Improve Cancer Detection Rates Research Articles

Prior Negative Biopsy, PSA Density, and Anatomic Location Impact Cancer Detection Rate of MRI-Targeted PI-RADS Index Lesions.

MRI fusion prostate biopsy has improved the detection of clinically significant prostate cancer (CSC). Continued refinements in predicting the pre-biopsy probability of CSC are essential for optimal patient counseling. We investigated potential factors related to improved cancer detection rates (CDR) of CSC in patients with PI-RADS ≥ 3 lesions. The pathology of 980 index lesions in 980 patients sampled by transrectal mpMRI-targeted prostate biopsy across four medical centers between 2017-2020 was reviewed. PI-RADS lesion distribution included 291 PI-RADS-5, 374 PI-RADS-4, and 315 PI-RADS-3. We compared CDR of index PI-RADS ≥ 3 lesions based on location (TZ) vs. (PZ), PSA density (PSAD), and history of prior negative conventional transrectal ultrasound-guided biopsy (TRUS). Mean age, PSA, prostate volume, and level of prior negative TRUS biopsy were 66 years (43-90), 7.82 ng/dL (5.6-11.2), 54 cm3 (12-173), and 456/980 (46.5%), respectively. Higher PSAD, no prior history of negative TRUS biopsy, and PZ lesions were associated with higher CDR. Stratified CDR highlighted significant variance across subgroups. CDR for a PI-RADS-5 score, PZ lesion with PSAD ≥ 0.15, and prior negative biopsy was 77%. Conversely, the CDR rate for a PI-RADS-4 score, TZ lesion with PSAD < 0.15, and prior negative biopsy was significantly lower at 14%. For index PI-RADS ≥ 3 lesions, CDR varied significantly based on location, prior history of negative TRUS biopsy, and PSAD. Such considerations are critical when counseling on the merits and potential yield of prostate needle biopsy.

Conversations in Breast Cancer Screening: An Exploration of Age, Density, and Emerging Technologies

Breast Cancer remains a significant burden in Canada, reflecting global patterns as one of the most common cancers affecting women. In 2023, it was estimated that 26% of all new cancer cases among Canadian women were attributed to breast cancer, contributing to 13% of all cancer deaths in this group. Recent advancements in both detection and treatment of breast cancer have significantly improved cure rates, particularly when breast cancer is detected early. Early-stage breast cancer detected through screening can have a 5-year survival rate of 99%. Thus, the quest for early detection through effective and economical screening initiatives is a critical component in minimizing the burden of disease and reducing breast cancer-related mortality. However, ongoing dialogue continues within the medical community regarding the optimal timing of screening initiation for women at average risk. Discussion about the appropriate age to discontinue screening is an evolving topic. This conversation is complex and multifaceted, involving careful consideration of the intricate balance between the benefits of early detection, economic implications of population screening, and potential harms such as overdiagnosis and the psychological impact of false positives. Current Canadian guidelines, last updated in 2018, recommended mammography screening every 2–3 years for women aged 50–74 years, reflecting an expert consensus that considers both scientific evidence and population health needs. These guidelines are under revision with an update expected in 2024, while other major organizations have recently published new recommendations, reflecting the value of early detection at a younger age in the effort to minimize cancer deaths. Additionally, the efficacy of mammography alone as a screening modality in women with dense breast tissue, who constitute up to 43% of the screening population, has come into question.7,8 This challenge has catalyzed discussion around recommended supplementary screening modalities to improve cancer detection rates in women with dense breast tissue.9 This article explores the ongoing discourse on breast cancer screening recommendations for average-risk women, including the age at which to initiate and stop screening, imaging modalities, and emerging technologies.

Childhood Cancer in Cameroon and Kenya: Preliminary findings of an implementation effectiveness study for early detection of childhood cancer.

