Mammographic Detection Research Articles

Tamoxifen Chemoprevention Treatment and Time to First Diagnosis of Estrogen Receptor-Negative Breast Cancer

Tamoxifen's effect of reducing the risk of estrogen receptor (ER)-positive breast cancer is well established. Its effect on the time to first diagnosis of breast cancer has not been reported. We used information from the randomized, placebo-controlled Breast Cancer Prevention Trial (BCPT) to make that evaluation. A total of 13,388 women enrolled in BCPT, of whom 174 were diagnosed with ER-positive tumors and 69 were diagnosed with ER-negative tumors. A flexible semiparametric cure rate model was used to assess the effects of tamoxifen vs placebo treatment on the time to disease diagnosis. Multivariable logistic regression, adjusted for age and tumor size at diagnosis, was used to assess the association between the mammography detection rate and treatment with tamoxifen. All statistical tests were two-sided. The median times to diagnosis of ER-positive tumors were similar in both treatment groups (43 months for the placebo arm and 51 months for the treatment arm). Times to diagnosis of ER-negative tumors, however, differed between treatment groups, with median times to diagnosis of 36 months in the placebo arm vs 24 months in the tamoxifen arm (difference = 12 months, 95% confidence interval [CI] = 3 to 17 months, P = .037). ER-negative breast cancers in the tamoxifen arm were more likely than those in the placebo arm to be detected by mammography than by clinical breast examination alone after adjustment for age and tumor size, but the increase was only marginally statistically significant (odds ratio for mammography detection = 4.68, 95% CI = 0.86 to 25.32, P = .073). No differences were found in the mammography detection rates for ER-positive tumors by treatment arm. Although tamoxifen treatment does not reduce the incidence of ER-negative breast cancer, it may have advanced detection of such tumors by approximately 1 year, compared with that in the placebo arm. The time to diagnosis of ER-positive breast cancer was similar in both treatment arms.

Single Reading with Computer-Aided Detection for Screening Mammography

The sensitivity of screening mammography for the detection of small breast cancers is higher when the mammogram is read by two readers rather than by a single reader. We conducted a trial to determine whether the performance of a single reader using a computer-aided detection system would match the performance achieved by two readers. The trial was designed as an equivalence trial, with matched-pair comparisons between the cancer-detection rates achieved by single reading with computer-aided detection and those achieved by double reading. We randomly assigned 31,057 women undergoing routine screening by film mammography at three centers in England to double reading, single reading with computer-aided detection, or both double reading and single reading with computer-aided detection, at a ratio of 1:1:28. The primary outcome measures were the proportion of cancers detected according to regimen and the recall rates within the group receiving both reading regimens. The proportion of cancers detected was 199 of 227 (87.7%) for double reading and 198 of 227 (87.2%) for single reading with computer-aided detection (P=0.89). The overall recall rates were 3.4% for double reading and 3.9% for single reading with computer-aided detection; the difference between the rates was small but significant (P<0.001). The estimated sensitivity, specificity, and positive predictive value for single reading with computer-aided detection were 87.2%, 96.9%, and 18.0%, respectively. The corresponding values for double reading were 87.7%, 97.4%, and 21.1%. There were no significant differences between the pathological attributes of tumors detected by single reading with computer-aided detection alone and those of tumors detected by double reading alone. Single reading with computer-aided detection could be an alternative to double reading and could improve the rate of detection of cancer from screening mammograms read by a single reader. (ClinicalTrials.gov number, NCT00450359.)

Improvement of microcalcification cluster detection in mammography utilizing image enhancement techniques

In this work, the effect of an image enhancement processing stage and the parameter tuning of a computer-aided detection (CAD) system for the detection of microcalcifications in mammograms is assessed. Five (5) image enhancement algorithms were tested introducing the contrast-limited adaptive histogram equalization (CLAHE), the local range modification (LRM) and the redundant discrete wavelet (RDW) linear stretching and shrinkage algorithms. CAD tuning optimization was targeted to the percentage of the most contrasted pixels and the size of the minimum detectable object which could satisfactorily represent a microcalcification. The highest performance in two mammographic datasets, were achieved for LRM ( A Z = 0.932 ) and the wavelet-based linear stretching ( A Z = 0.926 ) methodology.

