Showing papers on "Mammography published in 2002"
TL;DR: The Breast Imaging Reporting and Data System (BI-RADS) lexicon was developed by the American College of Radiology to standardize mammographic reporting and is clinically useful and facilitates communication and research.
2,160 citations
TL;DR: Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts, which significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers.
Abstract: PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%,...
1,591 citations
TL;DR: The goal was to critically appraise and synthesize evidence about the overall effectiveness of breast cancer screening, as well as its effectiveness among women younger than 50 years of age, and to evaluate previous meta-analyses of these trials and of screening test characteristics and studies evaluating the harms associated with false-positive test results.
Abstract: Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian randomeffects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. Conclusions: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.
1,117 citations
University of California, San Francisco1, National Institutes of Health2, University of Washington3, Group Health Cooperative4, University of Vermont5, University of Nevada, Reno6, University of North Carolina at Chapel Hill7, University of New Mexico8, Dartmouth College9, Fred Hutchinson Cancer Research Center10
TL;DR: Overall, approximately 1 in every 1300 screening mammography examinations leads to a diagnosis of DCIS, and the clinical significance of screen-detected DCIS needs further investigation.
Abstract: Background: With the large number of women having mammography—an estimated 28.4 million U.S. women aged 40 years and older in 1998—the percentage of cancers detected as ductal carcinoma in situ (DCIS), which has an uncertain prognosis, has increased. We pooled data from seven regional mammography registries to determine the percentage of mammographically detected cancers that are DCIS and the rate of DCIS per 1000 mammograms. Methods: We analyzed data on 653 833 mammograms from 540 738 women between 40 and 84 years of age who underwent screening mammography at facilities participating in the National Cancer Institute’s Breast Cancer Surveillance Consortium (BCSC) throughout 1996 and 1997. Mammography results were linked to population-based cancer and pathology registries. We calculated the percentage of screen-detected breast cancers that were DCIS, the rate of screen-detected DCIS per 1000 mammograms by age and by previous mammography status, and the sensitivity of screening mammography. Statistical tests were two-sided. Results: A total of 3266 cases of breast cancer were identified, 591 DCIS and 2675 invasive breast cancer. The percentage of screendetected breast cancers that were DCIS decreased with age (from 28.2% [95% confidence interval (CI) = 23.9% to 32.5%] for women aged 40–49 years to 16.0% [95% CI = 13.3% to 18.7%] for women aged 70–84 years). However, the rate of screen-detected DCIS cases per 1000 mammograms increased with age (from 0.56 [95% CI = 0.41 to 0.70] for women aged 40–49 years to 1.07 [95% CI = 0.87 to 1.27] for women aged 70–84 years). Sensitivity of screening mammography in all age groups combined was higher for detecting DCIS (86.0% [95% CI = 83.2% to 88.8%]) than it was for detecting invasive breast cancer (75.1% [95% CI = 73.5% to 76.8%]). Conclusions: Overall, approximately 1 in every 1300 screening mammography examinations leads to a diagnosis of DCIS. Given uncertainty about the natural history of DCIS, the clinical significance of screen-detected DCIS needs further investigation. [J Natl Cancer Inst 2002;94: 1546–54]
581 citations
Journal Article•
TL;DR: The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer, and recommends screening mammography, with or without clinical breast examination (CBE), every 1 to 2 years for women aged 40 and older.
Abstract: Summary of the Recommendations The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1 to 2 years for women aged 40 and older. This is a grade B recommendation. (See Appendix Table 1 for a description of the USPSTF classification of recommendations.) The USPSTF found fair evidence that mammography screening every 12 to 33 months significantly reduces mortality from breast cancer. (See Appendix Table 2 for a description of the USPSTF classification of levels of evidence.) Evidence is strongest for women aged 50 to 69, the age group generally included in screening trials. For women aged 40 to 49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women. Most, but not all, studies indicate a mortality benefit for women undergoing mammography at ages 40 to 49, but the delay in observed benefit in women younger than 50 makes it difficult to determine the incremental benefit of beginning screening at age 40 rather than at age 50. The absolute benefit is smaller because the incidence of breast cancer is lower among women in their 40s than it is among older women. The USPSTF concluded that the evidence is also generalizable to women aged 70 and older (who face a higher absolute risk of breast cancer) if their life expectancy is not compromised by comorbid disease. The absolute probability of benefits of regular mammography increases along a continuum with age, whereas the likelihood of harms from screening (false-positive results and unnecessary anxiety, biopsies, and cost) diminishes from ages 40 to 70. The balance of benefits and potential harms, therefore, grows more favorable as women age. The precise age at which the potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40 to 49 (see Clinical Considerations). The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer. This is a grade I recommendation. No screening trial has examined the benefits of CBE alone (without accompanying mammography) compared to no screening, and design characteristics limit the generalizability of studies that have examined CBE. The