Coverage Of Breast Tissue Research Articles

Current status of prepectoral breast reconstruction in Argentina.

Breast cancer is among the most common cancers diagnosed in women, affecting one in eight women per year. Immediate implant-based breast reconstruction has emerged as the predominant approach for postmastectomy reconstruction, with a growing preference for the direct-to-implant (DTI) method over the traditional tissue expander technique. While conventionally, implants were typically positioned beneath the pectoralis major muscle, recent advancements have paved the way for implant placement above the muscle, in the prepectoral plane. Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques can be combined with prepectoral breast reconstruction. The presence of sufficient fatty tissue coverage is considered one of the foremost independent factors influencing the success of immediate breast reconstruction and flap viability. DTI is a safe approach for prepectoral implant-based reconstruction with a number of advantages. However, careful patient selection and judicious assessment of flap perfusion help identify an appropriate subset of patients for prepectoral DTI reconstruction. Proposed breast tissue coverage classification (BTCC) and rigorous perfusion assessment techniques will aid to minimize postoperative complications and reconstruction failure. Based on the obtained range of coverage values (distance between the Cooper's ligaments and the skin) of preoperative digital mammogram evaluation, a three-type BTCC is as follows: Type 1: <1 cm (poor coverage), Type 2: between 1 and 2 cm (medium coverage), Type 3: >2 cm (good coverage). Prepectoral DTI reconstruction provides good results with complication rates similar to those of subpectoral techniques, eliminating breast animation. A meticulous surgical technique is essential to preserve the vascular network that guarantees the survival of the skin flap and nipple-areola complex (NAC). In the good coverage group (Type 3), an immediate DTI reconstruction could be safely performed. Aesthetic complications as rippling can occur if prepectoral implants are placed in Type 1 patients. Preoperative planning for prepectoral placement should not depend on breast volume, but on breast tissue coverage. Flap evaluation based on preoperative imaging measurements may be helpful when planning a conservative mastectomy. Patient selection, preoperative and intraoperative mastectomy flap evaluation, and modifications in implant technology play a critical role in this new and rapidly growing method for implant-based breast reconstruction.

Clinical breast exam training using tactually accurate computer simulation among healthcare providers in ghana

BackgroundThe incidence and prevalence of breast cancer continue to grow each year in sub-Saharan Africa. With limited access to diagnostic testing in this resource-limited area, clinical breast exams are a priority. Diversity in clinical breast exam skills contributes to misdiagnosis and delayed diagnosis of breast cancer. Computer-based simulation improves clinical breast exam skills and has the potential to improve patient outcomes. ObjectivesThis study aimed to evaluate the effectiveness of tactually accurate computer simulation on participants’ clinical breast exam competence, confidence, and intent to perform clinical breast exams in their practice. MethodsThis was a retrospective study design analyzing MammaCare® training data and web-based survey data from 34 healthcare providers, including midwives, nurses, physician assistants, and medical officers, employed at five clinics in Ghana. ResultsParticipants demonstrated clinical breast exam skill competence. With each successive training module, the participants increased palpation coverage of breast tissue and decreased the number of false positive lumps identified as well as accurately identified true positive lumps. Participants reported increased confidence and intent to perform clinical breast exams and inquire about risk factors and symptoms patients may be experiencing. ConclusionsClinical breast exam skills training using tactually accurate computer simulation was effective and appropriate for practicing healthcare providers. The training may promote enhanced screening practices and early detection of breast cancer.

A Randomised Clinical Feasibility Trial of a Breast Immobilisation Device: The SuPPORT 4 All Bra

AimsDespite the breast being a mobile organ, there is currently no standard suitable immobilisation device to optimise radiotherapy for women with larger breasts treated after a wide local excision. The SuPPORT 4 All (S4A) bra was co-designed with patients and radiotherapy professionals. The purpose of this study was to test the feasibility of using the S4A bra in the existing breast cancer radiotherapy pathway. Materials and methodsA randomised feasibility trial was conducted in a single institution; the primary feasibility endpoint was the recruitment of 50 participants. Efficacy endpoints were also tested, including assessment of skin reactions, dose to organs at risk and patient comfort. Fifty women were randomised to receive either standard radiotherapy with no immobilisation (control) or radiotherapy with the S4A bra (intervention). A separate planning study was undertaken on the cases randomised to receive the S4A bra. Participants in the intervention arm (S4A bra) underwent two planning computed tomography scans, one with the bra on and one without the bra; allowing direct comparison of organs at risk data for S4A bra versus no bra. ResultsAll women who started radiotherapy wearing the S4A bra completed treatment with the bra; patient comfort did not change across the 3 weeks of treatment. Positional accuracy using the bra was comparable with existing published accuracy for methods without immobilisation. The mean ipsilateral lung doses showed some improvement when positioning with the S4A bra was compared with the no bra set-up (3.72 Gy versus 4.85 Gy for right-sided cases, 3.23 Gy versus 3.62 Gy for left-sided cases). ConclusionsThe S4A bra is feasible to use in the radiotherapy pathway with good patient adherence. The S4A bra has potential to reduce dose to organs at risk (specifically ipsilateral lung dose) while maintaining good breast tissue coverage, and improved patient dignity, warranting further investigation on a larger scale.

