Mammography Examination Research Articles

Manual or auto-mode: Does this affect radiation dose in digital mammography without compromising image quality?

IntroductionIn current practice, auto-filter exposure mode is used for most screening mammography examinations. However, with better understanding of the side effects of radiation, it is important to examine exposure parameters and practises to minimise radiation dose to patients. The purpose of this phantom study is to investigate the impact that different exposure modes (manual, auto-time and auto-filter) have on radiation dose, while maintaining images of diagnostic quality. MethodsThis study was conducted in three stages. In the first stage, 125 images were taken using a Gammex 156 phantom with polymethyl methacrylate blocks to reflect varying thicknesses (4.5, 5.0, 5.5, 6.0 and 6.5 cm). In the second stage, three mammographers independently assessed image quality and assigned scores based on the number of distinct fibers, masses and speck groups visible. Images with acceptable quality were further investigated in the third stage by comparing their average glandular dose (AGD) using the Kruskal–Wallis H test and Dunn's post-hoc pairwise analysis. ResultsSignificant differences in AGD were shown between the auto-filter mode and manual mode techniques for 6.0 cm, and between auto-time mode and manual mode techniques for 6.5 cm (p < 0.05). ConclusionFor 4.5, 5.0 and 5.5 cm phantoms, as AGD was not significantly different among the different modes, the auto-filter may remain the most practical option. However, significant reductions in AGD were obtained for the 6.0 and 6.5 cm phantoms when manual mode techniques were used. Implications for practiceManual mode techniques can potentially provide dose-saving opportunity in 6.0 and 6.5 cm breast thickness though future work on human breast should be done to confirm this. Results from this study will support future research based on patient data.

Pengabdian Masyarakat dengan “Deteksi Dini Kanker Payudara dengan SADARI”

Cancer is a disease that causes a lot of misery and death in humans. Breast cancer is the uncontrolled growth of cells in the breast. The emergence of these cancer cells occurs as a result of mutations or abnormal changes in genes that are responsible for maintaining cell growth and keeping it normal (healthy). Breast cancer can be detected early by means of breast selfexamination, clinical examination and mammography examination to find out early. BSE examination can be started early to become a routine habit in order to detect breast cancer early. The purpose of this service is to provide information about adolescent reproductive health, especially about early detection of breast cancer by conducting breast self-examination. The method used in this community service activity begins with the opening and introduction of the resource persons, then continues with the delivery of health education materials, a question and answer session to participants and finally closing. With this activity, the youth organizations find it helpful because young people have received information and supplies in detecting breast cancer from an early age.

Ionizing radiation and volumetric mammographic density.

Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose ionizing radiation (IR) has been recognized as a breast cancer risk factor. The aim of our study was to investigate association between lifetime low dose ionizing radiation (LDIR) and MD. A cross-sectional study included 467 women aged 40-60 years who underwent screening mammography in Łódź, Poland. The digital mammography examination of the breasts included both craniocaudal and mediolateral oblique views. The volumetric breast density (VBD) (%) and fibrograndular tissue volume (FG) (cm3) were determined based on the analysis of mammographic image ("for processing") using Volpara Imaging Software. The exposure to IR was estimated for each individual, based on the data from interviews about diagnostic or therapeutic medical procedures performed in the area of the neck, chest, abdomen and spine, which involved X-rays and γ rays and the data about the doses derived from literature. Linear and logistic regression were fitted with VBD and FG as the outcomes and organ breast dose, effective dose and number of mammographies as the determinants, adjusted for major confounders. The analyses showed no association between VBD or FG and the breast organ dose or the effective dose. The only significant finding observed concerned the association between the number of mammographies and the FG volume with β coefficient: 0.028 (95% CI: 0.012-0.043), and predicted mean FG volume >13.4 cm3 among the women with >3 mammographies when compared to those with none. This study does not, in general, provide support for the positive association between LDIR and MD. The weak association of the FG volume with the number of mammographies warrants further verification in larger independent studies. Int J Occup Med Environ Health. 2022;35(5):635-49.