USPSTF could not determine the benefits of CBE alone or the incremental benefit of adding CBE to mammography. The USPSTF therefore could not determine whether potential benefits of routine CBE outweigh the potential harms. The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE). This is a grade I recommendation. The USPSTF found poor evidence to determine whether BSE reduces breast cancer mortality. The USPSTF found fair evidence that BSE is associated with an increased risk of false-positive results and biopsies. Because of design limitations of published and ongoing studies of BSE, the USPSTF could not determine the balance of benefits and potential harms of BSE. Clinical Considerations The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (for example, false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. Clinicians should tell women that the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70. Women who are at increased risk for breast cancer (for example, those with a family history of breast cancer in a mother or sister, a previous breast biopsy revealing atypical hyperplasia, or first childbirth after age 30) are more likely to benefit from regular mammography than women at lower risk. The recommendation for women to begin routine screening in their 40s is strengthened by a family history of breast cancer having been diagnosed before menopause. The USPSTF did not examine whether women should be screened for genetic mutations (BRCA1 and BRCA2) that increase the risk of developing breast cancer, or whether women with genetic mutations might benefit from earlier or more frequent screening for breast cancer. In the trials that demonstrated the effectiveness of mammography in lowering breast cancer mortality, screening was performed every 12 to 33 months. For women aged 50 and older, there is little evidence to suggest that annual mammography is more effective than mammography done every other year. For women aged 40 to 49, available trials also have not reported a clear advantage of annual mammography over biennial mammography. Nevertheless, some experts recommend annual mammography based on the lower sensitivity of the test and on evidence that tumors grow more rapidly in this age group. The precise age at which to discontinue screening mammography is uncertain. Only two randomized, controlled trials enrolled women older than 69, and no trials enrolled women older than 74. Older women face a higher probability of developing and dying of breast cancer but also have a greater chance of dying of other causes. Women with comorbid conditions that limit their life expectancy are unlikely to benefit from screening. Clinicians should refer patients to mammography screening centers with proper accreditation and quality assurance standards to ensure accurate imaging and radiographic interpretation. Clinicians should adopt office systems to ensure timely and adequate follow-up of abnormal results. A listing of accredited facilities is available at www.fda.gov/cdrh/mammography/certified.html. Clinicians who advise women to perform BSE or who perform routine CBE to screen for breast cancer should understand that there is currently insufficient evidence to determine whether these practices affect breast cancer mortality and that they are likely to increase the incidence of clinical assessments and biopsies. The brief review of the evidence that is normally included in USPSTF recommendations is available in the complete recommendation and rationale statement on the USPSTF Web site (www.preventiveservices.ahrq.gov). Recommendations of Others Nearly all North American organizations support mammography screening, although groups vary in the recommended age to begin screening, the interval for screening, and the role of CBE. The American Medical Association (AMA) (1), the American College of Radiology (ACR) (2), and the American Cancer Society (ACS) (3) all support screening with mammography and CBE beginning at age 40. The American College of Obstetricians and Gynecologists (ACOG) (4) supports screening with mammography beginning at age 40 and CBE beginning at age 19. The Canadian Task Force on Preventive Health Care (CTFPHC) (5), the American Academy of Family Physicians (AAFP) (6), and the American College of Preventive Medicine (ACPM) (7) recommend beginning mammography for average-risk women at age 50. The AAFP and ACPM recommend that mammography in high-risk women begin at age 40, and the AAFP recommends that all women aged 40 to 49 be counseled about the risks and benefits of mammography before making decisions about screening (6, 7). A 1997 Consensus Development Panel convened by the U.S. National Institutes of Health concluded that the evidence was insufficient to determine the benefits of mammography among women aged 40 to 49. This panel recommended that women aged 40 to 49 should be counseled about potential benefits and harms before making decisions about mammography (8). In 2001, the CTFPHC concluded there was insufficient evidence to recommend for or against mammography in women 40 to 49 (9). Organizations differ on their recommendations for the appropriate interval for mammography. Annual mammography is recommended by the AMA, ACR, and ACS (1-3). Mammography every 1 to 2 years is recommended by the CTFPHC, AAFP, and ACPM (5-7). The ACOG recommends mammography every 1 to 2 years for women aged 40 to 49 and annually for women aged 50 and older (4). In its 2001 report, the CTFPHC recommends against teaching BSE to women aged 40 to 69 (10). The AMA, ACS, ACOG, and AAFP support teaching BSE (1, 3, 4, 6).
448 citations
TL;DR: There is a need to evaluate the effect of the screening program on the mortality of breast carcinoma, uncontaminated in the screening epoch by mortality from cases diagnosed in the prescreening period and cases diagnosed among unscreened women after the initiation of organized screening.
Abstract: The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties.
