While breast cancer continues to affect the lives of millions, contemporary writers and artists have responded to the ravages of the disease in creative expression. Mary K. DeShazer's book looks ...specifically at breast cancer memoirs and photographic narratives, a category she refers to as mammographies, signifying both the imaging technology by which most Western women discover they have this disease and the documentary imperatives that drive their written and visual accounts of it. Mammographies argues that breast cancer narratives of the past ten years differ from their predecessors in their bold address of previously neglected topics such as the link between cancer and environmental carcinogens, the ethics and efficacy of genetic testing and prophylactic mastectomy, and the shifting politics of prosthesis and reconstruction.
Objectives
Contrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary ...results of CESM using a larger panel of radiologists with different levels of CESM experience.
Methods
All women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve.
Results
CESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188).
Conclusion
CESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience.
Key Points
•
CESM is consistently superior to conventional mammography
•
CESM increases diagnostic accuracy regardless of a reader
’
s experience
•
CESM is an excellent problem
-
solving tool in recalls from screening programs
BI-RADS is a communication and data tracking system that has evolved since its inception as a brief mammography lexicon and reporting guide into a robust structured reporting platform and ...comprehensive quality assurance tool for mammography, ultrasound, and MRI. Consistent and appropriate use of the BI-RADS lexicon terminology and assessment categories effectively communicates findings, estimates the risk of malignancy, and provides management recommendations to patients and referring clinicians. The impact of BI-RADS currently extends internationally through six language translations. A condensed version has been proposed to facilitate a phased implementation of BI-RADS in resource-constrained regions. The primary advance of the 5th edition of BI-RADS is harmonization of the lexicon terms across mammography, ultrasound, and MRI. Harmonization has also been achieved across these modalities for the reporting structure, assessment categories, management recommendations, and data tracking system. Areas for improvement relate to certain common findings that lack lexicon descriptors and a need for further clarification of proper use of category 3. BI-RADS is anticipated to continue to evolve for application to a range of emerging breast imaging modalities.
The purpose of this article is to discuss the essential steps involved in performing, interpreting, managing, and reporting findings on contrast-enhanced mammography for successful implementation ...into clinical practice.
To successfully implement contrast-enhanced mammography into clinical practice, an understanding about the acquisition of images, image interpretation, and reporting of the spectrum of negative, benign, and malignant findings is essential.
Purpose:
The FDA approved the use of digital breast tomosynthesis (DBT) in 2011 as an adjunct to 2D full field digital mammography (FFDM) with the constraint that all DBT acquisitions must be paired ...with a 2D image to assure adequate interpretative information is provided. Recently manufacturers have developed methods to provide a synthesized 2D image generated from the DBT data with the hope of sparing patients the radiation exposure from the FFDM acquisition. While this much needed alternative effectively reduces the total radiation burden, differences in image quality must also be considered. The goal of this study was to compare the intrinsic image quality of synthesized 2D c-view and 2D FFDM images in terms of resolution, contrast, and noise.
Methods:
Two phantoms were utilized in this study: the American College of Radiology mammography accreditation phantom (ACR phantom) and a novel 3D printed anthropomorphic breast phantom. Both phantoms were imaged using a Hologic Selenia Dimensions 3D system. Analysis of the ACR phantom includes both visual inspection and objective automated analysis using in-house software. Analysis of the 3D anthropomorphic phantom includes visual assessment of resolution and Fourier analysis of the noise.
Results:
Using ACR-defined scoring criteria for the ACR phantom, the FFDM images scored statistically higher than c-view according to both the average observer and automated scores. In addition, between 50% and 70% of c-view images failed to meet the nominal minimum ACR accreditation requirements—primarily due to fiber breaks. Software analysis demonstrated that c-view provided enhanced visualization of medium and large microcalcification objects; however, the benefits diminished for smaller high contrast objects and all low contrast objects. Visual analysis of the anthropomorphic phantom showed a measureable loss of resolution in the c-view image (11 lp/mm FFDM, 5 lp/mm c-view) and loss in detection of small microcalcification objects. Spectral analysis of the anthropomorphic phantom showed higher total noise magnitude in the FFDM image compared with c-view. Whereas the FFDM image contained approximately white noise texture, the c-view image exhibited marked noise reduction at midfrequency and high frequency with far less noise suppression at low frequencies resulting in a mottled noise appearance.
