Early detection decreases breast cancer mortality. The ACR recommends annual mammographic screening beginning at age 40 for women of average risk. Higher-risk women should start mammographic ...screening earlier and may benefit from supplemental screening modalities. For women with genetics-based increased risk (and their untested first-degree relatives), with a calculated lifetime risk of 20% or more or a history of chest or mantle radiation therapy at a young age, supplemental screening with contrast-enhanced breast MRI is recommended. Breast MRI is also recommended for women with personal histories of breast cancer and dense tissue, or those diagnosed by age 50. Others with histories of breast cancer and those with atypia at biopsy should consider additional surveillance with MRI, especially if other risk factors are present. Ultrasound can be considered for those who qualify for but cannot undergo MRI. All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.
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.
Computer-aided detection identifies suspicious findings on mammograms to assist radiologists. Since the Food and Drug Administration approved the technology in 1998, it has been disseminated into ...practice, but its effect on the accuracy of interpretation is unclear.
We determined the association between the use of computer-aided detection at mammography facilities and the performance of screening mammography from 1998 through 2002 at 43 facilities in three states. We had complete data for 222,135 women (a total of 429,345 mammograms), including 2351 women who received a diagnosis of breast cancer within 1 year after screening. We calculated the specificity, sensitivity, and positive predictive value of screening mammography with and without computer-aided detection, as well as the rates of biopsy and breast-cancer detection and the overall accuracy, measured as the area under the receiver-operating-characteristic (ROC) curve.
Seven facilities (16%) implemented computer-aided detection during the study period. Diagnostic specificity decreased from 90.2% before implementation to 87.2% after implementation (P<0.001), the positive predictive value decreased from 4.1% to 3.2% (P=0.01), and the rate of biopsy increased by 19.7% (P<0.001). The increase in sensitivity from 80.4% before implementation of computer-aided detection to 84.0% after implementation was not significant (P=0.32). The change in the cancer-detection rate (including invasive breast cancers and ductal carcinomas in situ) was not significant (4.15 cases per 1000 screening mammograms before implementation and 4.20 cases after implementation, P=0.90). Analyses of data from all 43 facilities showed that the use of computer-aided detection was associated with significantly lower overall accuracy than was nonuse (area under the ROC curve, 0.871 vs. 0.919; P=0.005).
The use of computer-aided detection is associated with reduced accuracy of interpretation of screening mammograms. The increased rate of biopsy with the use of computer-aided detection is not clearly associated with improved detection of invasive breast cancer.
To retrospectively determine the mammographic characteristics of cancers missed at screening mammography and assess the ability of computer-aided detection (CAD) to mark the missed cancers.
A ...multicenter retrospective study accrued 1,083 consecutive cases of breast cancer detected at screening mammography. Prior mammograms were available in 427 cases. Of these, 286 had lesions visible in retrospect. The 286 cases underwent blinded review by panels of radiologists; a majority recommended recall for 112 cases. Two experienced radiologists compared prior mammograms in 110 of these cases with the subsequent screening mammograms (when cancer was detected), noting mammographic characteristics of breast density, lesion type, size, morphology, and subjective reasons for possible miss. The prior mammograms were then analyzed with a CAD program.
There were 110 patients with 115 cancers. On the prior mammograms with missed cancers, 35 (30%) of the 115 lesions were calcifications, with 17 of 35 (49%) clustered or pleomorphic. Eighty of the 115 (70%) were mass lesions, with 32 of 80 (40%) spiculated or irregular. For calcifications and masses, the most frequently suggested reasons for possible miss were dense breasts (12 of 35; 34%) and distracting lesions (35 of 80; 44%), respectively. CAD marked 30 (86%) of 35 missed calcifications and 58 (73%) of 80 missed masses.
Detection errors affected cases with calcifications and masses. CAD marked most (77%; 88 of 115) cancers missed at screening mammography that radiologists retrospectively judged to merit recall.
Although there currently is no evidence of reduced breast cancer mortality for screening women at high risk with mammography, magnetic resonance (MR) imaging, or ultrasonography (US), the presumptive ...evidence of early cancer detection provided by numerous observational studies has led to the publication of guidelines and recommendations for the selective use of these imaging modalities. In general, annual screening mammography is recommended for women of appropriately high risk beginning at age 30 years, supplemental screening with MR imaging is recommended for a subset of women at very high risk, and screening US is suggested for women for whom MR imaging is appropriate but unavailable, impractical, or poorly tolerated. The use of screening US remains controversial among women who have no substantial risk factors other than dense breasts.