432 citations
TL;DR: The CNBSS suggests that screening 40- to 49-year-old women is unlikely to reduce breast cancer by 20% or more, and the conduct and interpretation of the breast physical examination would be unbiased by knowledge of whether mammography would follow.
Abstract: After 11 to 16 years of follow-up, four or five annual screenings with mammography, breast physical examination, and breast self-examination had not reduced breast cancer mortality compared with us...
407 citations
365 citations
TL;DR: The preliminary simulation results support the proposed CVBCTBI modality for breast imaging in respect to its feasibility and practicability and the proposed imaging technique with isotropic spatial resolution will potentially provide significantly better low-contrast detectability of breast tumors and more accurate location of breast lesions.
Abstract: X-ray projection mammography, using a film/screen combination, or digital techniques, has proven to be the most effective imaging modality currently available for early detection of breast cancer. However, the inherent superimposition of structures makes a small carcinoma (a few millimeters in size) difficult to detect when it is occult or in dense breasts, leading to a high false-positive biopsy rate. Cone-beam x-ray-projection-based volume imaging using flat panel detectors (FPDs) may allow obtaining three-dimensional breast images, resulting in more accurate diagnosis of structures and patterns of lesions while eliminating the hard compression of breasts. This article presents a novel cone-beam volume computed tomographic breast imaging (CBVCTBI) technique based on the above techniques. Through a variety of computer simulations, the key issues of the system and imaging techniques were addressed, including the x-ray imaging geometry and corresponding reconstruction algorithms, x-ray characteristics of breast tissue and lesions, x-ray setting techniques, the absorbed dose estimation, and the quantitative effect of x-ray scattering on image quality. The preliminary simulation results support the proposed CVBCTBI modality for breast imaging in respect to its feasibility and practicability. The absorbed dose level is comparable to that of current mammography and will not be a prominent problem for this imaging technique. Compared to conventional mammography, the proposed imaging technique with isotropic spatial resolution will potentially provide significantly better low-contrast detectability of breast tumors and more accurate location of breast lesions.
315 citations
Journal Article•
TL;DR: It is believed that type II microcalcifications formed in benign ducts typically contain a larger amount of calcium carbonate and a smaller amount of protein than those formed in malignant ducts, which is a significant improvement over current X-ray mammography techniques, which are unable to reliably differentiate microCalcifications in benign and malignant breast lesions.
Abstract: We have applied Raman spectroscopy to analyze the chemical composition of microcalcifications occurring in benign and malignant lesions in the human breast. Microcalcifications were initially separated into two categories based on their Raman spectrum: type I, calcium oxalate dihydrate, and type II, calcium hydroxyapatite. Type I microcalcifications were diagnosed as benign, whereas type II were subdivided into benign and malignant categories using principal component analysis, a statistical technique. Although type II microcalcifications are primarily composed of calcium hydroxyapatite, they also contain trace amounts of several biological impurities. Using principal component analysis, we were able to highlight subtle chemical differences in type II microcalcifications that correlate with breast disease. On the basis of these results, we believe that type II microcalcifications formed in benign ducts typically contain a larger amount of calcium carbonate and a smaller amount of protein than those formed in malignant ducts. Using this diagnostic strategy, we were able to distinguish microcalcifications occurring in benign and malignant ducts with a sensitivity of 88% and a specificity of 93%. This is a significant improvement over current X-ray mammography techniques, which are unable to reliably differentiate microcalcifications in benign and malignant breast lesions.
307 citations
TL;DR: No significant difference in cancer detection was observed between digital mammography and screen-film mammography, andDigital mammography resulted in fewer recalls than did screen- film mammography.
Abstract: OBJECTIVE. The purpose of this work is to compare full-field digital mammography and screen-film mammography for the detection of breast cancer in a screening population.SUBJECTS AND METHODS. Full-field digital mammography was performed in addition to screen-film mammography in 6736 examinations of women 40 years old and older presenting for screening mammography at either of two institutions. Two views of each breast were acquired with each technique. The digital and screen-film mammograms were each interpreted independently. In addition to a clinical assessment, each finding was assigned a probability of malignancy for use in receiver operating characteristic analysis. In cases in which the digital and screen-film interpretations differed, a side-by-side analysis was performed to determine the reasons for the discrepancy. With few exceptions, findings detected on either technique were evaluated with additional imaging and, if warranted, biopsy.RESULTS. Additional evaluation was recommended on at least o...
TL;DR: Evaluated performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies found specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.
Abstract: PURPOSE: To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS: Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0–I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and χ2 tests. RESULTS: The study involved 47,798 screening and 13...
TL;DR: It is suggested that high sensitivity (high cancer detection rate) can be achieved with high specificity (low false-positive rate) in high-volume centers and there is great potential for optimizing mammography screening.
