Showing papers on "Digital mammography published in 2013"

Comparison of Digital Mammography Alone and Digital Mammography Plus Tomosynthesis in a Population-based Screening Program

Abstract: We found a significant increase in cancer detection rates, particularly for invasive cancers, and a simultaneous decrease in false-positive rates with use of mammography plus tomosynthesis compared with mammography alone.

Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study.

Abstract: Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D mammography with 2D mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.

Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography Alone: Results of a Multicenter, Multireader Trial

Abstract: The addition of tomosynthesis to digital mammography offers the dual benefit of improved diagnostic accuracy and significant reduction in false-positive recall rate, thereby avoiding unnecessary additional testing and decreasing attendant anxiety, inconvenience, and cost for women.

Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening.

Abstract: Although all breast density and age subgroups benefitted from the addition of tomosynthesis to conventional digital mammography, the patients receiving the greatest benefit were women with dense breasts and those younger than 50 years.

A review of breast tomosynthesis. Part I. The image acquisition process.

Abstract: Mammography is a very well-established imaging modality for the early detection and diagnosis of breast cancer. However, since the introduction of digital imaging to the realm of radiology, more advanced, and especially tomographic imaging methods have been made possible. One of these methods, breast tomosynthesis, has finally been introduced to the clinic for routine everyday use, with potential to in the future replace mammography for screening for breast cancer. In this two part paper, the extensive research performed during the development of breast tomosynthesis is reviewed, with a focus on the research addressing the medical physics aspects of this imaging modality. This first paper will review the research performed on the issues relevant to the image acquisition process, including system design, optimization of geometry and technique, x-ray scatter, and radiation dose. The companion to this paper will review all other aspects of breast tomosynthesis imaging, including the reconstruction process.

Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma.

Abstract: Bilateral dual-energy contrast-enhanced digital mammography was feasible, easily accomplished, and depicted known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography.

Implementation of breast tomosynthesis in a routine screening practice: an observational study

Abstract: OBJECTIVE. Digital mammography combined with tomosynthesis is gaining clinical acceptance, but data are limited that show its impact in the clinical environment. We assessed the changes in performance measures, if any, after the introduction of tomosynthesis systems into our clinical practice. MATERIALS AND METHODS. In this observational study, we used verified practice- and outcome-related databases to compute and compare recall rates, biopsy rates, cancer detection rates, and positive predictive values for six radiologists who interpreted screening mammography studies without (n = 13,856) and with (n = 9499) the use of tomosynthesis. Two-sided analyses (significance declared at p < 0.05) accounting for reader variability, age of participants, and whether the examination in question was a baseline were performed. RESULTS. For the group as a whole, the introduction and routine use of tomosynthesis resulted in significant observed changes in recall rates from 8.7% to 5.5% (p < 0.001), nonsignificant change...

Computer-Aided Breast Cancer Detection Using Mammograms: A Review

Abstract: The American Cancer Society (ACS) recommends women aged 40 and above to have a mammogram every year and calls it a gold standard for breast cancer detection. Early detection of breast cancer can improve survival rates to a great extent. Inter-observer and intra-observer errors occur frequently in analysis of medical images, given the high variability between interpretations of different radiologists. Also, the sensitivity of mammographic screening varies with image quality and expertise of the radiologist. So, there is no golden standard for the screening process. To offset this variability and to standardize the diagnostic procedures, efforts are being made to develop automated techniques for diagnosis and grading of breast cancer images. A few papers have documented the general trend of computer-aided diagnosis of breast cancer, making a broad study of the several techniques involved. But, there is no definitive documentation focusing on the mathematical techniques used in breast cancer detection. This review aims at providing an overview about recent advances and developments in the field of Computer-Aided Diagnosis (CAD) of breast cancer using mammograms, specifically focusing on the mathematical aspects of the same, aiming to act as a mathematical primer for intermediates and experts in the field.

A review of breast tomosynthesis. Part II. Image reconstruction, processing and analysis, and advanced applications

Abstract: Many important post-acquisition aspects of breast tomosynthesis imaging can impact its clinical performance. Chief among them is the reconstruction algorithm that generates the representation of the three-dimensional breast volume from the acquired projections. But even after reconstruction, additional processes, such as artifact reduction algorithms, computer aided detection and diagnosis, among others, can also impact the performance of breast tomosynthesis in the clinical realm. In this two part paper, a review of breast tomosynthesis research is performed, with an emphasis on its medical physics aspects. In the companion paper, the first part of this review, the research performed relevant to the image acquisition process is examined. This second part will review the research on the post-acquisition aspects, including reconstruction, image processing, and analysis, as well as the advanced applications being investigated for breast tomosynthesis.

