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Canadian Association of Radiologists... Feb 2022The purpose of this article is to provide a detailed and updated review of the physics, techniques, indications, limitations, reporting, implementation and management of... (Review)
Review
OBJECTIVES
The purpose of this article is to provide a detailed and updated review of the physics, techniques, indications, limitations, reporting, implementation and management of contrast enhanced mammography.
BACKGROUND
Contrast enhanced mammography (CEM), is an emerging iodine-based modified dual energy mammography technique. In addition to having the same advantages as standard full-field digital mammography (FFDM), CEM provides information regarding tumor enhancement, relying on tumor angiogenesis, similar to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). This article reviews current literature on CEM and highlights considerations that are critical to the successful use of this modality.
CONCLUSION
Multiple studies point to the advantage of using CEM in the diagnostic setting of breast imaging, which approaches that of DCE-MRI.
Topics: Breast; Breast Neoplasms; Contrast Media; Female; Humans; Mammography; Radiographic Image Enhancement; Sensitivity and Specificity
PubMed: 34492211
DOI: 10.1177/08465371211029047 -
European Radiology Apr 2019Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast... (Review)
Review
Digital breast tomosynthesis (DBT) has been widely implemented in place of 2D mammography, although it is less effective in women with extremely dense breasts. Breast ultrasound detects additional early-stage, invasive breast cancers when combined with mammography; however, its relevant limitations, including the shortage of trained operators, operator dependence and small field of view, have limited its widespread implementation. Automated breast sonography (ABS) is a promising technique but the time to interpret and false-positive rates need to be improved. Supplemental screening with contrast-enhanced magnetic resonance imaging (MRI) in high-risk women reduces late-stage disease; abbreviated MRI protocols may reduce cost and increase accessibility to women of average risk with dense breasts. Contrast-enhanced digital mammography (CEDM) and molecular breast imaging improve cancer detection but require further validation for screening and direct biopsy guidance should be implemented for any screening modality. This article reviews the status of screening women with dense breasts. KEY POINTS: • The sensitivity of mammography is reduced in women with dense breasts. Supplemental screening with US detects early-stage, invasive breast cancers. • Tomosynthesis reduces recall rate and increases cancer detection rate but is less effective in women with extremely dense breasts. • Screening MRI improves early diagnosis of breast cancer more than ultrasound and is currently recommended for women at high risk. Risk assessment is needed, to include breast density, to ascertain who should start early annual MRI screening.
Topics: Biopsy; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Magnetic Resonance Imaging; Mammography; Mass Screening; Multimodal Imaging; Risk Assessment; Ultrasonography, Mammary
PubMed: 30255244
DOI: 10.1007/s00330-018-5668-8 -
Clinical Imaging 2016The aim of this study was to test a novel dual-modality imaging system that combines full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in a... (Clinical Trial)
Clinical Trial Comparative Study
PURPOSE
The aim of this study was to test a novel dual-modality imaging system that combines full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in a single platform. Our Aceso system, named after the Greek goddess of healing, was specifically designed for the early detection of cancer in women with dense breast tissue.
MATERIALS AND METHODS
Aceso was first tested using two industry standards: a Contrast Detail Mammography (CDMAM) phantom as endorsed by European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services was used to assess the FFDM images; and the CIRS 040GSE ultrasound phantom was imaged to evaluate the quality of the ABUS images. In addition, 58 women participated in a clinical trial: 51 were healthy volunteers aged between 40 and 65, while 7 were patients referred by the breast clinic, 6 of whom had biopsy-proven breast cancer.
RESULTS
The CDMAM tests showed that the FFDM results were "acceptable" but fell short of "achievable" which was attributed to the low dose used. The ABUS images had good depth penetration (80 mm) and adequate axial resolution (0.5 mm), but the lateral resolution of 2 mm was judged to be too coarse. In a 42-year-old volunteer with extremely dense breast tissue, the ABUS modality detected a lesion (a benign cyst) that was mammographically occult in the FFDM image. For a 73-year-old patient with fatty breasts, a malignant lesion was successfully detected and co-registered in the FFDM and ABUS images. On average, each woman spent less than 11 min in the acquisition room.
CONCLUSIONS
While there is room for improvement in the quality of both the FFDM and ABUS images, Aceso has demonstrated its ability to acquire clinically meaningful images for a range of women with varying breast densities and, therefore, has potential as a screening device.