The ACR BI-RADS experience: learning from history Burnside, Elizabeth S; Sickles, Edward A; Bassett, Lawrence W ...
Journal of the American College of Radiology,
12/2009, Letnik:
6, Številka:
12
Journal Article
Recenzirano
Odprti dostop
The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice ...reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.
To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of ...performance benchmarks for screening mammography.
Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV(1)), biopsy recommendation (PPV(2)), biopsy performed (PPV(3)), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th, 75th, and 90th percentiles and as graphic presentations by using smoothed curves.
There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to >/=80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%-13.3%; PPV(1), 4.8% and 3.4%-6.2%; and PPV(2), 24.6% and 18.8%-32.0%. Mean cancer detection rate was 4.7 per 1000, and the median corrected mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented.
Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate.
To determine the false-negative rate in screening mammography, the capability of computer-aided detection (CAD) to identify these missed lesions, and whether or not CAD increases the radiologists' ...recall rate.
All available screening mammograms that led to the detection of biopsy-proved cancer (n = 1,083) and the most recent corresponding prior mammograms (n = 427) were collected from 13 facilities. Panels of radiologists evaluated the retrospectively visible prior mammograms by means of blinded review. All mammograms were analyzed by a CAD system that marks features associated with cancer. The recall rates of 14 radiologists were prospectively measured before and after installation of the CAD system.
At retrospective review, 67% (286 of 427) of screening mammography-detected breast cancers were visible on the prior mammograms. At independent, blinded review by panels of radiologists, 27% (115 of 427) were interpreted as warranting recall on the basis of a statistical evaluation index; and the CAD system correctly marked 77% (89 of 115) of these cases. The original attending radiologists' sensitivity was 79% (427 of 427 + 115). There was no statistically significant increase in the radiologists' recall rate when comparing the values before (8.3%) with those after (7.6%) installation of the CAD system.
The original attending radiologists had a false-negative rate of 21% (115 of 427 + 115). CAD prompting could have potentially helped reduce this false-negative rate by 77% (89 of 115) without an increase in the recall rate.
To evaluate a range of performance parameters pertinent to the comprehensive auditing of diagnostic mammography examinations, and to derive performance benchmarks therefrom, by pooling data collected ...from large numbers of patients and radiologists that are likely to be representative of mammography practice in the United States.
Institutional review board approval was met, informed consent was not required, and this study was Health Insurance Portability and Accountability Act compliant. Six mammography registries contributed data to the Breast Cancer Surveillance Consortium (BCSC), providing patient demographic and clinical information, mammogram interpretation data, and biopsy results from defined population-based catchment areas. The study involved 151 mammography facilities and 646 interpreting radiologists. The study population included women 18 years of age or older who underwent at least one diagnostic mammography examination between 1996 and 2001. Collected data were used to derive mean performance parameter values, including abnormal interpretation rate, positive predictive value (for abnormal interpretation, biopsy recommended, and biopsy performed), cancer diagnosis rate, invasive cancer size, and the percentages of minimal cancers, axillary node-negative invasive cancers, and stage 0 and I cancers. Additional benchmarks were derived for these performance parameters, including 10th, 25th, 50th (median), 75th, and 90th percentile values.
The study involved 332,926 diagnostic mammography examinations. Mean performance parameter values were abnormal interpretation rate, 8.0%; positive predictive value for abnormal interpretation, 31.4%; positive predictive value for biopsy recommended, 31.5%; positive predictive value for biopsy performed, 39.5%; cancer diagnosis rate, 25.3 per 1000 examinations; invasive cancer size, 20.2 mm; percentage of minimal cancers, 42.0%; percentage of axillary node-negative invasive cancers, 73.6%; and percentage of stage 0 and I cancers, 62.4%.
The presented BCSC outcomes data and performance benchmarks may be used by mammography facilities and individual radiologists to evaluate their own performance for diagnostic mammography as determined by means of periodic comprehensive audits.
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