ACR–AAPM–SIIM Technical Standard for Electronic Practice of Medical Imaging

Abstract: This technical standard has been revised by the American College of Radiology (ACR), the American Association of Physicists in Medicine (AAPM), and the Society for Imaging Informatics in Medicine (SIIM). For the purpose of this technical standard, the images referred to are those that diagnostic radiologists would normally interpret, including transmission projection and cross-sectional X-ray images, ionizing radiation emission images, and images from ultrasound and magnetic resonance modalities. Research, nonhuman and visible light images (such as dermatologic, histopathologic, or endoscopic images) are out of scope, though many of the same principles are applicable. Increasingly, medical imaging and patient information are being managed using digital data during acquisition, transmission, storage, display, interpretation, and consultation. The management of these data during each of these operations may have an impact on the quality of patient care. This technical standard is applicable to any system of digital image data management, from a single-modality or single-use system to a complete picture archiving and communication system (PACS) to the electronic transmission of patient medical images from one location to another for the purposes of interpretation and/or consultation. It defines goals, qualifications of personnel, equipment guidelines, specifications of data manipulation and management, and quality control and quality improvement procedures for the use of digital image data that should result in high-quality radiological care. A glossary of commonly used terminology (Appendix A) and a reference list are included. In all cases for which an ACR practice guideline or technical standard exists for the modality being used or the specific examination being performed, that practice guideline or technical standard will continue to apply when digital image data management systems are used. Digital mammography is outside the scope of this document. For further information, see the ACR–AAPM–SIIM Practice Guideline for Determinants of Image Quality in Digital Mammography. The goals of the electronic practice of medical imaging include, but are not limited to: Initial acquisition or generation and recording of accurately labeled and identified image data. Transmission of data to an appropriate storage medium from which it can be retrieved for display for formal interpretation, review, and consultation. Retrieval of data from available prior imaging studies to be displayed for comparison with a current study. Transmission of data to remote sites for consultation, review, or formal interpretation. Appropriate compression of image data to facilitate transmission or storage, without loss of clinically significant information. Archiving of data to maintain accurate patient medical records in a form that: May be retrieved in a timely fashion Meets applicable facility, state, and federal regulations Maintains patient confidentiality Promoting efficiency and quality improvement. Providing interpreted images to referring providers. Supporting telemedicine by making medical image consultations available in medical facilities without on-site medical imaging support. Providing supervision of off-site imaging studies. Providing timely availability of medical images, image consultation, and image interpretation by: Facilitating medical image interpretations in on-call situations Providing subspecialty support as needed. Enhancing educational opportunities for practicing radiologists. Minimizing the occurrence of poor image quality. Appropriate database management procedures applicable to all of the above should be in place.

Value of one-view breast tomosynthesis versus two-view mammography in diagnostic workup of women with clinical signs and symptoms and in women recalled from screening.

Abstract: OBJECTIVE. The purpose of this study is to compare the diagnostic value of one-view digital breast tomosynthesis versus two-view full-field digital mammography (FFDM) alone, and versus a combined reading of both modalities. MATERIALS AND METHODS. The datasets of one-view digital breast tomosynthesis and two-view FFDM of abnormal mammograms in 144 consecutive women admitted for diagnostic workup with clinical signs and symptoms (n = 78) or recalled from screening (n = 66) were read alone and in a combined setting. The malignant or benign nature of the lesions was established by histologic analysis of biopsied lesions or by 12–16-month follow-up. RESULTS. Eighty-six of the 144 patients were found to have breast cancer. The BI-RADS categories for one-view digital breast tomosynthesis were significantly better than those for two-view FFDM (p < 0.001) and were equal to those of the combined reading in both women admitted for diagnostic workup and women recalled from screening. The sensitivity and negative pred...

Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers

Abstract: BACKGROUND: Current clinical guidelines recommend earlier, more intensive breast cancer screening with both magnetic resonance imaging (MRI) and mammography for women with breast cancer susceptibility gene (BRCA) mutations. Unspecified details of screening schedules are a challenge for implementing guidelines. METHODS: A Markov Monte Carlo computer model was used to simulate screening in asymptomatic women who were BRCA1 and BRCA2 mutation carriers. Three dual-modality strategies were compared with digital mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals beginning at age 25 years (Alt25), 2) annual MRI beginning at age 25 years with alternating DM added at age 30 years (MRI25/Alt30), and 3) DM and MRI alternating at 6-month intervals beginning at age 30 years (Alt30). Primary outcomes were quality-adjusted life years (QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness (dollars per QALY gained). Additional outcomes included potential harms of screening, and lifetime costs stratified into component categories (screening and diagnosis, treatment, mortality, and patient time costs). RESULTS: All 3 dual-modality screening strategies increased QALYs and costs. Alt30 screening had the lowest incremental costs per additional QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY). False-positive test results increased substantially with dual-modality screening and occurred more frequently in BRCA2 carriers. Downstream savings in both breast cancer treatment and mortality costs were outweighed by increases in up-front screening and diagnosis costs. The results were influenced most by estimates of breast cancer risk and MRI costs. CONCLUSIONS: Alternating MRI and DM screening at 6-month intervals beginning at age 30 years was identified as a clinically effective approach to applying current guidelines, and was more cost-effective in BRCA1 gene mutation carriers compared with BRCA2 gene mutation carriers. Cancer 2013. © 2012 American Cancer Society.

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI.

Abstract: Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size. We retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality. The median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77). DBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.

Radiologist Assessment of Breast Density by BI-RADS Categories Versus Fully Automated Volumetric Assessment

Abstract: OBJECTIVE. The objective of our study was to estimate mammographic breast density using a fully automated volumetric breast density measurement method in comparison with BI-RADS breast density categories determined by radiologists. MATERIALS AND METHODS. A total of 791 full-field digital mammography examinations with standard views were evaluated by three blinded radiologists as BI-RADS density categories 1–4. For fully automated volumetric analysis, volumetric breast density was calculated with fully automated software. The volume of fibroglandular tissue, the volume of the breast, and the volumetric percentage density were provided. RESULTS. The weighted overall kappa was 0.48 (moderate agreement) for the three radiologists' estimates of BI-RADS density. Pairwise comparisons of the radiologists' measurements of BI-RADS density revealed moderate to substantial agreement, with kappa values ranging from 0.51 to 0.64. There was a significant difference in mean volumetric breast density among the BI-RADS den...

Breast density measurements with ultrasound tomography: A comparison with film and digital mammography

Abstract: Purpose: To investigate the use of the whole-breast sound speed measurement as a marker of breast density (BD), a known risk factor for breast cancer. Methods: As part of an ongoing study of breast cancer detection, 249 patients were scanned with a clinical prototype that operates on the principles of ultrasound tomography. Typically, 40–100 sound speed tomograms were reconstructed from the scan data, corresponding to the entire volume of the breast of each patient. The data were used to estimate the volume averaged sound speed (VASS) of the breast for each patient. The corresponding mammograms were used to calculate mammographic percent density (MPD) using CUMULUS software. Film mammograms were available for 164 patients while 85 digital mammograms were available for the remaining patients. Standard statistical techniques were used to determine associations of breast sound speed with a variety of mammographic measures such as percent density, area of dense tissue, and area of nondense tissue. Furthermore, associations of breast sound speed with continuous variables such as age and weight and dichotomous variables such as parity and menopausal status were also assessed. Results: VASS was found to be significantly associated with MPD. The Spearman correlation coefficient (rs) between VASS and MPD was found to be 0.77 and 0.71 for film and digital mammography, respectively. VASS was positively correlated with dense areas by mammography, both digital (rs = 0.46) and film (rs = 0.56). VASS was negatively associated with nondense area by mammography, both digital (rs = −0.58) and film (rs = −0.63). BD by all methods was less in postmenopausal than in premenopausal women. The MPD was lower in the postmenopausal group (by 6.6%, p < 0.08, for the digital group and 7.73%, p < 0.007, for the film group). The VASS was also lower in the postmenopausal group (by 15 m/s, p < 0.001 for the digital group and 8 m/s, p < 0.08, for the film group). The association of MPD with age was characterized with rs = −0.06 (p < 0.6) for digital mammography and rs = −0.53 (p < 0.002) for film mammography. For weight, the MPD associations were characterized by rs = −0.53 (p < 0.0001) for digital mammography and −0.38 (p < 0.0001) for film mammography. The association of VASS with age was rs = −0.33 (p < 0.002) for the digital group and −0.17 (p < 0.03) for the film group. For weight, the relationship was characterized with rs = −0.45 (p < 0.001) for the digital group and −0.37 (p < 0.0001) for the film group. Conclusions: The association between VASS and MPD is strong for both film and digital mammography, suggesting that VASS is a viable measure of breast density. This result sets the stage for future work that will focus on directly testing the association of VASS with breast cancer risk.

