Increase In Cancer Detection Rate Research Articles

Cancer detection rate of breast-MR in supplemental screening after negative mammography in women with dense breasts. Preliminary results of the MA-DETECT-Study after 200 participants

BACKGROUNDDue to increased cancer detection rates (CDR), breast MR (breast MRI) can reduce underdiagnosis of breast cancer compared to conventional imaging techniques, particularly in women with dense breasts. The purpose of this study is to report the additional breast cancer yield by breast MRI in women with dense breasts after receiving a negative screening mammogram. METHODSFor this study we invited consecutive participants of the national German breast cancer Screening program with breast density categories ACR C & D and a negative mammogram to undergo additional screening by breast MRI. Endpoints were CDR and recall rates. This study reports interim results in the first 200 patients. At a power of 80% and considering an alpha error of 5%, this preliminary population size is sufficient to demonstrate a 4/1000 improvement in CDR. RESULTSIn 200 screening participants, 8 women (40/1000, 17.4–77.3/1000) were recalled due to positive breast MRI findings. Image-guided biopsy revealed 5 cancers in 4 patients (one bilateral), comprising four invasive cancers and one case of DCIS. 3 patients revealed 4 invasive cancers presenting with ACR C breast density and one patient non-calcifying DCIS in a woman with ACR D breast density, resulting in a CDR of 20/1000 (95%-CI 5.5–50.4/1000) and a PPV of 50% (95%-CI 15.7–84.3%). CONCLUSIONOur initial results demonstrate that supplemental screening using breast MRI in women with heterogeneously dense and very dense breasts yields an additional cancer detection rate in line with a prior randomized trial on breast MRI screening of women with extremely dense breasts. These findings are highly important as the population investigated constitutes a much higher proportion of women and yielded cancers particularly in women with heterogeneously dense breasts.

Clinical role of abbreviated and ultrafast mri in breast imaging.

Current breast cancer screening relies on mammography, digital breast tomosynthesis and breast ultrasound. In select populations, breast MRI is also of great utility. However, multiple factors limit widespread use of breast MRI for screening. Efforts have been made to increase the availability of breast MRI for screening, in large part due to the increased cancer detection rate of breast MRI compared to mammography. Techniques include shortening standard breast MRI protocols with the potential for accommodating MRI screening in a higher number of patients. This review will explain the role of abbreviated breast MRI and ultrafast breast MRI in breast imaging, and detail how these approaches differ from standard dynamic contrast-enhanced breast MRI. In addition, limitations and advantages of these techniques will also be discussed.

Potential Usefulness a Coronal View using an Automated Breast Ultrasound System in Detecting Breast Lesions.

An automated breast ultrasound system (ABUS) combined with screening mammography has increased cancer detection rates; however, supplemental ABUS use has increased recall rates. In this study, we aimed to identify an accurate and efficient method of ABUS interpretation and evaluate the potential usefulness of its coronal view versus the conventional transverse view. This retrospective observer study included comprised 114 ABUS cases (40 normal, 35 benign, 39 malignant). Ten physicians from multiple institutions interpreted the anonymized coronal and transverse views independently. The observers scored their confidence in the lesion detection for each case using a continuous scale and recorded reading times for each coronal and transverse view interpretation. Free-response receiver operating characteristic analysis was employed to compare detection accuracies between views; a paired t-test was used to compare the average reading times. Detection accuracy did not differ significantly between the coronal and transverse views (figure of merit=0.740 and 0.745, respectively; p = 0.72). However, the average reading time for the coronal view was significantly shorter than that for the transverse view (149.7 vs. 200.3 seconds per case, p = 0.003). The coronal view obtained with the ABUS was useful for interpretation and associated with significantly shorter reading times compared with the conventional transverse view while maintaining breast lesion detection accuracy.

Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?

IntroductionGastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based...

Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis

ObjectivesTo evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT).Material and methodsWe analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI.ResultsA total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively.ConclusionAI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women.Clinical relevance statementArtificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis.Key Points• AI systems based on deep learning technology offer potential for improving breast cancer screening programs.• Using artificial intelligence as support for reading improves radiologists’ performance in breast cancer screening programs with mammography or tomosynthesis.• Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.

