Showing papers on "Digital mammography published in 2014"

Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography

Abstract: mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). CONCLUSIONS AND RELEVANCE Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

Screening Outcomes Following Implementation of Digital Breast Tomosynthesis in a General-Population Screening Program

Abstract: Screening mammography, despite ongoing controversy regarding its risk-benefit ratio, remains the mainstay of early breast cancer detection (1,2) Digital breast tomosynthesis (DBT), a relatively new x-ray technology (3,4) that images the breast in 3-D, has shown promise in addressing some limitations of conventional mammography by alleviating the effect of superimposed structures that can lead to erroneous interpretations (5–8) This new technology is increasingly implemented in breast clinics across the country, despite relatively little data on its clinical outcomes and effectiveness in specific patient populations (9) Early enthusiasm for DBT is based mostly on retrospective reader studies that compared DBT combined with digital mammography (DM) imaging vs DM alone These studies demonstrated reductions of up to 30% to 40% in false-positives, with similar or slightly improved cancer detection (6,10–12) In the United States, Food and Drug Administration (FDA) approval was granted to a single vendor in 2011 (Hologic, Inc, Bedford, MA) based on a large multicenter retrospective reader study that demonstrated statistically significant improvement in performance when DBT was combined with DM (13,14) More recently, two prospective European trials have also shown improvements in screening outcomes with DBT An interim analysis from the Oslo Screening Trial (n = 12631) and the final results from the Italian Screening with Tomosynthesis or Standard Mammography Trial (STORM, n = 7292) have demonstrated reductions in recalls of 15% to 17% and improvements in cancer detection of 33% to 53% (15,16) Furthermore, in the Oslo trial there was a 40% increase in the detection of invasive cancers with a stable rate of in situ cancer detection However, in both of these trials subject compliance with screening invitations was less than 100%, and there were complex reading protocols requiring at least two readers per case, which is uncommon in clinical practices in the United States More recently, two separate US centers have reported early results from DBT screening (17,18) These data again demonstrate improvements in outcomes with reductions in recalls up to 37% and increases in cancer detection up to 35% At both sites, however, there was concurrent screening with DM alone and, therefore, a potential for bias in the selection of patients screened with DBT and potentially imaged with DBT at recall In a recent report from a consortium of 13 US practices, a 15% reduction in recall rate and a 29% increase in cancer detection were seen with DBT screening compared with DM alone screening However, no patient-level data was reported, and eleven of the thirteen sites had concurrent DM screening, leading to possible biases in selection of patients for DBT (19) Here we report the patient-level outcomes of implementing DBT screening for the entire screening population at our institution beginning October 2011 We compare outcomes for the cohort screened with DBT over a period of 17 months to the cohort screened with DM alone during the 12 months prior to DBT implementation All women presenting for routine screening were imaged with DBT after its implementation, and radiologist readers remained the same over the DM and DBT cohorts, providing a “pre and post” comparison of DBT to DM-alone screening

Comparison of Two-dimensional Synthesized Mammograms versus Original Digital Mammograms Alone and in Combination with Tomosynthesis Images

Abstract: The use of synthetic mammography in lieu of full-field digital mammography (FFDM), whether alone or in combination with tomosynthesis data sets, does not result in any clinically meaningful differences in diagnostic accuracy and may eliminate the need for FFDM as part of a routine clinical study.

Clinical Performance Metrics of 3D Digital Breast Tomosynthesis Compared With 2D Digital Mammography for Breast Cancer Screening in Community Practice

Abstract: OBJECTIVE. The objective of our study was to assess the clinical performance of combined 2D-3D digital breast tomosynthesis (DBT), referred to as “3D DBT,” compared with 2D digital mammography (DM) alone for screening mammography in a community-based radiology practice. MATERIALS AND METHODS. Performance outcomes measures were assessed for 14 radiologists who interpreted more than 500 screening mammography 3D DBT studies after the initiation of tomosynthesis. Outcomes from screening mammography during the study period between August 9, 2011, and November 30, 2012, using 3D DBT (n = 23,149 patients) versus 2D DM (n = 54,684 patients) were compared. RESULTS. For patients screened with 3D DBT, the relative change in recall rate was 16.1% lower than for patients screened with 2D DM (p > 0.0001). The overall cancer detection rate (CDR), expressed as number of cancers per 1000 patients screened, was 28.6% greater (p = 0.035) for 3D DBT (6.3/1000) compared with 2D DM (4.9/1000). The CDR for invasive cancers with...

Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme.

Abstract: Objectives Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM.

Addition of Tomosynthesis to Conventional Digital Mammography: Effect on Image Interpretation Time of Screening Examinations

Abstract: Our study demonstrates that the time to interpret images from a combined tomosynthesis-mammography screening examination in the clinical setting is on average 47% longer than the time required to interpret images from a conventional digital mammography screening examination.

Benefits, Harms, and Costs for Breast Cancer Screening After US Implementation of Digital Mammography

Abstract: textBackground Compared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear. Methods Using five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs. Results For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective. Conclusions The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.

Detection of mammographically occult architectural distortion on digital breast tomosynthesis screening: initial clinical experience.

Abstract: OBJECTIVE. Digital breast tomosynthesis (DBT) has been shown to improve the sensitivity of screening mammography. DBT may have the most potential impact in cases of subtle mammographic findings such as architectural distortion (AD). The objective of our study was to determine whether DBT provides better visualization of AD than digital mammography (DM) and whether sensitivity for cancer detection is increased by the addition of DBT as it relates to cases of mammographically occult AD. MATERIALS AND METHODS. Retrospective review of BI-RADS category 0 reports from 9982 screening DM examinations with adjunct DBT were searched for the term “architectural distortion” and were reviewed in consensus by three radiologists. ADs were classified by whether they were seen better on DM or DBT, were seen equally well on both, or were occult on either modality. The electronic medical record was reviewed to identify additional imaging studies, biopsy results, and surgical excision pathology results. RESULTS. Review ident...

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Abstract: To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts. Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I2). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively. A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0 % and 79.0 %, and for DM they were 89.0 % and 72.0 %, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15 % and 18 %; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively. Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography. • Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis. • DBT appears to have superior diagnostic accuracy relative to digital mammography. • DBT images were captured at a lower dose than 2D images. • DBT displays abnormal features of lesions more clearly than DM. • Digital breast tomosynthesis could become the first choice for assessing breast lesions.

Diagnostic accuracy and recall rates for digital mammography and digital mammography combined with one-view and two-view tomosynthesis: results of an enriched reader study.

Abstract: OBJECTIVE. The purpose of this study was to compare two methods of combining tomosynthesis with digital mammography by assessing diagnostic accuracy and recall rates for digital mammography alone and digital mammography combined with one-view tomosynthesis and two-view tomosynthesis. SUBJECTS AND METHODS. Three hundred ten cases including biopsy-proven malignancies (51), biopsy-proven benign findings (47), recalled screening cases (138), and negative screening cases (74) were reviewed by 15 radiologists sequentially using digital mammography, adding one-view tomosynthesis, and then two-view tomosynthesis. Cases were assessed for recall and assigned a BI-RADS score and probability of malignancy for each imaging method. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Screening recall rates were compared using pooled logistical regression analysis. A p value of < 0.0167 was considered significant. RESULTS. The area under the ROC curve (AUC) for digital mammography (DM...

Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer

Abstract: Aim: To define the accuracy of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to digital mammography (DM) and ultrasound (US) in the preoperative assessment of breast cancer. Patients and Methods: We performed a prospective study of 200 consecutive women with histologically-proven breast cancer using the above imaging techniques. Accuracy measurements were estimated using a lesion-by-lesion analysis for unifocal, multifocal/multicentric, bilateral and all carcinomas. We also calculated sensitivity according to breast density. Results: DBT had higher sensitivity than DM (90.7% vs. 85.2%). Combined DM and DBT with US yielded a 97.7% sensitivity; despite high sensitivity of MRI (98.8%), the addition of MRI to combined DM with DBT and US did not significantly improve sensitivity. Overall accuracy did not significantly differ between MRI and DM with DBT and US (92.3% vs. 93.7%). Breast density affected sensitivity of DM and DBT (statistically significant difference for DM), not MRI. Conclusion: There is little gain in sensitivity and no gain in overall accuracy, by performing MRI for patients who have been evaluated with DM with DBT and US. Breast cancer assessment and treatment has evolved considerably in the past decade, including the range of breast imaging modalities. Women suspected or known to have breast cancer on the basis of conventional imaging (mammography and ultrasound (US)) now have the option of undergoing additional imaging before progressing to histological evaluation and surgical management. In particular, magnetic resonance imaging (MRI) has been increasingly used in addition to conventional imaging for preoperative assessment in patients newly-diagnosed with breast cancer, although this remains a controversial practice (1, 2). The recent availability and application of digital breast tomosynthesis (DBT) (3) further challenges clinicians in terms of deciding whether (and which) imaging additional to conventional imaging improves the accuracy of preoperative assessment. We aimed to examine the gain in accuracy when DBT is added to conventional imaging, and to compare this with MRI, in women suspected of having breast cancer on the basis of conventional imaging. The purpose of our study was to help define the accuracy and therefore the potential application of these additional imaging modalities in the preoperative setting for patients newly-diagnosed with breast cancer.