Abstract: Background: Countries with centralized, high-volume mammography screening programs, such as the U.K. and Sweden, emphasize high specificity (low percentage of false positives) and high sensitivity (high percentage of true positives). By contrast, the United States does not have centralized, high-volume screening programs, emphasizes high sensitivity, and has lower average specificity. We investigated whether high sensitivity can be achieved in the context of high specificity and whether the number of mammograms read per radiologist (reader volume) drives both sensitivity and specificity. Methods: The U.K.’s National Health Service Breast Screening Programme uses the PERFORMS 2 test as a teaching and assessment tool for radiologists. The same 60-film PERFORMS 2 test was given to 194 high-volume U.K. radiologists and to 60 U.S. radiologists, who were assigned to low-, medium-, or high-volume groups on the basis of the number of mammograms read per month. The standard binormal receiver-operating characteristic (ROC) model was fitted to the data of individual readers. Detection accuracy was measured by the sensitivity at specificity = 0.90, and differences among sensitivities were determined by analysis of variance. Results: The average sensitivity at specificity = 0.90 was 0.785 for U.K. radiologists, 0.756 for high-volume U.S. radiologists, 0.702 for medium-volume U.S. radiologists, and 0.648 for low-volume U.S. radiologists. At this specificity, low-volume U.S. radiologists had statistically significantly lower sensitivity than either high-volume U.S. radiologists or U.K. radiologists, and medium-volume U.S. radiologists had statistically significantly lower sensitivity than U.K. radiologists (P<.001, for all comparisons). Conclusions: Reader volume is an important determinant of mammogram sensitivity and specificity. High sensitivity (high cancer detection rate) can be achieved with high specificity (low false-positive rate) in high-volume centers. This study suggests that there is great potential for optimizing mammography screening. [J Natl Cancer Inst 2002;94: 369–75]
TL;DR: Round robin analysis was used to assess the quality of the classification of lesion candidates into actual lesions and false-positives by a Bayesian neural network, and use of computerized analysis of breast sonograms may ultimately facilitate the use of sonography in breast cancer screening programs.
Abstract: We investigated the use of a radial gradient index (RGI) filtering technique to automatically detect lesions on breast ultrasound. After initial RGI filtering, a sensitivity of 87% at 0.76 false-positive detections per image was obtained on a database of 400 patients (757 images). Next, lesion candidates were segmented from the background by maximizing an average radial gradient (ARD) index for regions grown from the detected points. At an overlap of 0.4 with a radiologist lesion outline, 75% of the lesions were correctly detected. Subsequently, round robin analysis was used to assess the quality of the classification of lesion candidates into actual lesions and false-positives by a Bayesian neural network. The round robin analysis yielded an Az value of 0.84, and an overall performance by case of 94% sensitivity at 0.48 false-positives per image. Use of computerized analysis of breast sonograms may ultimately facilitate the use of sonography in breast cancer screening programs.
TL;DR: Screening mammography may influence the detection of lymphomatous involvement of the breast in patients diagnosed with extralymph node lymphoma.
Abstract: BACKGROUND
The involvement of the breast by lymphoma is a rare form of extralymph node lymphoma and represents either primary disease or systemic involvement. The authors hypothesized that screening mammography may influence the detection of lymphomatous involvement of the breast.
METHODS
All patients (n = 81 patients) who were diagnosed with lymphomatous involvement of the breast at the study institution between 1988 and 1999 were evaluated retrospectively.
RESULTS
Clinical information was available for 73 patients who could be classified into three major groups according to their diagnosis: primary breast lymphoma (PBL) (44%), breast involvement from disseminated disease at the time of initial diagnosis (29%), and recurrence of preexisting lymphoma to the breast (27%). The majority of PBL were of intermediate or high grade, and the majority of disseminated lymphomas involving the breast were of low grade. Lymphomatous recurrence to the breast was slightly more likely to be of intermediate grade rather than low grade. In 91% of patients, the diagnosis of lymphoma was made after the evaluation of a palpable mass. All patients who were identified after the evaluation of an abnormal screening mammogram (9%) had low-grade lymphomas. Of the 32 patients with PBL, screening mammography discovered only 1. Nineteen percent of patients with PBL also had a history of an autoimmune disorder.
CONCLUSIONS
These findings suggest that screening mammography has not altered substantially the detection of breast lymphoma. The clinical outcome of patients with breast lymphoma is dependent on histology and appears to parallel that of patients with lymphoma of similar histology involving other sites. Cancer 2002;94:6–13. © 2002 American Cancer Society.
TL;DR: A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.
Abstract: Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. Methods. A stratified random sample of 801 African American women completed baseline (1993‐1994) and follow-up (1996‐1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = −1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations. (Am J Public Health. 2002;92:646‐654)
TL;DR: US- guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers.
