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European Journal of Radiology Nov 2022Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy... (Review)
Review
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Contrast Media; Magnetic Resonance Imaging
PubMed: 36108478
DOI: 10.1016/j.ejrad.2022.110513 -
The British Journal of Radiology Mar 2024Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best... (Review)
Review
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
Topics: Humans; Female; Retrospective Studies; Prospective Studies; Contrast Media; Mammography; Breast Neoplasms; Magnetic Resonance Imaging; Sensitivity and Specificity
PubMed: 38374651
DOI: 10.1093/bjr/tqae017 -
Diagnostic and Interventional Imaging Oct 2019Although mammography is currently the imaging technique of choice for screening and diagnosis, it has some limitations, especially in patients with high-density breasts.... (Review)
Review
Although mammography is currently the imaging technique of choice for screening and diagnosis, it has some limitations, especially in patients with high-density breasts. The evolution from film screen to full-field digital mammography has recently led to the development of new imaging techniques, which are less expensive and widely available. Contrast-enhanced spectral mammography (CESM) is one of them, coupling X-ray breast imaging to the intravenous administration of an iodinated contrast material. CESM provides both morphological information, similar to mammography, and functional information of tumor perfusion. In this review, the imaging technique, the specificity of interpretation of CESM compared to MRI and the currently available data are presented. The clinical performances of CESM versus those of mammography and MRI and its additional value in preoperative local assessment and screening is discussed. The potential advantages and disadvantages are mentioned and we also discuss how CESM contributes to the detection of lesions and how it can be used in daily clinical workflow.
Topics: Antineoplastic Agents; Breast; Breast Neoplasms; Contraindications, Procedure; Contrast Media; Drug Monitoring; Early Detection of Cancer; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Mammography; Neoadjuvant Therapy; Patient Preference; Problem Solving; Radiation Dosage; Sensitivity and Specificity
PubMed: 30962168
DOI: 10.1016/j.diii.2019.01.011 -
Journal of Medical Radiation Sciences Sep 2020To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the...
INTRODUCTION
To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the breast.
METHODS
A retrospective review of 2688 paired full-field digital mammography (FFDM) CC view mammograms of women attending BreastScreen NSW between August and October 2015 was undertaken. PMM visualisation and measurements of PMM width and length, compressed breast thickness, the posterior nipple line (PNL) and age were recorded. Statistical analysis was performed using descriptive and inferential statistics to investigate associations between key breast measurements, age and PMM visualisation.
RESULTS
PMM visualisation was reported in 10.4% of images unilaterally (one breast, left or right only), 14.1% bilaterally (both left and right breasts) and 24.5% overall (unilateral and bilateral combined). There was little or no correlations between PMM length or width and age, breast compressed thickness or PNL. Multiple logistic regression analysis found that up to 15% of the variance in visualisation of the PMM was accounted for by the predictors overall. While some predictors provided a statistically significant contribution to the model, the contribution was small and the odds ratio for all predictors approximated 1.
CONCLUSION
This research could not replicate the '30% rule', and visualisation of the PMM was determined not to be influenced by the variables investigated. The significance of the 'rule' itself must be challenged where the vast majority of images (70-85%) do not comply, and there is no requirement for repeat imaging if the 'rule' is not met. Further research should be undertaken to validate this study including analysis of diagnostic images for comparison.
Topics: Breast; Humans; Image Processing, Computer-Assisted; Mammography; Pectoralis Muscles; Practice Guidelines as Topic
PubMed: 32567806
DOI: 10.1002/jmrs.404 -
Journal of the National Cancer Institute Sep 2019Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy...
BACKGROUND
Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy and efficiency. We aimed to compare the stand-alone performance of an AI system to that of radiologists in detecting breast cancer in DM.
METHODS
Nine multi-reader, multi-case study datasets previously used for different research purposes in seven countries were collected. Each dataset consisted of DM exams acquired with systems from four different vendors, multiple radiologists' assessments per exam, and ground truth verified by histopathological analysis or follow-up, yielding a total of 2652 exams (653 malignant) and interpretations by 101 radiologists (28 296 independent interpretations). An AI system analyzed these exams yielding a level of suspicion of cancer present between 1 and 10. The detection performance between the radiologists and the AI system was compared using a noninferiority null hypothesis at a margin of 0.05.
RESULTS
The performance of the AI system was statistically noninferior to that of the average of the 101 radiologists. The AI system had a 0.840 (95% confidence interval [CI] = 0.820 to 0.860) area under the ROC curve and the average of the radiologists was 0.814 (95% CI = 0.787 to 0.841) (difference 95% CI = -0.003 to 0.055). The AI system had an AUC higher than 61.4% of the radiologists.
CONCLUSIONS
The evaluated AI system achieved a cancer detection accuracy comparable to an average breast radiologist in this retrospective setting. Although promising, the performance and impact of such a system in a screening setting needs further investigation.