Regression Analysis between the Different Breast Dose Quantities Reported in Digital Mammography and Patient Age, Breast Thickness, and Acquisition Parameters.

Breast cancer is the leading cause of cancer death among women worldwide. Screening mammography is considered the primary imaging modality for the early detection of breast cancer. The radiation dose from mammography increases the patients’ risk of radiation-induced cancer. The mean glandular dose (MGD), or the average glandular dose (AGD), provides an estimate of the absorbed dose of radiation by the glandular tissues of a breast. In this paper, MGD is estimated for the craniocaudal (CC) and mediolateral–oblique (MLO) views using entrance skin dose (ESD), X-ray spectrum information, patient age, breast glandularity, and breast thickness. Moreover, a regression analysis is performed to evaluate the impact of mammography acquisition parameters, age, and breast thickness on the estimated MGD and other machine-produced dose quantities, namely, ESD and organ dose (OD). Furthermore, a correlation study is conducted to evaluate the correlation between the ESD and OD, and the estimated MGD per image view. This retrospective study was applied to a dataset of 2035 mammograms corresponding to a cohort of 486 subjects with an age range of 28–86 years who underwent screening mammography examinations. Linear regression metrics were calculated to evaluate the strength of the correlations. The mean (and range) MGD for the CC view was 0.832 (0.110–3.491) mGy and for the MLO view was 0.995 (0.256–2.949) mGy. All the mammography dose quantities strongly correlated with tube exposure (mAs): ESD (R2 = 0.938 for the CC view and R2 = 0.945 for the MLO view), OD (R2 = 0.969 for the CC view and R2 = 0.983 for the MLO view), and MGD (R2 = 0.980 for the CC view and R2 = 0.972 for the MLO view). Breast thickness showed a better correlation with all the mammography dose quantities than patient age, which showed a poor correlation. Moreover, a strong correlation was found between the calculated MGD and both the ESD (R2 = 0.929 for the CC view and R2 = 0.914 for the MLO view) and OD (R2 = 0.971 for the CC view and R2 = 0.972 for the MLO view). Furthermore, it was found that the MLO scan views yield a slightly higher dose compared to CC scan views. It was also found that the glandular absorbed dose is more dependent on glandularity than size. Despite being more reflective of the dose absorbed by the glandular tissue than OD and ESD, MGD is considered labor-intensive and time-consuming to estimate.

Contrast Enhanced Mammography in Routine Clinical Practice: Frequency and Malignancy Rates of Enhancing Otherwise Occult Findings

BackgroundIn routine clinical practice, contrast-enhanced mammography (CEM) examinations identify enhancing findings seen only on subtraction images that have no low-energy mammographic or sonographic correlate. The purpose of this study is to report the frequency and malignancy rates of enhancing findings seen only on subtraction images in a tertiary care breast imaging practice. Materials and methodsConsecutive review of CEM exams from December 2015 to May 2020. Chi square tests were used to determine associations between cancer diagnosis and clinical characteristics of enhancing findings seen only on subtraction images, P < .05 indicating a statistically significant difference. ResultsFour percent (100/2464) of CEM examinations identified 108 enhancing findings seen only on subtraction images. Twenty of those CEM enhancing findings were directly managed as a multifocal disease. Of those further evaluated with MR, 23% (19/78) with associated MR correlates were treated surgically as presumed multicentric or multifocal disease following multidisciplinary review. The remaining 76% (59/78) of enhancing findings were seen only on subtraction images, these included: 20% (12/59) and downgraded to benign on MR 80% (47/59) with suspicious findings which underwent MR vacuum assisted breast biopsy yielding: 26% (12/47) malignancy, 9% (4/47) high risk, and 66% (31/47) benign diagnoses. ConclusionEnhancing findings seen on subtraction only CEM images are seen in 4% of cases in clinical practice. MR correlation can help characterize CEM findings to: (1) avoid unnecessary biopsy for benign findings, and (2) guide tissue sampling or empiric surgical planning for suspicious findings.