e23096 Background: Early childhood cancer detection reduces mortality, particularly in LMIC contexts where an improved understanding of early warning signs and symptoms (EWSS) and integration of vital referral pathways into existing health systems are crucial to improved childhood cancer outcomes. Our project seeks to adapt and implement a Ghanaian-developed EWSS intervention for Kenya and Cameroon using implementation science frameworks to move beyond the common but ineffective train-and-hope approach. Cameroon operates on a three-tiered sub-sector health system, with the intermediate level consisting of regional delegations that support districts1. In Kenya a six-tiered health system delivers primary care (1-2), mid-level care (3-4), advanced care with centers of excellence (5-6) 2. Health system contexts will inform implementation planning and execution. Methods: Health system stakeholders convened in each country to launch their EWSS initiative. Two-day meetings were collaboratively led by local stakeholders and the research team, guided by The Implementation Roadmap3, a multi-implementation framework resource. They discussed l) local barriers to childhood cancer detection, 2) referral pathways, 3) leadership and operational implementation teams, 4) sustainable EWSS training, and 4) target settings. Results: Stakeholders endorsed the EWSS program and identified individuals to form implementation teams to plan and execute implementation reflective of health system organization and realities. Both countries engaged in an evidence-based implementation planning process, reviewed EWSS core components and training logistics, and endorsed a sustainable tiered training model targeting clinicians and oncologists across system levels and institutional providers. Training content will be adapted for country, region, and county contexts. Both countries endorsed and identified district childhood cancer champions to facilitate training and coordinate timely referrals. Common implementation barriers identified included high healthcare worker turnover, transportation logistics for in-person training, and remuneration options for trainees. Conclusions: Health system leaders in Kenya and Cameroon endorsed an evidence-based EWSS implementation and sustainment approach and identified adaptations responsive to the health system contexts. Implementation will be locally led to ensure effectiveness, sustainability, and appropriate cultural EWSS adaptation. Moving forward, local implementation teams will work with researcher-facilitators to implement EWSS toward improved cancer detection rates.

Using an artificial intelligence platform to enhance cancer detection rates in primary care.

1560 Background: Patients with cancer who are diagnosed in a primary care setting have the best survival outcomes compared to any other route (e.g. Emergency department, routine referrals, incidental findings etc). This is primarily attributed to detection of cancer at an early stage. In the UK, the Cancer Detection Rate (CDR) metric serves as a measure of this, representing the percentage of cancer diagnoses originating from primary care referral routes. However, detecting cancer presents significant challenges, primarily due to the non-specific nature of cancer presentations, their tendency to overlap with symptoms of other conditions, and their relatively low prevalence. Artificial intelligence (AI) platforms may be able to support this endeavor but are yet to be established. C the Signs is an AI-enabled clinical decision support tool integrated into primary care practices to help clinicians stratify the risk of cancer and advise on which cancer pathway is most appropriate (if at all) for the patient’s presentation and history. Methods: An observational cohort study was undertaken between 1st May 2021 and 31st March 2022 where 35 practices (covering a population of almost 420,000) within the same geographic region in the East of England were offered the use of C the Signs, with the practices opting out as controls. All practices had the same access to referral and cancer diagnostic pathways within the region. The primary end point was to identify if C the Signs had a statistical impact on cancer detection rates in primary care through nationally linked data via Public Health England. Results: In practices utilizing C the Signs the CDR significantly increased from 58.7% in 2020-21 (prior to the implementation of C the Signs) to 66.0% in 2021-22, reflecting a significant increase of 12.3% (p &lt;0.05). In contrast, practices not using C the Signs maintained a stable CDR of 58.4% in both years. There was no statistically significant variance observed in the referral rate between the two groups, indicating no notable increase in diagnostic or referral activities. Conclusions: These findings underscore the importance of integrating cutting-edge technologies into primary care to improve cancer detection rates and facilitate early-stage diagnosis. Implementation of such advancements holds promise for reducing cancer-related mortality rates and enhancing overall patient outcomes.

New technologies for nephron-sparing surgery in upper urinary tract cancers.

Nephron-sparing surgery (NSS) is the preferred treatment in patients with low-risk upper tract urothelial carcinoma (UTUC). Improving both instruments and topical chemotherapy regimens efficacy is crucial to achieve better outcomes. The purpose of this review is to summarize the most recent evidence on technological advances for the conservative management of UTUC with implications on diagnosis and treatment. Novel diagnostic tools, lasers, and topical chemotherapy systems delivery have been implemented to optimize NSS outcomes for UTUC. Photodynamic ureteroscopy has been reported to improve cancer detection rate as compared with conventional imaging or ureteroscopy, especially in case of carcinoma in situ. However, refinements in photosensitizer administration and dedicated instruments are needed. The armamentarium of lasers for UTUC ablation is composed of several devices with peculiar characteristics. Together with Ho:YAG and Tm:YAG lasers, the Thulium Fiber Laser (TFL) is gaining momentum in UTUC ablation. Strengths and weaknesses of each laser must be considered to maximize oncological and safety outcomes. Several novel endocavitary chemotherapy delivery systems have been tested to reduce tumor recurrence and progression after NSS. Administration of gel-based chemotherapeutic agents has been proven to be effective in humans; conversely, drug-eluting ureteral stent systems are still conceptual.

