Evaluation Of Breast Disease Research Articles

The Research Progress of Cone-Beam Breast Computed Tomography in Clinical Application

Cone-beam breast computed tomography (CBBCT) is a specialized imaging modality for breast examination that can generate high-resolution three-dimensional images with 3D isotropic resolution. This method has high sensitivity and better displays breast cancer lesions and microcalcifications, especially in the dense breast. When combined with CBBCT plain and enhanced scans, the efficiency of diagnosis and treatment can be further improved. Enhanced CT scans provide a better display of the morphological characteristics of tumor lesions, surrounding tissues, and blood vessels, thereby providing more comprehensive diagnostic information. The imaging manifestations of breast cancer on CBBCT are closely related to the molecular subtypes and immunohistochemical receptor status of the tumor. By incorporating imaging characteristics, the molecular subtypes, and the status of immunohistochemical receptors of breast cancer, the diagnosis and evaluation of the disease can be predicted and assessed accurately. In recent years, CBBCT has shown great potential in the diagnosis and evaluation of breast cancer. This article provides a review of the operational characteristics of cone beam breast CT and the recent research progress in the diagnosis and evaluation of breast diseases.

A prospective evaluation of breast thermography enhanced by a novel machine learning technique for screening breast abnormalities in a general population of women presenting to a secondary care hospital.

Artificial intelligence-enhanced breast thermography is being evaluated as an ancillary modality in the evaluation of breast disease. The objective of this study was to evaluate the clinical performance of Thermalytix, a CE-marked, AI-based thermal imaging test, with respect to conventional mammography. A prospective, comparative study performed between 15 December 2018 and 06 January 2020 evaluated the performance of Thermalytix in 459 women with both dense and nondense breast tissue. Both symptomatic and asymptomatic women, aged 30-80 years, presenting to the hospital underwent Thermalytix followed by 2-D mammography and appropriate confirmatory investigations to confirm malignancy. The radiologist interpreting the mammograms and the technician using the Thermalytix tool were blinded to the others' findings. The statistical analysis was performed by a third party. A total of 687 women were recruited, of whom 459 fulfilled the inclusion criteria. Twenty-one malignancies were detected (21/459, 4.6%). The overall sensitivity of Thermalytix was 95.24% (95% CI, 76.18-99.88), and the specificity was 88.58% (95% CI, 85.23-91.41). In women with dense breasts (n = 168, 36.6%), the sensitivity was 100% (95% CI, 69.15-100), and the specificity was 81.65% (95% CI, 74.72-87.35). Among these 168 women, 37 women (22%) were reported as BI-RADS 0 on mammography; in this subset, the sensitivity of Thermalytix was 100% (95% CI, 69.15-100), and the specificity was 77.22% (95% CI, 69.88-83.50). Thermalytix showed acceptable sensitivity and specificity with respect to mammography in the overall patient population. Thermalytix outperformed mammography in women with dense breasts and those reported as BI-RADS 0.

Diagnostic Accuracy of MR Mammography in Comparison with Digital Mammography and Sonomammography

Background. Even though the sensitivity of contrast-enhanced breast magnetic resonance mammography (CE-MRM) is consistently high in the range of 94-100%, conventionally, digital mammography and sonomammography continue as standard imaging modalities for the detection and evaluation of breast disease.
 The objective of the study was to detect additional lesions that go undetected by routine digital mammography and sonomammography using CE-MRM.
 Materials and Methods. In a prospective study, 68 patients who came for screening diagnostic mammogram and had breast lesions of Breast Imaging-Reporting and Data System category 3-6 were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonomammography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral CE-MRM.
 Results. In this prospective study, we included 68 patients (mean age - 50.6 years, range - 30-73 years). A total of 74 lesions were evaluated. In detecting these lesions, digital mammography had a sensitivity of 40.0%, specificity of 100% and diagnostic accuracy of 63.5%. CE-MRM sensitivity was found to be 71.7%, specificity - 96.6% and diagnostic accuracy - 83.7%. Among the 27 additional lesions detected by CE-MRM, histopathological evaluation confirmed only 19, indicating the sensitivity of 100%, specificity of 85.4%, positive predictive value of 67.8%, negative predictive value of 100%, diagnostic accuracy of 89.2%.
 Conclusions. The diagnostic accuracy of CE-MRM was found to be 83.7%, with a specificity of 96.6%. CE-MRM detected 19 additional lesions that were undetected by either digital mammography or ultrasonography. CE-MRM is sensitive in detecting additional malignant lesions which are not detected by other imaging modalities.

