The ease with which target lesions were located and biopsy coordinates calculated, including lesion depth, as well as the fact that digital breast tomosynthesis (DBT) allows one to directly control the position of the needle versus the target, contributed to a significantly reduced overall procedure time for DBT vacuum-assisted biopsy (VAB) versus prone stereotactic VAB (13 vs 29 minutes, respectively).

Digital Breast Tomosynthesis–guided Vacuum-assisted Breast Biopsy: Initial Experiences and Comparison with Prone Stereotactic Vacuum-assisted Biopsy

Background

In the UK, women aged 50–73 years are invited for screening by mammography every 3 years. In 2009–10, more than 2.24 million women in this age group in England were invited to take part in the programme, of whom 73% attended a screening clinic. Of these, 64,104 women were recalled for assessment. Of those recalled, 81% did not have breast cancer; these women are described as having a false-positive mammogram.

 Objective

The aim of this systematic review was to identify the psychological impact on women of false-positive screening mammograms and any evidence for the effectiveness of interventions designed to reduce this impact. We were also looking for evidence of effects in subgroups of women.

 Data sources

MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register for Controlled Trials, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment (HTA), Cochrane Methodology, Web of Science, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index-Science, Conference Proceeding Citation Index-Social Science and Humanities, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the International Bibliography of the Social Sciences, the British Library's Electronic Table of Contents and others. Initial searches were carried out between 8 October 2010 and 25 January 2011. Update searches were carried out on 26 October 2011 and 23 March 2012.

 Review methods

Based on the inclusion criteria, titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias.

 Results

Eleven studies were found from 4423 titles and abstracts. Studies that used disease-specific measures found a negative psychological impact lasting up to 3 years. Distress increased with the level of invasiveness of the assessment procedure. Studies using instruments designed to detect clinical levels of morbidity did not find this effect. Women with false-positive mammograms were less likely to return for the next round of screening [relative risk (RR) 0.97; 95% confidence interval (CI) 0.96 to 0.98] than those with normal mammograms, were more likely to have interval cancer [odds ratio (OR) 3.19 (95% CI 2.34 to 4.35)] and were more likely to have cancer detected at the next screening round [OR 2.15 (95% CI 1.55 to 2.98)].

 Limitations

This study was limited to UK research and by the robustness of the included studies, which frequently failed to report quality indicators, for example failure to consider the risk of bias or confounding, or failure to report participants' demographic characteristics.

 Conclusions

We conclude that the experience of having a false-positive screening mammogram can cause breast cancer-specific psychological distress that may endure for up to 3 years, and reduce the likelihood that women will return for their next round of mammography screening. These results should be treated cautiously owing to inherent weakness of observational designs and weaknesses in reporting. Future research should include a qualitative interview study and observational studies that compare generic and disease-specific measures, collect demographic data and include women from different social and ethnic groups.

Systematic review of the psychological consequences of false-positive screening mammograms

For screening women at increased risk for breast cancer, the sensitivity of contrast agent–enhanced mammography was 87.5%, compared with 50.0% for digital mammography (P = .03), with a specificity ...

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2019182660

Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer.

The purpose of this review is to examine the most recent data and guidelines regarding screening for breast cancer in average risk women. The differing recommendations for screening reflect differences in value judgements between the benefits (decreased cancer-related death and morbidity) and the harms (potential for overdiagnosis, false positives, false negatives, anxiety, and cost of care) of breast cancer screening. There are multiple organizations with recommendations for breast cancer screening in women at average risk. All organizations recommend mammography to screen for breast cancer but differ in the age at which to initiate mammograms, screening interval, and the age at which to stop screening. The final decision regarding breast cancer screening should be individualized based on the patient’s needs and values and include shared decision-making.

Breast Cancer Screening for Women at Average Risk

Comparison of screening CEDM and MRI for women at increased risk for breast cancer: A pilot study.