Abstract: Background
The wire-guided excision of nonpalpable breast cancer often results in tumor resections with inadequate margins. This prospective, randomized trial was undertaken to investigate whether intraoperative ultrasound (US) guidance enables a better margin clearance than the wire-guided technique in the breast-conserving treatment of nonpalpable breast cancers.
TL;DR: BI-RADS training resulted in improved agreement with the consensus of experienced breast imagers for feature analysis and final assessment, and it is important that trainees showed improved rates of recommending biopsy for malignant lesions.
Abstract: PURPOSE: To determine whether training in the Breast Imaging Reporting and Data System (BI-RADS) improves observer performance and agreement with the consensus of experienced breast imagers with regard to mammographic feature analysis and final assessment. MATERIALS AND METHODS: A test set of mammograms was developed, with 54 proven lesions consisting of 28 masses (nine [32%] malignancies) and 26 microcalcifications (10 [38%] malignancies). Three experienced breast imagers reviewed cases independently and by means of consensus. Twenty-three practicing mammogram-interpreting physicians reviewed mammograms before and after a day’s lectures on BI-RADS. Observer performance before and after training was measured by means of agreement (κ) with consensus description and assessments, rate of biopsy of malignant and benign lesions, and areas under receiver operating characteristic (ROC) curves. Performance was also measured for 11 participants 2–3 months after training. RESULTS: Improved agreement with consensus ...
TL;DR: MRI appears to be a valuable technique for assessment of response to chemotherapy and identification of multifocal disease prior to surgery.
Abstract: Purpose. To compare the value of conventional imaging modalities and MRI for determination of response to neoadjuvant chemotherapy for breast cancer.
Material and methods. Sixty tumors (53 ductal carcinomas, seven invasive lobular carcinomas) in 51 patients were evaluated by physical examination, mammography, ultrasound, and MRI at baseline before therapy, after three courses of chemotherapy, and after six courses prior to surgery. Data from physical examination and imaging studies were compared to histopathological findings.
Results. (i) MRI was the most reliable technique for evaluation of residual tumor size; this parameter was correctly estimated in 63% of cases by MRI versus, respectively 52, 38, and 43% by physical examination, mammography, and ultrasound, (ii) MRI correctly identified the response to chemotherapy in all cases of complete response (five cases), and in 45/55 cases of partial response (43 cases) or no response (12 cases), and (iii) among the 32 patients who underwent a mastectomy, MRI correctly revealed the multifocal nature of the disease for 12/15 multifocal lesions found at histological examination; both mammography and sonography were accurate in only six of the 15 cases.
Conclusion. MRI appears to be a valuable technique for assessment of response to chemotherapy and identification of multifocal disease prior to surgery.
Journal Article•
TL;DR: In this article, Liss et al. investigated whether the specific histologic features of BRCA1/2-associated breast cancer influence imaging and found that prominent pushing margins of the tumor partly explain these results.
Abstract: Female BRCA1/2 mutation carriers develop in up to 50% breast cancer (BC) before age 50 years. We investigated whether the specific histologic features of BRCA1/2‐associated breast cancer influence imaging. We correlated the mammographic results with the histology of 34 BC in BRCA1/2 mutation carriers and 34 sporadic cancers in patients, matched for age and year of diagnosis. Mammography was significantly more frequently false‐negative in carriers than controls (62% vs. 29% p = 0.01), despite comparable tumor size (mean ⊘ 1.51 vs. 1.75) and breast density (high 41% vs. 53%). The image in carriers was significantly less as spiculated mass (6 vs. 18 p = 0.01). Cancers of BRCA1/2 mutation carriers had frequently higher mitotic counts (p < 0.0001) and prominent pushing margins around the tumor (p = 0.08) (p = 0.05 for 32 BRCA1). We also observed that prominent “pushing margins” correlated significantly with a false‐negative mammography (p = 0.005) and with a mammographic image of a smooth, not a spiculated, mass (p = 0.01). False‐negative mammography correlated independently with: BRCA1/2 mutation (p = 0.02), prominent pushing margins (p = 0.03) and high breast density (p = 0.01). MRI was carried out in 12 carriers, had 100% sensitivity and detected 5 cancers, still occult at physical examination and mammography. A BRCA1/2 mutation and high breast density at mammography contribute independently to false‐negative mammography results. In mutation carriers any mammographic mass must be regarded with suspicion. Pushing margins of the tumor partly explain these results. For early BC detection in mutation carriers additional methods like MRI may be needed. This may not be necessary in other young women with breast symptoms. © 2002 Wiley‐Liss, Inc.
TL;DR: Higher breast density and previous mammographic examination appear to impair performance, and diagnostic mammography in women with signs or symptoms of breast cancer shows higher sensitivity and lower specificity than screening mammography does.
