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European Journal of Radiology May 2024To analyse digital breast tomosynthesis (DBT) reading times in the screening setting, compared to 2D full-field digital mammography (FFDM), and investigate the impact of...
PURPOSE
To analyse digital breast tomosynthesis (DBT) reading times in the screening setting, compared to 2D full-field digital mammography (FFDM), and investigate the impact of reader experience and professional group on interpretation times.
METHOD
Reading time data were recorded in the PROSPECTS Trial, a prospective randomised trial comparing DBT plus FFDM or synthetic 2D mammography (S2D) to FFDM alone, in the National Health Service (NHS) breast screening programme, from January 2019-February 2023. Time to read DBT+FFDM or DBT+S2D and FFDM alone was calculated per case and reading times were compared between modalities using dependent T-tests. Reading times were compared between readers from different professional groups (radiologists and radiographer readers) and experience levels using independent T-tests. The learning curve effect of using DBT in screening on reading time was investigated using a Kruskal-Wallis test.
RESULTS
Forty-eight readers interpreted 1,242 FFDM batches (34,210 FFDM cases) and 973 DBT batches (13,983 DBT cases). DBT reading time was doubled compared to FFDM (2.09 ± 0.64 min vs. 0.98 ± 0.30 min; p < 0.001), and DBT+S2D reading was longer than DBT + FFDM (2.24 ± 0.62 min vs. 2.04 ± 0.46 min; p = 0.006). No difference was identified in reading time between radiologists and radiographers (2.06 ± 0.71 min vs. 2.14 ± 0.46 min, respectively; p = 0.71). Readers with five or more years of experience reading DBT were quicker than those with less experience (1.86 ± 0.56 min vs. 2.37 ± 0.65 min; p = 0.008), and DBT reading time decreased after less than 9 months accrued screening experience (p = 0.01).
CONCLUSIONS
DBT reading times were double those of FFDM in the screening setting, but there was a short learning curve effect with readers showing significant improvements in reading times within the first nine months of DBT experience.
CLINICALTRIALS
gov Identifier: NCT03733106.
PubMed: 38852330
DOI: 10.1016/j.ejrad.2024.111535 -
European Journal of Radiology Jun 2024To investigate the impact of adding digital breast tomosynthesis (DBT) to full field digital mammography (FFDM) in screening asymptomatic women with an elevated breast...
PURPOSE
To investigate the impact of adding digital breast tomosynthesis (DBT) to full field digital mammography (FFDM) in screening asymptomatic women with an elevated breast cancer life time risk (BCLTR) but without known genetic mutation.
METHODS
This IRB-approved single-institution multi-reader study on prospectively acquired FFDM + DBT images included 429 asymptomatic women (39-69y) with an elevated BC risk on their request form. The BCLTR was calculated for each patient using the IBISrisk calculator v8.0b. The screening protocol and reader study consisted of 4-view FFDM + DBT, which were read by four independent radiologists using the BI-RADS lexicon. Standard of care (SOC) included ultrasound (US) and magnetic resonance imaging (MRI) for women with > 30 % BCLTR. Breast cancer detection rate (BCDR), sensitivity and positive predictive value were assessed for FFDM and FFDM + DBT and detection outcomes were compared with McNemar-test.
RESULTS
In total 7/429 women in this clinically elevated breast cancer risk group were diagnosed with BC using SOC (BCDR 16.3/1000) of which 4 were detected with FFDM. Supplemental DBT did not detect additional cancers and BCDR was the same for FFDM vs FFDM + DBT (9.3/1000, McNemar p = 1). Moderate inter-reader agreement for diagnostic BI-RADS score was found for both study arms (ICC for FFDM and FFDM + DBT was 0.43, resp. 0.46).
CONCLUSION
In this single institution study, supplemental screening with DBT in addition to standard FFDM did not increase BCDR in this higher-than-average BC risk group, objectively documented using the IBISrisk calculator.
PubMed: 38852327
DOI: 10.1016/j.ejrad.2024.111540 -
Cureus May 2024To assess the knowledge and attitude regarding breast cancer screening and mammograms among 40 years and older females in the United Arab Emirates.
OBJECTIVES
To assess the knowledge and attitude regarding breast cancer screening and mammograms among 40 years and older females in the United Arab Emirates.