Dying To Find Out: The Cost of Time at the Dawn of the Multicancer Early Detection Era.

Cancer is a significant burden worldwide that adversely impacts life expectancy, quality of life, health care costs, and workforce productivity. Although currently recommended screening tests for individual cancers reduce mortality, they detect only a minority of all cancers and sacrifice specificity for high sensitivity, resulting in a high cumulative rate of false positives. Blood-based multicancer early detection tests (MCED) based on next-generation sequencing (NGS) and other technologies hold promise for broadening the number of cancer types detected in screened populations and hope for reducing cancer mortality. The promise of this new technology to improve cancer detection rates and make screening more efficient at the population level demands the development of novel trial designs that accelerate clinical adoption. Carefully designed clinical trials are needed to address these issues.

Breast Cancer Classification by Gene Expression Analysis using Hybrid Feature Selection and Hyper-heuristic Adaptive Universum Support Vector Machine

Comprehensive assessments of the molecular characteristics of breast cancer from gene expression patterns can aid in the early identification and treatment of tumor patients. The enormous scale of gene expression data obtained through microarray sequencing increases the difficulty of training the classifier due to large-scale features. Selecting pivotal gene features can minimize high dimensionality and the classifier complexity with improved breast cancer detection accuracy. However, traditional filter and wrapper-based selection methods have scalability and adaptability issues in handling complex gene features. This paper presents a hybrid feature selection method of Mutual Information Maximization - Improved Moth Flame Optimization (MIM-IMFO) for gene selection along with an advanced Hyper-heuristic Adaptive Universum Support classification model Vector Machine (HH-AUSVM) to improve cancer detection rates. The hybrid gene selection method is developed by performing filter-based selection using MIM in the first stage followed by the wrapper method in the second stage, to obtain the pivotal features and remove the inappropriate ones. This method improves standard MFO by a hybrid exploration/exploitation phase to accomplish a better trade-off between exploration and exploitation phases. The classifier HH-AUSVM is formulated by integrating the Adaptive Universum learning approach to the hyper- heuristics-based parameter optimized SVM to tackle the class samples imbalance problem. Evaluated on breast cancer gene expression datasets from Mendeley Data Repository, this proposed MIM-IMFO gene selection-based HH-AUSVM classification approach provided better breast cancer detection with high accuracies of 95.67%, 96.52%, 97.97% and 95.5% and less processing time of 4.28, 3.17, 9.45 and 6.31 seconds, respectively.

