Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with ...organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.
Neuronal activity within the premotor region HVC is tightly synchronized to, and crucial for, the articulate production of learned song in birds. Characterizations of this neural activity detail ...patterns of sequential bursting in small, carefully identified subsets of neurons in the HVC population. The dynamics of HVC are well described by these characterizations, but have not been verified beyond this scale of measurement. There is a rich history of using local field potentials (LFP) to extract information about behavior that extends beyond the contribution of individual cells. These signals have the advantage of being stable over longer periods of time, and they have been used to study and decode human speech and other complex motor behaviors. Here we characterize LFP signals presumptively from the HVC of freely behaving male zebra finches during song production to determine if population activity may yield similar insights into the mechanisms underlying complex motor-vocal behavior. Following an initial observation that structured changes in the LFP were distinct to all vocalizations during song, we show that it is possible to extract time-varying features from multiple frequency bands to decode the identity of specific vocalization elements (syllables) and to predict their temporal onsets within the motif. This demonstrates the utility of LFP for studying vocal behavior in songbirds. Surprisingly, the time frequency structure of HVC LFP is qualitatively similar to well-established oscillations found in both human and non-human mammalian motor areas. This physiological similarity, despite distinct anatomical structures, may give insight into common computational principles for learning and/or generating complex motor-vocal behaviors.
Despite technological advancements focused on reducing breast cancer mortality through early detection, there have been reported disparities in the access to these imaging services with underserved ...patient populations (including racial minority groups and patients of low socioeconomic status) showing underutilization compared to other patient groups. These underserved populations tend to have more advanced breast cancer presentations, in part due to delays in diagnosis resulting in later stage of disease presentation. To make matters worse, the COVID-19 pandemic declared in March 2020 has resulted in significant healthcare disruptions leading to extensive delays in breast imaging services which are expected to negatively impact breast cancer mortality long-term. Given the worsening disparity in breast cancer mortality among racial/ethnic minorities and financially disadvantaged groups, it is vital to address these disparity gaps with the goal of reducing the barriers to timely breast cancer diagnosis and addressing breast cancer mortality differences among breast cancer patients. Therefore, this review aims to provide a discussion highlighting the disparities related to breast imaging access, the effects of the COVID-19 pandemic on these disparities, current targeted interventions implemented in breast imaging practices to reduce these disparities, and future directions on the journey to reducing disparity gaps for breast imaging patients. Tackling the root cause factors of the persistent breast cancer-related disparities is critical to meeting the needs of patients who are disadvantaged and can lead to continued improvement in the quality of individualized care for patients who have higher breast cancer morbidity and mortality risks.
This study describes 94 patients who presented with suspected COVID-19 vaccine-related axillary adenopathy on breast imaging. All biopsies recommended within 12 weeks of the second vaccine dose were ...benign. Among women not recommended for biopsy, the median interval between the second vaccine dose and ultrasound follow-up was 15.9 weeks. Three biopsies yielding malignant diagnoses were recommended 12.0-13.1 weeks after the second vaccine dose. Lengthening imaging follow-up to 12-16 weeks after the second dose may reduce unnecessary biopsy recommendations.
Studies have shown improved targeting and sampling of noncalcified lesions (asymmetries, masses, and architectural distortion) with digital breast tomosynthesis (DBT)-guided biopsy in comparison with ...digital mammography (DM)-guided stereotactic biopsy. Literature that compares the two techniques specifically for sampling calcifications has been scarce.
The purpose of this study was to compare the performance and outcomes of DM- and DBT-guided biopsy of suspicious calcifications.
This retrospective study included 1310 patients (mean age, 58 ± 12 SD years) who underwent a total of 1354 9-gauge vacuum-assisted core biopsies of suspicious calcifications performed at a single institution from May 22, 2017, to December 31, 2021. The decision to use a DM-guided or DBT-guided technique was made at the discretion of the radiologist performing the biopsy. Procedure time, the number of exposures during the procedure, and the histopathologic outcomes were recorded. The two techniques were compared using a two-sample
test for continuous variables and a chi-square test for categoric variables. Additional tests were performed using generalized estimating equations to control for the effect of the individual radiologist performing the biopsy.
A total of 348 (26%) biopsies used DM guidance, and 1006 (74%) used DBT guidance. The mean procedure time was significantly lower for DBT-guided biopsy (14.9 ± 8.0 SD minutes) than for DM-guided biopsy (24.7 ± 14.3 minutes) (
< .001). The mean number of exposures was significantly lower for DBT-guided biopsy (4.1 ± 1.0 SD exposures) than for DM-guided biopsy (9.1 ± 3.3 exposures) (
< .001). The differences in procedure time and number of exposures remained significant (both
< .001) when controlling for the effect of the radiologist performing the biopsy. There were no significant differences (all
> .05) between DM-guided and DBT-guided biopsy in terms of the malignancy rate on initial biopsy (20% vs 19%), the rate of high-risk lesion upgrading (14% vs 22%), or the final malignancy rate (23% vs 22%).