Should we screen BRCA1 mutation carriers only with MRI? A multicenter study.

Abstract: BRCA1 mutation carriers are offered screening with MRI and mammography. Aim of the study was to investigate the additional value of digital mammography over MRI screening. BRCA1 mutation carriers, who developed breast cancer since the introduction of digital mammography between January 2003 and March 2013, were included. The images and reports were reviewed in order to assess whether the breast cancers were screen-detected or interval cancers and whether they were visible on mammography and MRI, using the breast imaging and data system classification allocated at the time of diagnosis. In 93 BRCA1 mutation carriers who underwent screening with MRI and mammography, 82 invasive breast cancers and 12 ductal carcinomas in situ (DCIS) were found. Screening sensitivity was 95.7 % (90/94). MRI detected 88 of 94 breast cancers (sensitivity 93.6 %), and mammography detected 48 breast cancers (sensitivity 51.1 %) (two-sided p < 0.001). Forty-two malignancies were detected only by MRI (42/94 = 44.7 %). Two DCIS were detected only with mammography (2/94 = 2.1 %) concerning a grade 3 in a 50-year-old patient and a grade 2 in a 67-year-old patient. Four interval cancers occurred (4/94 = 4.3 %), all grade 3 triple negative invasive ductal carcinomas. In conclusion, digital mammography added only 2 % to the breast cancer detection in BRCA1 patients. There was no benefit of additional mammography in women below age 40. Given the potential risk of radiation-induced breast cancer in young mutation carriers, we propose to screen BRCA1 mutation carriers yearly with MRI from age 25 onwards and to start with mammographic screening not earlier than age 40.

Radiation Exposure of Contrast-Enhanced Spectral Mammography Compared With Full-Field Digital Mammography

Abstract: Objectives Contrast-enhanced spectral mammography (CESM) shows promising initial results but comes at the cost of increased dose as compared with full-field digital mammography (FFDM) We aimed to quantitatively assess the dose increase of CESM in comparison with FFDM Materials and methods Radiation exposure-related data (such as kilovoltage, compressed breast thickness, glandularity, entrance skin air kerma (ESAK), and average glandular dose (AGD) were retrieved for 47 CESM and 715 FFDM patients All examinations were performed on 1 mammography unit Radiation dose values reported by the unit were validated by phantom measurements Descriptive statistics of the patient data were generated using a statistical software package Results Dose values reported by the mammography unit were in good qualitative agreement with those of phantom measurements Mean ESAK was 105 mGy for a CESM exposure and 746 mGy for an FFDM exposure Mean AGD for a CESM exposure was 280 mGy and 155 mGy for an FFDM exposure Conclusions Compared with our institutional FFDM, the AGD of a single CESM exposure is increased by 125 mGy (+81%), whereas ESAK is increased by 307 mGy (+41%) Dose values of both techniques meet the recommendations for maximum dose in mammography

