Increase In Cancer Detection Rate Research Articles

Breast cancer screening with digital breast tomosynthesis - 4 year experience and comparison with national data

BackgroundTo determine if mammography combined with digital breast tomosynthesis (DBT), leads to superior performance in screening for breast cancer compared to digital mammography (DM) alone. MethodsWe retrospectively collected data from A) the results of population-based mammography-screening provided by the National Cancer Registry in Taiwan, and B) the results from all screening mammography performed with DBT from 2012 through 2015 at Kaohsiung Veterans General Hospital (VGHKS) since the institution of DBT at the end of 2011. This was compared data from 3 years with DM performed prior to DBT implementation. We calculated the results of medical audit of VGHKS and compared this with national data. Fisher's exact test is applied. ResultsVGHKS data demonstrated a higher cancer detection rate (CDR) and positive predictive value 1 (PPV 1) than the national average. Most prominently in the year 2014, our CDR was 120% better than that of the national average. CDR ranged from 6.3 to 8.1‰ prior to the introduction of DBT, and following DBT implementation this improved to 8.5–11.4‰, reflecting a mean increase of 32.2%. Early cancer detection was 50% higher and node negative rate was 25% higher than the national average of latest year. A 17.8% reduction in recall rate (RR) was achieved due to a decrease in unnecessary recall. ConclusionThere was a 32.2% increase in CDR and a 17.8% decrease in RR when DBT was used as an adjunct to DM, as compared to DM alone. CDRs were approximately twofold better than national average data. DBT was more effective at detecting cancer in ductal carcinoma in situ and stage 1.

Screening Mammography and Digital Breast Tomosynthesis: Controversies.

Breast cancer screening with mammography reduces breast cancer mortality; however, diverging recommendations regarding screening have caused controversy. The emerging technology of digital breast tomosynthesis (DBT) may soon become the mainstay of breast cancer screening. We present recommendations for breast cancer screening based on guidelines. A PubMed literature review was performed and the results from five large clinical studies comparing the efficacy of digital mammography alone versus digital mammography with DBT are examined. We emphasize the importance of annual screening to reduce breast cancer mortality. Our review of the literature demonstrates that DBT increases cancer detection rates and reduces callbacks. Additional research is needed to determine whether the increased cancer detection rates are associated with a decrease in mortality.

Gene methylation biomarkers in sputum as a classifier for lung cancer risk.

CT screening for lung cancer reduces mortality, but will cost Medicare ∼2 billion dollars due in part to high false positive rates. Molecular biomarkers could augment current risk stratification used to select smokers for screening. Gene methylation in sputum reflects lung field cancerization that remains in lung cancer patients post-resection. This population was used in conjunction with cancer-free smokers to evaluate classification accuracy of a validated eight-gene methylation panel in sputum for cancer risk. Sputum from resected lung cancer patients (n=487) and smokers from Lovelace (n=1380) and PLuSS (n=718) cohorts was studied for methylation of an 8-gene panel. Area under a receiver operating characteristic curve was calculated to assess the prediction performance in logistic regressions with different sets of variables. The prevalence for methylation of all genes was significantly increased in the ECOG-ACRIN patients compared to cancer-free smokers as evident by elevated odds ratios that ranged from 1.6 to 8.9. The gene methylation panel showed lung cancer prediction accuracy of 82–86% and with addition of clinical variables improved to 87–90%. With sensitivity at 95%, specificity increased from 25% to 54% comparing clinical variables alone to their inclusion with methylation. The addition of methylation biomarkers to clinical variables would reduce false positive screens by ruling out one-third of smokers eligible for CT screening and could increase cancer detection rates through expanding risk assessment criteria.

Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study.

