Mammography Research Articles

Knowledge of women regarding risk factors, signs and symptoms and breast cancer screening

Objective: To assess the women knowledge regarding breast cancer and screening. Methodology: The quantitative cross-sectional study was used to assess the women knowledge regarding risk factors, signs and symptoms, and breast cancer screening. The estimated sample size was 366, and they were selected using the purposive sampling technique. There are two parts to the data collection tool. The first part of the questionnaire was used to collect the socio demographic data of the participants. The second part of the questionnaire was used to assess knowledge about risk factors, signs, and symptoms and about breast cancer screening. The questionnaire was prepared in English and translated into Arabic for the convenience of the participants. Results: Regarding knowledge related to breast cancer screening, 86.7% had adequate knowledge regarding breast self-screening and the analysis related to the knowledge of the participants regarding risk factors, signs, and symptoms shows they had very low knowledge. There is a significant association found between participants with a family history of breast cancer, age at first birth, age at puberty with knowledge regarding breast cancer screening. Conclusion: According to the findings of this study, overall, most of the participants had adequate knowledge about breast cancer screening, but the knowledge related to risk factors, signs, and symptoms was very low. This study reflects the need for greater efforts to increase breast cancer awareness through health education.

Breast Cancer Screening Behavior among Working Women in Japan: Characteristics and Factors Inhibiting Screening.

Improving breast cancer screening rates is crucial for early detection. However, factors hindering regular screening among working women remain unclear. This study aimed to clarify screening behavior among working women in Japan and associated discouraging factors. Surveys were conducted from April to May 2019 among women aged 40-60 at public offices and companies in Tottori Prefecture. We used two surveys: the "Basic Attributes Questionnaire" and the "Structural Questionnaire on Rejecting Screening." Data analysis involved chi-squared tests, logistic regression analysis, factor analysis, and nonparametric tests. Completed questionnaires analyzed were 668 out of 825 collected (response rate: 81.0%). Most participants were part-time employees with an average age of 51 years. Over 60% reported undergoing regular screening. Logistic regression analysis identified part-time employment, lack of children, a discouraging workplace atmosphere, and absence of personal connections to breast cancer patients as factors associated with avoiding breast cancer screening. Factor analysis identified five factors and 16 items as reasons for not undergoing regular screening. Women who had no spouse, no children or felt that their workplace was not encouraging breast screening felt difficulty in scheduling screening most strongly. Individuals who had part-time employment and had no children, did not know a breast cancer patient, or considered that their workplace environment was not supportive were more likely to avoid undergoing regular breast cancer screening. Also, women who did not undergo regular screening experienced difficulty in scheduling. In the future, the challenge lies in disseminating accurate knowledge about breast cancer to foster awareness without excessive anxiety.

Breast cancer screening awareness, practice, and perceived barriers: A community-based cross-sectional study among women in south-eastern Bangladesh.

Breast cancer is a leading cause of mortality in Bangladesh. An early-stage screening is the best way to reduce both the morbidity and mortality burden of breast cancer. The study evaluated awareness, practice, and perceived barriers towardbreast cancer screening in Bangladesh. A community-based cross-sectional study was conducted from October 2021 to December 2022 in Chattogram, Bangladesh, where 869 women (18 years or above) were randomly selected in this study. Among 869 participants, 47.3% of women were recruited from urban areasand 52.7% participated from rural areas. Only 32.68% of respondents (urban vs. rural: 44.28% vs. 22.27%) were aware of breast self-examination (BSE) and 52.47% of respondents (urban vs. rural: 63.75% vs. 42.36%) had ever heard Clinical Breast Examination (CBE), respectively. Among the respondents, 27.73% (urban vs. rural: 40.15% vs. 16.59%) performed their BSE, and only 14.61% of respondents (urban vs. rural: 21.90% vs. 8.08%) had ever visited for CBE. Women residing in rural areas were approximately three times (AOR: 0.36[95%CI: 0.25-0.52], AOR: 0.37[95%CI: 0.23-0.58]) less likely to perform BSE and CBE, respectively, than urban dwellers. We found that higher-educated women tend to do more BSE and CBE than women with low levels of education. Perceptions of having "no symptoms" and being "risk-free" are leading barriers to breast screening among women. Poor awareness and practice were observed in screening among the urban and rural women in Bangladesh. Urban area dwellers had comparatively better understanding and practice than rural dwellers. We think extending health education and health promotion activities towardbreast cancer screening is essential in this region.