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI Valutazione dell'estensione del carcinoma mammario: confronto tra mammografia digitale, tomosintesi, ecografia e risonanza magnetica nella diagnosi pre-operatoria

Abstract: Purpose. Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size.

Digital Compared with Screen-Film Mammography: Performance Measures in Concurrent Cohorts within an Organized Breast Screening Program

Abstract: Cancer detection with digital mammography that involves direct radiography technology was similar to that with screen film mammography in women aged 50–74 years; however, for computed radiography, the risk of cancer detection is significantly lower—by 21%—among all screening techniques.

Computed tomography breast imaging and biopsy system

Abstract: A prone CT breast x-ray imaging system is described that can image a full breast to create a conventional two-dimensional digital image in very high resolution (e.g., ≦25 micron pixels). The system is capable of imaging the entire breast in three-dimensional based on multiple projection views from a one-dimensional or two-dimensional detector. Data can be acquired and reconstructed with a limited number of views from limited angles or with conventional cone beam CT algorithms. The resulting three-dimensional image enables the detection and diagnosis of fine micro calcifications and small masses as may be distributed throughout the breast, thus allowing radiologists to make an improved determination of malignancy as opposed to conventional two-dimensional digital mammography. In addition, the injection of intravenous contrast in conjunction with or without pre and post contrast subtraction imaging provides a radiologist with morphologic information on the existing tumor burden in the breast. This capability may obviate the need for an independent contrast MRI exam of the breast which is increasingly performed for local staging and determination of tumor extent in a patient with a known cancer. Integrated biopsy capability permits convenient and rapid biopsy of any area suspicious for malignancy.

Comparative power law analysis of structured breast phantom and patient images in digital mammography and breast tomosynthesis.

Abstract: Purpose: This work characterizes three candidate mammography phantoms with structured background in terms of power law analysis in the low frequency region of the power spectrum for 2D (planar) mammography and digital breast tomosynthesis (DBT). Methods: The study was performed using three phantoms (spheres in water, Voxmam, and BR3D CIRS phantoms) on two DBT systems from two different vendors (Siemens Inspiration and Hologic Selenia Dimensions). Power spectra (PS) were calculated for planar projection, DBT projection, and reconstructed images and curve fitted in the low frequency region from 0.2 to 0.7 mm−1 with a power law function characterized by an exponent β and magnitude κ. The influence of acquisition dose and tube voltage on the power law parameters was first explored. Then power law parameters were calculated from images acquired with the same anode/filter combination and tube voltage for the three test objects, and compared with each other. Finally, PS curves for automatic exposure controlled acquisitions (anode/filter combination and tube voltages selected by the systems based on the breast equivalent thickness of the test objects) were compared against PS analysis performed on patient data (for Siemens 80 and for Hologic 48 mammograms and DBT series). Dosimetric aspects of the three test objects were also examined. Results: The power law exponent (β) was found to be independent of acquisition dose for planar mammography but varied more for DBT projections of the sphere-phantom. Systematic increase of tube voltage did not affect β but decreased κ, both in planar and DBT projection phantom images. Power spectra of the BR3D phantom were closer to those of the patients than these of the Voxmam phantom; the Voxmam phantom gave high values of κ compared to the other phantoms and the patient series. The magnitude of the PS curves of the BR3D phantom was within the patient range but β was lower than the average patient value. Finally, PS magnitude for the sphere-phantom coincided with the patient curves for Siemens but was lower for the Hologic system. Close agreement of doses for all three phantoms with patient doses was found. Conclusions: Power law parameters of the phantoms were close to those of the patients but no single phantom matched in terms of both magnitude (κ) and texture (β) for the x-ray systems in this work. PS analysis of structured phantoms is feasible and this methodology can be used to suggest improvements in phantom design.