To compare the incremental diagnostic value of targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) fusion to conventional 14-cores biopsy. Uni-institutional, institutional review board (IRB) approved prospective blinded study comparing TRUS-guided random and targeted biopsy using mpMRI-TRUS fusion, in 100 consecutive men. We included men with clinical-laboratorial suspicious for prostate cancer and Likert score ≥ 3 mp-MRI. Patients previously diagnosed with prostate cancer were excluded. All patients were submitted to 14-cores TRUS-guided biopsy (mpMRI data operator-blinded), followed by targeted biopsy using mpMRI-TRUS fusion. There was an overall increase in cancer detection rate, from 56% with random technique to 62% combining targeted biopsy using mpMRI-TRUS fusion; incremental diagnosis was even more relevant for clinically significant lesions (Gleason ≥ 7), diagnosing 10% more clinically significant lesions with fusion biopsy technique. Diagnosis upgrade occurred in 5 patients that would have negative results in random biopsies and had clinically significant tumours with the combined technique, and in 5 patients who had the diagnosis of significant tumours after fusion biopsy and clinically insignificant tumours in random biopsies(p=0.0010). Targeted biopsy using mpMRI-TRUS fusion has incremental diagnostic value in comparison to conventional random biopsy, better detecting clinically significant prostate cancers. • mpMRI-TRUS targeted biopsy increases overall cancer detection rate, but not statistically significant. • mpMRI-TRUS targeted biopsy actually improves the diagnosis of clinically significant PCa. • There was no evidence to acquire the mpMRI-TRUS fusion cores alone.

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography.

To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening. Screening performance metrics from 13 institutions were examined for 12months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3-22months). Screening metrics for women ages 40-49, 50-59, 60-69, and 70+, included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected. Performance parameters were compared for women screened with digital mammography alone (n=278,908) and digital mammography+tomosynthesis (n=173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40-69. Largest recall rate reduction with tomosynthesis was for women 40-49, decreasing from 137 (95% CI 117-156) to 115 (95% CI 95-135); difference, -22 (95% CI -26 to -18; P<.001). Simultaneous increase in invasive cancer detection rate for women 40-49 from 1.6 (95% CI 1.2-1.9) to 2.7 (95% CI 2.2-3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6-1.6; P<.001) was observed. Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40-69 and decreased recall rates for all age groups with largest performance gains seen in women 40-49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.

Breast cancer screening: Does tomosynthesis augment mammography?

Digital breast tomosynthesis (DBT) is a relatively new imaging technology that is being adopted widely for breast cancer screening. Initial evidence suggests that it may reduce recall rates and increase cancer detection rates when added to digital mammography screening. However, more rigorous, prospective studies are needed to determine whether it improves long-term clinical outcomes of breast cancer screening.

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.

A PRELIMINARY STUDY OF RISK FACTORS OF BREAST CANCER AND THE USEFULNESS OF BREAST MRI AS AN ADDITION TO MAMMOGRAPHY IN DETECTING BREAST CANCER IN HIGH RISK WOMEN

The risk factors of breast cancer among women, such as genetic, family history and lifestyle factors, can be divided into high-, intermediate- and average-risk. Determining these risk factors may actually help in preventing breast cancer occurrence. Besides that, screening of breast cancer which include mammography, can be done in promoting early breast cancer detection. Breast magnetic resonance imaging (MRI) has been recommended as a supplemental screening tool in high risk women. The aim of this study was to identify the significant risk factor of breast cancer among women and also to determine the usefulness of breast MRI as an addition to mammography in detection of breast cancer in high risk women. This retrospective cohort study design was conducted using patients’ data taken from those who underwent mammography for screening or diagnostic purposes in Advanced Medical and Dental Institute, Universiti Sains Malaysia, from 2007 until 2015. Data from 289 subjects were successfully retrieved and analysed based on their risk factors of breast cancer. Meanwhile, data from 120 subjects who had high risks and underwent both mammography and breast MRI were further analysed. There were two significant risk factors of breast cancer seen among the study population: family history of breast cancer (p-value=0.012) and previous history of breast or ovarian cancer (p-value &lt;0.001). Breast MRI demonstrated high sensitivity (90%) while mammography demonstrated high specificity (80%) in detection of breast cancer in all 120 subjects. The number of cases of breast cancer detection using breast MRI [46 (38.3%)] was higher compared to mammography [24 (20.0%)]. However, breast MRI was found to be non-significant as an adjunct tool to mammography in detecting breast cancer in high risk women (p-value=0.189). A comprehensive screening guideline and surveillance of women at high risk is indeed useful and should be implemented to increase cancer detection rate at early stage

Comparison Between a Combined Transrectal and Transperineal Approach and a Transrectal Approach for Prostate Rebiopsy.