Improving Decision-making in Prepectoral Direct-to-implant Reconstruction After Nipple Sparing Mastectomy: The Key Role of Flap Thickness Ratio

We report our experience in direct-to-implant breast reconstruction with prepectoral polyurethane implants, with a focus on intraoperative mastectomy flap thickness compared to preoperative data (flap thickness ratio) as a reliable predictive variable of ischemic complications and reconstructive outcomes (satisfaction with breast). BackgroundThe optimization of nipple sparing mastectomy and implant-based reconstruction techniques led to an increase in the popularity of prepectoral reconstruction. The aim of this study is to explore the ratio between the intraoperative and preoperative breast tissue coverage assessment as reliable tool in order to predict the risk of ischemic complications in prepectoral reconstruction. MethodsWe analyzed 124 preoperative digital mammograms of 100 patients who underwent prepectoral implant-based reconstruction. We applied a Rancati modified score for breast tissue coverage classification, adding 4 measurements on the craniocaudal view. The intraoperative mastectomy flap thickness was measured using an intraoperative ultrasound assessment. We investigated the differences between the groups with and without ischemic complications related to the preoperative, intraoperative, and flap thickness ratio data. ResultsThe flap thickness ratio was lower in ischemic complication group compared to no ischemic complication group (0.4 vs. 0.8) with statistically significant differences for all ischemic complication subgroups: major mastectomy flap necrosis (P = .000), minor mastectomy flap necrosis (P = .005), partial nipple areola complex necrosis (P = .007), and implant exposure (P = .001).

First proof-of-concept evaluation of the FUSION-X-US-II prototype for the performance of automated breast ultrasound in healthy volunteers

PurposeThe FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the new prototype.MethodsIn this prospective feasibility study, the FUSION-X-US-II prototype was used to perform ABUS in 30 healthy volunteers without history of breast cancer. The ABUS images of the prototype were interpreted by a physician with specialization in breast diagnostics. Any detected lesions were measured and classified using BI-RADS® scores. Image quality was rated subjectively by the physician and coverage of the breast was measured. Patient comfort was evaluated by a questionnaire after the examination.ResultsOne hundred and six scans were performed (61 × CC, 23 × ML, 22 × MLO) in 60 breasts. Image acquisition and processing by the prototype was fast and accurate. Breast coverage by ABUS was approximately 90.8%. Sixteen breast lesions (all benign, classified as BIRADS® 2) were identified. The examination was tolerated by all patients.ConclusionThe FUSION-X-US-II prototype allows a rapid ABUS scan with mostly high patient comfort. Technical developments resulted in an improvement of quality and coverage compared to previous prototype versions. The results are encouraging for a test of the prototype in a clinical setting in combination with tomosynthesis.

Can Breast Compression Be Reduced in Digital Mammography and Breast Tomosynthesis?

The objective of this study was to investigate the impact of decreasing breast compression during digital mammography and breast tomosynthesis (DBT) on perceived pain and image quality. In this two-part study, two groups of women with prior mammograms were recruited. In part 1, subjects were positioned for craniocaudal (CC) and mediolateral oblique (MLO) views, and four levels of compression force were applied to evaluate changes in breast thickness, perceived pain, and relative tissue coverage. No imaging was performed. In part 2, two MLO DBT images of one breast of each patient were acquired at standard and reduced compression. Blurring artifacts and tissue coverage were judged by three breast imaging radiologists, and compression force, breast thickness, relative tissue coverage, and perceived pain were recorded. Only the first reduction in force was feasible because further reduction resulted in inadequate breast immobilization. Mean force reductions of 48% and 47% for the CC and MLO views, respectively, resulted in a significantly reduced perceived pain level, whereas the thickness of the compressed breast increased by 0.02 cm (CC view) and 0.09 (MLO view, part 1 of the study) and 0.38 cm (MLO view, part 2 of the study), respectively, with no change in tissue coverage or increase in motion blurring. Mammography and DBT acquisitions may be possible using half of the compression force used currently, with a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage.