PENERAPAN BUDAYA KESELAMATAN TENAGA KESEHATAN DI RUANGAN MAMOGRAFI

A safety culture needs to be applied by health workers for breast diagnostic examinations with x-ray mammography, even though the exposure factor is relatively low compared to other modalities. This study aimed to ensure the application of a safety culture in the operation of mammography examinations. The research method is to measure the scattering radiation exposure with a survey meter and a voltage exposure factor of 28 kV, 20 mAS, Mo/Mo mode around the left and right of the operator's booth in the mammography room from the primary beam with a distance variation of 150 cm- 210 cm and a height of 50 cm, 100 cm, and 160 cm. The results showed that the position of the mammography examination operator must be right behind the Pb glass in the operator's room because if you ignore it, you are not in the correct position behind the Pb glass and do not use personal protective equipment, you will get the potential for exposure to scattered radiation from 11.7 – 24.6 µSv/h. Recommendations related to the procedure need improvement by providing a footmark behind the operator's desk and an alternative to moving the operator's station. Implementing a safety culture includes commitments, strategies, conservative actions, simulation of hazards and unsafe acts, and continuous improvement, which active participation by the regulatory body and hospital management as part of the permit holder's responsibility for protecting radiation workers. Keywords: safety culture, radiation potential, mammography, management

Assessing Risk and Knowledge of Women on Breast Cancer and Providing Lifestyle Advice for the Management of Breast Cancer Risk

Breast cancer is the most common cancer and is the main cause of cancer mortality among women in the world. Overall, 1 in 28 women is likely to develop breast cancer during her lifetime. Although the mortality rate is decreasing, the incidence is persistently increasing due to urbanization and lifestyle changes. So, there is a need to assess the personal breast cancer risk and increase the knowledge of women on early detection. The present study aims to assess the risk and knowledge of women on breast cancer. The main objective of the study is to identify the women at high risk, to create awareness among women about early screening and detection and to educate lifestyle management to decrease breast cancer risk. A descriptive cross-sectional study was performed during the period of June 2019 to November 2019 in the women attended for mammographic examination. A total of 270 women responded to the study. The results showed that five-year risk is found to be high for 31.1% of women and low for 68.8% of women with a mean of 1.4 and the standard deviation is 1.24. About 14.81% of women were found to have strong lifetime risk and 30.37% of women had average lifetime risk and 54.81% women had usual lifetime risk. The mean lifetime risk of the women is 16.09 and the standard deviation is 10.2. The majority of the participants have low knowledge on breast cancer; BSE, and mammography i.e., 80% of them were lack of knowledge. The mean knowledge score is 6.34 and the standard deviation is 5.45. The women who had high five-year and strong lifetime risk are eligible for breast cancer prevention and management approaches. The women with moderate lifetime risk were advised with regular screening and Breast Self-Examination practices.

Performance of artificial intelligence-based breast cancer screening in a community setting: a real-world evaluation study