Computer‐Aided Detection in Mammography

SummaryIn breast cancer imaging many innovations continue to take place. This article discusses computer‐aided detection (CAD) of breast cancer in mammograms, which is the first large‐scale application of independent computerized interpretation of radiological images. Thousands of systems have already been installed worldwide and use of CAD is rapidly expanding with the introduction of digital mammography. Radiologists are generally pleased with the new technology, in particular for its ability to mark clustered microcalcifications with high sensitivity. However, most believe that the performance of CAD for mass detection should still be improved to make it more useful. Most clinical studies indicate that CAD is effective in practice, both for detection of masses and microcalcifications. Future developments show a trend towards using CAD not only for detection but also for characterization of lesions.

Ultrasound, Mammography, or Both for Breast Cancer Detection?

More than half of women younger than 50 and one third of women older than 50 have dense breast tissue, which can hamper mammographic detection of

Increase in mammography detected breast cancer over time at a community based regional cancer center: a longitudinal cohort study 1990-2005.

BackgroundCoincident with the advent of mammography screening, breast carcinoma in situ has increased in the US population.MethodsWe conducted a prospective cohort study of all women presenting with primary breast cancer, aged 21–94, and biopsy confirmed Stage 0-IV from 1990–2005 identified and tracked by our registry. Clinical presentation characteristics including age, race, TNM stage, family and pregnancy history, histologic type and method of detection by patient (PtD), physician (PhysD) or mammography (MgD) were chart abstracted at time of diagnosis. Cases with unknown or other method of detection (n = 84), or unusual cell types (n = 26) were removed (n = 6074).ResultsFrom 1990 to 1998 the percentage of PtD and MgD cases was roughly equivalent. In 1999 the percentage of MgD cases increased to 56% and PtD dropped to 37%, a significant 20% differential, constant to 2005 (Pearson chi square = 120.99, p < .001). Overall, percent TNM stage 0 (breast carcinoma in situ) cases increased after 1990, percent stage I and III cases declined, and stage II and IV cases remained constant (Pearson chi square = 218.36, p < .001). Increase in MgD over time differed by age group with an 8.5% increase among women age 40–49 and 12% increase among women age 50–95. Women age 21–39 rarely had MgD BC. In forward stepwise logistic regression modeling, significant predictors of MgD BC by order of entry were TNM stage, age at diagnosis, diagnosis year, and race (chi square = 1867.56, p < .001).ConclusionIn our cohort the relative proportion of mammography detected breast cancer increased over time with a higher increase among women age 50+ and an increase of breast carcinoma in situ exclusively among MgD cases. The increase among women currently targeted by mammography screening programs (age ≥ 50) combined with an increase of breast carcinoma in situ most often detected by mammography screening indicates a possible incidence shift to lower stage breast cancer as a result of mammographic detection.

Criteria for the definition of early cancer of the breast (author's transl)

In order to define cancer of the breast limited to the breast parenchyma 114 infiltrating carcinomas with a maximum size of 1 cm and 88 non-infiltrating carcinomas (without size limitation) were investigated histologically for axillary lymph node metastases. All carcinomas with a size of up to 0.5 cm (25 cases) were free of lymph node metastases. Infiltrating carcinomas with a size of more than 0.5 cm up to 1 cm (108 cases) showed metastases in 25%. Non-infiltrating carcinomas of more than 0.5 cm (69 cases) had lymph node metastases in 1.4%. Considering the excellent prognosis, by histologically criteria infiltrating carcinomas of up to 0.5 cm and all non-infiltrating carcinomas can be considered as cases of "early breast cancer". For detection of these carcinomas mammography is of considerable importance, particularly when micro-calcifications are demonstrated. Among non-invasive carcinomas 74% were thus discovered by this method.