Breast Imaging: Past and Present

AbstractBreast imaging has evolved over several decades; however, a significant leap has happened in the past couple of decades. Multiple modalities are available for the evaluation of breast diseases; Mammography, Digital Breast Tomosynthesis, Ultrasound, Magnetic Resonance Imaging (MRI), and Contrast Enhanced Mammography (CEM) are a few of the frequently used ones. Image-guided interventions have further evolved, core needle biopsy, vacuum-assisted biopsy, clip placements, and wire localization to name a few. At times, it is difficult to choose between the modalities for disease evaluation and intervention. In this article, we have tried to cover in brief the evolution of breast imaging over years and have discussed the imaging approach to some frequent clinical presentations along with the approach to the evaluation of mammography.

The use of telemedicine to maintain breast cancer follow‐up and surveillance during the COVID‐19 pandemic

As a result from restricted economic activities and social distancing due to the coronavirus disease-2019 (COVID-19) pandemic, we observed a 49.4% decrease in outpatient appointments at our Institution. to minimize this impact on screening and oncological follow-up of breast cancer patients, telemedicine appointments were established. The authors demonstrate how a cancer center in the largest city in Brazil has managed outpatient appointments during the COVID-19 pandemic. This is a retrospective study of patients who had their appointments through telemedicine at the AC Camargo Cancer Center between June 2020 and October 2020, during the COVID-19 pandemic. Of the 77 patients who had telemedicine appointments, 36 (46.8%) accounted for breast cancer follow-up, 20 (26%) for breast cancer screening, 10 (13%) for benign breast disease evaluation, 7 (9%) for a second opinion, and 4 (5.2%) for general orientations. Routine surveillance/follow-up exams were requested for 45 (58.4%) patients and breast image exams and a request to return for a personal appointment for 30 (39%) patients. Two (2.6%) patients were requested to schedule a personal appointment immediately for a physical exam. In conclusion, telemedicine may be a feasible alternative to reduce personal outpatient appointments for cancer follow-up and breast cancer screening during the COVID-19 pandemic.

Application of Infrared Thermal Imaging in Breast Disease Detection

Breast diseases are a threat to the physical and mental health of women.The occurrence of breast cancer and mortality resulting from it ranks the highest among cancer cases in women.Hence,early detection and diagnosis of breast cancer becomes extremely important.Traditional structural imaging has some limitations in early detection of diseases,while infrared thermal imaging,as a functional imaging technology,can provide effective clues for early screening of breast cancer.This work mainly reviews the usefulness of employing infrared thermal imaging in the early detection and prognosis evaluation of breast diseases.

Clinico-Radiological and Pathological Correlation of Breast Lesions in Patients Presenting to a Tertiary Hospital in Western Nepal