To evaluate whether a combination method involving the transrectal (TR) and transperineal (TP) approach can increase the cancer detection rate relative to the TR approach regarding repeat prostate biopsy. One thousand and nineteen patients underwent initial prostate biopsies and 298 repeat prostate biopsies. All initial biopsies were conducted transrectally. Of the repeat biopsies, 179 (60.1%) were performed using the combined transrectal and transperineal (TR+TP) approach; 113 (37.9%) were carried out transrectally. All biopsies were performed under ultrasound guidance using a 16-gauge core biopsy needle; 651 were diagnosed as prostate cancer; 224 patients underwent radical prostatectomies (RPs). We evaluated the cancer detection rates between the biopsy methods in the repeat biopsy cohort and compared the clinical and pathological features of the RP specimens between the initial and repeat biopsy groups. A median of 12 and 20 cores were obtained in the initial and repeat biopsy patients, respectively. Cancer detection rates regarding biopsies 1, 2, 3, 4 and 5 were 49.2% (551/1,119), 34.7% (75/216), 33.3% (20/60), 26.7% (4/15) and 14.3% (1/7), respectively. There were no significant differences between the TR and the TR+TP approach (32.7% vs. 33.5%). RP specimens diagnosed using repeat biopsies showed more anterior dominant tumors relative to those diagnosed using the initial biopsies (59.5% vs. 35.9%; p<0.001). The TR+TP combination approach could not increase cancer detection rates relative to the TR approach in the repeat biopsy cohort. However, 16-gauge needle biopsy demonstrated acceptable cancer detection rates in the comparatively small number of biopsy cores.

Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program.

