic examination, all lesions were diagnosed as DCISM, with a focus of invasive carcinoma less than or equal to 1mm in diameter within an area of DCIS. Sixteen (76%) lesions were high nuclear grade, four (19%) were intermediate and one was low grade (5%). Sixteen (76%) had the presence of necrosis. Positivity for ER and PR was noted in 75% and 38%. Nodal metastasis was present in one case with axillary lymph node dissection. Mean follow-up time for 16 women was 36 months without evidence of local or systemic recurrence. One patient developed a second primary in the contralateral breast 3 years later. CONCLUSION: The clinical presentation and radiologic appearance of a mass are commonly encountered in DCISM lesions (48% and 57%, respectively), irrespective of lesion size, mimicking findings seen in invasive carcinoma. Despite its potential for nodal metastasis (5% in our series), mean follow-up at 36 months was good with no evidence of local or systemic recurrence at follow-up. Knowledge of these clinical and imaging findings in DCISM lesions may alert the clinician to the possibility of microinvasion and guide appropriate management
— id: 95528, year: 2010, vol: 73, page: 102, stat: Journal Article,

Surgical Outcome of High-Risk Lesions at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy
Elias, K; Mercado, C; Toth, H; Moy, L
2009 MAY ;192(5):646-651, American journal of roentgenology
— id: 99180, year: 2009, vol: 192, page: 646, stat: Journal Article,

Is breast MRI helpful in the evaluation of inconclusive mammographic findings?
Moy, Linda; Elias, Kristin; Patel, Vashali; Lee, Jiyon; Babb, James S; Toth, Hildegard K; Mercado, Cecilia L
2009 Oct;193(4):986-993, American journal of roentgenology
OBJECTIVE: The purpose of this study was to evaluate the usefulness of MRI of the breast in cases in which mammographic or sonographic findings are inconclusive. MATERIALS AND METHODS: We retrospectively reviewed images from 115 MRI examinations of the breast performed from 1999 to 2005 for the indication of problem-solving for inconclusive findings on a mammogram. Forty-eight of the 115 women (41.8%) were at high risk. We discerned whether sonography or MRI was used as an adjunctive tool and correlated the findings with those in the pathology database. RESULTS: The equivocal findings most frequently leading to MRI were asymmetry and architectural distortion. No suspicious MRI correlate was found in 100 of 115 cases (87%). These cases were found stable at follow-up mammography or MRI after a mean of 34 months. Fifteen enhancing masses (13%) that corresponded to the mammographic abnormality were seen on MR images. All masses identified at MRI were accurately localized for biopsy, and six malignant lesions were identified. Four of six malignant tumors were seen in one mammographic view only; two were seen on second-look ultrasound images. MRI had a sensitivity of 100% and compared with mammography had significantly higher specificity (91.7% vs 80.7%, p = 0.029), positive predictive value (40% vs 8.7%, p = 0.032), and overall accuracy (92.2% vs 78.3%, p = 0.0052). Eighteen incidental lesions (15.7%) were detected at MRI, and all were subsequently found benign. CONCLUSION: We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images
— id: 102506, year: 2009, vol: 193, page: 986, stat: Journal Article,

Sonographically guided marker placement for confirmation of removal of mammographically occult lesions after localization
Mercado, Cecilia L; Guth, Amber A; Toth, Hildegard K; Moy, Linda; Axelrod, Deborah; Cangiarella, Joan
2008 Oct;191(4):1216-1219, American journal of roentgenology
OBJECTIVE: We evaluated the benefit of placing a marker under sonographic guidance at the time of localization to aid in identifying mammographically occult lesions within the specimen at the time of surgical excision and to evaluate margin status. MATERIALS AND METHODS: We reviewed 135 sonographically guided needle localizations performed on mammographically occult lesions. Imaging during the localization procedure, marker placement, and specimen radiographs were reviewed, and the findings were correlated with the histopathologic findings. RESULTS: Of the 135 mammographically occult lesions, 77 were localized without marker placement and 58 with marker placement. The 58 localizations with marker placement were for masses with a mean lesion size of 9 mm. Specimen radiography of these lesions showed a marker within the specimen in 56 cases (97%) and visualization of the lesion in only seven cases (12%). Specimen radiography of localizations without marker placement showed visualization of the lesion in 18 cases (23%). Of the 11 malignant lesions (19%) localized with marker placement, none had a positive inked margin, but five (46%) had close margins necessitating reexcision. Of the 26 malignant lesions (34%) localized without marker placement, two (8%) had a positive inked margin, and eight (31%) had close margins necessitating reexcision. CONCLUSION: At needle localization of breast lesions, marker placement under sonographic guidance is beneficial because it enables immediate confirmation of accurate surgical removal of the localized lesion at surgical excision. Use of marker placement, however, does not reduce the percentage of cases with close margins necessitating reexcision
— id: 93371, year: 2008, vol: 191, page: 1216, stat: Journal Article,

