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Cureus Nov 2023Breast cancer is a prevalent global health concern, necessitating accurate diagnostic tools for effective management. Diagnostic imaging plays a pivotal role in breast... (Review)
Review
Breast cancer is a prevalent global health concern, necessitating accurate diagnostic tools for effective management. Diagnostic imaging plays a pivotal role in breast cancer diagnosis, staging, treatment planning, and outcome evaluation. Radiomics is an emerging field of study in medical imaging that contains a broad set of computational methods to extract quantitative features from radiographic images. This can be utilized to guide diagnosis, treatment response, and prognosis in clinical settings. A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Quality was assessed using the radiomics quality score. Diagnostic sensitivity and specificity of radiomics analysis, with 95% confidence intervals (CIs), were included for meta-analysis. The area under the curve analysis was recorded. An extensive statistical analysis was performed following the Cochrane guidelines. Statistical significance was determined if p-values were less than 0.05. Statistical analyses were conducted using Review Manager (RevMan), Version 5.4.1. A total of 31 manuscripts involving 8,773 patients were included, with 17 contributing to the meta-analysis. The cohort comprised 56.2% malignant breast cancers and 43.8% benign breast lesions. MRI demonstrated a sensitivity of 0.91 (95% CI: 0.89-0.92) and a specificity of 0.84 (95% CI: 0.82-0.86) in differentiating between benign and malignant breast cancers. Mammography-based radiomic features predicted breast cancer subtype with a sensitivity of 0.79 (95% CI: 0.76-0.82) and a specificity of 0.81 (95% CI: 0.79-0.84). Ultrasound-based analysis yielded a sensitivity of 0.92 (95% CI: 0.90-0.94) and a specificity of 0.85 (95% CI: 0.83-0.88). Only one study reported the results of radiomic evaluation from CT, which had a sensitivity of 0.95 (95% CI: 0.88-0.99) and a specificity of 0.56 (95% CI: 0.45-0.67). Across different imaging modalities, radiomics exhibited robust diagnostic accuracy in differentiating benign and malignant breast lesions. The results underscore the potential of radiomic assessment as a minimally invasive alternative or adjunctive diagnostic tool for breast cancer. This is pioneering data that reports on a novel diagnostic approach that is understudied and underreported. However, due to study limitations, the complexity of this technology, and the need for future development, biopsy still remains the current gold standard method of determining breast cancer type.
PubMed: 38024014
DOI: 10.7759/cureus.49015 -
Insights Into Imaging Dec 2023Calcifications on mammography can be indicative of breast cancer, but the prognostic value of their appearance remains unclear. This systematic review and meta-analysis... (Review)
Review
BACKGROUND
Calcifications on mammography can be indicative of breast cancer, but the prognostic value of their appearance remains unclear. This systematic review and meta-analysis aimed to evaluate the association between mammographic calcification morphology descriptors (CMDs) and clinicopathological factors.
METHODS
A comprehensive literature search in Medline via Ovid, Embase.com, and Web of Science was conducted for articles published between 2000 and January 2022 that assessed the relationship between CMDs and clinicopathological factors, excluding case reports and review articles. The risk of bias and overall quality of evidence were evaluated using the QUIPS tool and GRADE. A random-effects model was used to synthesize the extracted data. This systematic review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
RESULTS
Among the 4715 articles reviewed, 29 met the inclusion criteria, reporting on 17 different clinicopathological factors in relation to CMDs. Heterogeneity between studies was present and the overall risk of bias was high, primarily due to small, inadequately described study populations. Meta-analysis demonstrated significant associations between fine linear calcifications and high-grade DCIS [pooled odds ratio (pOR), 4.92; 95% confidence interval (CI), 2.64-9.17], (comedo)necrosis (pOR, 3.46; 95% CI, 1.29-9.30), (micro)invasion (pOR, 1.53; 95% CI, 1.03-2.27), and a negative association with estrogen receptor positivity (pOR, 0.33; 95% CI, 0.12-0.89).
CONCLUSIONS
CMDs detected on mammography have prognostic value, but there is a high level of bias and variability between current studies. In order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary.
CRITICAL RELEVANCE STATEMENT
Mammographic calcification morphology descriptors (CMDs) have prognostic value, but in order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary.
SYSTEMATIC REVIEW REGISTRATION
CRD42022341599 KEY POINTS: • Mammographic calcifications can be indicative of breast cancer. • The prognostic value of mammographic calcifications is still unclear. • Specific mammographic calcification morphologies are related to lesion aggressiveness. • Variability between studies necessitates standardization in calcification evaluation to achieve clinical utility.