Digital Breast Tomosynthesis: Lessons Learned from Early Clinical Implementation

Abstract: The limitations of mammography are well known and are partly related to the fact that with conventional imaging, the three-dimensional volume of the breast is imaged and presented in a two-dimensional format. Because normal breast tissue is similar in x-ray attenuation to some breast cancers, clinically relevant malignancies may be obscured by normal overlapping tissue. In addition, complex areas of normal tissue may be perceived as suspicious. The limitations of two-dimensional breast imaging lead to low sensitivity in detecting some cancers and high false-positive recall rates. Although mammographic screening has been shown to reduce breast cancer deaths by approximately 30%, controversy exists over when and how often screening mammography should occur. Digital breast tomosynthesis (DBT) is rapidly being implemented in breast imaging clinics around the world as early clinical data demonstrate that it may address some of the limitations of conventional mammography. With DBT, multiple low-dose x-ray images are acquired in an arc and reconstructed to create a three-dimensional image, thus minimizing the impact of overlapping breast tissue and improving lesion conspicuity. Early studies of screening DBT have shown decreased false-positive callback rates and increased rates of cancer detection (particularly for invasive cancers), resulting in increased sensitivity and specificity. In our clinical practice, we have completed more than 2 years of using two-view digital mammography combined with two-view DBT for all screening and select diagnostic imaging examinations (over 25,000 patients). Our experience, combined with previously published data, demonstrates that the combined use of DBT and digital mammography is associated with improved outcomes for screening and diagnostic imaging. Online supplemental material is available for this article.

Mammographic and ultrasound features of invasive lobular carcinoma of the breast.

Abstract: IntroductionInvasive lobular cancer (ILC) is an important contributor to false negative mammography. This study aims to assess the value of digital mammography and to identify imaging features that could assist the radiologist to suggest the diagnosis of ILC prior to biopsy.

A study on mastectomy samples to evaluate breast imaging quality and potential clinical relevance of differential phase contrast mammography.

Abstract: OBJECTIVES Differential phase contrast and scattering-based x-ray mammography has the potential to provide additional and complementary clinically relevant information compared with absorption-based mammography. The purpose of our study was to provide a first statistical evaluation of the imaging capabilities of the new technique compared with digital absorption mammography. MATERIALS AND METHODS We investigated non-fixed mastectomy samples of 33 patients with invasive breast cancer, using grating-based differential phase contrast mammography (mammoDPC) with a conventional, low-brilliance x-ray tube. We simultaneously recorded absorption, differential phase contrast, and small-angle scattering signals that were combined into novel high-frequency-enhanced images with a dedicated image fusion algorithm. Six international, expert breast radiologists evaluated clinical digital and experimental mammograms in a 2-part blinded, prospective independent reader study. The results were statistically analyzed in terms of image quality and clinical relevance. RESULTS The results of the comparison of mammoDPC with clinical digital mammography revealed the general quality of the images to be significantly superior (P < 0.001); sharpness, lesion delineation, as well as the general visibility of calcifications to be significantly more assessable (P < 0.001); and delineation of anatomic components of the specimens (surface structures) to be significantly sharper (P < 0.001). Spiculations were significantly better identified, and the overall clinically relevant information provided by mammoDPC was judged to be superior (P < 0.001). CONCLUSIONS Our results demonstrate that complementary information provided by phase and scattering enhanced mammograms obtained with the mammoDPC approach deliver images of generally superior quality. This technique has the potential to improve radiological breast diagnostics.

Impact of Computer-Aided Detection Systems on Radiologist Accuracy With Digital Mammography

Abstract: OBJECTIVE. The purpose of this study was to assess the impact of computer-aided detection (CAD) systems on the performance of radiologists with digital mammograms acquired during the Digital Mammographic Imaging Screening Trial (DMIST). MATERIALS AND METHODS. Only those DMIST cases with proven cancer status by biopsy or 1-year follow-up that had available digital images were included in this multireader, multicase ROC study. Two commercially available CAD systems for digital mammography were used: iCAD SecondLook, version 1.4; and R2 ImageChecker Cenova, version 1.0. Fourteen radiologists interpreted, without and with CAD, a set of 300 cases (150 cancer, 150 benign or normal) on the iCAD SecondLook system, and 15 radiologists interpreted a different set of 300 cases (150 cancer, 150 benign or normal) on the R2 ImageChecker Cenova system. RESULTS. The average AUC was 0.71 (95% CI, 0.66–0.76) without and 0.72 (95% CI, 0.67–0.77) with the iCAD system (p = 0.07). Similarly, the average AUC was 0.71 (95% CI, 0...