Interpretation and clinical applications of breast MRI: self-assessment module
Moy, Linda; Mercado, Cecilia L
2008 Dec;191(6 Suppl):S60-S67, American journal of roentgenology
The educational objectives for this self-assessment module on the interpretation and clinical applications of breast MRI are for the participant to exercise, self-assess, and improve his or her understanding of the imaging and clinical features of cancer and other breast masses on MRI
— id: 91457, year: 2008, vol: 191, page: S60, stat: Journal Article,

The utility of MRI in preoperative planning for brest-conserving therapy
Kaufman, G; Guth, AA; Singh, A; Axelrod, D; Moy, L
2007 DEC ;106(1):S43-S43, Breast cancer research & treatment
— id: 75800, year: 2007, vol: 106, page: S43, stat: Journal Article,

Does Sonographically Guided Clip Placement Facilitate Confirmation of Removal of Mammographically Occult Lesions After Localization?
Mercado CL; Guth AA; Axelrod DM; Moy L; Toth HK; Cangiarella J
2007 ;188:A32-A34 #110, American journal of roentgenology
— id: 97098, year: 2007, vol: 188, page: A32, stat: Journal Article,

Prone mammoPET acquisition improves the ability to fuse MRI and PET breast scans
Moy, Linda; Noz, Marilyn E; Maguire, Gerald Q Jr; Ponzo, Fabio; Deans, Abby E; Murphy-Walcott, Antoinette D; Kramer, Elissa L
2007 Mar;32(3):194-198, Clinical nuclear medicine
PURPOSE: This study compared prone acquisition of PET scans with traditional supine acquisition to improve fusion of PET scans with MRI scans and improve evaluation of enhancing breast lesions detected on MRI. MATERIALS AND METHODS: MRI breast scans are acquired in the prone position using a breast coil to allow the breasts to hang pendant. An apparatus was fabricated to allow prone acquisition of PET scans. Fused scans from 2 patients acquired both prone and supine were contrasted with those from 3 patients acquired supine only. All 5 MRI scans were acquired on standard scanners. The PET scans were acquired with a PET/CT unit using a low-dose CT scan for attenuation correction. The PET and MRI volumes were matched twice (using a semiautomated registration method) by different operators. The additional value of fusion was judged using reports from the original (nonfused) MRI and PET, joint rereading of the volumes side by side, and examination of fused images. RESULTS: Of 12 enhancing lesions on breast MRI, 7 demonstrated uptake on PET/CT. In the 3 supine-only cases, the fused images were not interpretable because of the marked distortion of the breasts. In the 2 prone cases, the fused images increased our confidence in characterizing a lesion as benign or malignant. Interpretations were confirmed by clinical follow up in 2 or histologic results in 3 patients. CONCLUSIONS: PET MRI fusion is feasible and may assist in localizing lesions detected on either study. A more extensive study is underway to confirm the value of this fusion technique
— id: 73838, year: 2007, vol: 32, page: 194, stat: Journal Article,

Improving specificity of breast MRI using prone PET and fused MRI and PET 3D volume datasets
Moy, Linda; Ponzo, Fabio; Noz, Marilyn E; Maguire, Gerald Q Jr; Murphy-Walcott, Antoinette D; Deans, Abby E; Kitazono, Mary T; Travascio, Laura; Kramer, Elissa L
2007 Apr;48(4):528-537, Journal of nuclear medicine
MRI is a sensitive method for detecting invasive breast cancer, but it lacks specificity. To examine the effect of combining PET with MRI on breast lesion characterization, a prototype positioning device was fabricated to allow PET scans to be acquired in the same position as MRI scans--that is, prone. METHODS: To test the hypothesis that fusion of (18)F-FDG PET and MRI scans improves detection of breast cancer, 23 patients with suspected recurrent or new breast cancer underwent a routine whole-body PET scan, a prone PET scan of the chest, and a routine breast MRI scan. The attenuation-corrected prone PET and MRI datasets were registered twice by different operators. The fusion results were judged for quality by visual inspection and statistical analysis. A joint reading of the MRI and PET scans side by side and integrated images was performed by a nuclear medicine physician and a radiologist. Sensitivity and specificity of MRI and combined MRI and PET scans were calculated on the basis of pathology reports or at least 1 y of clinical and radiologic follow-up. RESULTS: All fusions were verified to be well matched using specific anatomic criteria. A total of 45 lesions was assessed. Lesion size range was 0.6 to 10.0 cm. Of the 44 breasts examined, 29 were suspicious for cancer, of which 15 were found to be positive on surgical excision. In lesion-by-lesion analysis, sensitivity and specificity of MRI alone were 92% and 52%, respectively; after MRI and PET fusion, they were 63% and 95%, respectively. The positive predictive value and the negative predictive value for MRI alone were 69% and 85%, respectively; after MRI and PET fusion, they were 94% and 69%, respectively. CONCLUSION: Acquisition of prone PET scans using the new positioning device permitted acquisition of prone scans suitable for fusion with breast MRI scans. Fused PET and MRI scans increased the specificity of MRI but decreased the sensitivity in this small group of patients. Additional data are needed to confirm the statistical significance of these preliminary findings
— id: 95529, year: 2007, vol: 48, page: 528, stat: Journal Article,