INTRODUCTION: Breast masses are frequently encountered problem, especially in females. Mammography and ultrasound are considered the standard imaging techniques for detection and evaluation of breast disease. The study was done to discuss the role of mammography and ultrasound in evaluation of breast mases with cytological correlation and to compare the sensitivity, specificity, positive predictive value and negative predictive value of ultrasonography6 with mammography in breast masses in different age groups and in patients with different breast density.MATERIALS AND METHODS: It was a non randomized prospective study carried out in Manipal teaching hospital Pokhara. The data for study was collected from patients with breast lump who attended the department of Radiology during the period from October 2013 to October 2014. Mammography and ultrasonography were performed on all cases presented with breast lump. A Fine needle aspiration cytology correlation was then performed with formed the basis for definitive judgement.RESULTS: The study analyzed 50 total numbers of patients presented to Radiology department who had breast lumps. Patients were aged between 20 and 75 years. Maximum numbe3r of patients were between 40 and 49 yrs constituting 40%. The mean age was 39.8 years ± 12.85 yrs. Ultrasound was significantly more sensitive than mammography in age less than 40 years. Mammogram had a significantly higher sensitivity than ultrasound in age group of more than 40 yrs. By using combined modalities (ultrasonography combined with mammogram), all benign cases were diagnosed correctly. For malignant breast masses, 10% were diagnosed as false negative but no cases were diagnosed false positive by combined modalities. Ultrasound was more sensitive than mammography in dense and heterogeneously dense breast whereas mammography was more sensitive than ultrasound in predominantly fatty breast.CONCLUSION: Combination of ultrasound and mammogram is more sensitive than other modality alone.Journal of Universal College of Medical Sciences, Vol. 5, No. 2, 2017, Page: 40-44

Magnetic Resonance Imaging of the Breast.

Magnetic resonance imaging (MRI) is an imaging modality that is complementary to mammography and ultrasound in the evaluation of breast disease. It has demonstrated utility in many clinical scenarios, and shows promise in others. In this chapter, we discuss the indications and contraindications to MRI. We include information that is essential for the clinician to understand when considering a breast MRI for his patient.

The United States’ national accreditation program for breast centers: a model for excellence in breast disease evaluation and management

The evaluation and management of patients with breast disease have historically been disorganized and fragmented, leading to inefficiencies in patient flow and increased anxiety. The NAPBC was founded to address this deficiency and optimize the system. Evidence-based breast center standards were developed by a multinational, multidisciplinary Board and revised after pilot surveys. The Board defined 17 essential components in the continuum of care, available on site or referred. Physician surveyors were trained to conduct triennial site visits to assure compliance with standards. Correction of deficiencies is required within 12 months. Since the first accreditation award in late 2008, the NAPBC has grown rapidly. By the end of 2015, there will be 650 breast centers accredited by the NAPBC, with an additional 50 programs being scheduled for survey. Re-survey for continued accreditation occurs every 3 years. There has been minimal attrition. Survey results from our accredited centers indicate a high level of patient and facility satisfaction. Although only one foreign breast center has been NAPBC-accredited, and two scheduled for survey, the interest level is high. Thirty-two breast centers from 17 countries have requested information. The NAPBC provides an ideal model for facilities to render state of the art evaluation and treatment throughout the continuum of care for patients with breast disease. Accredited centers are afforded internal and external assessment of their performance based on recognized standards that demonstrate a commitment to quality care. The centers attain national recognition and public promotion. Patients, facilities and their providers are the ultimate beneficiaries.

Digital Breast Tomosynthesis: Principles and Practice

Digital breast tomosynthesis (DBT) has shown improved breast cancer detection and reduction in recall rates in comparison to full-field digital mammography on many recent clinical trials. This article will provide an analysis of some of the DBT research to date regarding the benefits this technology affords for breast cancer detection, as well as review recent DBT technology updates, such as the synthetic view (C-view) and DBT-guided biopsy. This article will assess the current utilization of DBT for breast cancer screening, as well as its use in the diagnostic evaluation of breast disease. The limitations of the technology, such as the visualization and characterization of calcifications, will be discussed, as well as how the technology may change in the future.