PubMed: 38051355
DOI: 10.1186/s13244-023-01529-z -
The Indian Journal of Radiology &... Jul 2024Although abundant literature is currently available on the use of deep learning for breast cancer detection in mammography, the quality of such literature is widely... (Review)
Review
Although abundant literature is currently available on the use of deep learning for breast cancer detection in mammography, the quality of such literature is widely variable. To evaluate published literature on breast cancer detection in mammography for reproducibility and to ascertain best practices for model design. The PubMed and Scopus databases were searched to identify records that described the use of deep learning to detect lesions or classify images into cancer or noncancer. A modification of Quality Assessment of Diagnostic Accuracy Studies (mQUADAS-2) tool was developed for this review and was applied to the included studies. Results of reported studies (area under curve [AUC] of receiver operator curve [ROC] curve, sensitivity, specificity) were recorded. A total of 12,123 records were screened, of which 107 fit the inclusion criteria. Training and test datasets, key idea behind model architecture, and results were recorded for these studies. Based on mQUADAS-2 assessment, 103 studies had high risk of bias due to nonrepresentative patient selection. Four studies were of adequate quality, of which three trained their own model, and one used a commercial network. Ensemble models were used in two of these. Common strategies used for model training included patch classifiers, image classification networks (ResNet in 67%), and object detection networks (RetinaNet in 67%). The highest reported AUC was 0.927 ± 0.008 on a screening dataset, while it reached 0.945 (0.919-0.968) on an enriched subset. Higher values of AUC (0.955) and specificity (98.5%) were reached when combined radiologist and Artificial Intelligence readings were used than either of them alone. None of the studies provided explainability beyond localization accuracy. None of the studies have studied interaction between AI and radiologist in a real world setting. While deep learning holds much promise in mammography interpretation, evaluation in a reproducible clinical setting and explainable networks are the need of the hour.
PubMed: 38912238
DOI: 10.1055/s-0043-1775737 -
Radiography (London, England : 1995) Aug 2023Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in... (Review)
Review
INTRODUCTION
Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in asymptomatic women. Nordic countries (Denmark, Finland, Iceland, Norway, Sweden, the Faroe Islands, and Greenland) demonstrated high participation rates; however, breast cancer mortality could be limited by further optimizing screening. This review aimed to explore factors that affect women's participation in mammography screening in Nordic countries.
METHOD
A systematic review of segregated mixed research synthesis using a deductive approach was conducted. The following databases and platforms were searched to identify relevant studies: CINAHL with Full Text (EBSCOHost), MEDLINE (EBSCOHost), PsycInfo (ProQuest), Scopus (Elsevier) and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI). The Critical Appraisal Skills Program was used for quality assessment. The Health Promotion Model was applied to integrate findings from qualitative and qualitative research. All methodological steps followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
The final selection (16 articles) included studies from three Nordic countries: Denmark (four quantitative studies), Norway (one qualitative and four quantitative studies), and Sweden (three qualitative and seven quantitative studies). Sixty-three factors were identified as barriers, facilitators, or factors with no influence.
CONCLUSION
A substantial number of obtained factors, spread across a wide spectrum, describe (non-)participation in mammography screening as a versatile phenomenon.
IMPLICATIONS FOR PRACTICE
The findings of this review could benefit the mammography staff and providers regarding possible interventions aimed at improving screening participation rates.