Mammographic Performance in a Population-based Screening Program: Before, during, and after the Transition from Screen-Film to Full-Field Digital Mammography

Abstract: Improvements in recall rate and positive predictive value for full-field digital mammography (FFDM) were noted after the initial transitional phase from screen-film to FFDM; screening with FFDM was associated with lower recall and biopsy rates, which are known limitations associated with screening for breast cancer.

The Evolution of Breast Imaging: Past to Present

Abstract: The practice of breast imaging has transitioned through a wide variety of technologic advances from the early days of direct-exposure film mammography to xeromammography to screen-film mammography to the current era of full-field digital mammography and digital breast tomosynthesis. Along with these technologic advances, organized screening, federal regulations based on the Mammography Quality Standards Act, and the development of the American College of Radiology Breast Imaging Reporting and Data System have helped to shape the specialty of breast imaging. With the development of breast ultrasonography and breast magnetic resonance imaging, both complementary to mammography, additional algorithms for diagnostic workup and screening high-risk subgroups of women have emerged. A substantial part of breast imaging practice these days also involves breast interventional procedures-both percutaneous biopsy to obtain tissue diagnosis and localization procedures to guide surgical excision. This article reviews the evolution of breast imaging starting from a historical perspective and progressing to the present day.

Clinical study in phase- contrast mammography: image-quality analysis

Abstract: The first clinical study of phase-contrast mammography (PCM) with synchrotron radiation was carried out at the Synchrotron Radiation for Medical Physics beamline of the Elettra synchrotron radiation facility in Trieste (Italy) in 2006–2009. The study involved 71 patients with unresolved breast abnormalities after conventional digital mammography and ultrasonography exams carried out at the Radiology Department of Trieste University Hospital. These cases were referred for mammography at the synchrotron radiation facility, with images acquired using a propagation-based phase-contrast imaging technique. To investigate the contribution of phase-contrast effects to the image quality, two experienced radiologists specialized in mammography assessed the visibility of breast abnormalities and of breast glandular structures. The images acquired at the hospital and at the synchrotron radiation facility were compared and graded according to a relative seven-grade visual scoring system. The statistical analysis highlighted that PCM with synchrotron radiation depicts normal structures and abnormal findings with higher image quality with respect to conventional digital mammography.

Development and validation of a modelling framework for simulating 2D-mammography and breast tomosynthesis images

Abstract: Planar 2D x-ray mammography is generally accepted as the preferred screening technique used for breast cancer detection. Recently, digital breast tomosynthesis (DBT) has been introduced to overcome some of the inherent limitations of conventional planar imaging, and future technological enhancements are expected to result in the introduction of further innovative modalities. However, it is crucial to understand the impact of any new imaging technology or methodology on cancer detection rates and patient recall. Any such assessment conventionally requires large scale clinical trials demanding significant investment in time and resources. The concept of virtual clinical trials and virtual performance assessment may offer a viable alternative to this approach. However, virtual approaches require a collection of specialized modelling tools which can be used to emulate the image acquisition process and simulate images of a quality indistinguishable from their real clinical counterparts. In this paper, we present two image simulation chains constructed using modelling tools that can be used for the evaluation of 2D-mammography and DBT systems. We validate both approaches by comparing simulated images with real images acquired using the system being simulated. A comparison of the contrast-to-noise ratios and image blurring for real and simulated images of test objects shows good agreement ( < 9% error). This suggests that our simulation approach is a promising alternative to conventional physical performance assessment followed by large scale clinical trials.

Comparison of Direct Digital Mammography, Computed Radiography, and Film-Screen in the French National Breast Cancer Screening Program

Abstract: OBJECTIVE. The purpose of this article was to compare the performance of digital mammography using hardcopy image reading against film-screen mammography in a French national routine population-based screening program with a decentralized organization. The French context offered the opportunity to examine separately computed radiography and direct digital mammography performances in a large cohort. MATERIALS AND METHODS. The study includes 23,423 direct digital mammography, 73,320 computed radiography, and 65,514 film-screen mammography examinations performed by 123 facilities in Bouches du Rhone, France, for women 50–74 years old between 2008 and 2010. We compared abnormal mammography findings rate, cancer detection rate, and tumor characteristics among the technologies. RESULTS. Abnormal finding rates were higher for direct digital mammography (7.78% vs 6.11% for film-screen mammography and 5.34% for computed radiography), particularly in younger women and in denser breasts. Cancer detection rates were ...