Clinical application of a semiautomatic 3D fusion tool where automatic fusion techniques are difflicult to use
Noz, ME; Maguire, GQ; Zeleznik, MP; Olivecrona, L; Olivecrona, H; Axel, L; Srichai, MB; Moy, L; Murphy-Walcott, A
2006 ;4057:195-205, Lecture notes in computer science
The purpose of this paper is to demonstrate the clinical advantages of using semiautomatic volume registration where automatic registration is problematic due to large deformations, small bone anatomy, or extraneous structures. Examples are drawn from clinical cases of MRI/PET breast studies, CT angiography/SPECT cardiac studies, and total wrist arthroplasty. These types of studies should be contrasted with those involving the head, thorax, and pelvis where there is much less deformation and the existence of (some) large bones facilitates automatic matching
— id: 69353, year: 2006, vol: 4057, page: 195, stat: Journal Article,

Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer
Yeh, Eren; Slanetz, Priscilla; Kopans, Daniel B; Rafferty, Elizabeth; Georgian-Smith, Dianne; Moy, Linda; Halpern, Elkan; Moore, Richard; Kuter, Irene; Taghian, Alphonse
2005 Mar;184(3):868-877, American journal of roentgenology
OBJECTIVE: The objective of our study was to determine the relative accuracy of mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer as compared with the gold standards of physical examination and pathology. SUBJECTS AND METHODS: Forty-one women with stage IIB-III palpable breast cancer were prospectively enrolled in a study investigating the effects of sequential single-agent chemotherapy (doxorubicin followed by paclitaxel or vice versa) on tumor imaging. The study cohort consisted of the first 31 patients (age range, 31-65 years; mean, 45 years) who completed the protocol. All underwent physical examination, mammography, sonography, and MRI before and after receiving each neoadjuvant chemotherapeutic drug. Imaging studies were reviewed by two radiologists using conventional lexicons for lesion analysis, and the findings were compared with clinical response and pathology results. RESULTS: Complete, partial, and stable clinical response as defined by clinical examination was seen in 15, 14, and two of the 31 patients, respectively. Agreement rates about the degree of response were 32%, 48%, and 55%, respectively, for mammography, sonography, and MRI compared with clinical evaluation and did not differ statistically. Agreement about the rate of response as measured by clinical examination, mammography, sonography, and MRI compared with the gold standard (pathology) was 19%, 26%, 35%, and 71%, respectively. Of the four, MRI agreed with the gold standard significantly more often (p < 0.002 for all three paired comparisons with MRI). When there was disagreement with the gold standard, none of the four exhibited a significant tendency to either under- or overestimate. CONCLUSION: MRI appears to provide the best correlation with pathology-better than physical examination, mammography, and sonography-in patients undergoing neoadjuvant chemotherapy. However, MRI may overestimate (6%) or underestimate (23%) residual disease in approximately 29% of the patients (95% confidence interval, 14-48%)
— id: 95530, year: 2005, vol: 184, page: 868, stat: Journal Article,

Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review
Moy, Linda; Slanetz, Priscilla J; Moore, Richard; Satija, Sameer; Yeh, Eren D; McCarthy, Kathleen A; Hall, Deborah; Staffa, Mary; Rafferty, Elizabeth A; Halpern, Elkan; Kopans, Daniel B
2002 Oct;225(1):176-181, Radiology
PURPOSE: To determine the number of patients who received a diagnosis of breast cancer after having an area of clinical concern at presentation and combined negative mammographic and ultrasonographic (US) findings. MATERIALS AND METHODS: During a 4-year period, 829 patients with a palpable abnormality at presentation and combined negative mammographic and US findings were identified. The number of women who went on to receive a diagnosis of breast cancer was determined retrospectively. The authors searched the breast imaging database and the pathology database, sent a contact letter to the referring physicians, and linked their data to the State Cancer Registry. They also analyzed the breast parenchymal density among all patients who had more than 2 years of follow-up. RESULTS: Of the 829 women, 374 had follow-up information. Two-hundred thirty-three patients had negative imaging findings with more than 2 years of follow-up. The other 141 women were presumed to be cancer free, as they were not identified by the State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis of breast cancer in the area of the palpable abnormality. The six cancers were diagnosed among the 156 women who had radiographically dense breast tissue (Breast Imaging Reporting and Data System category 3 or 4). Among the 77 women with predominantly fatty tissues, no cancers were diagnosed. CONCLUSION: A negative mammographic and US finding of a palpable abnormality does not exclude breast cancer, but the likelihood of breast cancer is low, approximately 2.6%-2.7%. It may be higher if the breast tissues are dense and lower if they are predominantly fatty
— id: 39585, year: 2002, vol: 225, page: 176, stat: Journal Article,