Familiarity, confidence and preference of artificial intelligence feedback and prompts by Australian breast cancer screening readers.

Objectives This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike.

Effect of Health Education on the Uptake of breast cancer screening among nursing students in Plateau State, Nigeria: A quasi-experimental study

Objective: This study aimed to assess the effect of health education on breast cancer screening uptake among female nursing students in Plateau State, Nigeria. Methods: A quasi-experimental study involving 50 female nursing students that were selected using a systematic random sampling each from the Colleges of Nursing Jos South Local Government Area (LGA) (experimental group) and Jos North LGA (control group) both in Plateau State. The intervention involved health education training in the experimental group only for six (6) weeks. The tool used was a structured questionnaire with Cronbach’s alpha coefficient of 0.782. Data analysis was done using IBM SPSS Version 22. ANOVA was used to compare mean changes in uptake scores as appropriate. Results were presented in tables and p&lt; 0.05 was taken as statistically significant. Results: The mean breast cancer screening uptake scores were 1.00 ± 0.700, 2.46 ± 0.706 and 2.54 ± 0.676 at baseline, one-month and three-month post-intervention respectively among the experimental group with a statistically significant difference in mean uptake score, (F[2, 147] = [77.982], p &lt;0.001) (Effect size, R2=0.515). In the control group, the uptake scores were 1.04 ± 0.755, 1.16 ± 0.738, and 1.26 ± 0.694 at baseline, one month post-intervention and three-month post-intervention respectively. There was no statistically significant difference in mean uptake scores between at least two phases (F [2, 147] = (1.140), p =0.323). Conclusion: Health educational intervention can significantly improve breast screening uptake. There is a need to constantly educate youths on this benefit.

Multiscale Monte Carlo simulations for dosimetry in x-ray breast imaging: Part II - Microscopic scales.

Although the benefits of breast screening and early diagnosis are known for reducing breast cancer mortality rates, the effects and risks of low radiation doses to the cells in the breast are still ongoing topics ofstudy. To study specific energy distributions ( ) in cytoplasm and nuclei of cells corresponding to glandular tissue for different x-ray breast imagingmodalities. A cubic lattice (500 μm length side) containing 4064 spherical cells was irradiated with photons loaded from phase space files with varying glandular voxel doses ( ). Specific energy distributions were scored for nucleus and cytoplasm compartments using the PENELOPE (v. 2018) + penEasy (v. 2020) Monte Carlo (MC) code. The phase space files, generated in part I of this work, were obtained from MC simulations in a voxelized anthropomorphic phantom corresponding to glandular voxels for different breast imaging modalities, including digital mammography (DM), digital breast tomosynthesis (DBT), contrast enhanced digital mammography (CEDM) and breast CT (BCT). In general, the average specific energy in nuclei is higher than the respective glandular dose scored in the same region, by up to 10%. The specific energy distributions for nucleus and cytoplasm are directly related to the magnitude of the glandular dose in the voxel ( ), with little dependence on the spatial location. For similar values, for nuclei is different between DM/DBT and CEDM/BCT, indicating that distinct x-ray spectra play significant roles in . In addition, this behavior is also present when the specific energy distribution ( ) is considered taking into account the GDD in thebreast. Microdosimetry studies are complementary to the traditional macroscopic breast dosimetry based on the mean glandular dose (MGD). For the same MGD, the specific energy distribution in glandular tissue varies between breast imaging modalities, indicating that this effect could be considered for studying the risks of exposing the breast to ionizingradiation.

Outcomes of High-Risk Breast MRI Screening in Women Without Prior History of Breast Cancer: Effectiveness Data from a Tertiary Care Center.