Direct to Implant Reconstruction in Nipple Sparing Mastectomy: Patient Selection by Preoperative Digital Mammogram.

Background:Digital mammography clearly distinguishes gland tissue density from the overlying nonglandular breast tissue coverage, which corresponds to the existing tissue between the skin and the superficial layer of the fascia superficialis surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning and reducing the rate of necrotic complications after direct to implant (DTI) reconstruction in nipple sparing mastectomy (NSM).Methods:Thirty NSMs in 22 patients with type 3 tissue coverage (subcutaneous tissue thickness of 2 cm or more) were selected for DTI reconstruction after NSM to evaluate immediate skin flap/nipple areola complex ischemic complications and patient satisfaction.Results:We experienced no wound healing problems or ischemic complications immediately after surgery in our population. Only 1 seroma was observed as a short-term complication. Quality of life and patients’ satisfaction level were optimal at 3 and 6 months follow-up, respectively. The aesthetic results have been evaluated as good/excellent in all cases.Conclusions:DTI immediate reconstruction with silicone implants following NSM appears to be a safe option in selected cases with enough tissue coverage, also providing a high level of patient satisfaction. The possibility of selecting cases for this procedure according to the preoperative digital mammogram showing more than 2 cm of superficial tissues thickness may help reducing the risk of immediate ischemic complications.

WE-FG-207A-03: Low-Dose Cone-Beam Breast CT: Physics and Technology Development

WE-FG-207A-03: Low-Dose Cone-Beam Breast CT: Physics and Technology Development

WE-FG-207A-02: Why We Need Breast CT? - Clinical Perspective

WE-FG-207A-02: Why We Need Breast CT? - Clinical Perspective

WE-FG-207A-04: Performance Characteristics of Photon-Counting Breast CT

WE-FG-207A-04: Performance Characteristics of Photon-Counting Breast CT

WE-FG-207A-00: Advances in Dedicated Breast CT

WE-FG-207A-00: Advances in Dedicated Breast CT

WE-FG-207A-01: Introduction to Dedicated Breast CT - Early Studies

WE-FG-207A-01: Introduction to Dedicated Breast CT - Early Studies

WE-FG-207A-05: Dedicated Breast CT as a Diagnostic Imaging Tool: Physics and Clinical Feasibility

WE-FG-207A-05: Dedicated Breast CT as a Diagnostic Imaging Tool: Physics and Clinical Feasibility

Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction.

Digital mammography clearly distinguishes gland tissue density from the overlying non-glandular breast tissue coverage, which corresponds to the existing tissue between the skin and the Cooper's ligaments surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning of the most adequate surgical techniques and reconstructive procedures for each case. This study aimed to describe the results of a retrospective study of 352 digital mammograms in 176 patients with different breast volumes who underwent preoperative conservative mastectomies. The breast tissue coverage thickness and its relationship with the breast volume were evaluated. The breast tissue coverage thickness ranged from 0.233 to 4.423 cm, with a mean value of 1.952 cm. A comparison of tissue coverage and breast volume revealed a non-direct relationship between these factors. Preoperative planning should not depend only on breast volume. Flap evaluations based on preoperative imaging measurements might be helpful when planning a conservative mastectomy. Accordingly, we propose a breast tissue coverage classification (BTCC).

Comparative study of breast tissue coverage in cone-beam breast CT versus digital mammography

Objective To evaluate the d breast tissue coverage of cone-beam breast computed tomography (CBBCT) compared with conventional digital mammography. Methods CBBCT scans and digital mammography in 96 patients (141 breasts) over the age of 35 were prospectively assessed in the study. CBBCT scans were performed within 1 week after digital mammography. Superior, inferior, medial, lateral, posterior coverage of breast tissue in CBBCT and digital mammography were evaluated, respectively. It wasconsidered as positive if there was a breast coverage. McNemar test was used to assess differences in breast coverage between CBBCT and digital mammography. Results Within all the 141 cases, digital mammography covers the superior aspects in 141 cases (100.0%), inferior aspects in 88 cases (62.4%), medial aspects in 52 cases (36.9%), lateral aspects in 60 cases (42.6%), and posterior aspects in 17 cases (12.0%). CBBCT covers the superior aspects in 136 cases (96.4%), the inferior aspects in 136 cases (96.4%), the medial aspects in 129 cases (91.5%), the lateral aspects in 129 cases (91.5%), and the posterior aspects in 129 cases (91.5%). CBBCT had statistically significant better coverage than digital mammography in the inferior, medial, lateral, and posterior aspects (χ2 values were 42.48, 67.95, 60.05 and 108.08, respectively; all P values<0.01) regions. No statistically significant difference (χ2 value=3.20,P=0.074) was found in the superior aspects. Conclusion CBBCT has better breast tissue coverage than conventional digital mammography, especially in posterior aspects of breast tissues. Key words: Mammography; Cone beam computed tomography