METHODS
A cross-sectional questionnaire-based study was conducted on women faculty, staff, and female patients attending our hospital. The inclusion criteria were women ≥ 40 years old who agreed to participate. The exclusion criteria were women < 40 and those ≥ 40 years who refused to participate. A signed informed consent was taken. A p-value of < 0.5 was considered significant.
RESULTS
Among the 460 women enrolled, 420 completed the survey (response rate 91%). The mean age was 48.4 ± 8.2 years. A total of 63.4% of the participants were < 50 years of age. A total of 53.3% were never screened before. About 98% believed that screening is beneficial in early detection. Social media (52.2%) and health professionals (46%) played a vital role in creating awareness. The majority of women were aware of self-breast examinations (73.3%), followed by mammography (68.6%). About 84% and 68.3%, of the participants had incorrect knowledge of the timing and frequency of mammograms, respectively. Only 16.3% of the participants were recommended by their physician, while the rest (83.7%) performed screening based on their awareness. No significant association was found between nutritional status (p=0.252), age at first pregnancy (p=0.409), or having children (p= 0.377) with mammogram uptake. There was a significant association between the perceived benefit of screening and mammogram uptake (p=0.033). There was a positive association between radiation therapy to the chest area and mammogram uptake (p<0.024). A statistically significant association was found between the correct timing of mammograms with family history of cancer (p = 0.037) and previous exposure to radiation therapy to the chest (p = 0.002).
CONCLUSION
There is a need to increase knowledge and awareness regarding breast cancer screening and mammograms among women in UAE. Specifically, breast self-examination should be encouraged and recommended.
PubMed: 38846223
DOI: 10.7759/cureus.59766 -
Gland Surgery May 2024Mammographic architectural distortion (AD) is usually subtle and has variable presentations and causes, which poses a diagnostic challenge for breast radiologists and...
BACKGROUND
Mammographic architectural distortion (AD) is usually subtle and has variable presentations and causes, which poses a diagnostic challenge for breast radiologists and consequently a complex decision-making challenge for clinicians and patients. Presently, there is no reliable imaging standard to differentiate between malignant and benign ADs preoperatively. This study aimed to perform a comprehensive analysis of detailed mammographic and ultrasonographic features and clinical characteristics to enhance the diagnostic and differential efficacy for AD lesions. The findings have the potential to boost the diagnostic confidence of breast radiologists when encountering with AD lesions and could be instrumental in refining clinical management strategies for ADs.
METHODS
This retrospective study included consecutive female patients with ADs on screening or diagnostic mammography from January 6, 2015, to December 28, 2018. The patient's clinical data, mammographic and ultrasonographic or "second look" ultrasonographic findings, and pathological results were reviewed. The continuous variables were analyzed using the -test. The categorical variables were assessed using the Chi-square test or two-tailed Fisher's exact test. Logistic regression analyses were conducted to evaluate potential risk factors for pathologically proven malignant ADs. Machine learning model based on multimodal clinical and imaging features was constructed using R software.
RESULTS
Ultimately, 344 patients with 346 AD lesions were enrolled in the study (mean age: 47.40±10.07 years; range, 19-84 years). Of the ADs, 228 were malignant and 118 were non-malignant. Palpable AD on mammography was more likely to indicate malignancy than non-palpable AD (83.43% 49.15%, P<0.001). AD associated with other mammographic findings was more likely to be malignant than pure AD (73.58% 59.36%, P=0.005). Ultrasonography (US) correlates were observed in 345 of these 346 AD lesions. Among these US correlates, 63 (18.26%, 63/345) were detected by "second look" ultrasound. For the US correlates, the mammographic ADs that appeared as non-mass-like hypoechoic areas and masses on US were more likely to be malignant than those that appeared as other abnormalities (P<0.001). The sensitivity, specificity and diagnostic accuracy of the eXtreme Gradient Boosting (XGBoost) model based on clinical and comprehensive imaging features in differentiation of AD lesions in the validation set were 66.46%, 94.23% and 78.9%, respectively, and the AUC was 0.886 (95% confidence interval: 0.825-0.947).
CONCLUSIONS
The application of mammograms-guided "second-look" ultrasound could enhance the detection of US correlates, particularly non-mass-like features. The comprehensive analysis based on clinical and multimodal imaging features could be beneficial in improving the diagnostic and differential efficacy for AD lesions detected on mammography and instrumental in refining clinical management strategies for ADs.