Abstract: Background: The performance of diagnostic mammography for women with signs or symptoms of breast cancer has not been well studied. We evaluated whether age, breast density, self-reported breast lump, and previous mammography influence the performance of diagnostic mammography. Methods: From January 1996 through March 1998, prospective diagnostic mammography data from women aged 25–89 years with no previous breast cancer were linked to cancer outcomes data in six mammography registries participating in the Breast Cancer Surveillance Consortium. We used the final mammographic assessment at the end of the imaging work-up to determine abnormal mammographic examination rate, positive predictive value (PPV), sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. We used age, breast density, prior mammogram, and self-reported breast lump jointly as predictors of performance. All statistical tests were two-sided. Results: Of 41 427 diagnostic mammograms, 6279 (15.2%) were judged abnormal. The overall PPV was 21.8%, sensitivity was 85.8%, and specificity was 87.7%. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased (P = .007 and P<.001, respectively), that previous mammography decreased sensitivity (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36 to 0.74; P<.001) but increased specificity (OR = 1.43, 95% CI = 1.31 to 1.57; P<.001), and that a self-reported breast lump increased sensitivity (OR = 1.64, 95% CI = 1.13 to 2.38; P = .013) but decreased specificity (OR = 0.54, 95% CI = 0.49 to 0.59; P<.001). ROC analysis showed that higher breast density and previous mammography were negatively related to accuracy (P<.001 for both). Conclusions: Diagnostic mammography in women with signs or symptoms of breast cancer shows higher sensitivity and lower specificity than screening mammography does. Higher breast density and previous mammographic examination appear to impair performance. [J Natl Cancer Inst 2002;94:1151–9] Diagnostic mammography is commonly used to identify possible breast cancers in women who present with signs or symptoms of the disease. These signs or symptoms may include a palpable breast lump, nipple discharge or retraction, and breast dimpling or other skin changes. A diagnostic mammographic examination usually consists of standard screening views and additional views using spot compression and/or magnification of a specific area. Although mammography may be sufficient to evaluate the clinical finding, additional imaging with ultrasound, ductography, or other imaging techniques may also be done. Sensitivity and specificity have been well studied for screening mammography studies (1–3) but not for diagnostic evaluations. Diagnostic mammography may have superior performance over screening mammography, because noticeable symptoms or clinical findings may indicate a more advanced tumor that is easier to locate and identify. Dee and Sickles (4) found that tumors detected by diagnostic mammography were larger than those detected by screening mammography. However, the performance of diagnostic mammography could also be altered by characteristics of the woman, including age, breast density, history of previous mammography, and presence of breast cancer symptoms. We performed a large prospective study of women with signs or symptoms of breast cancer who were undergoing diagnostic mammography. The records from the mammography registries of the Breast Cancer Surveillance Consortium (BCSC), a population-based consortium of community radiology practices (5), were linked with cancer outcomes. We evaluated the performance of diagnostic mammography and how performance may be influenced by the characteristics of the women undergoing mammography. METHODS Study Sample and Population
TL;DR: MRI was carried out in 12 carriers, had 100% sensitivity and detected 5 cancers, still occult at physical examination and mammography, which suggests additional methods like MRI may be needed for early BC detection in mutation carriers.
Abstract: Female BRCA1/2 mutation carriers develop in up to 50% breast cancer (BC) before age 50 years. We investigated whether the specific histologic features of BRCA1/2-associated breast cancer influence imaging. We correlated the mammographic results with the histology of 34 BC in BRCA1/2 mutation carriers and 34 sporadic cancers in patients, matched for age and year of diagnosis. Mammography was significantly more frequently false-negative in carriers than controls (62% vs. 29% p = 0.01), despite comparable tumor size (mean solidus in circle 1.51 vs. 1.75) and breast density (high 41% vs. 53%). The image in carriers was significantly less as spiculated mass (6 vs. 18 p = 0.01). Cancers of BRCA1/2 mutation carriers had frequently higher mitotic counts (p < 0.0001) and prominent pushing margins around the tumor (p = 0.08) (p = 0.05 for 32 BRCA1). We also observed that prominent "pushing margins" correlated significantly with a false-negative mammography (p = 0.005) and with a mammographic image of a smooth, not a spiculated, mass (p = 0.01). False-negative mammography correlated independently with: BRCA1/2 mutation (p = 0.02), prominent pushing margins (p = 0.03) and high breast density (p = 0.01). MRI was carried out in 12 carriers, had 100% sensitivity and detected 5 cancers, still occult at physical examination and mammography. A BRCA1/2 mutation and high breast density at mammography contribute independently to false-negative mammography results. In mutation carriers any mammographic mass must be regarded with suspicion. Pushing margins of the tumor partly explain these results. For early BC detection in mutation carriers additional methods like MRI may be needed. This may not be necessary in other young women with breast symptoms.