Topics: Female; Humans; Mammography; Breast Neoplasms; Scandinavian and Nordic Countries; Qualitative Research; Norway
PubMed: 37421878
DOI: 10.1016/j.radi.2023.06.010 -
Journal of Medicine and Life Dec 2023Early detection measures for breast cancer, such as breast self-exams, clinical breast exams, and mammography, have considerable benefits in effectively reducing breast... (Review)
Review
Early detection measures for breast cancer, such as breast self-exams, clinical breast exams, and mammography, have considerable benefits in effectively reducing breast cancer-related mortality. As the incidence of breast cancer is steadily increasing, it is crucial to raise awareness on early detection. This scoping review assessed the current knowledge, attitudes, practices, and perceptions of breast cancer screening among female medical students. We used the six phases of Arksey and O'Malley's framework from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) template. Our analysis included 43 articles from Google Scholar and PubMed search engines, focusing on female medical students. Our results showed that most female medical students had a satisfactory level of knowledge about the most common signs, symptoms, and early detection methods of breast cancer. Generally, their attitude and perceptions were positive regarding breast cancer-related preventive measures. However, the level of practice was reduced. Further efforts are necessary to promote and improve the practice of breast self-examination, clinical breast exams, and mammography among female medical students. Potential interventions could include modifications to the medical curriculum and social media campaigns to enhance engagement and adoption of these practices.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Students, Medical; Health Knowledge, Attitudes, Practice; Mammography
PubMed: 38585536
DOI: 10.25122/jml-2023-0412 -
BMC Women's Health Feb 2024The incidence of breast cancer among Chinese women has gradually increased in recent years. This study aims to analyze the situation of breast cancer screening programs... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of breast cancer among Chinese women has gradually increased in recent years. This study aims to analyze the situation of breast cancer screening programs in China and compare the cancer detection rates (CDRs), early-stage cancer detection rates (ECDRs), and the proportions of early-stage cancer among different programs.
METHODS
We conducted a systematic review and meta-analysis of studies in multiple literature databases. Studies that were published between January 1, 2010 and June 30, 2023 were retrieved. A random effects model was employed to pool the single group rate, and subgroup analyses were carried out based on screening model, time, process, age, population, and follow-up method.
RESULTS
A total of 35 studies, including 47 databases, satisfied the inclusion criteria. Compared with opportunistic screening, the CDR (1.32‰, 95% CI: 1.10‰-1.56‰) and the ECDR (0.82‰, 95% CI: 0.66‰-0.99‰) were lower for population screening, but the proportion of early-stage breast cancer (80.17%, 95% CI: 71.40%-87.83%) was higher. In subgroup analysis, the CDR of population screening was higher in the urban group (2.28‰, 95% CI: 1.70‰-2.94‰), in the breast ultrasonography (BUS) in parallel with mammography (MAM) group (3.29‰, 95% CI: 2.48‰-4.21‰), and in the second screening follow-up group (2.47‰, 95% CI: 1.64‰-3.47‰), and the proportion of early-stage breast cancer was 85.70% (95% CI: 68.73%-97.29%), 88.18% (95% CI: 84.53%-91.46%), and 90.05% (95% CI: 84.07%-94.95%), respectively.
CONCLUSION
There were significant differences between opportunistic and population screening programs. The results of these population screening studies were influenced by the screening process, age, population, and follow-up method. In the future, China should carry out more high-quality and systematic population-based screening programs to improve screening coverage and service.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; China; Ultrasonography, Mammary; Mass Screening
PubMed: 38321439
DOI: 10.1186/s12905-024-02924-4 -
European Radiology Aug 2023In approximately 45% of invasive breast cancer (IBC) patients treated with neoadjuvant systemic therapy (NST), ductal carcinoma in situ (DCIS) is present. Recent studies... (Meta-Analysis)
Meta-Analysis Review
Imaging findings for response evaluation of ductal carcinoma in situ in breast cancer patients treated with neoadjuvant systemic therapy: a systematic review and meta-analysis.
OBJECTIVES
In approximately 45% of invasive breast cancer (IBC) patients treated with neoadjuvant systemic therapy (NST), ductal carcinoma in situ (DCIS) is present. Recent studies suggest response of DCIS to NST. The aim of this systematic review and meta-analysis was to summarise and examine the current literature on imaging findings for different imaging modalities evaluating DCIS response to NST. More specifically, imaging findings of DCIS pre- and post-NST, and the effect of different pathological complete response (pCR) definitions, will be evaluated on mammography, breast MRI, and contrast-enhanced mammography (CEM).
METHODS
PubMed and Embase databases were searched for studies investigating NST response of IBC, including information on DCIS. Imaging findings and response evaluation of DCIS were assessed for mammography, breast MRI, and CEM. A meta-analysis was conducted per imaging modality to calculate pooled sensitivity and specificity for detecting residual disease between pCR definition no residual invasive disease (ypT0/is) and no residual invasive or in situ disease (ypT0).
RESULTS
Thirty-one studies were included. Calcifications on mammography are related to DCIS, but can persist despite complete response of DCIS. In 20 breast MRI studies, an average of 57% of residual DCIS showed enhancement. A meta-analysis of 17 breast MRI studies confirmed higher pooled sensitivity (0.86 versus 0.82) and lower pooled specificity (0.61 versus 0.68) for detection of residual disease when DCIS is considered pCR (ypT0/is). Three CEM studies suggest the potential benefit of simultaneous evaluation of calcifications and enhancement.