To evaluate the diagnostic performance outcomes of a breast MRI screening program in high-risk women without prior history of breast cancer. Retrospective cohort study of 1 405 consecutive screening breast MRI examinations in 681 asymptomatic women with high risk of breast cancer without prior history of breast cancer from January 1, 2015, to December 31, 2019. Outcomes (sensitivity, specificity, positive predictive value, negative predictive value, false-negative rate [FNR], cancer detection rate [CDR]) and characteristics of cancers were determined based on histopathology or 12-month follow-up. MRI examinations performed, BI-RADS assessments, pathology outcomes, and CDRs were analyzed overall and by age decade. Results in incidence screening round (MRI in last 18 months) and nonincidence round were compared. Breast MRI achieved CDR 20/1000, sensitivity 93.3% (28/30), and specificity 83.4% (1 147/1375). Twenty-eight (28/1 405, CDR 20/1000) screen-detected cancers were identified: 18 (64.3%, 18/28) invasive and 10 (35.7%, 10/28) ductal carcinoma in situ. Overall, 92.9% (26/28) of all cancers were stage 0 or 1 and 89.3% (25/28) were node negative. All 14 incidence screening round malignancies were stage 0 or 1 with N0 disease. Median size for invasive carcinoma was 8.0 mm and for ductal carcinoma in situ was 9.0 mm. There were two false-negative exams for an FNR 0.1% (2/1 405). High-risk screening breast MRI was effective at detecting early breast cancer and associated with favorable outcomes.

Breast cancer screening awareness among transgender individuals in Bangkok, Thailand

Background: Transgender women have higher rates of mortality associated with cancer diagnosis owing to inadequate transgender-specific cancer screening, leading to delayed diagnosis. Gender-affirming hormone therapy, age, and genetics are risk factors for breast cancer in transgender women. For transgender men, the risks were similar to those for cisgender women. However, population-based data on breast cancer screening and awareness among these sex groups are limited. Aim: This study aimed to assess breast cancer screening awareness, screening utilization, and factors associated with screening awareness among transgender individuals in Bangkok, Thailand. Methods: This multi-centered study included participants aged 18–80 years without a history of breast cancer. Data were collected using a structured questionnaire from October 2021 to October 2022. Sociodemographic data, hormonal use, gender affirming surgery, breast cancer screening awareness, utilization, and reasons for not undergoing screening were recorded. Associations with breast screening awareness were analyzed using multiple logistic regression analysis. Results: In Bangkok, 402 transgender women and 333 transgender men were surveyed. Among them, 92.8% and 64.6% of the women and men groups, respectively, had received gender-affirming hormone therapy. The women group had a higher awareness of breast cancer screening (70.9%) than the men group (60.8%). However, only 4% and 17.1% of the women and men patients, respectively, underwent breast cancer screening. A history of gender-affirming hormone therapy use was associated with a higher likelihood of breast cancer screening awareness among women. Among the men, older participants who later underwent breast-reduction surgery had a family history of breast cancer, and other types of cancer were positively associated with higher breast cancer screening awareness. Conclusion: Although awareness of breast cancer screening among urban transgender individuals is high, multiple factors limit their access to breast cancer screening.

Emotions and Narrative Reappraisal Strategies of Users of Breast Cancer Screening: Reconstructing the Past, Passing Through the Present, and Predicting Emotions.

Emotional forecasting, meaning how a person anticipates feeling as a consequence of their choices, drives healthcare decision-making. Research, however, suggests that people often do not fully anticipate or otherwise grasp the future emotional impacts of their decisions. Emotional reappraisal strategies, such as putting emotions into words and sharing emotions with others, may mitigate potential undesirable effects of emotions on decision-making. The use of such strategies is important for consequential decisions, such as obtaining timely mammography screening for breast cancer, whereby earlier diagnosis may impact the success of treatment. In this study, we explored the use of emotional reappraisal strategies for decision-making regarding breast cancer screening attendance among women aged 50-69years. Data were collected through semi-structured interviews following mammography with a reflexive thematic methodological approach employed for analysis. Results shed light on how participants' emotional response narratives were reconstructed before the mammography, felt during the mammography, and forecasted while awaiting the results. Future research should consider how individuals experience and manage their emotions as they access breast screening services.

Evidence-informed recommendations on managing breast screening atypia: perspectives from an expert panel consensus meeting reviewing results from the Sloane atypia project.

Evidence-based clinical guidelines are essential to maximize patient benefit and to reduce clinical uncertainty and inconsistency in clinical practice. Gaps in the evidence base can be addressed by data acquired in routine practice. At present, there is no international consensus on management of women diagnosed with atypical lesions in breast screening programmes. Here, we describe how routine NHS breast screening data collected by the Sloane atypia project was used to inform a management pathway that maximizes early detection of cancer and minimizes over-investigation of lesions with uncertain malignant potential. A half-day consensus meeting with 11 clinical experts, 1 representative from Independent Cancer Patients' Voice, 6 representatives from NHS England (NHSE) including from Commissioning, and 2 researchers was held to facilitate discussions of findings from an analysis of the Sloane atypia project. Key considerations of the expert group in terms of the management of women with screen detected atypia were: (1) frequency and purpose of follow-up; (2) communication to patients; (3) generalizability of study results; and (4) workforce challenges. The group concurred that the new evidence does not support annual surveillance mammography for women with atypia, irrespective of type of lesion, or woman's age. Continued data collection is paramount to monitor and audit the change in recommendations.