TL;DR: Stereotactic large‐core needle biopsy is an accurate diagnostic instrument for nonpalpable breast disease and may safely replace needle localised open‐breast biopsy provided that high‐risk and normal breast tissue diagnoses are followed by needle or open-breasts biopsy.
Abstract: Stereotactic large-core needle biopsy is increasingly applied for the diagnosis of nonpalpable breast disease. Our study examines whether this minimally invasive technique is sufficiently accurate to replace surgical breast biopsy. In a prospective multicenter study, 973 consecutive women with 1,029 nonpalpable breast lesions were offered stereotactic 14-gauge needle biopsy. If the needle biopsy yielded breast cancer, the patient was offered therapeutic surgery. Surgical biopsy was proposed in cases of needle biopsies without malignancy. An expert panel reviewed all discrepancies in histologic diagnosis between the needle biopsy and open biopsy. Forty-five patients withdrew from participation and 113 (11%) planned needle biopsy procedures were cancelled. Of the 871 successful biopsy procedures, 95% were confirmed surgically. In 13 cases (1.5%), insufficient material was obtained for histologic assessment. Fifty-five percent of the needle biopsies were diagnosed as malignant (290 invasive cancers, 190 ductal carcinoma in situ). Thirteen of the 322 lesions (4%, 95% CI 2-7%) with a benign needle biopsy diagnosis contained malignancy after surgery. Six of the 26 (23%, 95% CI 9-44%) lesions with a high-risk diagnosis (atypical ductal or lobular hyperplasia or lobular carcinoma in situ) were diagnosed as malignant after surgery. Five of the 30 lesions containing normal breast tissue held malignancy (17%, 95% CI 6-35%). Guidelines for the management of different categories of needle biopsy diagnoses were made. Application of these guidelines to the present findings resulted in sensitivity and specificity rates of 97% (95% CI 95-98%) and 99% (95% CI 97-100%), respectively. Stereotactic large-core needle biopsy is an accurate diagnostic instrument for nonpalpable breast disease. It may safely replace needle localised open-breast biopsy provided that high-risk and normal breast tissue diagnoses are followed by needle or open-breast biopsy.
TL;DR: The frequency of BI-RADS category 3 lesions has remained stable; patient compliance for follow-up has increased; and the positive predictive value for carcinoma of the breast in nonpalpable, probably benign lesions that had been detected on and followed up with mammography has decreased.
Abstract: OBJECTIVE. Using data collected for one series during 1987-1989 and data collected for another series during 1996, we sought to compare the frequency of and positive predictive value for carcinoma of the breast in nonpalpable, probably benign lesions that had been detected on and followed up with mammography.MATERIALS AND METHODS. During 1996, mammography was performed in 18,435 women of whom 544 (3.0%) had lesions assigned to Breast Imaging Reporting and Data System (BI-RADS) category 3 for nonpalpable, probably benign lesions. The lesions in the women were assessed as BI-RADS category 3 after the patients had undergone a diagnostic study that included additional imaging, sonography, and a focused physical examination. Patients with BI-RADS category 3 lesions were recommended for mammographic surveillance. A minimum of 2 years of follow-up data was available for 511 patients, our study population. We compared the findings for our study population with those of the previous study.RESULTS. Ninety-seven per...
TL;DR: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics.
Abstract: Despite many recent improvements in mammography (1), the ultimate interpretation still depends on individual physicians. The level of agreement among radiologists interpreting the same test set of mammograms is relatively low (2–6), which may delay the detection of breast cancer (7). However, recent data have shown that mammography test sets may not adequately represent actual clinical practice in a community setting (8). Few studies of variability have been done in the community setting. One study (9) found variability among radiologists' recommendations for biopsy, with radiologists in academic settings having a higher positive predictive value in their recommendations to undergo biopsy compared with community radiologists. This community-based study, however, did not control for possible differences in the patient populations or for differences among radiologists other than their affiliation with an academic institution.
In our previous work (10), we estimated that a woman's cumulative risk of experiencing at least one false-positive interpretation after 10 mammograms was approximately 50%. Several variables predicted the likelihood of a woman having a false-positive result (11). Risk ratios for a false-positive screening result increased with younger age of the woman, family history of breast cancer, use of hormone replacement therapy (HRT), time between screenings, no comparison with previous mammograms, and the radiologists' tendency to call mammograms abnormal. The single largest predictor, noted in our earlier work (11), was the radiologist's individual tendency to call mammograms abnormal.
The present study was designed to explore in more detail the extent of variability among radiologists in a community setting. Our goals were to 1) describe variability among radiologists in their specific observations, interpretations, and false-positive rates in screening mammograms; 2) evaluate the impact on variability of additional individual characteristics of the patients and the radiologists (i.e., sex, age, experience) and of additional testing characteristics (i.e., year of the mammogram, health maintenance organization [HMO] versus community facility); and 3) determine if the variability noted among radiologists would be reduced after adjusting for differences in patients, radiologists, and testing characteristics.