Topics: Adult; Aged; Breast; Breast Neoplasms; Equipment Design; Female; Healthy Volunteers; Humans; Mammography; Middle Aged; Phantoms, Imaging; Ultrasonography, Mammary
PubMed: 27133694
DOI: 10.1016/j.clinimag.2015.11.024 -
Journal of Digital Imaging Apr 2017Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional...
Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional elements to be considered in this scenario. A major goal of mammography is related to the detection of structures on the order of micrometers (μm) and the need to distinguish the different types of tissues, with very close density values. The diagnosis in mammography faces the difficulty that the breast tissues and pathological findings have very close linear attenuation coefficients within the energy range used in mammography. The aim of this study was to develop a methodology for optimizing exposure parameters of digital mammography based on a new Figure of Merit: FOM ≡ (IQF)/AGD, considering the image quality and dose. The study was conducted using the digital mammography Senographe DS/GE, and CDMAM and TORMAM phantoms. The characterization of clinical practice, carried out in the mammography system under study, was performed considering different breast thicknesses, the technical parameters of exposure, and processing options of images used by the equipment's automatic exposure system. The results showed a difference between the values of the optimized parameters and those ones chosen by the automatic system of the mammography unit, specifically for small breast. The optimized exposure parameters showed better results than those obtained by the automatic system of the mammography, for the image quality parameters and its impact on detection of breast structures when analyzed by radiologists.
Topics: Adult; Breast; Female; Humans; Mammography; Middle Aged; Organ Size; Phantoms, Imaging; Radiation Dosage; Radiographic Image Enhancement
PubMed: 27896452
DOI: 10.1007/s10278-016-9928-3 -
Radiologia 2015To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer. (Review)
Review
OBJECTIVE
To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer.
MATERIAL AND METHODS
We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis.
RESULTS
Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive.
CONCLUSIONS
The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening.
Topics: Breast Neoplasms; Female; Humans; Mammography
PubMed: 25306860
DOI: 10.1016/j.rx.2014.06.006 -
European Radiology Aug 2020To summarise and compare the performance of magnification mammography and digital zoom utilising a full-field digital mammography (FFDM) system in the detection and...
OBJECTIVES
To summarise and compare the performance of magnification mammography and digital zoom utilising a full-field digital mammography (FFDM) system in the detection and diagnosis of microcalcifications.
METHODS
We ran an extended search in MEDLINE, EMBASE, CINAHL, Engineering Village and Web of Science. Diagnostic test studies, experimental breast phantom studies and a Monte Carlo phantom study were included. A narrative approach was selected to summarise and compare findings regarding the detection of microcalcifications, while a hierarchical model with bivariate analysis was used for the meta-analysis of sensitivity and specificity for diagnosing microcalcifications.
RESULTS
Nine studies were included. Phantom studies suggested that the size of microcalcifications, magnification or zoom factor, exposure factors and detector technology determine whether digital zoom is equivalent to magnification mammography in the detection of microcalcifications. Pooled sensitivity for magnification and zoom calculated from the diagnostic test studies was 0.93 (95% CI 0.84-0.97) and 0.85 (95% CI 0.70-0.94), respectively. Pooled specificity was 0.55 (95% CI 0.51-0.58) and 0.56 (95% CI 0.50-0.62), respectively. The differences between the sensitivities and specificities were not statistically significant.
CONCLUSIONS
Digital zoom may be equivalent to magnification mammography. Diagnostic test studies and phantom studies using newer detector technology would contribute additional knowledge on this topic.
KEY POINTS
• The performance of digital zoom is comparable to magnification for detecting microcalcifications when newer detector technology and optimised imaging procedures are utilised. • The accuracy of digital zoom appears equivalent to geometric magnification in diagnosing microcalcifications.
Topics: Breast Diseases; Calcinosis; Female; Humans; Mammography; Phantoms, Imaging; Sensitivity and Specificity
PubMed: 32222798
DOI: 10.1007/s00330-020-06798-6 -
Breast (Edinburgh, Scotland) Jun 2013To compare the accuracy of screen-film mammography (SFM) and full-field digital mammography (FFDM) for population-based breast cancer screening. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To compare the accuracy of screen-film mammography (SFM) and full-field digital mammography (FFDM) for population-based breast cancer screening.
STUDY DESIGN AND SETTING
A quantitative systematic review was performed including randomized controlled trials and cohort studies.