Despite improvements in treatment strategies, breast cancer survival rates in India remain low because of poor awareness and advanced stages at presentation. Early diagnosis and treatment can improve the survival rates of patients with breast cancer. A population-based breast cancer screening programme with mammography is often not feasible in resource-constrained settings. Thermalytix, a novel breast cancer screening technology, applies artificial intelligence algorithms over thermal images to generate an automated interpretation report indicating breast health. The Thermalytix testing equipment is portable, requires minimal skills to operate, and operation is 20 times less expensive than a mammography. The test has been used to screen women in community settings in India. This study was done to assess the performance of the Thermalytix test in identifying women suspicious of breast cancer in community settings. Women who underwent Thermalytix tests in community-based screening camps in the Indian states of Karnataka and Maharashtra between Aug 12, 2017, and May 31, 2021, were included in this study. The Thermalytix test captured five thermal images in multiple views from each participant and the tool automatically generated a triage report. A more detailed report with annotations of probably abnormal regions and an overall breast health score ranging from 0 to 5 (B-score) was also generated. A B-score of 4 or 5 on triage indicates a high level of concern and prompts a recommendation to follow-up with breast ultrasonography. A B-score of 3 prompts a recommendation to repeat the Thermalytix test after 3 months. A B-score of 1 or 2 indicates thermal patterns of low level, usually prompting a recommendation to continue routine screening. Participants with B-scores of 4 or 5 on the Thermalytix test were followed-up with a telephone call to obtain information about their subsequent tests, such as mammography, ultrasonography, or histopathological examination. Women with a follow-up report were categorised as having "Normal", "Abnormal-Benign", or "Abnormal-Malignant" findings (as per their Breast Imaging Reporting and Data System score of 1, 2 or 3, or 4 or 5, respectively). 13 932 women were included in the analysis. 775 women complained of a breast lump, 625 (4·5%) of whom were given B-scores of 4 or 5 after Thermalytix testing and were referred for follow-up breast ultrasonography. 117 (18·7%) of these 625 women underwent standard follow-up investigations. Abnormalities were detected in 78 of the 117 followed-up women (74 benign and four malignant breast lesions), indicating that Thermalytix has a positive predictive value of 66·7% in detecting benign and malignant breast lesions. In resource-constrained countries where systematic screening programmes with mammography is not scalable or feasible, the portable, radiation-free Thermalytix test is a promising option for affordable and accessible breast cancer screening. This screening test is not resource-intensive and can be set up in remote locations and operated with minimal training. The Thermalytix test can be used to triage women for referral for further evaluation in secondary or tertiary health-care centres, which makes it a logistically and economically feasible option for breast cancer screening in low-income and middle-income countries. This programme was sponsored by Niramai Health Analytix and was executed in collaboration with National Health Mission, Maharashtra, India, and Bruhat Bengaluru Mahanagara Palike, Municipal Corporation of Bangalore City, Karnataka, India.

Chronic non-lactational granulomatous mastitis treated with local negative pressure

In the given clinical observation, the authors discuss management of a patient with chronic non-lactational mastitis.A 42-year-old patient with chronic non-lactational granulomatous mastitis had conservative antibiotic therapy for more than a month. During this period, chronic mastitis was diagnosed twice with core biopsy. Ultrasound and mammography examination demonstrated the enlargement of inflammation area. Delayed surgical treatment and specific anatomic structure of the gland, in particular, its ductal structure, high content of adipose tissue, caused the enlargement of the affected area after which half of the tissue volume had to be incised.After surgery, the patient was prescribed a complex therapy for 1.5 months including physical processing of the wound (ozone-oxygen mixture, NO-flows, negative pressure therapy (NPWT)).For more than three years of follow-up, the patient had no disease recurrences. The applied complex treatment allowed to get a stable aesthetically acceptable result.

Lactating Adenoma in Pregnancy: A Case Report

Background: Lactating adenoma is a rare palpable breast lesion that occurs late in pregnancy or the lactation period and is commonly found in young primiparous women in the second or third decade of life. This case report aims to describe lactating adenoma and its management.&#x0D; Case presentation: A woman, 24 years old, 26 weeks pregnant, came to the Surgical Oncology Polyclinic of Dr. Moewardi Hospital Surakarta with a complaint of a lump in the right breast from the last 4 months. The lump was felt to be getting bigger, painful to the point that sometimes fluid came out of the nipple of her right breast. The patient had a history of previous lumps with a diagnosis of fibroadenoma that had been operated on. On palpation multiple nodules are palpable. Mammography examination showed a mass with partial calcification (BIRADS 3). The patient was diagnosed with a tumur of mammae dextra suspected of malignant cT2N1Mx with G1P0A0 26 weeks gestation. Histopathological examination results showed a lactating adenoma.&#x0D; Conclusion: There are several recommendations for the management of lactating adenoma during pregnancy. An antepartum biopsy is recommended for women with a breast mass in the first or second trimester, postpartum for masses that appear in the late third trimester, and fine-needle aspiration biopsy as an alternative for masses that appear in the early third trimester. Treatment with bromocriptine, a dopamine agonist, may be given to reduce the size of the lactating adenoma.

Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database.

PurposeThe aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic.MethodsScreening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.ResultsIn total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.ConclusionsCOVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.