Mamografija u screeningu karcinoma dojke

Mamografija u screeningu karcinoma dojke&#x0D; Autori: Mersiha Mehmedović1*, Semra Šeper1&#x0D; 1Klinički centar univerziteta u Sarajevu &#x0D; ABSTRAKT&#x0D; From the early 70s of the last century until today, huge progress has been made in the technological development of imaging methods for breast cancer screening, which includes imaging methods, methods of image analysis and optimization of image quality. The introduction of artificial intelligence has made it possible for devices to offer valuable information that helps with greater precision in diagnostic disciplines and the detection of changes that deserve the attention of medical staff.&#x0D; Objectives and methodology&#x0D; In the framework of the work, and in accordance with the analysis of available research, we present the advantages and disadvantages of available imaging modalities in breast cancer screening and prove that digital tomosynthesis provides the best results in breast cancer screening.&#x0D; By analyzing the available data and consulting the professional literature available on the PubMed service, we try to answer the following question:&#x0D; Is breast cancer screening with digital breast tomosynthesis (DTD) associated with improved cancer detection rates in all age groups and all breast density groups compared with digital mammography?&#x0D; Retrospective research was conducted by analyzing research published on PubMed in the last 10 years, with open access to information about the design and method of conducting the research and a description of the key aspects of the research conducted.&#x0D; Globally, in 2020, 2.3 million women were diagnosed with breast cancer, with 685,000 deaths per year. By the end of 2020, there were 7.8 million living women diagnosed with breast cancer in the last 5 years, making it the most common cancer in the world.&#x0D; According to the report Health status of the population, which was published by the Institute for Public Health of the Federation of Bosnia and Herzegovina in 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women. Although the Ministry's report emphasized a slight downward trend, other studies show that the age limit of women who develop this disease is decreasing. This emphasizes the importance of timely and early detection of the appearance of malignant neoplasms, at a time when the disease is best treated.&#x0D; Breast cancer is most often diagnosed in women aged 55 to 64, and the risk increases with age. Early diagnosis increases the patient's chances of achieving a cure and also reduces the morbidity of treatment. Breast cancer therapies continue to improve and have contributed to a reduction in mortality, but early diagnosis through mammographic screening has had a greater overall impact on mortality reduction.&#x0D; Breast cancer arises in epithelial cells of the ducts (85%) or lobules (15%) in the tissue of the mammary gland. Initially, a cancerous growth is confined to a duct or lobule ("in situ") where it generally causes no symptoms and has minimal potential for spread (metastasis). Over time, these in situ (stage 0) cancers can progress to invade the surrounding breast tissue (invasive breast cancer) and then spread to nearby lymph nodes (regional metastases) or to other organs in the body (distant metastases). If a woman dies from breast cancer, it is because of widespread metastases.&#x0D; Conclusion&#x0D; Globally, but also at the level of Bosnia and Herzegovina, breast cancer represents an important public health problem. According to the report of the Institute of Public Health of the Federation of Bosnia and Herzegovina from 2018, malignant neoplasms of the breast (C50) are among the leading causes of death from malignant neoplasms in women in the Federation of Bosnia and Herzegovina. Multiple studies have shown improved screening results with digital breast tomosynthesis, including lower recall rates and higher cancer detection rates, ranging from 1.6 cancers/1000 scans to 2.4 cancers/1000 scans. The use of DTD reduced the number of recalls for false positive findings on screening (15%-37%), which contributed to the improvement of specificity in the diagnostic evaluation. Numerous retrospective studies have shown that DTB increased cancer detection by 15-30%, and the radiation dose was higher by up to 20%. Based on the above-mentioned conclusions, we can conclude that we have proven that breast cancer screening by digital breast tomosynthesis is associated with improved cancer detection rates in all age groups and all groups of breast density compared to digital mammography.

Are contrast enhanced mammography and digital breast tomosynthesis equally effective in diagnosing patients recalled from breast cancer screening?

Full-field digital mammography (FFDM) is widely used in breast cancer screening. However, to improve cancer detection rates, new diagnostic tools have been introduced. Contrast enhanced mammography (CEM) and digital breast tomosynthesis (DBT) are used in the diagnostic setting, however their accuracies need to be compared.The aim of the study was to evaluate the diagnostic performance of CEM and DBT in women recalled from breast cancer screening program. The study included 402 consecutive patients recalled from breast cancer screening program, who were randomized into two groups, to undergo either CEM (202 patients) or DBT (200 patients). All visible lesions were evaluated and each suspicious lesion was histopathologically verified. CEM detected 230 lesions; 119 were classified as benign and 111 as suspicious or malignant, whereas DBT identified 209 lesions; 105 were classified as benign and 104 as suspicious or malignant. In comparison to histopathology, CEM correctly detected cancer in 43 out of 44 cases, and DBT in all 33 cases, while FFDM identified 15 and 18 neoplastic lesions in two groups, respectively. CEM presented with 97% sensitivity, 63% specificity, 70% accuracy, 38% PPV and 99% NPV, while DBT showed 100% sensitivity, 60% specificity, 32%, PPV, 100% NPV and 66% accuracy. The CEM's AUC was 0.97 and DBT's 0.99. The ROC curve analysis proved a significant (p<0.000001) advantage of both CEM and DBT over FFDM, however, there was no significant difference between CEM and DBT diagnostic accuracies (p=0.23). In this randomized, prospective study CEM and DBT show similar diagnostic accuracy.

Randomized trial of surveillance with abbreviated MRI in women with a personal history of breast cancer– impact on patient anxiety and cancer detection