RESULTS
Ten studies (comprising 667,649 women, 82,573 of whom underwent SFM and FFDM) were included. The area under the summary receiver operating characteristic (SROC) curve was 0.92 (SE ± 0.06) for SFM and 0.91 (SE ± 0.11) for FFDM. The results in the random-effects model were 0.95 (95% CI, 0.72-1.24) and 0.52 (95% CI, 0.28-0.95) for SFM versus FFDM in all age and younger groups, respectively.
CONCLUSION
FFDM is more accurate than SFM only in women less than 50 years old.
Topics: Area Under Curve; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; ROC Curve; Radiographic Image Enhancement; X-Ray Film
PubMed: 23489759
DOI: 10.1016/j.breast.2013.02.013 -
Australian and New Zealand Journal of... Oct 2009A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from... (Review)
Review
OBJECTIVE
A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia.
METHODS
A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography.
RESULTS
Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography.
CONCLUSION
Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis.
IMPLICATIONS
The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia.
Topics: Australia; Breast Neoplasms; Cost-Benefit Analysis; Humans; Mammography; Mass Screening; Resource Allocation
PubMed: 19811478
DOI: 10.1111/j.1753-6405.2009.00424.x -
International Journal of Occupational... Oct 2022Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose...
OBJECTIVES
Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose ionizing radiation (IR) has been recognized as a breast cancer risk factor. The aim of our study was to investigate association between lifetime low dose ionizing radiation (LDIR) and MD.
MATERIAL AND METHODS
A cross-sectional study included 467 women aged 40-60 years who underwent screening mammography in Łódź, Poland. The digital mammography examination of the breasts included both craniocaudal and mediolateral oblique views. The volumetric breast density (VBD) (%) and fibrograndular tissue volume (FG) (cm) were determined based on the analysis of mammographic image ("for processing") using Volpara Imaging Software. The exposure to IR was estimated for each individual, based on the data from interviews about diagnostic or therapeutic medical procedures performed in the area of the neck, chest, abdomen and spine, which involved X-rays and γ rays and the data about the doses derived from literature. Linear and logistic regression were fitted with VBD and FG as the outcomes and organ breast dose, effective dose and number of mammographies as the determinants, adjusted for major confounders.
RESULTS
The analyses showed no association between VBD or FG and the breast organ dose or the effective dose. The only significant finding observed concerned the association between the number of mammographies and the FG volume with β coefficient: 0.028 (95% CI: 0.012-0.043), and predicted mean FG volume >13.4 cm3 among the women with >3 mammographies when compared to those with none.
CONCLUSIONS
This study does not, in general, provide support for the positive association between LDIR and MD. The weak association of the FG volume with the number of mammographies warrants further verification in larger independent studies. Int J Occup Med Environ Health. 2022;35(5):635-49.
Topics: Breast Density; Breast Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Humans; Mammography; Radiation, Ionizing
PubMed: 35913368
DOI: 10.13075/ijomeh.1896.01916 -
Cancer Prevention Research... Sep 2023Mammographic percentage of volumetric density is an important risk factor for breast cancer. Epidemiology studies historically used film images often limited to...
UNLABELLED
Mammographic percentage of volumetric density is an important risk factor for breast cancer. Epidemiology studies historically used film images often limited to craniocaudal (CC) views to estimate area-based breast density. More recent studies using digital mammography images typically use the averaged density between craniocaudal (CC) and mediolateral oblique (MLO) view mammography for 5- and 10-year risk prediction. The performance in using either and both mammogram views has not been well-investigated. We use 3,804 full-field digital mammograms from the Joanne Knight Breast Health Cohort (294 incident cases and 657 controls), to quantity the association between volumetric percentage of density extracted from either and both mammography views and to assess the 5 and 10-year breast cancer risk prediction performance. Our results show that the association between percent volumetric density from CC, MLO, and the average between the two, retain essentially the same association with breast cancer risk. The 5- and 10-year risk prediction also shows similar prediction accuracy. Thus, one view is sufficient to assess association and predict future risk of breast cancer over a 5 or 10-year interval.
PREVENTION RELEVANCE
Expanding use of digital mammography and repeated screening provides opportunities for risk assessment. To use these images for risk estimates and guide risk management in real time requires efficient processing. Evaluating the contribution of different views to prediction performance can guide future applications for risk management in routine care.
Topics: Humans; Female; Breast Neoplasms; Mammography; Breast; Breast Density; Risk Factors
PubMed: 37428020
DOI: 10.1158/1940-6207.CAPR-22-0499