Assessing breast cancer screening results through the lens of COVID-19 pandemic.

e22507 Background: In January, 2020 World Health Organization (WHO) declared the COVID-19 outbreak as the first global health emergency. Lockdowns and restrictive procedures with the full and partial cancellation of preventive measures, including breast cancer (BC) screening, took place in Kazakhstan in 2020-2021. Purpose of this study: to determine the impact of the COVID-19 pandemic on BC screening results. Methods: The main screening indicators before (2018-2019) and during the COVID-19 pandemic (2020-2021) were studied: planned coverage and number of examined patients, the proportion of BI-RADS categories (where BI-RADS categories 4-5 are accepted as suspicious for malignancy, additional imaging by ultrasound and/or mammography followed biopsy is recommended), the number of detected cancer cases, the stage of the disease according to the screening database and the Electronic Cancer Registry. Results: 1,624,667 women underwent BC screening in 2018-2019 (96.2% of the planned amount of 1,688,829 women). 1,532,591 (79.4%) women were examined in 2020-2021, though the planned amount was 1,930,515. Before the epidemic, 23,296 patients received BI-RADS categories 4-5 (1.43% from examined women) and were referred for additional ultrasound and mammography examination, in 2020-2021 – 25,008 women (1.63%). 74.2% (1,205,094 women) had BI-RADS category 1 in 2018-2019 and 63.4% (971,754 patients) – during the pandemic. In 2018-2019 - 3,377 BC cases were detected (cancer detection rate was 2.0 per 1000 investigations). In 2020-2021 - 2,474 BC cases were identified (cancer detection rate 1.6 per 1000 investigations). Proportion of screen-detected cancers in stage 0-I was 45.1% in 2018-2019 and 47.5% in 2020-2021. During the pandemic, the number of participants who underwent BC screening significantly decreased (by 20.6% of the planned). The level of cancer detection decreased too (by 22.8%). There was an increase in patients requiring further examination (BI-RADS categories 4-5) and decrease the number women with BI-RADS 1. With an increase in indications for additional ultrasound and radiological examination, the number of revealed cancers reduced by 1.5 times (in 2018-2019, 14.5% patients with BI-RADS categories 4-5 had BC confirmed, in 2020-2021 – only 9.9%). Conclusions: BC screening has been significantly reduced during the COVID-19 pandemic. At the same time, attention should be paid to the increase in overdiagnosis of mammographic pathology, possibly due to an increase in the density of breast tissue on the background of nonspecific inflammation accompanied by lymphadenopathy. The impact of COVID-19 on BC is still unknown. Further research will be needed to confirm the link between COVID-19 and mammography picture and BC.

Effects of lower screening activity during the COVID-19 pandemic on breast cancer patient pathways: Evidence from the age cut-off of organized screening

We examined the effects of the COVID-19 pandemic on the screening, diagnosis and treatment of breast cancer in Hungary based on administrative data until June 2021, covering three pandemic waves. After correcting for trend and seasonality, the number of mammography examinations decreased by 68% in 2020q2, was around its usual level in 2020q3 and was reduced by 20–35% throughout 2020q4-2021q2. The reduction was caused by a combination of supply-side (temporary suspensions of screening) and demand-side (lower screening participation during the pandemic waves) factors. The number of new breast cancer diagnoses and mastectomy surgeries responded with a lag, and were below their usual level by 15-30% in all quarters between 2020q2 and 2021q2, apart from 2020q4, when there was no significant difference. Using a regression discontinuity framework, we found that the partial mastectomy rate (indicative of early diagnosis) dropped more substantially in 2020q2 in the 61–65 years old age group that was just below the age cut-off of organized screening than in the 66–70 years old age group, and this difference was partially offset in 2021q1. We suggest that policymakers need to motivate the target population (by providing both information and incentives) to catch up on missed screenings.

Diagnostic reference levels (DRLs) for chest radiography, non-contrast head computed tomography and mammography examinations in Nigeria: review of national data

Diagnostic reference levels (DRLs) for chest radiography, non-contrast head computed tomography and mammography examinations in Nigeria: review of national data

Contrast-Enhanced Spectral Mammography-Based Prediction of Non-Sentinel Lymph Node Metastasis and Axillary Tumor Burden in Patients With Breast Cancer.