HomeRadiologyVol. 280, No. 3 PreviousNext CommunicationsFree AccessErrataIncreased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening ProgramRichard E. Sharpe, Jr , Shambavi Venkataraman, Jordana Phillips, Vandana Dialani, Valerie J. Fein-Zachary, Seema Prakash, Priscilla J. Slanetz, Tejas S. MehtaRichard E. Sharpe, Jr , Shambavi Venkataraman, Jordana Phillips, Vandana Dialani, Valerie J. Fein-Zachary, Seema Prakash, Priscilla J. Slanetz, Tejas S. MehtaRichard E. Sharpe, Jr Shambavi VenkataramanJordana PhillipsVandana DialaniValerie J. Fein-ZacharySeema PrakashPriscilla J. SlanetzTejas S. MehtaPublished Online:Aug 17 2016https://doi.org/10.1148/radiol.2016164018MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:Radiology 2016;278(3):698–706 DOI:10.1148/radiol.2015142036Erratum in:Radiology 2016;280(2):981 DOI:10.1148/radiol.2016164018Last paragraph of “Screening Protocol and Examination Interpretation,” the following clarification should be added: These examinations were excluded from RR variation analysis because of the low sample size and heterogeneity of this cohort.Article HistoryPublished online: Aug 17 2016Published in print: Sept 2016 FiguresReferencesRelatedDetailsCited ByDifferential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysisTongLi, NehmatHoussami, NaomiNoguchi, AileenZeng, M. LukeMarinovich2022 | British Journal of Cancer, Vol. 127, No. 1Digital breast tomosynthesis (DBT)-guided biopsy of calcifications: pearls and pitfallsSadiaChoudhery, TaraAnderson, ElizabethValencia2021 | Clinical Imaging, Vol. 72Comparison of two-view versus single-view digital breast tomosynthesis and 2D-mammography in breast cancer surveillance imagingAndriaHadjipanteli, PetrosPolyviou, IliasKyriakopoulos, MariosGenagritis, NatasaKotziamani, DemetrisMoniatis, AnnePapoutsou, AnastasiaConstantinidou, Gayle E.Woloschak2021 | PLOS ONE, Vol. 16, No. 9Optimization of the Radiation Dose of Digital Breast Tomosynthesis in Opportunistic Screening by Studying the Effect of Different Combinations of FFDM and DBT ViewsMeihongSheng, JuanJi, ChenyingZhang, ZiruiZhang, ShenchuGong, YihuaLu2021 | International Journal of General Medicine, Vol. Volume 14Malignant Outcomes of Architectural Distortion on Tomosynthesis: A Systematic Review and Meta-AnalysisSadiaChoudhery, Matthew P.Johnson, Nicholas B.Larson, TaraAnderson2021 | American Journal of Roentgenology, Vol. 217, No. 2Tomosynthesis-guided breast and axillary localizations: tips and tricksSadiaChoudhery, TaraAnderson2020 | The British Journal of Radiology, Vol. 93, No. 1114Prone Versus Upright Digital Tomosynthesis–Guided BiopsySadiaChoudhery, MatthewJohnson, Robert T.Fazzio2020 | American Journal of Roentgenology, Vol. 215, No. 3Masses in the era of screening tomosynthesis: Is diagnostic ultrasound sufficient?SadiaChoudhery, JessicaAxmacher, Amy LynnConners, JenniferGeske, KathyBrandt2019 | The British Journal of Radiology, Vol. 92, No. 1096Accompanying This ArticleIncreased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening ProgramOct 9 2015RadiologyRecommended Articles Clinical Performance of Synthesized Two-dimensional Mammography Combined with Tomosynthesis in a Large Screening PopulationRadiology2017Volume: 283Issue: 1pp. 70-76Implementation of Synthesized Two-dimensional Mammography in a Population-based Digital Breast Tomosynthesis Screening ProgramRadiology2016Volume: 281Issue: 3pp. 730-736Does Reader Performance with Digital Breast Tomosynthesis Vary according to Experience with Two-dimensional Mammography?Radiology2017Volume: 283Issue: 2pp. 371-380Comparative Benefit-to–Radiation Risk Ratio of Molecular Breast Imaging, Two-Dimensional Full-Field Digital Mammography with and without Tomosynthesis, and Synthetic Mammography with TomosynthesisRadiology: Imaging Cancer2019Volume: 1Issue: 1Breast MRI Finds More Invasive Cancers than Digital Breast Tomosynthesis in Women with Dense Breasts Undergoing ScreeningRadiology: Imaging Cancer2020Volume: 2Issue: 4See More RSNA Education Exhibits Digital Breast Tomosynthesis: An Update on the State of the Technology, Evidence, and Clinical PracticeDigital Posters2019Integrating Digital Breast Tomosynthesis into a Hybrid Academic-Private PracticeDigital Posters2019Abbreviated Breast MRI: Past, Present, and FutureDigital Posters2019 RSNA Case Collection Invasive Lobular CarcinomaRSNA Case Collection2021Breast edemaRSNA Case Collection2021Slow-growing cancerRSNA Case Collection2020 Vol. 280, No. 3 Metrics Altmetric Score PDF download

Diagnosis and Monitoring of Prostatic Lesions: A Comparison of Three Modalities: Multiparametric MRI, Fusion MRI/Transrectal Ultrasound (TRUS), and Traditional TRUS

Purpose: Transrectal ultrasound (TRUS) has been the gold standard of imaging for diagnosing prostate cancer for decades but is plagued by user error and undersampling. We aim to explore imaging modalities that are now being used in combination or alone for screening, diagnosis, and/or active surveillance of prostate cancer.Methods: A PubMed literature search was performed to include articles published up to April 2016. Data were extracted and analyzed.Results: Several large-scale studies have found an increased cancer detection rate in MRI-targeted lesions with an improved ability to target anterior lesions as well as an increased cancer detection in high-risk cancers using fusion platforms vs TRUS alone.Conclusions: To date, there have been few head-to-head trials to directly compare the use of multiparametric MRI (mpMRI), transrectal ultrasound, and MRI-ultrasound fusion modalities for accurate and reliable detection, active surveillance, or biopsy procedure success rates. Further investigation utilizing these modalities are needed before they can be relied upon in active surveillance management, although mpMRI appears to be currently the most reliable in monitoring and diagnosing prostate lesions.