CONCLUSIONS AND CLINICAL RELEVANCE
Calcifications on mammography can remain despite complete response of DCIS, and residual DCIS does not always show enhancement on breast MRI and CEM. Moreover, pCR definition effects diagnostic performance of breast MRI. Given the lack of evidence on imaging findings of response of the DCIS component to NST, further research is demanded.
KEY POINTS
• Ductal carcinoma in situ has shown to be responsive to neoadjuvant systemic therapy, but imaging studies mainly focus on response of the invasive tumour. • The 31 included studies demonstrate that after neoadjuvant systemic therapy, calcifications on mammography can remain despite complete response of DCIS and residual DCIS does not always show enhancement on MRI and contrast-enhanced mammography. • The definition of pCR has impact on the diagnostic performance of MRI in detecting residual disease, and when DCIS is considered pCR, pooled sensitivity was slightly higher and pooled specificity slightly lower.
Topics: Humans; Female; Carcinoma, Intraductal, Noninfiltrating; Breast Neoplasms; Neoadjuvant Therapy; Breast; Mammography; Calcinosis; Magnetic Resonance Imaging; Carcinoma, Ductal, Breast
PubMed: 37020070
DOI: 10.1007/s00330-023-09547-7 -
Radiography (London, England : 1995) Jan 2024A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening... (Review)
Review
INTRODUCTION
A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mammograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography.
METHODS
This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience.
RESULTS
The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment, and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients.
CONCLUSION
This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people.
IMPLICATIONS FOR PRACTICE
This scoping review provides guidance to healthcare providers and services for better patient/client-centered care.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; Pain; Patient Satisfaction
PubMed: 38141428
DOI: 10.1016/j.radi.2023.11.016 -
Cureus Apr 2024This systematic review aimed to critically assess the effectiveness of mammography, ultrasound, and magnetic resonance imaging (MRI) in the detection of breast... (Review)
Review
This systematic review aimed to critically assess the effectiveness of mammography, ultrasound, and magnetic resonance imaging (MRI) in the detection of breast carcinoma within dense breast tissue. An exhaustive search of contemporary literature was undertaken, focusing on the diagnostic accuracy, false positive and negative rates, and clinical implications of the aforementioned imaging modalities. Each modality was assessed in isolation and side by side against the others to draw comparative inferences. While mammography remains a foundational imaging modality, its effectiveness waned within the context of dense breast tissue. Ultrasound demonstrated a strong differentiation prowess, especially among specific demographic cohorts. MRI, despite its exceptional precision and differentiation capabilities, exhibited a tendency for slightly elevated false positive rates. No single modality emerged as singularly superior for all cases. Instead, an integrated approach, combining the strengths of each modality based on individual patient profiles and clinical scenarios, is recommended. This tailored approach ensures optimized detection rates and minimizes diagnostic ambiguities, underscoring the significance of individualized patient care in the field of diagnostic radiology.
PubMed: 38800325
DOI: 10.7759/cureus.59054 -
British Journal of Cancer Feb 2024There is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was...
BACKGROUND
There is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was to synthesise the evidence on the outcomes of mammography screening in women aged 75 years and older.
METHODS
A systematic review of mammography screening studies in women aged 75 years and over.
RESULTS
Thirty-six studies were included in this review: 27 observational studies and 9 modelling studies. Many of the included studies used no or uninformative comparison groups resulting in a potential bias towards the benefits of screening. Despite this, there was mixed evidence about the benefits and harms of continuing mammography screening beyond the age of 75 years. Some studies showed a beneficial effect on breast cancer mortality, and other studies showed no effect on mortality. Some studies showed some harms (false positive tests and recalls) being comparable to those in younger age-groups, with other studies showing increase in false positive screens and biopsies in older age-group. Although reported in fewer studies, there was consistent evidence of increased overdiagnosis in older age-groups.
CONCLUSION
There is limited evidence available to make a recommendation for/against continuing breast screening beyond the age of 75 years. Future studies should use more informative comparisons and should estimate overdiagnosis given potentially substantial harm in this age-group due to competing causes of death. This review was prospectively registered with PROSPERO (CRD42020203131).
Topics: Aged; Female; Humans; Age Factors; Breast; Breast Neoplasms; Mammography; Mass Screening
PubMed: 38030747
DOI: 10.1038/s41416-023-02504-7