PurposeTo establish and evaluate non-invasive models for estimating the risk of non-sentinel lymph node (NSLN) metastasis and axillary tumor burden among breast cancer patients with 1–2 positive sentinel lymph nodes (SLNs).Materials and MethodsBreast cancer patients with 1–2 positive SLNs who underwent axillary lymph node dissection (ALND) and contrast-enhanced spectral mammography (CESM) examination were enrolled between 2018 and 2021. CESM-based radiomics and deep learning features of tumors were extracted. The correlation analysis, least absolute shrinkage and selection operator (LASSO), and analysis of variance (ANOVA) were used for further feature selection. Models based on the selected features and clinical risk factors were constructed with multivariate logistic regression. Finally, two radiomics nomograms were proposed for predicting NSLN metastasis and the probability of high axillary tumor burden.ResultsA total of 182 patients [53.13 years ± 10.03 (standard deviation)] were included. For predicting the NSLN metastasis status, the radiomics nomogram built by 5 selected radiomics features and 3 clinical risk factors including the number of positive SLNs, ratio of positive SLNs, and lymphovascular invasion (LVI), achieved the area under the receiver operating characteristic curve (AUC) of 0.85 [95% confidence interval (CI): 0.71–0.99] in the testing set and 0.82 (95% CI: 0.67–0.97) in the temporal validation cohort. For predicting the high axillary tumor burden, the AUC values of the developed radiomics nomogram are 0.82 (95% CI: 0.66–0.97) in the testing set and 0.77 (95% CI: 0.62–0.93) in the temporal validation cohort.DiscussionCESM images contain useful information for predicting NSLN metastasis and axillary tumor burden of breast cancer patients. Radiomics can inspire the potential of CESM images to identify lymph node metastasis and improve predictive performance.

Inclusion of the US Preventive Services Task Force Recommendation for Mammography in State Comprehensive Cancer Control Plans in the US

The recommendations for the age and frequency that women at average risk for breast cancer should undergo breast cancer mammography screening have been a matter of emotional, political, and scientific debate over the past decades. Multiple national organizations provide recommendations for breast cancer screening age and frequency. US Centers for Disease Control and Prevention (CDC) funding for state comprehensive cancer control (CCC) planning requires compliance with stated objectives for attaining goals. US Preventive Services Task Force (USPSTF) recommendations on cancer prevention and control are currently used to require coverage of prevention services. To evaluate the consistency of state CCC plan objectives compared with the most current (2016) USPSTF recommendations for the age and frequency that individuals should undergo mammography screening and to make recommendations for improvement of state CCC plans. This cross-sectional study used a descriptive, point-in-time evaluation and was conducted from November 1, 2019, to June 30, 2021. In November 2019, the most recent CCC plans from 50 US states and the District of Columbia were downloaded from the CDC website. The recommended ages at which to begin and end mammography examinations and the frequency of mammography examinations were extracted from plan objectives. The recommendations found in CCC plan objectives regarding the ages at which to begin and end mammography examinations and the frequency of mammography examinations for women with average risk for breast cancer were compared with USPSTF recommendations. Of the 51 CCC plans, 16 (31%) were consistent with all USPSTF recommendations for age and frequency that women at average risk should undergo mammography. Twenty-six plans (51%) were partially consistent with recommendations, and 9 plans (18%) were not consistent with any of the 3 guideline components. Compared with the USPSTF recommendation, state CCC plans are not homogenous regarding the age and frequency that women at average risk for breast cancer should undergo mammography. This variation is partially due to differences in state-specific planning considerations and discretion, variations in recommendations among national organizations, and publication of plans prior to the most current USPSTF recommendation (2016). Specifying the concept that high-risk populations need different age and frequency of screening recommendations than the general population may reduce heterogeneity among plans.

Management of Architectural Distortion on Digital Breast Tomosynthesis With Nonmalignant Pathology at Biopsy.