Possibilities of immunocytochemical staining for HBME-1 expression in the «diagnostic search» of differentiated thyroid cancer. Own investigation

Objective — to investigate HBME-1 expression variants on cytological material classified as doubtful (III, IV, V), according to the Bethesda categories, to evaluate the value of the HBME-1 expression test on the corresponding histological material of nodular goiter, follicular tumor with an uncertain potential for malignancy for the differential diagnosis of thyroid carcinoma (ThC). Materials and methods. The analysis was performed on the data of 14 patients with thyroid nodular lesions and cytological Bethesda categories III, IV, and V (“gray zone“). The HBME-1 expression was determined by the results of immunocytochemical (ICC) and immunohistochemical (IHC) staining with the use of mouse monoclonal antibodies against human HBME-1 (1 : 500; cat № BSB 3459; «Bio SB» «Bioscince for the World» Santa Barbara USA). The HBME-1 expression grade was calculated as the sum of the score for staining intensity and cytoplasmic positive cells square, present in the IHC sample. HBME-1 positive result was considered with an IHC score &gt;6 point. Results. From 14 investigated patients, five were defined as HBME-1 positive. According to the postoperative histological conclusion for the group of HBME-1 positive patients, thyroid carcinoma was diagnosed in four subjects, including three cases of papillary ThC and one follicular ThC; in one patient follicular tumor of uncertain malignant potential (FT-UMP) was reported. Importantly, immunocytochemical and immunohistochemical HBME-1 reactions in the specimens of these patients were of the same intensity. Among 9 HBME-1 preoperative negative patients, none had malignancy according to the final histological study. Nodular goiter was diagnosed in six patients, and tumor of uncertain malignant potential (FT-UMP) was reported for three subjects. Histological specimens of all 9 patients were HBME-1 negative as well. The obtained results demonstrated an increase in cancer detection rates with increasing Bethesda category. Application of statistical software for biomedical research МedCalc revealed that positive predictive value (PPV) of the HBME-1 expression test was 80% (95% confidence interval CI 38.4—96.3%), and diagnostic efficiency was 92.9% (CI 66.1—99.8%). These results suggest the great potential of the test, however, due to the limited observations, the confidence intervals are too wide. Conclusions. HBME-1 can be used as an immuno­cytochemical marker for the differentiation of benign and malignant thyroid nodules, its use will help to reduce the number of unnecessary surgical removals of benign tumors, which will improve the quality of life of patients and reduce the burden on medical services.

Artificial intelligence (AI) for breast cancer screening: BreastScreen population-based cohort study of cancer detection.

Artificial intelligence (AI) has been proposed to reduce false-positive screens, increase cancer detection rates (CDRs), and address resourcing challenges faced by breast screening programs. We compared the accuracy of AI versus radiologists in real-world population breast cancer screening, and estimated potential impacts on CDR, recall and workload for simulated AI-radiologist reading. External validation of a commercially-available AI algorithm in a retrospective cohort of 108,970 consecutive mammograms from a population-based screening program, with ascertained outcomes (including interval cancers by registry linkage). Area under the ROC curve (AUC), sensitivity and specificity for AI were compared with radiologists who interpreted the screens in practice. CDR and recall were estimated for simulated AI-radiologist reading (with arbitration) and compared with program metrics. The AUC for AI was 0.83 compared with 0.93 for radiologists. At a prospective threshold, sensitivity for AI (0.67; 95% CI: 0.64-0.70) was comparable to radiologists (0.68; 95% CI: 0.66-0.71) with lower specificity (0.81 [95% CI: 0.81-0.81] versus 0.97 [95% CI: 0.97-0.97]). Recall rate for AI-radiologist reading (3.14%) was significantly lower than for the BSWA program (3.38%) (-0.25%; 95% CI:-0.31 to-0.18; P<0.001). CDR was also lower (6.37 versus 6.97 per 1000) (-0.61; 95% CI:-0.77 to-0.44; P<0.001); however, AI detected interval cancers that were not found by radiologists (0.72 per 1000; 95% CI: 0.57-0.90). AI-radiologist reading increased arbitration but decreased overall screen-reading volume by 41.4% (95% CI: 41.2-41.6). Replacement of one radiologist by AI (with arbitration) resulted in lower recall and overall screen-reading volume. There was a small reduction in CDR for AI-radiologist reading. AI detected interval cases that were not identified by radiologists, suggesting potentially higher CDR if radiologists were unblinded to AI findings. These results indicate AI's potential role as a screen-reader of mammograms, but prospective trials are required to determine whether CDR could improve if AI detection was actioned in double-reading with arbitration. National Breast Cancer Foundation (NBCF), National Health and Medical Research Council (NHMRC).