Short-term outcomes of screening mammography using computer-aided detection a population-based study of medicare enrollees

Abstract: In the past decade, 2 technologies have transformed screening methods in the United States. First, digital mammography has supplanted film-screen mammography as the predominant method of image acquisition and storage. Second, most radiologists now use computer algorithms, or computer-aided detection (CAD), to mark and reassess potentially suspicious lesions that may have been missed on initial mammogram review. In 2001, Congress extended Medicare coverage to CAD, and CAD has since diffused widely into U.S. practice (1–3). In Europe, where double-reading by 2 radiologists is common, some have proposed replacing the second reader with CAD (4). Despite broad uptake, the effectiveness and clinical utility of CAD in screening mammography remains controversial. In individual radiology practices, CAD adoption has been associated with greater rate of cancer detection, along with commensurate increases in false-positive rates (5–9), and within 3 British health system breast screening centers, outcomes were similar whether mammograms were double-read or interpreted by a single reader using CAD (10). However, in some practices, CAD adoption has been associated with little, if any, clinical effect (11, 12). The clinical effect of CAD may be heterogeneous across practices (13) or radiologists (14). In addition, CAD may differentially facilitate detection of noninvasive breast cancer, or ductal carcinoma in situ (DCIS), rather than invasive breast cancer (6–8, 15– 18). Because randomized clinical trials suggest that the effect of mammography on breast cancer mortality derives chiefly from detecting invasive cancer (19, 20), it is crucial to delineate the effect of CAD on the detection of invasive and noninvasive breast cancer. In multicenter studies, CAD has not been associated with a clear improvement in the diagnosis of invasive breast cancer (15, 16) despite greater false-positive (15, 16) and biopsy rates (15). However, because breast cancer is uncommon, studies to date may have had insufficient sample sizes of participants with cancer to precisely estimate the association of CAD with detection of invasive versus noninvasive breast cancer or its association with invasive breast cancer stage, size, or lymph node status, all of which are important predictors of breast cancer survival. As stated in a U.S. Preventive Services Task Force evidence review, new digital technologies, such as CAD, “have become widely used in the United States without definitive studies of their effect on screening” (21). Ideally, clinical trials would compare breast cancer outcomes among women screened with CAD versus without CAD, but such trials would require long-term follow-up of very large samples (22). To our knowledge, no such trials are planned or ongoing. However, now that CAD has diffused into clinical practice in the United States, the linked SEER (Surveillance, Epidemiology and End Results)–Medicare data enable a large-sample, population-based observational study of the clinical effect of CAD within the Medicare population. Although evaluation of CAD among both younger and older women having screening is desirable, the SEER–Medicare data offer sample sizes and analytic precision that cannot otherwise be achieved. Therefore, we assessed associations between CAD use during screening mammography received by Medicare enrollees and the incidence of invasive breast cancer and DCIS; invasive breast cancer stage, size, and lymph node status; and subsequent diagnostic testing among women without breast cancer.

The Adjunctive Digital Breast Tomosynthesis in Diagnosis of Breast Cancer

Abstract: Purpose. To compare the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for breast cancers. Materials and Methods. Fifty-seven female patients with pathologically proved breast cancer were enrolled. Three readers gave a subjective assessment superiority of the index lesions (mass, focal asymmetry, architectural distortion, or calcifications) and a forced BIRADS score, based on DM reading alone and with additional DBT information. The relevance between BIRADS category and index lesions of breast cancer was compared by chi-square test. Result. A total of 59 breast cancers were reviewed, including 17 (28.8%) mass lesions, 12 (20.3%) focal asymmetry/density, 6 (10.2%) architecture distortion, 23 (39.0%) calcifications, and 1 (1.7%) intracystic tumor. Combo DBT was perceived to be more informative in 58.8% mass lesions, 83.3% density, 94.4% architecture distortion, and only 11.6% calcifications. As to the forced BIRADS score, 84.4% BIRADS 0 on DM was upgraded to BIRADS 4 or 5 on DBT, whereas only 27.3% BIRADS 4A on DM was upgraded on DBT, as BIRADS 4A lesions were mostly calcifications. A significant P value (<0.001) between the BIRADS category and index lesions was noted. Conclusion. Adjunctive DBT gives exquisite information for mass lesion, focal asymmetry, and/or architecture distortion to improve the diagnostic performance in mammography.