Imaging characteristics of interval cancers detected on Full Field Digital Mammography (FFDM) versus Digital Breast Tomosynthesis (DBT)

ObjectiveTo compare imaging features of interval cancers detected in patients screened with full field digital mammography (FFDM) versus digital breast tomosynthesis (DBT). Materials/MethodsThis retrospective observational study consisted of female patients undergoing screening DM or FFDM at an academic medical center and two outpatient imaging facilities between January 2012 and June 2017. A natural language processing algorithm queried breast imaging reports for breast density and BI-RADS category. This was cross-referenced to an institutional breast cancer registry to identify interval cancers. Retrospective consensus review of the cases was done to categorize imaging features of interval cancers on FFDM vs DBT. ResultsThe rate of interval cancers was comparable in patients screened with FFDM (30/39793) and DBT (29/32180) (p = 0.58). There was no significant difference in the rate, histopathology, or imaging features of interval cancers in patients screened with FFDM versus DBT. The most common mammographic features on diagnostic imaging across both groups was the presence of a mass (13/47). Almost equally common was negative diagnostic mammogram with mass detected only on ultrasound (11/47). The rate of interval cancers detected by high-risk surveillance breast MRI was increased in patients who previously had screening with DBT relative to those who had screening with FFDM (p = 0.0419). ConclusionThere is no significant difference in rate of detection, histopathology, or imaging features of interval cancers in patients screened with FFDM versus DBT. However, across both cohorts, the most common features on diagnostic mammogram were either the presence of a mass or a negative mammogram.

Breast cancer screening motivation and behaviours of women aged over 75years.

In Australia, breast screening is offered free every two years to women aged 50-74years. Women aged ≥75 are eligible to receive a free mammogram but do not receive an invitation. This study aimed to explore the motivations and behaviours of women living in Australia aged ≥75years regarding ongoing breast cancer screening given the public health guidance. Sixty women aged ≥75 were recruited from metropolitan, regional, and rural areas across Australia to participate in a descriptive qualitative study. Semi-structured interviews were used to seek reflection on women's experience of screening, any advice they had received about screening beyond 75, their understanding of the value of screening and their intention to participate in the future. Thematic analysis of transcripts led to the development of themes. Themes resulting from the study included: reasons to continue and discontinue screening, importance of inclusivity in the health system and availability of information. Regular screeners overwhelmingly wished to continue screening and had strong beliefs in the benefits of screening. Women received limited information about the benefits or harms of screening beyond age 75 and very few had discussed screening with their Primary Healthcare Provider. No longer receiving an invitation to attend screening impacted many women's decision-making. More information via structured discussion with health professionals is required to inform women about the risks and benefits of ongoing screening. No longer being invited to attend screening left many women feeling confused and for some this led to feelings of discrimination.

Automated 3-D Ultrasound Elastography of the Breast: An In Vivo Validation Study

Studies have indicated that adding 2-D quasi-static elastography to B-mode ultrasound imaging improved the specificity for malignant lesion detection, as malignant lesions are often stiffer (increased strain ratio) compared with benign lesions. This method is limited by its user dependency and so unsuitable for breast screening. To overcome this limitation, we implemented quasi-static elastography in an automated breast volume scanner (ABVS), which is an operator-independent 3-D ultrasound system and is especially useful for screening women with dense breasts. The study aim was to investigate if 3-D quasi-static elastography implemented in a clinically used ABVS can discriminate between benign and malignant breast lesions. Volumetric breast ultrasound radiofrequency data sets of 82 patients were acquired before and after automated transducer lifting. Lesions were annotated and strain was calculated using an in-house-developed strain algorithm. Two strain ratio types were calculated per lesion: using axial and maximal principal strain (i.e., strain in dominant direction). Forty-four lesions were detected: 9 carcinomas, 23 cysts and 12 other benign lesions. A significant difference was found between malignant (median: 1.7, range: [1.0-3.2]) and benign (1.0, [0.6-1.9]) using maximal principal strain ratios. Axial strain ratio did not reveal a significant difference between benign (0.6, [-12.7 to 4.9]) and malignant lesions (0.8, [-3.5 to 5.1]). Three-dimensional strain imaging was successfully implemented on a clinically used ABVS to obtain, visualize and analyze in vivo strain images in three dimensions. Results revealed that maximal principal strain ratios are significantly increased in malignant compared with benign lesions.