Abstract P5-04-08: Breast cancer screening using ultrasound increases recall, biopsy, and cancer detection rates

Abstract Background: Ultrasound is often used as an adjunct to mammography for breast cancer (BC) screening. Usage of screening ultrasound (US) varies by state, likely due to differences in state-specific breast density notification laws and mandates requiring insurance coverage of supplemental screening for women at elevated risk of breast cancer. Screening US can increase cancer detection rates among women with dense breasts, but may increase recalls and benign biopsies. As more states adopt policies mandating insurance coverage for “medically necessary” breast cancer imaging, it is important to understand the impact to screening US utilization and subsequent service utilization. This analysis examines use of screening US by state as well as associated rates of recall, biopsy, and cancer detection. Methods: We analyzed deidentified administrative claims. We included women aged 18-74 years with ≥1 claim for screening mammography in 2018. First claim was index date. Continuous enrollment was required in a commercial (COM) or Medicare Advantage (MA) plan from 1/2016 to index date (baseline period) and from index date to 6 months after (follow-up period). Recall, biopsy, and cancer detection rates were calculated for the follow-up period. Recall was defined as ≥1 claim for mammography, diagnostic ultrasound, or MRI in the follow-up period. We used CPT/HCPCS codes to identify procedures. Screening US was identified by CPT 76641 (complete) with modifier 50 (bilateral) or LT/RT (left/right). Using ICD codes, cancer detection was defined as ≥1 claim for DCIS or invasive BC. We examined screening US rates by insurance type, state, and age. Proportions were compared with chi-squared tests. Results: 939,410 women met study criteria (70% COM, 30% MA; Tables 1-2). In the COM population, recall, biopsy, and cancer detection rates with screening US were approximately two-fold higher than without (recall: 26.1% vs. 11.8%; biopsy: 5.0% vs 1.6%; cancer detection: 1.0% vs. 0.4%). In the MA population, recall, biopsy, and cancer detection rates with screening US were roughly three-fold higher than without (recall: 23.6% vs 9.0%; biopsy: 5.2% vs 1.6%; cancer detection: 1.9% vs 0.7%). In NY, NJ, and CT, the rate of screening US usage was &amp;gt; 14 times higher than in all other states (29.1% vs 1.9%). These three states had higher recall and biopsy rates, but similar cancer detection rates compared to all other states (recall: 14.4% vs. 11.4%; biopsy: 2.5% vs 1.7%; cancer detection: 0.6% vs. 0.5%). All proportion differences reached statistical significance (p &amp;lt; 0.001). Conclusion: Screening US was associated with increases in recall and biopsy, but modest increases in absolute cancer detection rates. Observed state by state variation of screening US is likely driven by laws requiring zero patient payment insurance coverage of “medically necessary” imaging which, as is the case with NY, NJ, and CT, is interpreted to include screening US. Our results demonstrate that screening US may lead to a large increase in recall rates and biopsies without consequentially improving the cancer detection rate. Table 1: Recall, biopsy, and cancer detection rates by age with and without use of adjunctive breast screening ultrasound in a commercially insured U.S. population * values are suppressed to comply with requirements for data release Table 2: Recall, biopsy, and cancer detection rates by age with and without use of adjunctive breast screening ultrasound in a Medicare Advantage (MA) U.S. population * values are suppressed to comply with requirements for data release Citation Format: James Staib, Rashna Soonavala, Stacey Dacosta Byfield, Kimberly Badal, Kierstin Catlett, Liz Maffey, Mi-Ok Kim, Kenneth Wimmer, Yiwey Shieh, Laura J. Esserman. Breast cancer screening using ultrasound increases recall, biopsy, and cancer detection rates [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-08.