Topics: Algorithms; Area Under Curve; Artificial Intelligence; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Image Processing, Computer-Assisted; Mammography; ROC Curve; Radiologists; Reproducibility of Results
PubMed: 30834436
DOI: 10.1093/jnci/djy222 -
Journal of the National Cancer Institute Jan 2021Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates.
METHODS
A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates.
RESULTS
The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = -3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with -0.02 per 1000 screens (95% CI = -0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes.
CONCLUSIONS
The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
Topics: Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Early Detection of Cancer; Female; Humans; Mammography; Tomography, X-Ray Computed
PubMed: 32572492
DOI: 10.1093/jnci/djaa080 -
AJR. American Journal of Roentgenology Mar 2017Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard... (Review)
Review
OBJECTIVE
Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen.
CONCLUSION
Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.
Topics: Breast Neoplasms; Evidence-Based Medicine; Female; Humans; Magnetic Resonance Imaging; Mammography; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Watchful Waiting
PubMed: 28075622
DOI: 10.2214/AJR.16.16300 -
Technology in Cancer Research &... Oct 2004Over the past several years, digital mammography systems have been installed clinically across North America in small but growing numbers. A photostimulable... (Review)
Review
Over the past several years, digital mammography systems have been installed clinically across North America in small but growing numbers. A photostimulable phosphor-based full-field digital mammography image was evaluated in this investigation. Commonly known as computed radiography (CR), its use closely mimics the screen-film mammography paradigm. System performance using modulation transfer function (MTF) and detective quantum efficiency (DQE) metrics show MTF(2.5 mm(-1)) = 0.5, DQE(2.5 mm(-1)) = 0.3, and MTF(5.0 mm(-1)) = 0.2, DQE(5.0 mm(-1)) = 0.05, for a 26 kVp beam, 0.03 mm molybdenum tube filtration, 4.5 cm tissue attenuation, and 15 mR incident exposure to the detector. Slightly higher DQE values were measured at 32 kVp with 0.025 mm rhodium tube filtration. CR mammography advantages include the ability to use existing mammography machines, where multiple rooms can be converted to "digital" operation, which allows overall cost savings compared to integrated digital mammography systems. Chief disadvantages include the labor-intensive handling of the cassettes prior to and after the imaging exam, lack of a direct interface to the x-ray system for recording technique parameters, and relatively slow processing time. Clinical experience in an IRB-approved research trial has suggested that digital mammography with photostimulable storage phosphors and a dedicated CR reader is a viable alternative to conventional screen-film mammography.
Topics: Breast Neoplasms; Female; Humans; Image Processing, Computer-Assisted; Tomography, X-Ray Computed; Xeromammography
PubMed: 15453806
DOI: 10.1177/153303460400300502 -
Radiologia 2019Breast tomosynthesis is a continually improving tool for diagnostic radiologists. This update about tomosynthesis reviews the advantages of the technique both in... (Review)
Review
Breast tomosynthesis is a continually improving tool for diagnostic radiologists. This update about tomosynthesis reviews the advantages of the technique both in patients with suspected or known disease and in screening, as well as its limitations, of which the dose of radiation is the most important. The more recent advent of synthesized mammography, computer-assisted detection, and tomosynthesis-guided biopsy have helped to reduce the dose of radiation used and have improved the diagnostic performance of tomosynthesis, so they are also discussed in this review.
Topics: Breast Neoplasms; Female; Humans; Mammography
PubMed: 30808510
DOI: 10.1016/j.rx.2019.01.002 -
American Journal of Epidemiology Jun 2019Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field... (Meta-Analysis)
Meta-Analysis Review
Reproductive Factors and Mammographic Density: Associations Among 24,840 Women and Comparison of Studies Using Digitized Film-Screen Mammography and Full-Field Digital Mammography.
Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field digital mammography (FFDM) on breast density research and to determine whether results are comparable across studies using FFDM and previous studies using traditional film-screen mammography. We studied 24,840 screening-age (40-74 years) non-Hispanic white women who were participants in the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California and underwent screening mammography with either Hologic (Hologic, Inc., Marlborough, Massachusetts) or General Electric (General Electric Company, Boston, Massachusetts) FFDM machines between 2003 and 2013. We estimated the associations of parity, age at first birth, age at menarche, and menopausal status with percent density and dense area as measured by a single radiological technologist using Cumulus software (Canto Software, Inc., San Francisco, California). We found that associations between reproductive factors and mammographic density measured using processed FFDM images were generally similar in magnitude and direction to those from prior studies using film mammography. Estimated associations for both types of FFDM machines were in the same direction. There was some evidence of heterogeneity in the magnitude of the effect sizes by machine type, which we accounted for using random-effects meta-analysis when combining results. Our findings demonstrate the robustness of quantitative mammographic density measurements across FFDM and film mammography platforms.
Topics: Adult; Aged; Breast Density; Breast Neoplasms; Female; Humans; Mammography; Menarche; Menopause; Middle Aged; Parity; Reproductive History; White People
PubMed: 30865217
DOI: 10.1093/aje/kwz033