Surgical and Radiology Trainees' Proficiency in Reading Mammograms: the Importance of Education for Cancer Localisation.

Medical imaging with mammography plays a very important role in screening and diagnosis of breast cancer, Australia's most common female cancer. The visualisation of cancers on mammograms often forms a diagnosis and guidance for radiologists and breast surgeons, and education platforms that provide real cases in a simulated testing environment have been shown to improve observer performance for radiologists. This study reports on the performance of surgical and radiology trainees in locating breast cancers. An enriched test set of 20 mammography cases (6 cancer and 14 cancer free) was created, and 18 surgical trainees and 32 radiology trainees reviewed the cases via the Breast Screen Reader Assessment Strategy (BREAST) platform and marked any lesions identifiable. Further analysis of performance with high- and low-density cases was undertaken, and standard metrics including sensitivity and specificity. Radiology trainees performed significantly better than surgical trainees in terms of specificity (0.72 vs. 0.35; P < 0.01). No significant differences were observed between the surgical and radiology trainees in sensitivity or lesion sensitivity. Mixed results were obtained with participants regarding breast density, with higher density cases generally having lower performance. The higher specificity of the radiology trainees compared to the surgical trainees likely represents less exposure to negative mammography cases. The use of high-fidelity simulated self-test environments like BREAST is able to benchmark, understand and build strategies for improving cancer education in a safe environment, including identifying challenging scenarios like breast density for enhanced training.

A hematological parameter-based model for distinguishing non-puerperal mastitis from invasive ductal carcinoma.

Non-puerperal mastitis (NPM) accounts for approximately 4-5% of all benign breast lesions. Ultrasound is the preferred method for screening breast diseases; however, similarities in imaging results can make it challenging to distinguish NPM from invasive ductal carcinoma (IDC). Our objective was to identify convenient and objective hematological markers to distinguish NPM from IDC. We recruited 89 patients with NPM, 88 with IDC, and 86 with fibroadenoma (FA), and compared their laboratory data at the time of admission. LASSO regression, univariate logistic regression, and multivariate logistic regression were used to screen the parameters for construction of diagnostic models. Receiver operating characteristic curves, calibration curves, and decision curves were constructed to evaluate the accuracy of this model. We found significant differences in routine laboratory data between patients with NPM and IDC, and these indicators were candidate biomarkers for distinguishing between the two diseases. Additionally, we evaluated the ability of some classic hematological markers reported in previous studies to differentiate between NPM and IDC, and the results showed that these indicators are not ideal biomarkers. Furthermore, through rigorous LASSO and logistic regression, we selected age, white blood cell count, and thrombin time to construct a differential diagnostic model that exhibited a high level of discrimination, with an area under the curve of 0.912 in the training set and with 0.851 in the validation set. Furthermore, using the same selection method, we constructed a differential diagnostic model for NPM and FA, which also demonstrated good performance with an area under the curve of 0.862 in the training set and with 0.854 in the validation set. Both of these two models achieved AUCs higher than the AUCs of models built using machine learning methods such as random forest, decision tree, and SVM in both the training and validation sets. Certain laboratory parameters on admission differed significantly between the NPM and IDC groups, and the constructed model was designated as a differential diagnostic marker. Our analysis showed that it has acceptable efficiency in distinguishing NPM from IDC and may be employed as an auxiliary diagnostic tool.

Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know.

Abstract Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited. The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy. Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence). In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.

Development and quality appraisal of a new English breast screening linked data set as part of the age, test threshold, and frequency of mammography screening (ATHENA-M) study.