Diagnostic Accuracy of Digital versus Film Mammography: Exploratory Analysis of Selected Population Subgroups in DMIST

To retrospectively compare the accuracy of digital versus film mammography in population subgroups of the Digital Mammographic Imaging Screening Trial (DMIST) defined by combinations of age, menopausal status, and breast density, by using either biopsy results or follow-up information as the reference standard. DMIST included women who underwent both digital and film screening mammography. Institutional review board approval at all participating sites and informed consent from all participating women in compliance with HIPAA was obtained for DMIST and this retrospective analysis. Areas under the receiver operating characteristic curve (AUCs) for each modality were compared within each subgroup evaluated (age < 50 vs 50-64 vs >or= 65 years, dense vs nondense breasts at mammography, and pre- or perimenopausal vs postmenopausal status for the two younger age cohorts [10 new subgroups in toto]) while controlling for multiple comparisons (P < .002 indicated a significant difference). All DMIST cancers were evaluated with respect to mammographic detection method (digital vs film vs both vs neither), mammographic lesion type (mass, calcifications, or other), digital machine type, mammographic and pathologic size and diagnosis, existence of prior mammographic study at time of interpretation, months since prior mammographic study, and compressed breast thickness. Thirty-three centers enrolled 49 528 women. Breast cancer status was determined for 42,760 women, the group included in this study. Pre- or perimenopausal women younger than 50 years who had dense breasts at film mammography comprised the only subgroup for which digital mammography was significantly better than film (AUCs, 0.79 vs 0.54; P = .0015). Breast Imaging Reporting and Data System-based sensitivity in this subgroup was 0.59 for digital and 0.27 for film mammography. AUCs were not significantly different in any of the other subgroups. For women aged 65 years or older with fatty breasts, the AUC showed a nonsignificant tendency toward film being better than digital mammography (AUCs, 0.88 vs 0.70; P = .0025). Digital mammography performed significantly better than film for pre- and perimenopausal women younger than 50 years with dense breasts, but film tended nonsignificantly to perform better for women aged 65 years or older with fatty breasts.

Computer-aided Detection in Full-Field Digital Mammography: Sensitivity and Reproducibility in Serial Examinations

To retrospectively evaluate the sensitivity and reproducibility of a computer-aided detection (CAD) system applied to serial digital mammograms obtained in women with breast cancer, with histologic analysis as the reference standard. This study was institutional review board approved, and patient informed consent was waived. A commercially available CAD system was applied to initial and follow-up digital mammograms obtained in 93 women with breast cancer (mean age, 52 years; age range, 32-81 years). The mean interval between mammographic examinations was 23 days (range, 7-58 days). There were 119 visible lesion components (70 masses, 49 microcalcifications). Sensitivity, false-positive mark rate, and reproducibility of the CAD system were evaluated for both sets of mammograms with the t test. Sensitivities of the CAD system at initial and follow-up digital mammography were 91% and 89%, respectively, for detection of masses. Sensitivity of the CAD system for detection of microcalcifications was 100% at both initial and follow-up digital mammography. Overall false-positive mark rates were 0.29 per image and 0.27 per image at initial and follow-up digital mammography, respectively. When craniocaudal and mediolateral oblique views were considered separately, sensitivities were 76% and 75%, respectively, for masses and 96% and 92%, respectively, for microcalcifications. The reproducibility of CAD marks was 80% for true-positive masses, 92% for true-positive microcalcifications, 9% for false-positive masses, and 8% for false-positive microcalcifications (P < .001). The sensitivity of the CAD system was consistently high for detection of breast cancer on initial and short-term follow-up digital mammograms. Reproducibility was significantly higher for true-positive CAD marks than for false-positive CAD marks. http://radiology.rsnajnls.org/cgi/content/full/246/1/71/DC1.