Sangre oculta en heces en pacientes sintomáticos en Atención Primaria: Un estudio retrospectivo en el área sanitaria de Toledo

AimTo review referral protocol in symptomatic patients from primary care of using 15μgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10μgHb/g faeces threshold and one sample. Material and methodsA retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15μgHb/g faeces) in the same population. ResultsFOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10μgHb/g faeces threshold. ConclusionsCorrect patient selection and optimal threshold increase cancer detection rate. The protocol with 10μgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose.

S3208 The Use of ERCP in the Diagnosis of Indeterminate Biliary Strictures: Experience From a Large Tertiary Care Center

Introduction: The diagnosis of indeterminate biliary strictures remains a challenge for the endoscopist and the sensitivity of ERCP based diagnostic methods such as brush cytology is relatively low, usually not exceeding 60%. The aim of this study is to look at the diagnostic performance of ERCP and ancillary techniques in the diagnosis of indeterminate biliary strictures. Methods: we have identified a retrospective cohort of patients who had ERCP for the diagnosis of indeterminate biliary strictures, excluding pancreatic malignancy or metastases from 1/2010 to 8/2020. Data was collected including demographics, type of diagnostic procedure, procedural details, cytology/pathology results from the specimen and need for repeat interventions. Results: A total of 116 patients were identified and 169 ERCP procedures were performed. 42 (36%) patients were male, 82 (71%) were white and the median age was 69 (IQR: 54-69). 59 (51%) patients had brushings alone, 33 (28%) brushings and forceps biopsy combined, 9 (8%) forceps biopsy alone and 15 (13%) had cholangioscopy and direct biopsies. The results of the pathology/cytology after the first ERCP were benign in 55 (46%), atypia in 32 (28%) and malignant in 29 (25%). DNA and FISH analysis of was done in 10 (9%). In 37 (32 %) patients a repeat ERCP was required and the median number of repeat ERCPs was 3 (IQR: 2-3). After a repeat ERCP, 8 (22%) lesions were reported to be malignant. The final diagnosis as malignant cholangiocarcinoma by ERCP was done on 37 (32%) of the patients. The accuracy of detection malignancy during the first ERCP was 54 % by brushings, 51 % by brushings and biopsy and 56 % by cholangioscopy (Table 1). Conclusion: ERCP with the different ancillary techniques are essential for the diagnosis of indeterminate biliary strictures. The combination of these methods with reintervention can increase cancer detection rates on indeterminate biliary strictures with or without FISH and DNA analysis. As described in other publications, we could reproduce a very high sensitivity and overall accuracy for the diagnosis of malignant strictures.Table 1.: Outcomes.

Pros and cons for breast cancer screening with tomosynthesis - a review of the literature.

Breast cancer screening programs using mammography proved their value in detecting breast cancer at early stages and, consequently, reducing the mortality from this disease.Due to the technological progress, the screening programs have shifted from screen-film mammography to digital mammography and nowadays digital breast tomosynthesis became the focus of breast imaging research. Using tomosynthesis in screening increases cancer detection rates and decreases recall and false-positive rates, thus improving the effectiveness of breast cancer screening programs, with positive consequences on health care costs and on patient psychology.More long-term follow-up data must be collected for assessing absolute sensitivity and specificity of digital breast tomosynthesis, together with efforts for addressing the limitations of the method.

Investigation of spectral performance for single-scan contrast-enhanced breast CT using photon-counting technology: A phantom study.