Evaluation of breast disease by clinical breast examination (CBE): Experience of a tertiary care hospital

Introduction: Breast cancer is the second most common cancer (10.4 % of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death in the world. In 2005, breast cancer caused 502,000 deaths worldwide. Clinical evaluation could function as a valuable diagnostic tool. Clinical evaluation, however, is a simple method to detect cases as it is inexpensive and non-invasive and if found to be accurate, might be of great value.Aim: To evaluate patients referred to colposcopy clinic in BSMMU for breast symptoms by clinical breast examination (CBE).Material and method: The study design was cross sectional study done in the colposcopy clinic in the department of Obstetrics and Gynaecology, under the ‘Establishment of National centre for cervical and breast cancer screening and training at BSMMU’ and ‘Cervical and breast cancer screening and training in BSMMU’ projects.Result: A total of 752 patients fulfilled the inclusion criteria , demographic features are demonstrated in mean age of the patients was 35.1±9.2 years, mean BMI was 22.5±2.1, about 30% subjects were postmenopausal and about 2% patients had history of breast cancer. Presenting complaint was a self-detected breast mass and found to have a mass on examination by her physician in 204 patients. 308 subjects complained of mastalgia; 34 patients complained of nipple discharge. Only 5 patients complained of axillary lymph node enlargement. Nipple abnormalities like retracted and cracked nipple was complained by 4% cases. Most patients (58%) were found to have normal findings. Palpable mass was found in 121 cases and bilateral in one case. Nipple abnormalities found in 10 cases. Tenderness and nipple discharge found in 15% and 4% cases respectively. Regarding the characteristics of the masses proved by cytology (FNAC), 109 were benign and 12 were malignant.Conclusion: CBE is an important screening procedure to identify breast pathology. Out of 752 patients breast pathology were identified in about 41% of patients and 10% breast lumps were malignant. So CBE should be done every three yearly in <40 and yearly in above 40 years women.J. Paediatr. Surg. Bangladesh 5(1): 20-24, 2014 (January)

Breast Intervention: How I Do It

Breast imaging has undergone many changes since the early years of mammography. Screening mammography is credited with contributing to the substantial decrease in breast cancer mortality through early detection. Screening mammography programs allow depiction of nonpalpable, suspicious findings requiring histologic evaluation, but most of which eventually are proved benign. Widespread acceptance of percutaneous breast biopsy techniques represents the most important practice-changing development in breast imaging. The radiologist now plays a vital role not only in the detection and evaluation of breast disease, but also in the diagnosis and management of breast cancer. Descriptions of the advantages of percutaneous breast biopsy and the techniques of performing breast intervention are the focus of this review.

Study of apparent diffusion coefficient value in breasts of different ages and different menstrual phases

Objective To analyze the differences of ADC values in breasts of women of different ages and different menstrual phases, so as to direct the choice of the examination time of MR DWI. MethodsThe breasts of 65 healthy volunteers were scanned with the routine MRI plain scan and DWI in the menstrual, proliferative and secretary phases. DWI was conducted with single shot echo planar imaging technique and b value were 0, 1000 s/mm2. The women were divided into three groups: Group 1(aged 20 to 29 years, 21 cases), Group 2 (aged 30 to 39, 21cases), and Group 3 (aged 40 to 49, 23 cases). The ADC values of all 130 breasts at nipple level in the different phases were measured. The ADC values in the three age groups and in the different menstrual phases were compared using ANOVA. Results The mean ADC values of Group 1 were (2.14±0.14) ×10-3, (2.03±0.18) ×10-3and (2.10±0.19)×10-3mm2/s for left breast, and (2.08±0.17) ×10-3, (2.02±0.16) ×10-3and (2.09±0.17) ×10-3mm2/s for right breast in the menstrual, proliferative and secretary phases. They were slightly higher than Group 3, which were (2.02±0.27) ×10-3, (1.97±0.25) ×10-3and (2.03±0.22)×10-3 mm2/s for left breast and (1.99±0.29) ×10-3, (1.93±0.26) ×10-3and (2.03±0.28)×10-3 mm2/s for right breast. The mean ADC values of Group 2 [left breast: (1.94±0.25) ×10-3, (1.91±0.21) ×10-3and (1.97±0.21)×10-3 mm2/s ; right breast: (1.97±0.26)×10-3, (1.89±0.25)×10-3and (1.96±0.22)×10-3 mm2/s) were the lowest among the three age groups. There were significant differences in different menstrual phases (F= 23.600, P＜0.01), but no statistical difference was found among the three age groups or between left breasts and right breasts (F= 1.683, 2.248;P＞0.05).Conclusions The mean ADC values of breasts decrease markedly in the proliferative phase.The effects of the menstrual cycle on the breast ADC values should be considered in the evaluation of breast diseases with DWI. Key words: Breast; Diffusion magnetic resonance imaging; Menstrual cycle