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography.

Abstract: Objective To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Comparative estimation of percentage breast tissue density for digital mammography, digital breast tomosynthesis, and magnetic resonance imaging

Abstract: Given the increasingly important role of breast density as an independent risk factor for breast cancer, and the variable breast imaging tests that potentially provide measures for density. We compared breast tissue density on digital mammography (FFDM), digital breast tomosynthesis (DBT), and magnetic resonance imaging (MRI) using semi-automated automated software. These three imaging modalities have not been previously directly compared for estimating breast tissue density. Following informed consent from all participating women, FFDM, DBT, and MRI were performed. Breast percentage density was calculated with semi-automated software, and compared, for all three imaging modalities. 48 patients (mean age, 41 years; range, 35–67 years) underwent FFDM, DBT, and MRI. Percent FFDM, DBT, and MRI breast density measures showed a positive linear correlation, (r = 0.95 for MRI and DBT, P < 0.0001; r = 0.97, P < 0.0001 for FFDM and DBT; r = 0.87 for FFDM and MRI). Linear regression analysis related to MRI and DBT had a high r 2 = 0.89 (95 % CI = 0.88–0.99, P 0.05). Breast density measures using FFDM, DBT, or MRI were generally well-correlated, although differences were noted between estimates when comparing FFDM and DBT, and for estimates comparing FFDM and MRI. No signficant differences in percentage density were observed when comparing DBT and MRI. Our work highlight that differences between FFDM, DBT, and MRI should be considered when measuring percentage breast density.

Digital Breast Tomosynthesis and the Challenges of Implementing an Emerging Breast Cancer Screening Technology Into Clinical Practice

Abstract: Emerging imaging technologies, including digital breast tomosynthesis, have the potential to transform breast cancer screening. However, the rapid adoption of these new technologies outpaces the evidence of their clinical and cost-effectiveness. The authors describe the forces driving the rapid diffusion of tomosynthesis into clinical practice, comparing it with the rapid diffusion of digital mammography shortly after its introduction. They outline the potential positive and negative effects that adoption can have on imaging workflow and describe the practice management challenges when incorporating tomosynthesis. The authors also provide recommendations for collecting evidence supporting the development of policies and best practices.

Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis

Abstract: Objective To evaluate the clinical value of combining oneview mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization. Methods A free-response receiver operating characteristic (FROC) experiment was conducted independently by six breast radiologists, obtaining data from 463 breasts of 250 patients. Differences in mean lesion detection fraction (LDF) and mean lesion characterization fraction (LCF) were analysed by analysis of variance (ANOVA) to compare clinical performance of the combination of techniques to standard two-view digital mammography. Results The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT(MLO)+MX(CC), was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT(MLO)+MX(CC) was non-inferior to two-view MX for malignant lesions. Conclusions This study shows that readers’ capabilities in detecting and characterizing breast lesions are improved by combining single-view digita lb reast tomosynthesis and single-view mammography compared to two-view digital mammography.

The emerging role of the molecular diagnostics laboratory in breast cancer personalized medicine.

Abstract: Breast cancer is a complex disease characterized by many morphological, clinical, and molecular features For many years, breast cancer has been classified according to traditional parameters, such as histological type, grade, tumor size, lymph node involvement and vascular invasion, and biomarkers (eg, estrogen receptor, progesterone receptor, and epidermal growth factor receptor 2), which are used in patient management With emerging imaging techniques (ie, digital mammography, tomosynthesis, ultrasonography, magnetic resonance imaging, nuclear medicine, and genomic techniques, such as real-time RT-PCR and microarrays), breast cancer diagnostics is going through a significant evolution Imaging technologies have improved breast cancer diagnosis, survival, and treatment by early detection of primary or metastatic lesions, differentiating benign from malignant lesions and promoting intraoperative surgical guidance and postoperative specimen evaluation Genomic and transcriptomic technologies make the analysis of gene expression signatures and mutation status possible so that tumors may be classified more accurately with respect to diagnosis and prognosis The -omic era has also made possible the identification of new biomarkers involved in breast cancer development, survival, and invasion that can be gradually incorporated into clinical testing These advances in both imaging and genomics contribute to more personalized and predictive patient management We review the progress made in breast cancer diagnosis and management using these new tools