The influence of patient positioning in breast CT on breast tissue coverage and patient comfort

Purpose: The presented study aimed at optimizing a patient table design for breast CT (BCT) systems with respect to breast tissue coverage and patient comfort. Additionally, the benefits and acceptance of an immobilization device for BCT using underpressure were evaluated. Materials and Methods: Three different study parts were carried out. In a positioning study women were investigated on an MRI tabletop with exchangeable inserts (flat and cone-shaped with different opening diameters) to evaluate their influence on breast coverage and patient comfort in various positioning alternatives. Breast length and volume were calculated to compare positioning modalities including various opening diameters and forms. In the second study part, an underpressure system was tested for its functionality and comfort on a stereotactic biopsy table mimicking a future CT scanner table. In the last study part, this system was tested regarding breast tissue coverage. Results: Best results for breast tissue coverage were shown for cone-shaped table inserts with an opening of 180 mm. Flat inserts did not provide complete coverage of breast tissue. The underpressure system showed robust function and tended to pull more breast tissue into the field of view. Patient comfort was rated good for all table inserts, with highest ratings for cone-shaped inserts. Conclusion: Cone-shaped tabletops appeared to be adequate for BCT systems and to allow imaging of almost the complete breast. An underpressure system proved promising for the fixation of the breast during imaging and increased coverage. Patient comfort appears to be adequate. Key points:

SU-D-204-03: A Study On the Impact of Decreased Breast Compression During Mammography On Perceived Pain, Breast Thickness and Tissue Coverage

Purpose: To investigate the impact of decreasing mechanical breast compression during mammography on perceived pain, compressed breast thickness and tissue coverage. Methods: In this IRB-approved, HIPAA-compliant study 72 women with prior mammograms were recruited to undergo positioning for both the cranio-caudal (CC) and medio-lateral oblique (MLO) views on a digital mammography/breast tomosynthesis system. One breast of each subject was compressed to four levels, including standard full compression for mammography. At each level of compression we recorded: (a) force in lb, (b) breast thickness in cm, (c) perceived pain (Rating: 0 (no-pain) -10 (severe pain)), and (d) relative tissue coverage. Video recording was used to document compression thickness and force displayed by the imaging system, in addition to the research technologist's and participant's voice input regarding the tissue coverage measured on an adhesive ruler placed on the breast and perceived pain rating, respectively. Results: On average, perceived pain to the subjects were reduced by 1.53 and 1.75 points in the CC and MLO views, respectively, in the pain ratings scale by reducing the compression force by one level, while the thickness of the compressed breast increased by an average of 0.02 and 0.09 cm, respectively. At this reduced compression step, there was no change in tissue coverage. Additional reductions in compression force resulted in 8.6% and 11.3% of compressions too low to adequately immobilize the breast, making them clinically impractical. Conclusion: Adequate CC and MLO view acquisitions may be possible with a reduction of compression force by approximately half, resulting in a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage. Considerably reducing the compression force used for mammography and breast tomosynthesis imaging and therefore reducing the pain perceived by the patients appears to be feasible. Ioannis Sechopoulos is consultant for Fuji Medical Systems USA.

The Influence of Patient Positioning in Breast CT on Breast Tissue Coverage and Patient Comfort.

The presented study aimed at optimizing a patient table design for breast CT (BCT) systems with respect to breast tissue coverage and patient comfort. Additionally, the benefits and acceptance of an immobilization device for BCT using underpressure were evaluated. Three different study parts were carried out. In a positioning study women were investigated on an MRI tabletop with exchangeable inserts (flat and cone-shaped with different opening diameters) to evaluate their influence on breast coverage and patient comfort in various positioning alternatives. Breast length and volume were calculated to compare positioning modalities including various opening diameters and forms. In the second study part, an underpressure system was tested for its functionality and comfort on a stereotactic biopsy table mimicking a future CT scanner table. In the last study part, this system was tested regarding breast tissue coverage. Best results for breast tissue coverage were shown for cone-shaped table inserts with an opening of 180 mm. Flat inserts did not provide complete coverage of breast tissue. The underpressure system showed robust function and tended to pull more breast tissue into the field of view. Patient comfort was rated good for all table inserts, with highest ratings for cone-shaped inserts. Cone-shaped tabletops appeared to be adequate for BCT systems and to allow imaging of almost the complete breast. An underpressure system proved promising for the fixation of the breast during imaging and increased coverage. Patient comfort appears to be adequate. Tissue coverage in breast CT is highly dependent on patient table design. An underpressure fixation system shows potential to increase breast coverage. The proposed breast CT patient table design combines good coverage and patient comfort.