Documentation of Complete Response in Metastatic Breast Cancer to Liver and Bone Achieved with Trastuzumab and Pegylated Liposomal Doxorubicin

We present a case report of a complete response to a combination of trastuzumab and pegylated liposomal doxorubicin in a female patient with recurrent metastatic HER-2 positive breast cancer after anthracy-cline-based adjuvant primary chemotherapy. To our knowledge this sequence of events has not previ-ously been reported.In September 2003, after routine mammographic detection, this 59-year-old business executive mother of two underwent right mastectomy and axillary node dissection with immediate reconstruction. Pathologic diagnosis included a T1N0M0 poorly differentiated in fi ltrating ductal carcinoma and further characterized by high proliferative fraction, negative hormone receptors, 3 + Her2 expression by immu-nohistochemistry, and 8-fold amplifi cation of Her2 by FISH. Entry into Intergroup Study N9831 (1) was precluded by presumed pressure related brachial paresis during her postoperative recovery. Her adjuvant chemotherapy consisted of four cycles of doxorubicin (60 mg/m

The Impact of Race and Mammographic Detection in Early Breast Cancer

The Impact of Race and Mammographic Detection in Early Breast Cancer

Image Quality, lesion detection, and diagnostic efficacy in digital mammography: Full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

Objective To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. Materials and methods In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. Results For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better ( p < 0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. Conclusion Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.

Disappointing Data on Computer-Aided Detection for Screening Mammography

In the decade since the FDA approved the use of computer-aided detection (CAD) for screening mammography, some breast-imaging centers have implemented

Improved Lesion Detection in MR Mammography: Three-Dimensional Segmentation, Moving Voxel Sampling, and Normalized Maximum Intensity–Time Ratio Entropy

The objective of this work was to develop a quantitative method for improving lesion detection in dynamic contrast-enhanced magnetic resonance mammography (DCEMRM). For this purpose, we segmented and analyzed suspicious regions according to their contrast enhancement dynamics, generated a normalized maximum intensity-time ratio (nMITR) projection, and explored it to extract important features, to improve accuracy and reproducibility of detection. A novel automated method is introduced to segment and analyze lesions in three dimensions. It consists of four consecutive stages: volume of interest selection, nMITR projection generation using a voxel sampling method based on a moving 3 x 3 mask, three-dimensional lesion segmentation, and feature extraction. The nMITR projection of the detected lesion is used to extract six features: mean, maximum, standard deviation, kurtosis, skewness, and entropy, and their diagnostic significance is studied in detail. High-resolution MR images of 52 breast masses from 46 women are analyzed using the technique developed. Entropy, standard deviation, and the maximum and mean value features were found to have high significance (P < 0.001) and diagnostic accuracy (0.86-0.97). The kurtosis and skewness were not significant. Automated analysis of DCEMRM using nMITR was shown to be feasible. The lesion detection method described is efficient and leads to improved, accurate, reproducible diagnoses. It is reliable in terms of observer variability and may allow for a better standardization of clinical evaluations. The findings demonstrate the usefulness of nMITR based features; nMITR-entropy shows the best performance for quantitative diagnosis.

MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component

Purpose To determine the role of magnetic resonance (MR) mammography in detection and assessment of extent of tumors with extensive intraductal component (EIC+). Material and methods In a prospective study, 233 consecutive women with a suspicious lesion underwent preoperative MR mammography and 209 invasive ductal carcinomas were detected. We studied the prediction of intraductal spread on mammography (MX), ultrasound (US) and MR. We compared the size of the total lesion on MX, US and MR and correlated it with histopathology. Enhancement patterns on MR were described. Results Of 209 invasive ductal carcinomas, 50 were EIC+ (24%). MX predicted intraductal spread in EIC+ carcinomas in 48.5%, US in 34.2% and MR in 68%. Compared to MX and US, MR was best in assessment of total tumor size. On MR, ductal spread in EIC+ tumors presented as ductal or linear enhancement, long spicules, a regional enhancing area or nodules adjacent to a mass. Conclusion MR had the highest sensitivity to predict intraductal spread and was superior in assessing total tumor size.