BACKGROUND. Digital breast tomosynthesis (DBT) has led to increased detection and biopsy of architectural distortion, which may yield malignancy, radial scar, or other benign pathologies. Management of nonmalignant architectural distortion on DBT remains controversial. OBJECTIVE. The purpose of this study was to determine upgrade rates of architectural distortion on DBT from nonmalignant pathology at biopsy to malignancy at surgery. METHODS. This retrospective study included cases of mammographically detected architectural distortion from July 1, 2016, to June 30, 2019, that were nonmalignant at image-guided needle biopsy and underwent surgical excision. Mammographic examinations included digital 2D mammography and DBT. Imaging data were extracted from radiology reports. Upgrade rates were summarized using descriptive statistics. Features of upgraded and nonupgraded cases were compared using Pearson chi-square test and Wilcoxon signed rank test. RESULTS. The study included 129 cases of architectural distortion with nonmalignant pathology at biopsy that underwent excision in 125 women (mean age, 54 years; range, 23-90 years). At biopsy, 92 (71.3%) were radial scars and 37 (28.7%) were other nonmalignant pathologies. Of 66 radial scars without atypia at biopsy, one (1.5%) was upgraded to ductal carcinoma in situ (DCIS) at surgery and none to invasive cancer. Of 24 benign pathologies without atypia at biopsy, one was considered discordant. Of the 23 remaining concordant cases, one (4.3%) was upgraded to DCIS at surgery and none to invasive cancer. The overall upgrade rate to cancer of architectural distortion with concordant nonmalignant pathology at biopsy was 10.2% (13/128). The upgrade rate to cancer of architectural distortion without atypia was 2.2% (2/89) and with atypia was 28.2% (11/39). Explored features (age, personal or family breast cancer history, presentation by screening vs diagnostic mammography, breast density, associated mammographic findings, presence and size of ultrasound correlate, biopsy modality) showed no signifi-cant associations with upgrade risk (p > .05). CONCLUSION. Architectural distortion on DBT with concordant nonmalignant pathology at biopsy has an overall upgrade rate to malignancy at surgery of 10.2%. Architectural distortion without atypia has a low upgrade rate of 2.2%. CLINICAL IMPACT. Imaging surveillance can be considered for architectural distortion on DBT yielding radial scar without atypia or other concordant benign pathologies without atypia at biopsy.

Inequality in the Utilization of Breast Cancer Screening between Women with and without Disabilities in Taiwan: A Propensity-Score-Matched Nationwide Cohort Study.

Because of the difficulties in accessing medical care, the likelihood of receiving breast cancer screening may be low for women with disabilities. We aimed to investigate differences in the utilization of breast cancer screening among women with and without disabilities. Participants included women with and without disabilities from 2004 to 2010, and it was observed whether the participants had received a breast cancer screening during 2011 and 2012. Propensity-score matching was employed to match disabled women with non-disabled women (1:1). Data sources included the National Health Insurance Research Database, the Cancer Screening Database, and the Disability Registration File. Conditional logistic regression was performed to examine the odds ratios (ORs) that both groups would undergo breast cancer screening. The proportion of women with disabilities who received breast cancer screening was 18.33%, which was significantly lower than that of women without disabilities (25.52%) (p < 0.001). Women with dementia had the lowest probability of receiving a mammography examination (OR = 0.34; 95% CI: 0.28–0.43), followed by those with multiple disabilities (OR = 0.43; 95% CI: 0.40–0.47) and intellectual disabilities (OR = 0.45; 95% CI: 0.41–0.50). In conclusion, compared to women without disabilities, those with disabilities were less likely to undergo breast cancer screening.

Evaluation of the Combination of Artificial Intelligence and Radiologist Assessments to Interpret Malignant Architectural Distortion on Mammography.