Evaluation of the Prostate Imaging Reporting and Data System for Magnetic Resonance Imaging Diagnosis of Prostate Cancer in Patients with Prostate-specific Antigen

Background:The European Society of Urogenital Radiology has built the Prostate Imaging Reporting and Data System (PI-RADS) for standardizing the diagnosis of prostate cancer (PCa). This study evaluated the PI-RADS diagnosis method in patients with prostate-specific antigen (PSA) <20 ng/ml.Methods:A total of 133 patients with PSA <20 ng/ml were prospectively recruited. T2-weighted (T2WI) and diffusion-weighted (DWI) magnetic resonance images of the prostate were acquired before a 12-core transrectal prostate biopsy. Each patient's peripheral zone was divided into six regions on the images; each region corresponded to two of the 12 biopsy cores. T2WI, DWI, and T2WI + DWI scores were computed according to PI-RADS. The diagnostic accuracy of the PI-RADS score was evaluated using histopathology of prostate biopsies as the reference standard.Results:PCa was histologically diagnosed in 169 (21.2%) regions. Increased PI-RADS score correlated positively with increased cancer detection rate. The cancer detection rate for scores 1 to 5 was 2.8%, 15.0%, 34.6%, 52.6%, and 88.9%, respectively, using T2WI and 12.0%, 20.2%, 48.0%, 85.7%, and 93.3%, respectively, using DWI. For T2WI + DWI, the cancer detection rate was 1.5% (score 2), 13.5% (scores 3–4), 41.3% (scores 5–6), 75.9% (scores 7–8), and 92.3% (scores 9–10). The area under the curve for cancer detection was 0.700 (T2WI), 0.735 (DWI) and 0.749 (T2WI + DWI). The sensitivity and specificity were 53.8% and 89.2%, respectively, when using scores 5–6 as the cutoff value for T2WI + DWI.Conclusions:The PI-RADS score correlates with the PCa detection rate in patients with PSA <20 ng/ml. The summed score of T2WI + DWI has the highest accuracy in detection of PCa. However, the sensitivity should be further improved.

PWE-141 Impact of The ‘Be Clear On Cancer’ National Oesophago-Gastric Cancer Awareness Campaign on Endoscopy Services and Cancer Diagnosis Rates and Outcomes

Introduction Previous regional pilot studies have suggested that media campaigns for upper gastrointestinal (UGI) cancers successfully increase public awareness of symptoms, increase two-week wait pathway (2 WW) general practitioner (GP) referrals and increase the numbers of cancers diagnosed.1 This prompted the roll-out of a nationwide televised media campaign, which promoted dyspepsia as a sign of cancer, from 26 th January to 22 nd February 2015. This study aimed to evaluate its impact, which is not well known to date, on the numbers of GP referrals made to a high volume endoscopy unit in London and the numbers and prognosis of the cancers diagnosed. Methods This was a retrospective observational study, analysing departmental and patient records at the Barking, Havering and Redbridge Hospitals NHS Trust. Total numbers of GP ‘urgent’ priority and ‘two-week wait’ (2 WW) cancer pathway referrals for UGI endoscopies were collected from a six month period before the onset of the campaign and compared with a six month period after the campaign onset. The total numbers, demographics and outcomes of the oesophago-gastric cancers referred and diagnosed in the pre- and post-campaign period were recorded. Student paired t tests and χ2 tests were used to assess for statistical significance. Results There were 1143 urgent/2 WW UGI endoscopy referrals made by GP’s in the pre-campaign period and 1448 referrals in the post-campaign period. There was a statistically significant rise of mean monthly 2 WW referrals in the post-campaign period by 36.5% (p = 0.001). The extra demand was most noticeable in the 2 month post-campaign period with a mean weekly referral rate increase of 46.5% (p = 0.001), equating to 20 extra UGI endoscopies requested per week. However, there was no statistically significant change in the overall rates of oesophago-gastric cancers detected in any age group (47 cancers pre-campaign vs. 38 post-campaign), in their staging or the proportion that could be treated with curative intent. Most of the cancers diagnosed in both groups actually presented as dysphagia (35–37%) and/or weight loss (22–27%) rather than dyspepsia (10–11%). Conclusion The national oesophago-gastric cancer awareness campaign significantly increased the demand placed on endoscopy services but did not meet its aim of detecting more cancers at an earlier curative stage. Most diagnosed were still in advanced stages 3 and 4. Perhaps future campaigns should place more emphasis on promoting awareness of dysphagia, which was more strongly associated with cancer detection, in addition to dyspepsia, in order to increase cancer detection rates. Reference 1 Cancer Research UK literature: http://naedi.org/beclearoncancer/oesophago-gastric Disclosure of Interest None Declared