Contrast-enhanced imaging of the breast is frequently used in breast MRI and has recently become more common in mammography. The purpose of this study was to make single-scan contrast-enhanced imaging feasible for photon-counting breast CT (pcBCT) and to assess the spectral performance of a pcBCT scanner by evaluating iodine maps and virtual non-contrast (VNC) images. We optimized the settings of a pcBCT to maximize the signal-to-noise ratio between iodinated contrast agent and breast tissue. Therefore, an electronic energy threshold dividing the x-ray spectrum used into two energy bins was swept from 23.17keV to 50.65keV. Validation measurements were performed by placing syringes with contrast agent (2.5mg/ml to 40mg/ml) in phantoms with 7.5cm and 12cm in diameter. Images were acquired at different tube currents and reconstructed with 300μm isotropic voxel size. Iodine maps and VNC images were generated using image-based material decomposition. Iodine concentrations and CT values were measured for each syringe and compared to the known concentrations and reference CT values. Maximal signal-to-noise ratios were found at a threshold position of 32.59keV. Accurate iodine quantification (average root mean square error of 0.56mg/ml) was possible down to a concentration of 2.5mg/ml for all tube currents investigated. The enhancement has been sufficiently removed in the VNC images, so they can be interpreted as unenhanced CT images. Only minor changes of CT values compared to a conventional CT scan were observed. Noise was increased by the decomposition by a factor of 2.62 and 4.87 (7.5cm and 12cm phantoms) but did not compromise the accuracy of the iodine quantification. Accurate iodine quantification and generation of VNC images can be achieved using contrast-enhanced pcBCT from a single CT scan in the absence of temporal or spatial misalignment. Using iodine maps and VNC images, pcBCT has the potential to reduce dose, shorten examination and reading time, and to increase cancer detection rates.

Assessment of Radiologist Performance in Breast Cancer Screening Using Digital Breast Tomosynthesis vs Digital Mammography

Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. To evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations. This cohort study included 198 radiologists from 104 radiology facilities in the Breast Cancer Surveillance Consortium who interpreted 251 384 DBT and 2 000 681 digital mammography (DM) screening examinations from 2009 to 2017, including 126 radiologists (63.6%) who interpreted DBT examinations during the study period and 72 (36.4%) who exclusively interpreted DM examinations (to adjust for secular trends). Data were analyzed from April 2018 to July 2019. Digital breast tomosynthesis and DM screening examinations. Recall rate and cancer detection rate. A total of 198 radiologists interpreted 2 252 065 DM and DBT examinations (2 000 681 [88.8%] DM examinations; 251 384 [11.2%] DBT examinations; 710 934 patients [31.6%] aged 50-59 years; 1 448 981 [64.3%] non-Hispanic white). Among the 126 radiologists (63.6%) who interpreted DBT examinations, 83 (65.9%) had unadjusted DM recall rates of no more than 12% before using DBT, with a median (interquartile range) recall rate of 10.0% (7.5%-13.0%). On DBT examinations, 96 (76.2%) had an unadjusted recall rate of no more than 12%, with a median (interquartile range) recall rate of 8.8% (6.3%-11.3%). A secular trend in recall rate was observed, with the multivariable-adjusted risk of recall on screening examinations declining by 1.2% (95% CI, 0.9%-1.5%) per year. After adjusting for examination characteristics and secular trends, recall rates were 15% lower on DBT examinations compared with DM examinations interpreted before DBT use (relative risk, 0.85; 95% CI, 0.83-0.87). Adjusted recall rates were significantly lower on DBT examinations compared with DM examinations interpreted before DBT use for 45 radiologists (35.7%) and significantly higher for 18 (14.3%); 63 (50.0%) had no statistically significant change. The unadjusted cancer detection rate on DBT was 5.3 per 1000 examinations (95% CI, 5.0-5.7 per 1000 examinations) compared with 4.7 per 1000 examinations (95% CI, 4.6-4.8 per 1000 examinations) on DM examinations interpreted before DM use (multivariable-adjusted risk ratio, 1.21; 95% CI, 1.11-1.33). In this study, DBT was associated with an overall decrease in recall rate and an increase in cancer detection rate. However, our results indicated that there is wide variability among radiologists, including a subset of radiologists who experienced increased recall rates on DBT examinations. Radiology practices should audit radiologist DBT screening performance and consider additional DBT training for radiologists whose performance does not improve as expected.