PurposeTo compare the mammographic malignant architectural distortion (AD) detection performance of radiologists who read mammographic examinations unaided versus those who read these examinations with the support of artificial intelligence (AI) systems.Material and MethodsThis retrospective case-control study was based on a double-reading of clinical mammograms between January 2011 and December 2016 at a large tertiary academic medical center. The study included 177 malignant and 90 benign architectural distortion (AD) patients. The model was built based on the ResNeXt-50 network. Algorithms used deep learning convolutional neural networks, feature classifiers, image analysis algorithms to depict AD and output a score that translated to malignant. The accuracy for malignant AD detection was evaluated using area under the curve (AUC).ResultsThe overall AUC was 0.733 (95% CI, 0.673-0.792) for Reader First-1, 0.652 (95% CI, 0.586-0.717) for Reader First-2, and 0.655 (95% CI, 0.590-0.719) for Reader First-3. and the overall AUCs for Reader Second-1, 2, 3 were 0.875 (95% CI, 0.830-0.919), 0.882 (95% CI, 0.839-0.926), 0.884 (95% CI, 0.841-0.927),respectively. The AUCs for all the reader-second radiologists were significantly higher than those for all the reader-first radiologists (Reader First-1 vs. Reader Second-1, P= 0.004). The overall AUC was 0.792 (95% CI, 0.660-0.925) for AI algorithms. The combination assessment of AI algorithms and Reader First-1 achieved an AUC of 0.880 (95% CI, 0.793-0.968), increased than the Reader First-1 alone and AI algorithms alone. AI algorithms alone achieved a specificity of 61.1% and a sensitivity of 80.6%. The specificity for Reader First-1 was 55.5%, and the sensitivity was 86.1%. The results of the combined assessment of AI and Reader First-1 showed a specificity of 72.7% and sensitivity of 91.7%. The performance showed significant improvements compared with AI alone (p<0.001) as well as the reader first-1 alone (p=0.006).ConclusionWhile the single AI algorithm did not outperform radiologists, an ensemble of AI algorithms combined with junior radiologist assessments were found to improve the overall accuracy. This study underscores the potential of using machine learning methods to enhance mammography interpretation, especially in remote areas and primary hospitals.

An Artificial Intelligence-based Mammography Screening Protocol for Breast Cancer: Outcome and Radiologist Workload.

Background Developments in artificial intelligence (AI) systems to assist radiologists in reading mammograms could improve breast cancer screening efficiency. Purpose To investigate whether an AI system could detect normal, moderate-risk, and suspicious mammograms in a screening sample to safely reduce radiologist workload and evaluate across Breast Imaging Reporting and Data System (BI-RADS) densities. Materials and Methods This retrospective simulation study analyzed mammographic examination data consecutively collected from January 2014 to December 2015 in the Danish Capital Region breast cancer screening program. All mammograms were scored from 0 to 10, representing the risk of malignancy, using an AI tool. During simulation, normal mammograms (score < 5) would be excluded from radiologist reading and suspicious mammograms (score > recall threshold [RT]) would be recalled. Two radiologists read the remaining mammograms. The RT was fitted using another independent cohort (same institution) by matching to the radiologist sensitivity. This protocol was further applied to each BI-RADS density. Screening outcomes were measured using the sensitivity, specificity, workload, and false-positive rate. The AI-based screening was tested for noninferiority sensitivity compared with radiologist screening using the Farrington-Manning test. Specificities were compared using the McNemar test. Results The study sample comprised 114 421 screenings for breast cancer in 114 421 women, resulting in 791 screen-detected, 327 interval, and 1473 long-term cancers and 2107 false-positive screenings. The mean age of the women was 59 years ± 6 (SD). The AI-based screening sensitivity was 69.7% (779 of 1118; 95% CI: 66.9, 72.4) and was noninferior (P = .02) to the radiologist screening sensitivity of 70.8% (791 of 1118; 95% CI: 68.0, 73.5). The AI-based screening specificity was 98.6% (111 725 of 113 303; 95% CI: 98.5, 98.7), which was higher (P < .001) than the radiologist specificity of 98.1% (111 196 of 113 303; 95% CI: 98.1, 98.2). The radiologist workload was reduced by 62.6% (71 585 of 114 421), and 25.1% (529 of 2107) of false-positive screenings were avoided. Screening results were consistent across BI-RADS densities, although not significantly so for sensitivity. Conclusion Artificial intelligence (AI)-based screening could detect normal, moderate-risk, and suspicious mammograms in a breast cancer screening program, which may reduce the radiologist workload. AI-based screening performed consistently across breast densities. © RSNA, 2022 Online supplemental material is available for this article.