PD26-08 IMPROVED TISSUE YIELD AND PROSTATE CANCER DETECTION OF A NOVEL BIOPSY PRESERVATION SYSTEM

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI1 Apr 2016PD26-08 IMPROVED TISSUE YIELD AND PROSTATE CANCER DETECTION OF A NOVEL BIOPSY PRESERVATION SYSTEM Michael Cohen, Boris Yudkevich, Helena Yodko, and Irit Elmalah Michael CohenMichael Cohen More articles by this author , Boris YudkevichBoris Yudkevich More articles by this author , Helena YodkoHelena Yodko More articles by this author , and Irit ElmalahIrit Elmalah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.369AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current handling of prostate biopsy cores has many flaws. Fragmentation, loss of orientation and length reduction are just few factors that may reduce cancer detection or obscure the tumor location. The SmartBxTM(SBx)(UC-care medical system) offers a semi-automated download of cores, while preserving its configuration and orientation as on the needle, onto a designated cassette which then goes a routine pathology lab processing. Our objectives were to assess this system against a routine download in maintaining tissue length and integrity, and examine its effect on cancer detection. METHODS Patients having a routine prostate biopsy (12-20 core, Bard® Magnum Biopsy gun, 18G needle) were consented for a random comparison between standard (Std.) download (i.e. into formalin vial) and the SBx download. Differences in core length and integrity were documented by camera. The core initial length was measured on the open needle, then, after processing, paraffin embedding and H&E staining,- on the glass slide. Cancer detection per biopsy core was checked for both methods. RESULTS A total of 3412 cores were taken from 376 Patients (Std.- 1768, SBx- 1653). The final core length was 10±5.8 mm using the Std. method vs. 12.4±3.7 mm using the SBx. The relative reduction in core length (i.e. vs. the initial, on the needle, 100%) was 62±17 % Vs.78±19 % respectively. Corresponding with this 24% relative increase (P <0.01) in core length, a 25% increase in cancer detection rate (10.7% vs. 13.3% per core, P<0.05) was observed for 216 patients with PSA<10, who had a 12 cores procedure. The SBx. kept core configuration and orientation, including fragments [Pic. A1-2]. CONCLUSIONS The use of the semi-automated SBx. download system led to an increased final cores length and cancer detection rate per core,- a linkage previously suggested, in tissues handled manually. Keeping cores orientation and configuration as seen on the biopsy needle allows a within-core cancer localization and, if integrated with new image guided- TRUS biopsy systems [Pic. A3], may offer a precise within-prostate cancer localization. This may have an important role in managing repeated biopsies, active surveillance and improve accurate planning of focal treatment of prostate cancer [Pic. A4]. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e647 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Cohen More articles by this author Boris Yudkevich More articles by this author Helena Yodko More articles by this author Irit Elmalah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Screening Outcomes of Breast Tomosynthesis vs. Conventional Mammography

Initial reports suggest that, compared with screening digital mammography (DM) alone, mammography coupled with digital breast tomosynthesis (DBT) increases cancer detection rates and lowers recall rates. Investigators at one academic U.S. center assessed whether these screening benefits would persist after the initial rollout of DBT. The shift from DM to DBT allowed them to compare screening performance during the first year, in which DM only was used (DM0), with 3 subsequent …

Is It Time to Stop Paying for Computer-Aided Mammography?