BackgroundAbbreviated breast MRI (A-MRI) substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on psychological distress in women with a prior history of breast cancer (PHBC). This study aimed to determine if surveillance mammography (MG) plus A-MRI reduced psychological distress and if A-MRI improved cancer detection rates (CDR) as compared to MG alone.MethodsThis prospective controlled trial of parallel design was performed at a tertiary cancer center on asymptomatic women with PHBC who were randomized into two groups: routine surveillance with MG or intervention of MG plus A-MRI in a 1:1 ratio. Primary outcome was anxiety measured by four validated questionnaires at three different time-points during the study. Other parameters including CDR and positive predictive value for biopsy (PPV3) were compared between imaging modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety measures and Fisher’s exact test to compare imaging outcomes.ResultsOne hundred ninety-eight patients were allocated to either MG alone (94) or MG plus A-MRI (104). No significant group difference emerged for improvement in trait anxiety, worry and perceived health status (all Time-by-surveillance group interaction ps > .05). There was some advantage of A-MRI in reducing state anxiety at Time 2 (p < .05). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99 ± 4.6 with MG alone vs 51.73 ± 2.56 with MG plus A-MRI, p > 0.05) and did not change over time. A-MRI detected 5 invasive cancers and 1 ductal carcinoma in situ (DCIS), and MG detected 1 DCIS. A-MRI had higher incremental CDR (48/1000(5/104) vs MG 5/1000(1/198, p = 0.01)) and higher biopsy rates (19.2% (20/104) vs MG 2.1% (2/94), p < 0.00001) with no difference in PPV3 (A-MRI 28.6% (6/21) vs MG 16.7% (1/6, p > .05).ConclusionThere was no significant impact of A-MRI to patient anxiety or perceived health status. Compared to MG alone, A-MRI had significantly higher incremental cancer detection in PHBC. Despite a higher rate of biopsies, A-MRI had no demonstrable impact on anxiety, worry, and perceived health status.Trial registrationClinicalTrials.gov (NCT02244593). Prospectively registered on Sept. 14, 2014.

PD57-09 THE IMPORTANCE OF MRI-TARGETED BIOPSY FOR TUMORS IN ANTERIOR FIBROMUSCULAR STROMA

You have accessJournal of UrologyCME1 May 2022PD57-09 THE IMPORTANCE OF MRI-TARGETED BIOPSY FOR TUMORS IN ANTERIOR FIBROMUSCULAR STROMA Hayato Yamamoto, Teppei Okamoto, Toru Yoneyama, and Chikara Ohyama Hayato YamamotoHayato Yamamoto More articles by this author , Teppei OkamotoTeppei Okamoto More articles by this author , Toru YoneyamaToru Yoneyama More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002637.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior prostate cancers are frequently missed since they can be neither palpable nor tangible on physical examination. The objective of this study was to analyze the MRI/transrectal ultrasound-fusion biopsies to detect and to characterize significant prostate cancer in the anterior fibromuscular stroma (AFS) and in the transition zone of the prostate. METHODS: One hundred and fourteen patients underwent prebiopsy 3 T multi parametric (mp) MRI and transperineal biopsy between February 2019 and May 2021. MRI images were analyzed using PIRADS (Prostate Imaging-Reporting and Data System) ver 2. All patients had systematic biopsies and targeted biopsies with rigid software registration in case of MRI-suspicious lesions. RESULTS: The positive rates of systematic and targeted biopsies were 10% and 29%, respectively with a significant difference. The cancer occupancy rate of the biopsy specimens was higher in the targeted biopsy, 22.2% and 36.3%, respectively. There were AFS tumors in 23 of 114 patients, and they harbored 23 lesions (10%) in AFS on mpMRI. The positive rate of targeted biopsy by PI-RADs category was 77% for PI-RADs 5, 42% for PI-RADs 4, and 16% for PI-RADs 3. The positive rate by target region were 24%, 31%, and 83% for peripheral zone (PZ), transition zone (TZ), and AFS, respectively. Especially, in PIRADs category 3 region, the positive rate in AFS region was a high positivity rate of 100%. CONCLUSIONS: Targeted biopsy has improved cancer detection rates. However, we should also pay attention to lesions of low PIRADs category in the AFS region. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e964 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hayato Yamamoto More articles by this author Teppei Okamoto More articles by this author Toru Yoneyama More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF DownloadLoading ...

Synthetic Mammography: Review of Benefits and Drawbacks in Clinical Use.

Digital breast tomosynthesis (DBT) has been widely adopted as a breast cancer screening tool, demonstrating decreased recall rates and other improved screening performance metrics when compared to digital mammography (DM) alone. Drawbacks of DBT when added to 2D DM include the increased radiation dose and longer examination time. Synthetic mammography (SM), a 2D reconstruction from the tomosynthesis slices, has been introduced to eliminate the need for a separate acquisition of 2D DM. Data show that the replacement of 2D DM by SM, when used with DBT, maintains the benefits of DBT, such as decreased recall rates, improved cancer detection rates, and similar positive predictive values. Key differences between SM and 2D DM include how the image is acquired, assessment of breast density, and visualization of mammographic findings, such as calcifications. Although SM is approved by the Food and Drug Administration and has been shown to be non-inferior when used with DBT, concerns surrounding SM include image quality and artifacts. The purpose of this review article is to review the benefits, drawbacks, and screening performance metrics of SM versus DBT.