Purpose To assess the extent of background parenchymal enhancement (BPE) at contrast material-enhanced (CE) spectral mammography and breast magnetic resonance (MR) imaging, to evaluate interreader agreement in BPE assessment, and to examine the relationships between clinical factors and BPE. Materials and Methods This was a retrospective, institutional review board-approved, HIPAA-compliant study. Two hundred seventy-eight women from 25 to 76 years of age with increased breast cancer risk who underwent CE spectral mammography and MR imaging for screening or staging from 2010 through 2014 were included. Three readers independently rated BPE on CE spectral mammographic and MR images with the ordinal scale: minimal, mild, moderate, or marked. To assess pairwise agreement between BPE levels on CE spectral mammographic and MR images and among readers, weighted κ coefficients with quadratic weights were calculated. For overall agreement, mean κ values and bootstrapped 95% confidence intervals were calculated. The univariate and multivariate associations between BPE and clinical factors were examined by using generalized estimating equations separately for CE spectral mammography and MR imaging. Results Most women had minimal or mild BPE at both CE spectral mammography (68%-76%) and MR imaging (69%-76%). Between CE spectral mammography and MR imaging, the intrareader agreement ranged from moderate to substantial (κ = 0.55-0.67). Overall agreement on BPE levels between CE spectral mammography and MR imaging and among readers was substantial (κ = 0.66; 95% confidence interval: 0.61, 0.70). With both modalities, BPE demonstrated significant association with menopausal status, prior breast radiation therapy, hormonal treatment, breast density on CE spectral mammographic images, and amount of fibroglandular tissue on MR images (P < .001 for all). Conclusion There was substantial agreement between readers for BPE detected on CE spectral mammographic and MR images. © RSNA, 2016.

Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging

OBJECTIVE. Second-opinion review of breast imaging studies can be a time-consuming and labor-intensive process. The purpose of this investigation was to determine whether reinterpretation of studies obtained at institutions outside a cancer center influences clinical management, specifically by revealing additional cancer and preventing unnecessary biopsy. MATERIALS AND METHODS. A review was conducted of breast imaging studies of 200 patients who underwent ultrasound and MRI at community facilities and had the images submitted for second opinions at a cancer center between January and April 2014. Each case was evaluated for concordance between the original report and the second-opinion interpretation. Second-opinion review resulting in the recommendation and performance of new biopsies was further subdivided into benign, high-risk, and malignant categories based on the histopathologic results obtained at the cancer center. RESULTS. Second-opinion review of the 200 cases showed a change in interpretation i...

Second-Opinion Review of Breast Imaging at a Cancer Center: Is It Worthwhile?

Purpose To determine the effect of subspecialty review of breast imaging on patients without a diagnosis of breast cancer who self-referred for a second opinion. Methods Institutional review board–approved retrospective review was performed of 415 breast imaging studies submitted to our cancer center for second-opinion review by 245 patients in 2014, excluding cases without follow-up or change in original BI-RADS 0 assessment. One hundred forty-seven patients with 176 lesions were included. Original and second-opinion interpretations and recommendations were compared with histopathology or follow-up imaging. Results Ninety-six of 176 (55%) lesions were reported as suspicious in the original interpretation. Second-opinion review was discordant with the original interpretation in 82 of 176 (47%) lesions. Second-opinion review downgraded 24 of 96 (25%) lesions originally reported as suspicious to benign or probably benign, averting biopsy of these lesions. Second-opinion review upgraded 31 of 80 (39%) lesions originally reported as benign or probably benign to suspicious. A total of 87 lesions were biopsied yielding malignancy in 23 (26%) biopsies. Twenty-eight of 87 (32%) biopsies performed were recommended after second-opinion review, with 8 of 28 (29%) of these biopsies yielding cancer. Eight of 23 (35%) cancers detected represented malignancy not initially detected in the original interpretation. Conclusion Second-opinion review is valuable in patients pursuing a breast imaging specialist’s opinion, even before they are diagnosed with breast cancer. Second-opinion review disagreed with the original interpretation for 47% of lesions, averted 25% of originally recommended biopsies, and detected cancer in 29% of additional biopsies recommended. Thirty-five percent of cancers diagnosed after second-opinion review were not initially detected in the original interpretation.

The Impact of Patient-Initiated Subspecialty Review on Patient Care.

BACKGROUND. Targeted ultrasound (US) can be performed to characterize and potentially biopsy areas of enhancement detected on contrast-enhanced mammography (CEM). OBJECTIVE. The purpose of this stu...

Donna D’Alessio

Papers

Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer.

Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging

Second-Opinion Review of Breast Imaging at a Cancer Center: Is It Worthwhile?

The Impact of Patient-Initiated Subspecialty Review on Patient Care.

Utility of Targeted Ultrasound to Predict Malignancy Among Lesions Detected on Contrast-Enhanced Digital Mammography.