DBT-guided biopsy of suspicious calcifications can be performed with shorter procedure time and fewer exposures compared with DM-guided biopsy, without a significant difference in rates of malignancy or high-risk lesion upgrading.
The use of a DBT-guided, rather than a DM-guided, biopsy technique for suspicious calcifications can potentially reduce patient discomfort and radiation exposure without affecting clinical outcomes.
To assess patient preferences for breast radiologists' attire and appearance.
A multi-institutional anonymous, voluntary 19-question survey was administered to patients undergoing screening and ...diagnostic mammography examinations over a 5-week period. Using a 5-point Likert scale, respondents were asked about their preferences for gender-neutral attire (white coat), male-presenting attire (scrubs, dress shirt with tie, or dress shirt without tie), and female-presenting attire (scrubs, dress, blouse with pants, and blouse with skirt). Patient responses were compared to demographic data using bivariable analysis and multivariable regression.
Response rate was 84.7% (957/1130). Mean respondent age was 57.2 years±11.9. Most respondents agreed/strongly agreed that the breast radiologist's appearance mattered (52.5%, 502/956) followed by being indifferent (28.1%, 269/956). Respondents with greater education levels felt less strongly (p=0.001) about the radiologist's appearance: 63.3% (70/110) less than college cared about appearance compared to 53.5% (266/497) college/vocational and 47.4% (165/348) graduate. Most respondents felt indifferent about a breast radiologist wearing a white coat (68.9%, 657/954) or about male-presenting breast radiologists wearing a tie (77.1%, 734/952) without significant demographic differences. Almost all respondents either prefer/strongly prefer (60.1%, 572/951) or were indifferent (39.6%, 377/951) to all breast radiologists wearing scrubs when performing procedures. While respondents approved of all attire choices overall, most respondents preferred scrubs for both male- and female-presenting breast radiologists (64.0%, 612/957 and 64.9%, 621/957, respectively).
A variety of breast radiologists' attire can be worn while maintaining provider professionalism and without compromising patient expectations.
Recall rates are lower for digital breast tomosynthesis (DBT) than full-field digital mammography (FFDM). This difference could have important implications with respect to one-view asymmetries given ...that missed cancers are often visible on one view.
To compare outcomes of one-view asymmetries recalled from DBT versus FFDM screening mammography, and to determine predictors of malignancy among recalled asymmetries.
This retrospective study first determined recall rates associated with one-view asymmetries for screening mammograms performed by DBT and FFDM from July 14, 2016 through July 14, 2020. Further analyses included patients recalled for a one-view asymmetry who completed subsequent diagnostic workup and all recommended follow-up. Patient and cancer characteristics were extracted from the electronic health record.
Recall rate associated with asymmetries was lower for screening by DBT (3169/128,755 2.5%) than FFDM (815/23,898 3.4%) (p<.001). Further analyses of patients who completed diagnostic workup and subsequent follow-up included 3119 patients (mean age, 57 years) for DBT and 811 patients (56 years) for FFDM. Distribution of final BI-RADS categories from subsequent diagnostic workup was not different between the two modalities (p>.99). Frequency of malignancy was not different between asymmetries recalled from DBT 54/3119 (1.7%) and FFDM (14/811) (1.7%) (p>.99). Malignant asymmetries identified on FFDM versus DBT were more frequently associated with architectural distortion on diagnostic workup 5/14 (36%) vs 5/54 (9%), p<.001; and were more commonly invasive ductal carcinoma (93% vs 57%) and less commonly invasive lobular carcinoma (0% vs 24%) (p=.05). In multivariable analysis, independent predictors of malignancy among recalled asymmetries on DBT were age (55-69 years, odds ratio (OR)=2.40, p=.04; ≥70 years, OR=7.93, p<.001; reference: <55 years), and breast density (not dense breasts, OR=2.47, p=.001; reference: dense breasts).
Recalled asymmetries were less frequent for DBT than FFDM. Malignancy rate was low for both modalities (1.7%). Age ≥55 and lower breast density predicted malignancy for DBT-recalled asymmetries.
Our results support use of DBT to reduce unnecessary recalls without altering PPV for asymmetry-associated malignancies. Patient factors should be considered when assessing whether a potential asymmetry on DBT screening represents overlapping fibroglandular tissue or a suspicious finding requiring diagnostic workup.
Among 707 women who were recommended to undergo annual diagnostic mammography (DM) surveillance after lumpectomy for breast cancer, 94.9%, 90.4%, and 84.3% of women presented for DM at years 1, 2, ...and 3 after lumpectomy. A total of 18.8%, 11.0%, and 9.9% of women received additional views at years 1, 2, and 3, compared with the 10.1% institutional screening recall rate. The postlumpectomy year 3 cancer detection rate of 11.7 cancers per 1000 DM examinations was below DM benchmarks. These preliminary findings suggest that returning to screening mammography may be acceptable after 1 year of postlumpectomy DM follow-up.
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