Conclusions:
Their analysis demonstrates many instances where the c-view image quality differs from FFDM. Compared to FFDM, c-view offers a better depiction of objects of certain size and contrast, but provides poorer overall resolution and noise properties. Based on these findings, the utilization of c-view images in the clinical setting requires careful consideration, especially if considering the discontinuation of FFDM imaging. Not explicitly explored in this study is how the combination of DBT + c-view performs relative to DBT + FFDM or FFDM alone.
The Future of Contrast-Enhanced Mammography Covington, Matthew F; Pizzitola, Victor J; Lorans, Roxanne ...
American journal of roentgenology (1976)
210, Issue:
2
Journal Article
Peer reviewed
The purpose of this article is to discuss facilitators of and barriers to future implementation of contrast-enhanced mammography (CEM) in the United States.
CEM provides low-energy 2D mammographic ...images analogous to digital mammography and contrast-enhanced recombined images that allow assessment of neovascularity similar to that offered by MRI. The utilization of CEM in the United States is currently low but could increase rapidly given the many potential indications for its clinical use.
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost ...or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
•CEM is an emerging imaging technique for breast cancer detection.•CEM has primarily been used in the diagnostic setting.•CEM may have a role in screening intermediate- or high-risk women for breast cancer.•With similar diagnostic performance to MRI, CEM may be a comparable alternative.
Screening for breast cancer with mammography Gøtzsche, Peter C; Jørgensen, Karsten Juhl; Gøtzsche, Peter C
Cochrane database of systematic reviews,
06/2013, Volume:
2013, Issue:
6
Journal Article
Peer reviewed
Open access
Background
A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary.
Objectives
To assess the effect of screening ...for breast cancer with mammography on mortality and morbidity.
Search methods
We searched PubMed (22 November 2012) and the World Health Organization's International Clinical Trials Registry Platform (22 November 2012).
Selection criteria
Randomised trials comparing mammographic screening with no mammographic screening.
Data collection and analysis
Two authors independently extracted data. Study authors were contacted for additional information.
Main results
Eight eligible trials were identified. We excluded a trial because the randomisation had failed to produce comparable groups.The eligible trials included 600,000 women in the analyses in the age range 39 to 74 years. Three trials with adequate randomisation did not show a statistically significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87).
We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all‐cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).
Total numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42), as were number of mastectomies (RR 1.20, 95% CI 1.08 to 1.32). The use of radiotherapy was similarly increased whereas there was no difference in the use of chemotherapy (data available in only two trials).
Authors' conclusions
If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. To help ensure that the women are fully informed before they decide whether or not to attend screening, we have written an evidence‐based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.
The aim of this study was to quantify the impact of organised mammography screening on breast cancer mortality across European regions. Therefore, a systematic review was performed including ...different types of studies from all European regions and stringently used clearly defined quality appraisal to summarise the best evidence.
Six databases were searched including Embase, Medline and Web of Science from inception to March 2018. To identify all eligible studies which assessed the effect of organised screening on breast cancer mortality, two reviewers independently applied predefined inclusion and exclusion criteria. Original studies in English with a minimum follow-up of five years that were randomised controlled trials (RCTs) or observational studies were included. The Cochrane risk of bias instrument and the Newcastle–Ottawa Scale were used to assess the risk of bias.
Of the 5015 references initially retrieved, 60 were included in the final analysis. Those comprised 36 cohort studies, 17 case–control studies and 7 RCTs. None were from Eastern Europe. The quality of the included studies varied: Nineteen of these studies were of very good or good quality. Of those, the reduction in breast cancer mortality in attenders versus non-attenders ranged between 33% and 43% (Northern Europe), 43%–45% (Southern Europe) and 12%–58% (Western Europe). The estimates ranged between 4% and 31% in invited versus non-invited.
This systematic review provides evidence that organised screening reduces breast cancer mortality in all European regions where screening was implemented and monitored, while quantification is still lacking for Eastern Europe. The wide range of estimates indicates large differences in the evaluation designs between studies, rather than in the effectiveness of screening.
•Study summarises current evidence of mortality reduction due to mammography screening.•Includes different types of studies, using a methodologically sound quality appraisal.•Impact ranges between 12% and 58% in screening attenders versus non-attenders.•Impact ranges between 4% and 31% in invited versus non-invited women.•Quantification of the actual effects is still lacking for Eastern Europe.•Results fortify that mammography screening reduces mortality from breast cancer.
PDF