FDG PET/CT for the Detection and Evaluation of Breast Diseases: Usefulness and Limitations

Positron emission tomography (PET) with fluorine 18 fluorodeoxyglucose (FDG) is used to diagnose, stage, and monitor breast cancer. FDG PET has the capability to depict abnormal metabolic activity before any anatomic change occurs; however, in the absence of identifiable anatomic structures on PET images, it may be impossible to identify the location of areas of increased radionuclide uptake. In such cases, the coregistration of PET images with images from computed tomography (CT) may help improve diagnostic accuracy and lead to better clinical management of patients with breast cancer. Although FDG PET/CT may have limited diagnostic value for detecting small primary breast tumors, well-differentiated breast cancer, or regional lymph node involvement, it is superior to conventional imaging modalities for detecting distant metastases and recurrences and for monitoring the response to therapy.

Breast MRI: State of the Art

Magnetic resonance imaging (MRI) of the breast has emerged as a useful adjunct in evaluation of breast disease. For the past 25 years its use has been explored extensively in the literature and specific clinical indications have been developed. This review will address the current state of the art of breast MRI, including image acquisition, interpretation, limitations, and current applications. We also will discuss briefly emerging techniques that may further advance the practice of breast MRI evaluation.

“You’ve got mail!”: The role of e-mail in clinical breast surgical practice

Easy Internet access is changing the practice of medicine in the US. At least 137 million Americans have access to the World Wide Web, and up to one-half would like to communicate with their physicians by e-mail. The membership of the American Society of Breast Surgeons was surveyed to evaluate the current role of e-mail in patient-doctor relationships. Due to the extensive discussions often involved in the evaluation of breast disease, and the elective nature of most surgical procedures, this specialty may be particularly well-suited to using e-mail communication as an extension of discussions during traditional office visits. A questionnaire was e-mailed to all members of the ASBS who had provided an e-mail address. About 1236 questionnaires were sent, and 285 surgeons responded, a 23% response rate. About 130 (46%) responders were female; 209 responders (73%) did not use e-mail to communicate with patients (76% of responding females, 70% of males). The oldest and youngest surgeons were least likely to use e-mail to communicate with patients. There was no gender-related difference in e-mail use. There was no difference in e-mail use between surgeons who limit their practice to breast disease and those who do not. Urban and university-based surgeons were more likely to use e-mail. Medical-legal liability concerns and confidentiality issues were the most common reasons for not using e-mail. Among those surgeons who did use e-mail, ability to answer at one's own discretion, and the ability to provide an organized response were the major reasons for using e-mail. Overall, the membership expressed a preference for personal interaction over electronic communication.

Accuracy of the “Triple Test” in the Diagnosis of Palpable Breast Masses in Saudi Females

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

An extended role for ultrasonographers in the evaluation of breast disease: initial experiences

An extended role for ultrasonographers in the evaluation of breast disease: initial experiences

Will there be a happy marriage between traditional histological evaluation of breast disease and molecular analysis?

Will there be a happy marriage between traditional histological evaluation of breast disease and molecular analysis?

Imaging and management of nonpalpable lesions of the breast

Mammography remains the primary imaging modality for the evaluation of breast disease. Its performance level is clearly related to strict quality control measures and comprehensive diagnostic imaging. Ultrasonography remains an adjunct tool for analysing nonpalpable and palpable masses; diagnostic criteria for benign lesions must be strictly applied. Reliable histologic diagnosis is possible with percutaneous large needle core biopsies; benign findings should always be correlated with imaging data and follow-up is essential to detect delayed false negatives. MR imaging is still under evaluation for most indications. Its high sensitivity and negative predictive value are of particular interest for the detection or elimination of breast cancer in selected populations.