Does MRI breast "density" (degree of background enhancement) correlate with mammographic breast density?

Abstract: Purpose To investigate whether mammographic breast densities and the respective degree of MRI background enhancement would correlate. Mammographic breast density is coded to communicate how likely a cancer is obscured by parenchyma. Similarly, background enhancement in breast MRI could obscure enhancing cancer tissue. Materials and Methods A total of 468 women underwent standard full-field digital mammography and dynamic contrast-enhanced breast MRI in our institution. Mammographic breast density was scored according to the American College of Radiology-classification; background enhancement in MRI was scored on a 4-point scale from absent to severe. Breast “density classes” were retrospectively compared by analyzing the differences between scores for mammography and MRI. Statistical correlation was calculated using the Spearman coefficient. Results Scores matched in 19% of women (90/468) but differed in 81% (378/468). A deviation by 1 point was observed in 33% (157/468), by 2 points in 38% (179/468), by 3 in 9% (42/468). Scores for background enhancement were lower than mammographic scores in 371/468 (79.3%), equivalent in 90/468 (19.2%), and higher in 7/468 (1.5%). Conclusion Mammographic breast density does not correlate with the degree of background enhancement in MRI. In the majority of women, scores for background enhancement in MRI will be lower than the respective mammographic density scores. J. Magn. Reson. Imaging 2014;40:483–489. © 2014 Wiley Periodicals, Inc.

Measurement of breast density with digital breast tomosynthesis--a systematic review.

Abstract: Digital breast tomosynthesis (DBT) has gained acceptance as an adjunct to digital mammography in screening. Now that breast density reporting is mandated in several states in the USA, it is increasingly important that the methods of breast density measurement be robust, reliable and consistent. Breast density assessment with DBT needs some consideration since quantitative methods are modelled for two-dimensional (2D) mammography. A review of methods used for breast density assessment with DBT was performed. Existing evidence shows Cumulus has better reproducibility than that of the breast imaging reporting and data system (BI-RADS®) but still suffers from subjective variability; MedDensity is limited by image noise, whilst Volpara and Quantra are robust and consistent. The reported BI-RADs inter-reader breast density agreement (k) ranged from 0.65 to 0.91, with inter-reader correlation (r) ranging from 0.70 to 0.93. The correlation (r) between BI-RADS and Cumulus ranged from 0.54–0.94, whilst that of BI-RADs and MedDensity ranged from 0.48–0.78. The reported agreement (k) between BI-RADs and Volpara is 0.953. Breast density correlation between DBT and 2D mammography ranged from 0.73 to 0.97, with agreement (k) ranging from 0.56 to 0.96. To avoid variability and provide more reliable breast density information for clinicians, automated volumetric methods are preferred.

Breast Positioning during Mammography: Mistakes to be Avoided

Abstract: Aims and objectives: Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram. Material and Methods: A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral–nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants. Results: As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis–nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal. Conclusion: Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

Technologist-performed handheld screening breast US imaging: how is it performed and what are the outcomes to date?

Abstract: Breast density-inform legislation is increasing the need for data on outcomes of tailored screening. Dense parenchyma can mask cancers, and denser tissue is also more likely to develop breast cancer than fatty tissue. Digital mammography is standard for women with dense breasts. Supplemental screening magnetic resonance imaging should be offered to women who meet high-risk criteria. Supplemental screening ultrasonographic (US) imaging may be appropriate in the much larger group of women with dense breasts. Both physician- and technologist-performed screening US imaging increases detection of node-negative invasive breast cancer. To meet anticipated demand in the United States, screening US images will most likely be acquired by trained technologists rather than physicians. While automated US offers standard documentation, there are few data on outcomes. US has been used diagnostically for decades to characterize masses seen by using mammography, but training specific to screening has been lacking. Standard approaches to training and documentation of technologist-performed handheld screening US imaging are needed. This article reviews the current status of technologist-performed handheld screening breast US imaging.