PubMed: 38845839
DOI: 10.21037/gs-24-110 -
F1000Research 2024Phyllodes tumor is a rare fibroepithelial neoplasm of the breast, which is classified histologically as benign, borderline, or malignant. Accurate preoperative diagnosis...
BACKGROUND
Phyllodes tumor is a rare fibroepithelial neoplasm of the breast, which is classified histologically as benign, borderline, or malignant. Accurate preoperative diagnosis allows the correct surgical planning and reoperation avoidance.
OBJECTIVE
To describe the clinical presentation and radiologic features of phyllodes tumors and differentiate between benign and non-benign (borderline and malignant) groups.
METHODS
A retrospective study of 57 patients with a diagnosis of phyllodes tumor who had preoperative imaging (mammography, ultrasound, or CT chest) and histological confirmation. The data was collected from 1 June 2011 to 30 September 2021. The imaging features of the phyllodes tumors were described according to the 5th edition of the ACR BI-RADS lexicon. For comparing between two groups, the student t-test, Wilcoxon rank sum test, Chi-square test, and Fisher's exact test were used for statistical analyses. The logistic regression analysis was calculated for non-benign phyllodes tumor prediction.
RESULTS
From 57 patients, the pathologic results were benign for 43 cases and non-benign phyllodes tumors for 14 cases. There was no differentiation of mammographic and CT features between benign and non-benign groups. Non-benign phyllodes tumors had the statistical significance of menopausal status, entire breast involvement, tumor size larger than 10 cm, and heterogeneous echo on univariable analysis. After multivariable analysis, menopausal status (odd ratios=13.79, p=0.04) and presence of vessels in the rim (odd ratios=16.51, p=0.019) or absent vascularity (odd ratios=8.45, p=0.047) on doppler ultrasound were significantly increased possibility of non-benign phyllodes tumor.
CONCLUSIONS
Menopausal status and presence of vessels in the rim or absent vascularity on Doppler ultrasound were important predictors for the diagnosis of non-benign phyllodes tumor.
Topics: Humans; Phyllodes Tumor; Female; Adult; Middle Aged; Breast Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Mammography; Aged; Young Adult
PubMed: 38845824
DOI: 10.12688/f1000research.145872.2 -
Nigerian Journal of Clinical Practice May 2024Breast cancer is the type of cancer that is seen all over the world and ranks first among female cancers in terms of incidence and cause of death.
BACKGROUND
Breast cancer is the type of cancer that is seen all over the world and ranks first among female cancers in terms of incidence and cause of death.
OBJECTIVE
This research was conducted to determine the breast cancer risk level and breast cancer knowledge level in women living in Northern Cyprus.
METHODS
The study, which was planned as a relational survey, was carried out as web-based. The research was completed with 657 adult female participants living in Northern Cyprus who volunteered to participate in the study. In order to collect data, the first section includes the introductory features, the second section includes the "Breast Cancer Risk Assessment Form" for determining breast cancer risk levels, the third section includes the "Comprehensive Breast Cancer Knowledge Test" to determine the breast cancer knowledge levels of the participants, and the fourth section includes the "Champion Health Belief Model Scale" was used.
RESULTS
It was determined that 95.2% of women were in the low risk group for breast cancer. The knowledge test mean score is 12.05, and it can be said that the scores obtained are above the average (min:4- max:18). It was found that 55.7% of the women knew how to do Breast Self-Examination (BSE), but only 15.4% of them regularly performed BSE every month. It was found that 80.9% of the women never had mammography and their knowledge scores increased with increasing education level (p< 0.001) and there was a significant relationship between non-smokers and their knowledge levels (p< 0.01).
IMPLICATIONS FOR PRACTICE
Despite the high scores of women in knowledge tests, it was observed that the frequency of applying BSE and having mammography was very low. Regardless of the risk factors for breast cancer, the importance of regular check-ups and BSE for every woman should be taught to women by health professionals, and group trainings should be planned for women who do not have training on this subject.
Topics: Humans; Female; Breast Neoplasms; Cyprus; Health Knowledge, Attitudes, Practice; Adult; Middle Aged; Breast Self-Examination; Surveys and Questionnaires; Risk Assessment; Risk Factors; Young Adult; Aged; Early Detection of Cancer; Adolescent
PubMed: 38842710
DOI: 10.4103/njcp.njcp_683_23 -
SA Journal of Radiology 2024Most ductal carcinoma in situ (DCIS) lesions manifest early as calcifications, which could be benign or malignant. The classified group of suspicious calcifications...