Deep learning in breast imaging.

Millions of breast imaging exams are performed each year in an effort to reduce the morbidity and mortality of breast cancer. Breast imaging exams are performed for cancer screening, diagnostic work-up of suspicious findings, evaluating extent of disease in recently diagnosed breast cancer patients, and determining treatment response. Yet, the interpretation of breast imaging can be subjective, tedious, time-consuming, and prone to human error. Retrospective and small reader studies suggest that deep learning (DL) has great potential to perform medical imaging tasks at or above human-level performance, and may be used to automate aspects of the breast cancer screening process, improve cancer detection rates, decrease unnecessary callbacks and biopsies, optimize patient risk assessment, and open up new possibilities for disease prognostication. Prospective trials are urgently needed to validate these proposed tools, paving the way for real-world clinical use. New regulatory frameworks must also be developed to address the unique ethical, medicolegal, and quality control issues that DL algorithms present. In this article, we review the basics of DL, describe recent DL breast imaging applications including cancer detection and risk prediction, and discuss the challenges and future directions of artificial intelligence-based systems in the field of breast cancer.

Impact of Race, Ethnicity, and Socioeconomic Status on Digital Breast Tomosynthesis Access and Use.

HomeRadiology: Imaging CancerVol. 3, No. 4 PreviousNext Research HighlightsFree AccessImpact of Race, Ethnicity, and Socioeconomic Status on Digital Breast Tomosynthesis Access and UseKenneth Wimmer, Kimberly RayKenneth Wimmer, Kimberly RayKenneth WimmerKimberly RayPublished Online:Jul 30 2021https://doi.org/10.1148/rycan.2021219013MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: To evaluate sociodemographic disparities regarding access to and use of digital breast tomosynthesis (DBT) for screening.■ Key Result: From 2011 to 2017, DBT access and use became more equitable across sociodemographic groups overall, but disparities were evident during early implementation and persisted throughout the study period for Black and Asian women, as well as women with less than a high school education and those living in rural areas.■ Impact: Efforts are needed to address barriers to DBT access and uptake among underserved women.In 2011, the Food and Drug Administration approved DBT, which has been shown in large, multicenter screening studies to improve cancer detection rates and decrease recall rates when compared to conventional two-dimensional mammography. DBT adoption has been hampered by equipment costs and inconsistent insurance coverage. Lee et al hypothesized that traditionally underserved populations have limited access to DBT and that these individuals would undergo DBT less frequently when available. The authors conducted a cross-sectional study of 2 313 118 screening examinations performed from 2011 to 2017 across 92 geographically diverse centers that are members of the Breast Cancer Surveillance Consortium. Of these examinations, 87.3% were performed in community settings unaffiliated with academic centers.Overall rates of DBT use were lower among Black (37.7%), Hispanic (44%), and Asian (42.8%) women relative to White women (53.1%). Women with lower educational attainment (defined as less than high school vs college level) and those who lived in zip codes with lower median income (defined as lowest vs highest income quartile) also demonstrated relatively lower DBT use rates (40.8% vs 50.6% and 43.9% vs. 51.4%, respectively). Disparities were most pronounced during the initial years of DBT adoption. For example, the relative risk of on-site DBT access for Black relative to White women was 0.05 (95% CI: 0.03, 0.11) in 2012, but increased during the study to peak at 1.28 (95% CI: 1.05, 1.56) in 2016. However, by the end of the study period, the authors observed persistent inequities in DBT access for Asian women, as well as women with less than a high school education and those living in rural areas.Interestingly, despite an improvement in DBT access over time, Black women consistently used DBT less than White women throughout the study period. This latter observation is especially salient as Black women are more likely than White women to present with advanced-stage breast cancer at the time of diagnosis. Thus, decreased DBT use by Black women may exacerbate existing racial disparities in breast cancer outcomes.Overall, the findings of the present study are consistent with prior studies showing that minorities and those of lower socioeconomic status experience delayed and diminished benefits from advanced imaging technologies. The ability to pay out-of-pocket and awareness of the relative benefits and risks of newer screening technologies are likely to influence DBT use. As practices continue to transition to offering DBT, results of this study should inform the efforts of radiology practices and policy makers to address barriers to DBT access and uptake among underserved populations.Highlighted ArticleLee, CI, Zhu, W, Onega, T, et al. Comparative access to and use of digital breast tomosynthesis screening by women's race/ethnicity and socioeconomic status. JAMA Netw Open 2021;4(2):e2037546. doi:https://doi.org/10.1001/jamanetworkopen.2020.37546Highlighted ArticleLee, CI, Zhu, W, Onega, T, et al. Comparative access to and use of digital breast tomosynthesis screening by women’s race/ethnicity and socioeconomic status. JAMA Netw Open 2021;4(2):e2037546. doi:10.1001/jamanetworkopen.2020.37546 Crossref, Medline, Google ScholarArticle HistoryPublished online: July 30 2021 FiguresReferencesRelatedDetailsRecommended Articles Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening PopulationRadiology2017Volume: 283Issue: 1pp. 70-76Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare InsuranceRadiology2022Volume: 306Issue: 2Addressing Racial Inequities in Access to State-of-the-Art Breast ImagingRadiology2022Volume: 306Issue: 2Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?Radiology2017Volume: 283Issue: 2pp. 371-380Racial Disparities in Digital Breast Tomosynthesis ScreeningRadiology: Imaging Cancer2021Volume: 3Issue: 4See More RSNA Education Exhibits Let’s Talk about Next-Generation Breast Cancer Screening Programs: How Should We Do? What Should We Use?Digital Posters2020Encouraging Mammography Screening: Strategies for Designing a Culturally and Linguistically Targeted Breast Cancer Educational Program for a Multicultural PopulationDigital Posters2018Developing a Personalized Breast Screening Program and Centralized Breast Imaging Center in a Community-Based Health Network: A How-To Guide with Clinical OutcomesDigital Posters2018 RSNA Case Collection Invasive Lobular CarcinomaRSNA Case Collection2021Breast edemaRSNA Case Collection2021Deodorant ArtifactRSNA Case Collection2021 Vol. 3, No. 4 Metrics Altmetric Score PDF download