Computer-aided detection (CAD) is a technology designed to address the problem of screening mammography’s imperfect sensitivity. Now used on over 90% of US mammograms, CAD essentially acts like an automated second reader by marking potentially suspicious spots for radiologists to review before making final recommendations. Early studies suggested that CAD could increase cancer detection rates by 20%.1 But subsequent research suggested little, if any, impact of CAD on cancer detection and raised concerns that CAD may increase recall and biopsy rates.2,3 However,most clinical studies to date have assessedCAD impacts when used with film mammograms. Digital mammographyhas now largely supplanted filmmammography in the United States. When used in the context of digital mammography, does CADyield net benefits towomen?A study by Lehman et al4 in this issue of JAMA Internal Medicine addresses this important question. In an observational study of 323 973 women undergoing digital screening mammography in diverse US practices, Lehmanet al4 found thatCADusewasnot associatedwith any improvement in sensitivity, specificity, positive predictive value, cancerdetection rates, or otherproximal screeningoutcomes. Indeed, among radiologists who interpreted digital mammograms with and without CAD, sensitivity was worse with CAD, contrary to CAD’s design. While earlier evaluations suggested that community radiologists often overreacted to CAD output, leading to higher rates of diagnostic investigation,2,5 Lehmanet al4 found little, if any, impact of CAD in modern digital mammography practice. It is possible that, with years of CAD use, many radiologistshave learned that theyieldofCAD isminimal so theynow largely ignoreCADoutput. It is also conceivable that improvements indigitalmammographytechnologyhaveswampedany incremental impacts of CAD on interpretation that may have been previously detectable. This observational studymay be confoundedbyunmeasured radiologist ormammography facility factors, althoughearlier research adjusting for these factors also found no benefits of CAD.2 Like all subgroup analyses, analyses of outcomes among subsets of radiologistsmust be interpretedcautiously.Despite these limitations, this study4 is another large-sample, real-world evaluation of CAD’s interpretive outcomes suggesting that CADyields no clinically significant benefits in typical mammography practice. The field of implementation science should take interest in interventions like CAD that are widely adopted in advance of strong evidence of effectiveness.Whatmade CAD so alluring topatients,practitioners,orboth,andwhywerepayerswilling (at least initially) to finance CAD?How is it that CAD is applied on 90% of US mammograms when it yields no clear benefits to patients? Thefirstessential step forbroadCADadoptionwasUSFood andDrugAdministration (FDA)approval in 1998.BecauseCAD is a device rather than a drug, the evidence bar for FDA approvalwas comparatively low. Its approvalwasbasedonsmall studies of CAD’s “safety” and “effectiveness.” Effectiveness, for example, was demonstrated by studies in which radiologists read sets of mammograms with enriched breast cancer prevalence, suggesting that CADcouldprompt increased cancerdetection. In addition,Congressionalmembers, lobbiedby industry, pressured the FDA to approve CAD.6 Evenso,CADwas still a longshot.UseofCADrequired film mammograms to be fed into machines to digitize images for computer analysis, andCADoutputhad tobeviewedondedicateddevices separate fromactualmammograms.Mammographywas already a loss-leader formany radiology practices, yet CAD added unreimbursed technician and radiologist effort. Without reimbursement, few mammography facilities could justify the capital costs forCAD installation.At the time, establishing reimbursement fornewpreventive services, such as CAD, required Congressional amendment of the Medicare statute.While Congress had previously addedMedicare benefits for preventive services, such as prostate cancer screening, these efforts required strong Congressional sponsorship and auspicious political winds.7 CAD ended up having both. Representing Silicon Valley (home of CAD’s leading manufacturer), California CongressRelated article page 1828 Digital ScreeningMammography and Computer-Aided Detection Original Investigation Research

Screening for dense breasts: digital breast tomosynthesis.

OBJECTIVE. Digital breast tomosynthesis (DBT) is a recent imaging technology that was developed to address the limitations of conventional 2D mammography. The limitations of standard mammography are well known and include reduced sensitivity in dense breasts. Clinical research studies of DBT and the implementation of DBT have revealed that DBT has potential benefits for evaluating patients with dense breasts. This article will discuss the benefits and limitations of DBT as a screening alternative for women with dense breasts. CONCLUSION. Studies to date have revealed that the use of DBT reduces recall rates and increases cancer detection rates. This has been demonstrated with the use of DBT for both screening and diagnostic purposes, as well as with imaging dense breasts. DBT has the ability to reduce breast tissue overlap, thus potentially revealing lesions that would otherwise have been missed. The limitations of DBT include longer interpretation times, higher costs, and increased radiation dose. These limitations present challenges that radiologists must consider before DBT implementation.