Performance of Combined Magnetic Resonance Imaging/Ultrasound Fusion-guided and Systematic Biopsy of the Prostate in Biopsy-naïve Patients and Patients with Prior Biopsies

BackgroundAs recent prospective studies showed targeted biopsies (TBs) to be superior to systematic biopsies (SBs), magnetic resonance imaging (MRI) is gaining wider acceptance in the diagnostic setup of prostate cancer (PCa). ObjectiveTo examine the performance of MRI/ultrasound fusion-guided TB in combination with SB in the detection of PCa in patients with and without prior biopsy. Design, setting, and participantsA total of 219 men undergoing combined transrectal TB and 12-core SB from February 2014 to November 2018 were analysed. For all patients showing a suspicion of PCa in multiparametric MRI, TB was performed using fusion imaging with real-time virtual sonography. Outcome measurements and statistical analysisCancer detection rates (CDRs) and significant CDRs for TB, SB, and TB+SB were analysed. Further stratification was performed for a number of previous biopsy sessions and Prostate Imaging Reporting and Data System (PI-RADS) score. Significant PCa was defined as any PCa with Gleason score ≥3+4. Results and limitationsOf all, 141 patients were biopsy naïve, while 78 patients had at least one prior biopsy. Median prostate-specific antigen (PSA) level prior to biopsy was 8.4ng/ml (interquartile range 5.5–11.8ng/ml). The overall CDR was 63.5% (139/219), while the PI-RADS–dependent CDRs for the combination of TB+SB were 29.1%, 67.7%, and 86.2% for patients with PI-RADS 3, 4, and 5, respectively. Looking at TB or SB alone, CDRs were 55.7% and 57.5%. The overall CDR for significant PCa was 51.6%. (18.2%, 50.5%, and 81.5% for PI-RADS 3, 4, and 5, respectively). CDRs were significantly higher for biopsy-naïve patients (65.2% vs 67.4% vs 71.6% for TB vs SB vs TB+SB) than for patients with one previous negative biopsy (38.2% vs 43.6% vs 50.9% for TB vs SB vs TB+SB; all p<0.01). ConclusionsMultiparametric MRI can raise the CDR in patients with and without biopsies performed earlier. With higher PI-RADS lesions, the risk of harbouring PCa increases. Combining TB with SB further improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy. Patient summaryMultiparametric magnetic resonance imaging before prostate biopsy increases cancer detection rates in biopsy-naïve patients and patients with a previous negative biopsy. The combination of targeted biopsy with systematic biopsy improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy.

Improved Cancer Detection Using Artificial Intelligence: a Retrospective Evaluation of Missed Cancers on Mammography

To determine whether cmAssist™, an artificial intelligence-based computer-aided detection (AI-CAD) algorithm, can be used to improve radiologists’ sensitivity in breast cancer screening and detection. A blinded retrospective study was performed with a panel of seven radiologists using a cancer-enriched data set from 122 patients that included 90 false-negative mammograms obtained up to 5.8 years prior to diagnosis and 32 BIRADS 1 and 2 patients with a 2-year follow-up of negative diagnosis. The mammograms were performed between February 7, 2008 (earliest) and January 8, 2016 (latest), and were all originally interpreted as negative in conjunction with R2 ImageChecker CAD, version 10.0. In this study, the readers analyzed the 122 studies before and after review of cmAssist™, an AI-CAD software for mammography. The statistical significance of our findings was evaluated using Student’s t test and bootstrap statistical analysis. There was a substantial and significant improvement in radiologist accuracy with use of cmAssist, as demonstrated in the 7.2% increase in the area-under-the-curve (AUC) of the receiver operating characteristic (ROC) curve with two-sided p value < 0.01 for the reader group. All radiologists showed a significant improvement in their cancer detection rate (CDR) with the use of cmAssist (two-sided p value = 0.030, confidence interval = 95%). The readers detected between 25 and 71% (mean 51%) of the early cancers without assistance. With cmAssist, the overall reader CDR was 41 to 76% (mean 62%). The percentage increase in CDR for the reader panel was significant, ranging from 6 to 64% (mean 27%) with the use of cmAssist. There was less than 1% increase in the readers’ false-positive recalls with use of cmAssist. With the use of cmAssist TM, there was a substantial and statistically significant improvement in radiologists’ accuracy and sensitivity for detection of cancers that were originally missed. The percentage increase in CDR for the radiologists in the reader panel ranged from 6 to 64% (mean 27%) with the use of cmAssist, with negligible increase in false-positive recalls.

Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density

Breast cancer screening examinations using digital breast tomosynthesis (DBT) has been shown to be associated with decreased false-positive test results and increased breast cancer detection compared with digital mammography (DM). Little is known regarding the size and stage of breast cancer types detected and their association with age and breast density. To determine whether screening examinations using DBT detect breast cancers that are associated with an improved prognosis and to compare the detection rates by patient age and breast density. This retrospective analysis of prospective cohort data from 3 research centers in the Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium included data of women aged 40 to 74 years who underwent screening examinations using DM and DBT from January 1, 2011, through September 30, 2014. Statistical analysis was performed from November 8, 2017, to August 14, 2018. Use of DBT as a supplement to DM at breast cancer screening examination. Recall rate, cancer detection rate, positive predictive value, biopsy rate, and distribution of invasive cancer subtypes. Among 96 269 women (mean [SD] patient age for all examinations, 55.9 [9.0] years), patient age was 56.4 (9.0) years for DM and 54.6 (8.9) years for DBT. Of 180 340 breast cancer screening examinations, 129 369 examinations (71.7%) used DM and 50 971 examinations (28.3%) used DBT. Screening examination with DBT (73 of 99 women [73.7%]) was associated with the detection of smaller, more often node-negative, HER2-negative, invasive cancers compared with DM (276 of 422 women [65.4%]). Screening examination with DBT was also associated with lower recall (odds ratio, 0.64; 95% CI, 0.57-0.72; P < .001) and higher cancer detection (odds ratio, 1.41; 95% CI, 1.05-1.89; P = .02) compared with DM for all age groups even when stratified by breast density. The largest increase in cancer detection rate and the greatest shift toward smaller, node-negative invasive cancers detected with DBT was for women aged 40 to 49 years. For women aged 40 to 49 years with nondense breasts, the cancer detection rate for examinations using DBT was 1.70 per 1000 women higher compared with the rate using DM; for women with dense breasts, the cancer detection rate was 2.27 per 1000 women higher for DBT. For these younger women, screening with DBT was associated with only 7 of 28 breast cancers (25.0%) categorized as poor prognosis compared with 19 of 47 breast cancers (40.4%) when screening with DM. The findings suggest that screening with DBT is associated with increased specificity and an increased proportion of breast cancers detected with better prognosis compared with DM. In the subgroup of women aged 40 to 49 years, routine DBT screening may have a favorable risk-benefit ratio.

Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques.

Full-field digital mammography (FFDM), the standard of care for breast cancer screening, has some limitations. With the advent of digital breast tomosynthesis (DBT), improvements including decreased recall rates and increased cancer detection rates have been observed. The quasi-three-dimensional capability of DBT reduces breast tissue overlap, a significant limitation of FFDM. However, early studies demonstrate that a few cancers detected at FFDM may not be diagnosed at DBT-only screening, and lesions with calcifications as the dominant feature may look less suspicious at DBT or not be visible at all. These findings support the use of combined FFDM and DBT protocols to optimize screening performance. However, this combination would approximately double the patient's radiation exposure. The development of computer algorithms that generate two-dimensional synthesized mammography (SM) views from DBT has improved calcification conspicuity and sensitivity. Therefore, SM may substitute for FFDM in screening protocols, reducing radiation exposure. DBT plus SM demonstrates significantly better performance than that of FFDM alone, although there are reports of missed malignant calcifications. Thus, some centers continue to perform FFDM with DBT. Use of DBT in breast imaging has also necessitated the development of DBT-guided biopsy. DBT-guided biopsy may have a higher success rate than that of stereotactic biopsy, with a shorter procedure time. While DBT brings substantial improvements to breast cancer imaging, it is important to be aware of its strengths and limitations regarding detection of calcifications. This article reviews the imaging appearance of breast calcifications at DBT, discusses calcification biopsy techniques, and provides an overview of the current literature. Online supplemental material is available for this article. ©RSNA, 2019 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2019.

Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level.

Even though the safety of the treatment for prostate cancer diagnosed by HoLEP has been reported, the diagnostic value of HoLEP for prostate cancer detection has not been confirmed. Therefore, we investigated the diagnostic potential of HoLEP for detecting prostate cancer. Between December 2009 and October 2015, 359 patients (median age, 70.9 years; range, 66.2-74.8) were treated simultaneously with HoLEP and transrectal prostate needle biopsy (TPNB). Of these, 199 patients with a normal digital rectal examination and serum PSA concentration between 3.5 and 10.0 ng/mL were included in the study. Univariate and multivariate logistic regression analyses were performed to identify the predictive factor for prostate cancer detected by HoLEP. Median PSA, prostate volume and PSA density were 4.97 ng/mL (range, 4.20-6.70), 57.40 gm (range, 43.67-77.80) and 0.09 ng/mL2 (range, 0.07-0.12), respectively. Prostate cancer (Gleason score ≥6) was detected in 46 cases (23.1%). Of these, 26 (56.5%) were detected by HoLEP pathology, 11 (23.9%) by TPNB pathology, and 9 (19.6%) by both. Univariate and multivariate logistic regression analyses were performed in 179 patients, including benign prostatic hyperplasia patients (N=153, 76.9%) and patients with cancer detected by HoLEP pathology. PSA density was identified as an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA. HoLEP is a viable modality for detecting prostate cancer in selected cases. PSA density was an independent predictor of prostate cancer detected by HoLEP in gray-zone PSA.

Applications of Advanced Breast Imaging Modalities.

Advanced mammographic imaging modalities have been implemented in clinical practices throughout the USA. The most notable and widely used has been the three-dimensional derivative of digital mammography, known as digital breast tomosynthesis (DBT). In this article, we review the screening and diagnostic applications of DBT, along with its limitations. We also briefly address several supplemental breast imaging modalities. The accumulating evidence from both small and large-scale trials has shown a significant reduction in recall rates and slight increase in cancer detection rates when using DBT. However, the incremental increase in cancers detected remains less than that achieved with several supplemental imaging modalities, including whole-breast ultrasound, MRI, and MBI (molecular breast imaging). Other modalities, such as CEM (contrast-enhanced mammography) and CET (contrast-enhanced tomography), are also being investigated. Numerous studies have confirmed the added value of DBT and its increased cancer detection rate in both the screening and diagnostic settings. However, the superior sensitivity of supplemental imaging modalities renders them essential, especially in high-risk patients, and potentially those with dense breasts.

The influence of prostate volume on prostate cancer detection using real-time elastography targeted biopsy

Objective To retrospectively evaluate the influence of prostate volume on prostate cancer detection using elastography targeted transperineal biopsy. Methods A total of 573 consecutive patients suspicious for prostate cancer were enrolled in this study. Patients underwent combined elastography-targeted biopsy and 10 core-systematic transperineal biopsy. In correlation with prostate biopsy pathology, the sensitivity of elastography-targeted biopsy and systematic biopsy were compared among four subgroups with different prostate volume. Results The overall prostate cancer detection rate was 42.9% (246/573). The increase in cancer detection rate by elastography-targeted biopsies was 9.1% (52/573). In patients with prostate volume of ≤30 ml, 30-50 ml, 50-80 ml and >80 ml, the sensitivity of elastography targeted biopsy were 91.1%(72/79), 81.3%(87/107), 70.5%(31/44) and 50.0%(8/16), respectively (P=0.000). The sensitivity of systematic biopsy were 77.2%(61/79), 77.6%(83/107), 86.4%(38/44) and 75.0%(12/16), respectively, in comparison among these four groups (P=0.601). For patients with prostate volume ≤30 ml, the sensitivity of elastography targeted biopsy was significantly higher than that of systematic biopsy (P=0.028). Conclusions Prostate cancer detection rate can be improved by elastography targeted biopsy. Prostate volume is correlated with the accuracy of elastography. The sensitivity of elastography targeted biopsy is higher in patients with a smaller prostate gland. Key words: Elasticity imaging techniques; Prostatic neoplasms; Biopsy