Effect of training and individual operator's expertise on prostate cancer detection through prostate biopsy: Implications for the current quantitative training evaluation system.

PurposeThis study was conducted to evaluate the relevance of training and experience to gaining expertise in prostate biopsy based on an assessment of outcomes from the performance of urology residents.Materials and MethodsWe retrospectively reviewed the medical records of 10,299 patients who underwent prostate biopsy by 50 operators under a unified urology residency program. The number of prostate biopsies performed by an operator for each patient was used as an indicator of operator experience. Residents were grouped into quartiles according to cancer detection rates in the first 50 and the last 50 procedures.ResultsAmong 10,299 patients (median age, 67.5 years; median prostate-specific antigen [PSA], 7.04 ng/mL), the overall prostate cancer detection rate and that for patients with PSA <10.0 ng/mL were 37.0% and 25.9%, respectively. Operator experience was a significant predictor for cancer detection in patients with PSA <10.0 ng/mL. Cancer detection rates and the proportion of more advanced prostate cancers were higher in the last 50 cases than in the first 50 cases. Detection rates varied significantly among operator; residents with higher detection rates at training initiation showed even higher detection rates after additional training.ConclusionsTraining that adds to the cumulative experience of a trainee appears to play a meaningful role in improving cancer detection rates. The level of skill required to achieve mastery for independent practice may be assessed from the accuracy results of prostate biopsy procedures, and trainees with poor rates will require more technical training to improve precision.

Polarization-dependent second-harmonic generation for collagen-based differentiation of breast cancer samples.

Nonlinear optical imaging techniques have been widely used to reveal biological structures for accurate diagnosis at the cellular as well as the tissue level. In the present study, polarization-dependent second-harmonic generation (PSHG) was used to determine collagen orientation in breast cancer biopsy tissues (grades 0, I, II and III). The obtained data were processed using fast Fourier transform (FFT) analysis, while second-harmonic generation (SHG) anisotropy and the "ratio parameter" values were also calculated. Such measurements were shown to be able to distinguish collagen structure modifications in different cancer grades tested. The analysis presented herein suggests that PSHG imaging could provide a quantitative evaluation of the tumor state and the distinction of malignant from benign breast tissues. The obtained results also allowed the development of a biophysical model, which can explain the aforementioned differentiations and is in agreement with the simulations relating the SHG anisotropy values with the mechanical tension applied to the collagen during cancer progression. The current approach could be a step forward for the development of new, nondestructive, label free optical diagnostic tools for cancer reducing the need of recalls and unnecessary biopsies, while potentially improving cancer detection rates.