A Reader Study Comparing Prospective Tomosynthesis Interpretations with Retrospective Readings of the Corresponding FFDM Examinations

To compare performance of prospective interpretations of clinical tomosynthesis (digital breast tomosynthesis [DBT]) plus full-field digital mammography (FFDM) examinations with retrospective readings of the corresponding FFDM examinations alone. Seven Mammography Quality Standard Act-qualified radiologists retrospectively interpreted 10,878 FFDM examinations that had been interpreted by other radiologists during prospective clinical interpretations of DBT plus FFDM. The radiologists were blinded to the Breast Imaging Reporting and Data System (BIRADS) category given during the clinical interpretations and the verified outcome by follow-up and/or any diagnostic workup that may have followed. Ratings (BIRADS 0, 1, or 2) were recorded. Group performance levels in terms of recall rates and attributable cancer detection rates were compared to the prospective clinical interpretations of the same examinations (DBT plus FFDM) using McNemar test (two sided/tailed) with significance level of .05. During the prospective clinical interpretations of DBT plus FFDM, 588 cases were recalled (588 of 10,878, 5.41%) compared to 888 cases recalled (888 of 10,878, 8.16%) during the FFDM-alone retrospective interpretations (absolute difference, 35%; P<.0001). There were 59 and 38 suspicious abnormalities later verified as cancers detected during the DBT plus FFDM and the FFDM-alone interpretations, respectively (absolute increase, 55%; P<.0001). Invasive cancer detections were 48 and 29, respectively (absolute increase, 66%; P<.0001). The combination of DBT plus FFDM for screening asymptomatic women resulted in a significant reduction in recall rates and a simultaneous increase in cancer detection rates when compared to retrospective interpretations of corresponding FFDM examinations alone.

Breast cancer screening using tomosynthesis in combination with digital mammography.

Mammography plays a key role in early breast cancer detection. Single-institution studies have shown that adding tomosynthesis to mammography increases cancer detection and reduces false-positive results. To determine if mammography combined with tomosynthesis is associated with better performance of breast screening programs in the United States. Retrospective analysis of screening performance metrics from 13 academic and nonacademic breast centers using mixed models adjusting for site as a random effect. Period 1: digital mammography screening examinations 1 year before tomosynthesis implementation (start dates ranged from March 2010 to October 2011 through the date of tomosynthesis implementation); period 2: digital mammography plus tomosynthesis examinations from initiation of tomosynthesis screening (March 2011 to October 2012) through December 31, 2012. Recall rate for additional imaging, cancer detection rate, and positive predictive values for recall and for biopsy. A total of 454,850 examinations (n=281,187 digital mammography; n=173,663 digital mammography + tomosynthesis) were evaluated. With digital mammography, 29,726 patients were recalled and 5056 biopsies resulted in cancer diagnosis in 1207 patients (n=815 invasive; n=392 in situ). With digital mammography + tomosynthesis, 15,541 patients were recalled and 3285 biopsies resulted in cancer diagnosis in 950 patients (n=707 invasive; n=243 in situ). Model-adjusted rates per 1000 screens were as follows: for recall rate, 107 (95% CI, 89-124) with digital mammography vs 91 (95% CI, 73-108) with digital mammography + tomosynthesis; difference, -16 (95% CI, -18 to -14; P < .001); for biopsies, 18.1 (95% CI, 15.4-20.8) with digital mammography vs 19.3 (95% CI, 16.6-22.1) with digital mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

Digital breast tomosynthesis changes management in patients seen at a tertiary care breast center.

Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change—25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (P < 0.001). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (P = 0.03). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1–0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen on FFDM. The increase in cancer detection rate was 17% for asymptomatic patients, 0% for symptomatic patients, and 100% for recalled patients. Conclusions. DBT increased cancer detection rate by 20% and decreased the recall rate in 8–25%. Advances in Knowledge. DBT led to a doubling of the cancer detection rate in recalled patients.