To build a data set capturing the whole breast cancer screening journey from individual breast cancer screening records to outcomes and assess data quality. Routine screening records (invitation, attendance, test results) from all 79 English NHS breast screening centres between January 1, 1988 and March 31, 2018 were linked to cancer registry (cancer characteristics and treatment) and national mortality data. Data quality was assessed using comparability, validity, timeliness, and completeness. Screening records were extracted from 76/79 English breast screening centres, 3/79 were not possible due to software issues. Data linkage was successful from 1997 after introduction of a universal identifier for women (NHS number). Prior to 1997 outcome data are incomplete due to linkage issues, reducing validity. Between January 1, 1997 and March 31, 2018, a total of 11 262 730 women were offered screening of whom 9 371 973 attended at least one appointment, with 139 million person-years of follow-up (a median of 12.4 person years for each woman included) with 73 810 breast cancer deaths and 1 111 139 any-cause deaths. Comparability to reference data sets and internal validity were demonstrated. Data completeness was high for core screening variables (>99%) and main cancer outcomes (>95%). The ATHENA-M project has created a large high-quality and representative data set of individual women's screening trajectories and outcomes in England from 1997 to 2018, data before 1997 are lower quality. This is the most complete data set of English breast screening records and outcomes constructed to date, which can be used to evaluate and optimize screening.

Service and clinical impacts of reader bias in breast cancer screening: a retrospective study.

To determine factors influencing reader agreement in breast screening and investigate the relationship between agreement level and patient outcomes. Reader pair agreement for 83 265 sets of mammograms from the Scottish Breast Screening service (2015-2020) was evaluated using Cohen's kappa statistic. Each mammography examination was read by two readers, per routine screening practice, with the second initially blinded but able to choose to view the first reader's opinion. If the two readers disagreed, a third reader arbitrated. Variation in reader agreement was examined by: whether the reader acted as the first or second reader, reader experience, and recall, cancer detection and arbitration recall rate. Readers' opinions varied by whether they acted as the first or second reader. Furthermore, reader 2 was more likely to agree with reader 1 if reader 1 was more experienced than they were, and less likely to agree if they themselves were more experienced than reader 1 (P < .001). Agreement was not significantly associated with cancer detection rate, overall recall rate or arbitration recall rates (P > .05). Lower agreement between readers led to a higher arbiter workload (P < .001). In mammography screening, the second reader's opinion is influenced by the first reader's opinion, with the degree of influence dependent on the readers' relative experience levels. While less-experienced readers relied on their more experienced reading partner, no adverse impact on service outcomes was observed. Allowing access to the first reader's opinion may benefit newly qualified readers, but reduces independent evaluation, which may lower cancer detection rates.

The integration of artificial intelligence with contrast-enhanced mammogram in the work up of suspicious breast lesions: what do you expect?

BackgroundThe enhancement overlaps at contrast-enhanced mammogram (CEM) between benign and malignant breast abnormalities presents a high probability of false-positive lesions and subjects females’ candidate for screening and diagnostic mammograms to unnecessary biopsy and anxiety. The current work aimed to evaluate the ability of mammograms scanned by artificial intelligence (AI) to enhance the specificity of CEM and support the probability of malignancy in suspicious and malignant looking breast lesions.MethodsThe study included 1524 breast lesions. The AI algorithm applied to the initial mammograms and generated location information for lesions. AI scoring suggested the probability of malignancy ranged from 100% (definite cancers) and < 10% (definite non-cancer) and correlated with recombinant contrast enhanced images.ResultsThe malignant proved abnormalities were 1165 (76.5%), and the benign ones were 359 (26.5%). BI-RADS 4 category was assigned in 704 lesions (46.2%) divided into 400 malignant (400/704, 56.8%) and 304 benign (304/704, 43.2%). BI-RADS 5 category presented by 820 lesions (53.8%), 765 of them were malignant (765/820, 93.3%) and 55 were benign (55/820, 6.7%). The sensitivity of digital mammogram whether supported by AI (93.9%) or contrast media (94.4%) was significantly increased to 97.2% (p < 0.001) when supported by both methods. Improvement of the negative predictive value (from 80.6% and 79.6% to 89.8%, p < 0.05) and the accuracy (from 91.1 and 88.8 to 94.0%, p < 0.01) was detected.ConclusionsContrast-enhanced mammogram helps in specification of different breast lesions in view of patterns of contrast uptake and morphology descriptors, yet with some overlap. The use of artificial intelligence applied on digital mammogram reduced the interpretational variability and limited attempts of re-biopsies of suspicious looking breast lesions assessed by contrast-enhanced mammograms.

Male Breast: A Review of the Literature and Current State of the Art of Diagnostic Imaging Work-Up.

Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.