Initial experience of magnetic resonance imaging/ultrasonography fusion transperineal biopsy: Biopsy techniques and results for 75 patients.

PurposeThe aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy.Materials and MethodsA total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated.ResultsOverall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion.ConclusionsTransperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PI-RADS score, tumor located at the anterior portion and in repeat biopsies.

New diagnostic tools forbreast cancer.

SummaryImaging plays a major role in the diagnosis, treatment, and follow-up of breast cancer. Findings that require further assessment will be detected both at screening and curative mammography. Most findings that are further worked up tend to yield benign diagnoses. Consequently, there is an ongoing search for new tools to reduce recalls and unnecessary biopsies while maintaining or improving cancer detection rates. The clinically most promising methods in this respect are described and discussed in this review.

Impact of the Addition of Digital Breast Tomosynthesis (DBT) to Standard 2D Digital Screening Mammography on the Rates of Patient Recall, Cancer Detection, and Recommendations for Short-term Follow-up

The addition of digital breast tomosynthesis (DBT) to digital screening mammography (DM) has been shown to decrease recall rates and improve cancer detection rates, but there is a lack of data regarding the impact of DBT on rates of short-term follow-up. We assessed possible changes in performance measures with the introduction of DBT at our facility. In our observational study, databases were used to compare rates of recall, short-term follow-up, biopsy, and cancer detection between women undergoing DM without (n = 10,477) and women undergoing DM with (n = 2304) the addition of DBT. Regression analysis was performed to determine associations with patient age, breast density, and availability of comparison examinations. The addition of DBT resulted in significantly lower recall rates (16%-14%, P = .017), higher rates of biopsy (12.7%-19.1%, P < .01), and increased detection of ductal carcinoma in situ, with a difference of 2.3 cases per 1000 screens (P = .044). A 33% increase in cancer detection rates was observed with DBT, which did not reach statistical significance. Short-term follow-up of probably benign findings was 80% higher in the DBT group (odds ratio = 1.80, 95% confidence interval = 1.38-2.36, P < .001). To our knowledge, we are the first to study the impact of DBT on rates of short-term follow-up, and observed an 80% increase over the DM group. Further research is needed to determine the malignancy rate of Breast Imaging Reporting and Data System 3 lesions detected with DBT, and establish appropriate follow-up to maximize cancer detection while minimizing expense and patient anxiety.

Ultrasound Guided, Freehand Transperineal Prostate Biopsy: An Alternative to the Transrectal Approach

IntroductionThere is growing interest in the use of transperineal prostate biopsy due to the advantages of decreased infection risk and improved cancer detection rates. However, brachytherapy stepper units and templates may increase costs and operative time for the practicing urologist. We present the safety, feasibility and early outcomes of a single urologist’s experience with ultrasound guided freehand transperineal prostate biopsy as an alternative to transrectal ultrasound guided biopsy. MethodsA retrospective review of all prospectively performed ultrasound guided freehand transperineal prostate biopsies between January 1, 2012 and April 30, 2014 was performed. Primary outcome measurements were safety and feasibility. ResultsA total of 274 ultrasound guided freehand transperineal prostate biopsies were performed in 244 patients. Operative and total operating room use times were 7.9 and 17.5 minutes, respectively, with an average of 14.4 cores obtained during each procedure. The overall cancer detection rates for all procedures, those in biopsy naïve patients and those performed for active surveillance were 62.8%, 56.4% and 89%, respectively. New diagnoses of prostate cancer occurred in 41.2% of patients with 10% positive after a previous negative transrectal ultrasound guided biopsy. Complications (Clavien grade I or greater) including systemic infection, urinary retention and hematuria or pain requiring physician or hospital intervention did not occur. ConclusionsThe use of ultrasound guided freehand transperineal prostate biopsy for the suspicion or surveillance of prostate cancer is feasible and safe. The results were encouraging with respect to the primary outcome measurements. Ultrasound guided freehand transperineal prostate biopsy with the patient under local anesthesia is currently under investigation. Large, prospective, randomized, multiple operator studies to evaluate the comparative effectiveness of freehand transperineal prostate biopsy and transrectal ultrasound guided biopsy techniques are recommended.