TL;DR: A novel method, called vibro-acoustography, uses the radiation force of ultrasound to vibrate tissue at low (kHz) frequency and utilizes the resulting response to produce images that are related to the hardness of the tissue.
Abstract: A novel method for detection and imaging of microcalcifications in breast tissue is presented. The method, called vibro-acoustography, uses the radiation force of ultrasound to vibrate tissue at low (kHz) frequency and utilizes the resulting response to produce images that are related to the hardness of the tissue. The method is tested on human breast tissues. The resulting vibro-acoustographic images are in agreement with corresponding X-ray mammography images of the specimens. The existence of microcalcifications in locations indicated by vibro-acoustography is confirmed by histology. Microcalcifications as small as 110 /spl mu/m in diameter are detected by this method. Resulting vibro-acoustographic images show microcalcifications with high contrast with respect to the background soft tissue. Structures such as dense sclerotic tissue do not seem to interfere with detection of microcalcifications.
TL;DR: Routine preoperative MR imaging appears to be unnecessary for most patients if a combination of mammography and whole-breast sonography is used, and can be restricted to problematic cases in women with dense breast parenchyma.
Abstract: OBJECTIVE. The purposes of our study were to compare the diagnostic value of whole-breast sonography and MR imaging as adjunctive techniques to mammography and to determine whether MR imaging should be used routinely in the preoperative assessment of patients with suspected breast cancer.SUBJECTS AND METHODS. One hundred four women (age range, 34-84 years; mean age, 60 years) with findings highly suggestive of malignancy in the breast were examined with mammography, sonography, and dynamic MR imaging before undergoing surgery. All visualized suspicious lesions were correlated histologically. The diagnostic relevance of sonographic and MR imaging findings was compared with the diagnostic value of the findings of clinical examination and mammography alone.RESULTS. Twenty-seven tumors showed multifocal or multicentric invasive growth at pathology. Of these 27, 48% were correctly diagnosed via mammography alone; 63%, via the combination of mammography and sonography; and 81%, via MR imaging. Nine of the index...
TL;DR: The data suggest that papillary lesions may be safely managed with imaging follow-up rather than with surgical excision after a benign diagnosis, and when the histologic diagnosis is benign.
Abstract: OBJECTIVE. Our objective was to assess the incidence of papillary lesions of the breast diagnosed at imaging-guided core needle biopsy and the need for surgical excision after a benign diagnosis.MATERIALS AND METHODS. This retrospective study included 1374 patients with consecutive suspicious breast lesions that underwent either mammography or sonographically guided large-core needle breast biopsy. Fifty-seven lesions (4%) were classified as papillary lesions. Eleven of the 57 cases were lost to follow-up (n = 6) or had not yet shown 2 years of stability (n = 5) and were excluded from this study. The remaining 46 papillary lesions constitute our study population.RESULTS. Surgical excision was performed in 17 (37%) of 46 papillary lesions. In the group of patients whose lesions were recommended for excision because carcinoma was identified at core biopsy, surgical excision revealed one false-positive and two true-positive diagnoses. In four cases, histologic diagnoses of the excisional biopsy and the core ...
TL;DR: The mammographic appearance of nonpalpable malignancies is related to pathologic characteristics with prognostic value, which varies with patient age and influences clinical management.
Abstract: ObjectiveTo study the relationship of mammographic appearance of nonpalpable breast cancer to the pathologic characteristics.Summary Background DataThe mammographic appearance of nonpalpable breast cancer may be associated with pathologic variables having prognostic significance, which could influen
TL;DR: A dual-energy radiography technique based on a tissue cancellation algorithm has been developed for mammography, with the aim of maximizing the low intrinsic contrast of pathologic tissues while being able to minimize or cancel the contrast between glandular and fat tissues.
Abstract: Dual-energy radiography has not evolved into a routine clinical examination yet due to intrinsic limitations of both dual-kVp imaging and single-exposure imaging with conventional x-ray sources. The recent introduction of novel quasi-monochromatic x-ray sources and detectors could lead to interesting improvements, especially in mammography where the complex structure of healthy tissues often masks the detectability of lesions. A dual-energy radiography technique based on a tissue cancellation algorithm has been developed for mammography, with the aim of maximizing the low intrinsic contrast of pathologic tissues while being able to minimize or cancel the contrast between glandular and fat tissues. Several images of a plastic test object containing various tissue equivalent inserts were acquired in the energy range 17-36 keV using a quasi-monochromatic x-ray source and a scintillator-coated CCD detector. Images acquired at high and low energies were nonlinearly combined to generate two energy-independent basis images. Suitable linear combinations of these two basis images result in the elimination of the contrast of a given material with respect to another. This makes it possible to selectively cancel certain details in the processed image.