BACKGROUND
Most ductal carcinoma in situ (DCIS) lesions manifest early as calcifications, which could be benign or malignant. The classified group of suspicious calcifications among DCIS and benign breast disease is clinically important to early evaluate patient risk factors and plan treatment options.
OBJECTIVES
To compare imaging features of suspicious calcifications between DCIS and benign breast disease.
METHOD
A retrospective study of 101 suspicious calcifications was performed at Thammasat University Hospital from June 2011 to October 2020. The calcifications were surgically excised by mammography-guided wire localisation. The mammographic features of the suspicious calcifications were reviewed according to the fifth edition of the American College of Radiology Breast Imaging-Reporting and Data System lexicon. For comparing between two groups, the student -test, Fisher's exact test and Mann-Whitney U test were used for statistical analyses. The logistic regression analysis was calculated for DCIS prediction.
RESULTS
The pathologic results of all 101 suspicious calcifications were DCIS (30 cases) and benign breast disease (71 cases). Linear morphology and segmental distribution correlated significantly with DCIS ( = 0.003 and = 0.024, respectively). After multivariable analysis, fine linear calcification still significantly elevated the risk of DCIS (odd ratios, 51.72 [95% confidence interval: 2.61, 1022.89], -value of 0.01), however, the odds of predicting DCIS was not statistically significant different among any distribution.
CONCLUSION
Ductal carcinoma in situ calcification has contrasting morphology and distribution features compared to benign breast disease. The calcification descriptor is considered an important implement for early diagnosis and distinguishes DCIS from other benign breast conditions.
CONTRIBUTION
Calcification descriptor is considered an important implement for early diagnosis and distinguishment of DCIS from other benign breast conditions.
PubMed: 38840823
DOI: 10.4102/sajr.v28i1.2852 -
OBG Management Dec 2023The US Preventive Services Task Force now recommends mammography screening every other year starting at age 40 to decrease the risk of dying from breast cancer, but...
The US Preventive Services Task Force now recommends mammography screening every other year starting at age 40 to decrease the risk of dying from breast cancer, but questions remain regarding biennial versus annual screening as well as disparities in risk factors and outcomes among Black people.
PubMed: 38835939
DOI: 10.12788/obgm.0334 -
Frontiers in Oncology 2024Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers... (Review)
Review
Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.
PubMed: 38835377
DOI: 10.3389/fonc.2024.1398196 -
PloS One 2024Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can... (Comparative Study)
Comparative Study
BACKGROUND
Neoadjuvant chemotherapy (NACT) is a treatment option for breast cancer patients that allows for the assessment of tumor response during treatment. This information can be used to adjust treatment and improve outcomes. However, the optimal imaging modalities and parameters for assessing tumor response to NACT are not well established.
METHODS
This study included 173 breast cancer patients who underwent NACT. Patients were imaged with ultrasound (US), mammography (MMG), and magnetic resonance imaging (MRI) at baseline, after two cycles of NACT, and before breast surgery. US parameters included lesion morphology, Doppler variables, and elastography measurements. MMG and MRI were evaluated for the presence of nodules and tumor dimensions. The pathological response to NACT was determined using the residual cancer burden (RCB) classification.
RESULTS
The US parameter with the highest power for predicting pathological complete response (pCR) was shear wave elastography (SWE) maximum speed inside the tumor at baseline. For nonluminal tumors, the end diastolic velocity measured by US after two cycles of NACT showed the highest predictive value for pCR. Similarly, SWE maximum speed after two cycles of NACT had the highest discriminating power for predicting RCB-III in luminal tumors, while the same parameter measured at baseline was most predictive for nonluminal tumors.
CONCLUSIONS
This study provides evidence that mid-treatment Doppler US and other imaging modalities can be used to predict the response to NACT in breast cancer patients. Functional parameters, such as blood flow velocities and SWE measurements, demonstrated superior predictive value for pCR, while morphological parameters had limited value. These findings have implications for personalized treatment strategies and may contribute to improved outcomes in the management of breast cancer.
Topics: Humans; Breast Neoplasms; Female; Neoadjuvant Therapy; Middle Aged; Magnetic Resonance Imaging; Mammography; Adult; Prospective Studies; Aged; Ultrasonography, Doppler; Elasticity Imaging Techniques; Predictive Value of Tests; Treatment Outcome
PubMed: 38833499
DOI: 10.1371/journal.pone.0302527