Mammography in detection clinically occult breast carcinoma

The significance of mammography in detection of nonpalpable breast cancer This prospective study was conducted at the Institute for oncology and radiology of Serbia in Belgrade. It involved 198 asymptomatic women with performed screening mammography, 154 specimen mammography, out of wich 38 had stereotaxic mark, "ex tempore" biopsy, while 44 women had "ex tempore" biopsy and adequate surgery. Screening mammography revealed suspect microcalcifications in 148 cases, impaired structural tissue in 59 and focal condensation in 55 cases. Histologic examination verified breast carcinoma in 80 patients with very statistical significance of ductal type, especially comedo subvariant (p < 0.001). Pleomorphic microcalcifications smaller than 0.5 mm of grouped or segmented form are statistically very significant for malignity (p < 0.001) as well as associated microcalcifications with altered architectony and focal tissue condensation (p < 0.001). Mammography has great significance in detection of occult breast carcinoma which are not only preinvasive, but olso microinvasive and invasive. This fact leads to the neccesity of introduction of legal obligation for mammography screening, especially for women aged between 50 and 70 years.

Breast MRI More Sensitive Than Mammography for Ductal Carcinoma In Situ

Breast magnetic resonance imaging is generally considered less sensitive than mammography for detection of ductal carcinoma in situ (DCIS), but this conclusion comes from studies in which MRI failed to detect DCIS that was already identified by mammographic microcalcification. Might MRI detect DCIS that is not apparent on mammography? In this …

Influence of young age at diagnosis and family history of breast or ovarian cancer on breast cancer outcomes in a population-based cohort study

The objective of this study was to examine the association of: (i) diagnosis at age </=35, (ii) first-degree family history of breast or ovarian cancer (BOC) and (iii) a research based definition of genetic risk, with tumor characteristics, treatment and survival in breast cancer (BC). Consenting female participants in the population-based Ontario Familial Breast Cancer Registry diagnosed with primary invasive BC between 1996 and 1998 were followed prospectively until 2005. Among 967 women, 105 were </=35 years old at diagnosis and 686 were classified as genetic risk cases, including 349 with a first-degree family history. Individuals diagnosed at age </=35 were more likely to self-detect tumors, to present with inflammatory BC, to have invasive ductal carcinoma of no special type, high T stage, and tumors with lymphovascular invasion (LVI), high grade and negative estrogen receptors. Younger women were more likely to receive chemotherapy and less likely to receive hormonal therapy. Diagnosis </=35 years old was associated with significantly reduced distant recurrence free survival, an effect that did not persist after adjustment for tumor and treatment related variables. Poor outcomes were restricted to younger women with hormone responsive BC. Family history was associated with increased rates of mammographic detection of BC, lower tumor stage and less frequent inflammatory BC, but had no association with BC outcomes. Women diagnosed with BC at age </=35 have more aggressive tumors; these adverse tumor characteristics, rather than age, lead to poor outcomes. Family history was not associated with survival.

Computer-aided detection in mammography: Applications and repercussions

Computer-aided detection in mammography: Applications and repercussions

Reduced mortality for women with mammography-detected breast cancer in east Denmark and south Sweden

The 5-year relative survival from breast cancer in Denmark is 10 percentage points lower than in Sweden. This difference has been demonstrated previously as being caused partly by more involved lymph nodes and larger tumours in Denmark. Sweden has had nationwide mammography-screening coverage since 1991, whereas this is still in its infancy in Denmark. In the search for an explanation for the remaining survival difference, patient delay was a likely candidate. This study compared patient delay and mammography-detection between two national regions. Data on patient delay and mammography were obtained from hospital records from 1989 and 1994, and analysed using Cox proportional hazard analysis of death within the first 5 years, with the factors age, country, delay/mammography detection and established patho-anatomic variables. A comparison of patient delay and mammography detection in 1989 and 1994 showed more mammography-detected tumours in south Sweden and more women with long delay in east Denmark. Mammography detection, but not long patient delay, had a significant effect on the death hazard when adjusting for patho-anatomic risk factors. The hazard ratio was not eliminated in 1989, but in 1994, the hazard ratio between east Denmark and south Sweden was reduced from 1.3 to 1.1. In conclusion, patient delay did not appear to have any effect on 5-year survival when adjusting for patho-anatomic factors, but tumour detection by mammography affected survival favourably and partly explained the survival difference between east Denmark and south Sweden.