MO-E-211-02: Breast MRI: Image Quality, Artifacts &amp; Quality Control

The quality of clinical breast MR images is influenced by the design and performance of the MR system, the breast coil, the breast MRI protocol, proper patient positioning, as well as patient-specific factors. MR system and coil quality control, protocol optimization, and technologist training are important to ensure high quality breast MR images. Common image quality issues encountered in clinical breast MR image include signal non-uniformity and inadequate breast tissue coverage, both of which can be influenced by the coil design. Inadequate fat or silicone saturation, wrap-around artifacts, and parallel imaging artifacts can often be minimized through technologist training. Breast MR protocol modification may be necessary to achieve improvements in signal-to-noise ratio (SNR), high contrast spatial resolution, or artifact reduction. Low SNR or non- uniform breast MR images may be coil performance related. Therefore it is important that breast coils be tested annually and whenever coil performance issues are suspected, as part of a comprehensive MR system quality control program. Educational objectives: 1. Describe common artifacts and image quality issues encountered in clinical breast MR images. 2. Discuss methods for addressing breast MR image quality problems. 3. Describe quality control procedures and accreditation programs specific to breast MRI.

Cone-Beam CT for Breast Imaging: Radiation Dose, Breast Coverage, and Image Quality

The primary objectives of this pilot study were to evaluate the radiation dose, breast coverage, and image quality of cone-beam breast CT compared with a conventional mammographic examination. Image quality analysis was focused on the concordance of cone-beam breast CT with conventional mammography in terms of mammographic findings. This prospective study was performed from July 2006 through August 2008. Twenty-three women were enrolled who met the inclusion criteria, which were age 40 years or older with final BI-RADS assessment category 1 or 2 lesions on conventional mammograms within the previous 6 months. The breasts were imaged with a flat-panel detector-based cone-beam CT system, and the images were reviewed with a 3D visualization system. Cone-beam breast CT image data sets and the corresponding mammograms were reviewed by three qualified mammographers. The parameters assessed and compared in this pilot study were radiation dose, breast tissue coverage, and image quality, including detectability of masses and calcifications. The mammograms and cone-beam breast CT images were independently reviewed side by side, and the reviewers were not blinded to the other technique. The observed agreement and Cohen's kappa were used to evaluate agreement between the mammographic and cone-beam breast CT findings and interobserver agreement. Each subject responded to a questionnaire on multiple parameters, including comfort of the cone-beam breast CT examination compared with mammography. For a conventional mammographic examination, the average glandular radiation dose ranged from 2.2 to 15 mGy (mean, 6.5 [SD, 2.9] mGy). For cone-beam breast CT, the average glandular dose ranged from 4 to 12.8 mGy (mean, 8.2 [SD, 1.4] mGy). The average glandular dose from cone-beam breast CT was generally within the range of that from conventional mammography. For heterogeneously dense and extremely dense breasts, the difference between the mean dose of conventional mammography and that of cone-beam breast CT was not statistically significant (7.0 vs 8.1 mGy, p = 0.06). Breast tissue coverage was statistically significantly better with cone-beam breast CT than with mammography in the lateral (p < 0.0001), medial (p < 0.0001), and posterior (p = 0.0002) aspects. Mammography had statistically significantly better coverage than cone-beam breast CT in the axilla and axillary tail (p < 0.0001). Overall, most calcifications and all masses detected with mammography were also detected with cone-beam breast CT. The interobserver agreement on cone-beam breast CT was 83.7% in the detectability of imaging findings. The overall interobserver agreement on type of findings, size of findings (<1, 1-4.99, and > or = 5 mm), and location of findings was 77.2%, 84.8%, and 78.3%, respectively. The results of this study show that cone-beam breast CT can be used to image the entire breast from chest wall to nipple with sufficient spatial and contrast resolution for detection of masses and calcifications at a radiation dose within the range of that of conventional mammography.