Specificity Of Screening Mammography Research Articles

Sensitivity and specificity of screening mammography without clinical breast examination among Japanese women aged 40-49years: analysis of data from the J-START results.

Current breast cancer screening programs worldwide offer only mammography for asymptomatic women, without clinical breast examination (CBE). The sensitivity and specificity of true asymptomatic screening mammography are important, especially in Japan. This study used data from the Japan Strategic Anti-cancer Randomized Trial (J-START) results, and then calculated the sensitivity and specificity of screening mammography without CBE among Japanese women aged 40-49years. The sensitivity and specificity of modern film mammography, performed biennially, among Japanese women aged 40-49years were 71.7% and 92.6%, respectively. The sensitivity of mammography alone was 47.4%. From the secondary analysis, the sensitivity of mammography alone was 44.1% for women with dense breasts and 34.8% for women with non-dense breasts. The sensitivity of mammography alone of 47.4% is too low. The low sensitivity of screening mammography for true asymptomatic Japanese women aged 40-49years places this population at an elevated risk, which can justify performing adjunctive ultrasonography.

Diagnostic Role of Digital Breast Tomosynthesis

Since its introduction in 2011, digital breast tomosynthesis has been adopted rapidly worldwide for screening mammography. Digital breast tomosynthesis is a new technology that acquires a series of low-dose images of the compressed breast from different angles while the x-ray tube moves along an overhead arc.1 This projection image dataset is then used to reconstruct 1-mm thin-section images in standard mammographic views. Displaying the breast tissue in 1-mm-thin slices results in decreased tissue overlap, improved lesion visibility, better delineation of lesion margins, and more accurate characterization of lesion architecture.1 Numerous studies have established that digital breast tomosynthesis increases the sensitivity and specificity of screening mammography. With the addition of digital breast tomosynthesis to conventional digital mammography, Skaane et al2 documented a 27% increase in the detection rate for in situ and invasive cancers combined, and a 40% increase in the detection rate for invasive cancers. Haas et al3 reported a significant reduction in screening recall rates from 12.0% to 8.4% with combined digital breast tomosynthesis and digital mammography, especially in women younger than age 50 years and those with dense breasts.

Breast image pre-processing for mammographic tissue segmentation

During mammographic image acquisition, a compression paddle is used to even the breast thickness in order to obtain optimal image quality. Clinical observation has indicated that some mammograms may exhibit abrupt intensity change and low visibility of tissue structures in the breast peripheral areas. Such appearance discrepancies can affect image interpretation and may not be desirable for computer aided mammography, leading to incorrect diagnosis and/or detection which can have a negative impact on sensitivity and specificity of screening mammography. This paper describes a novel mammographic image pre-processing method to improve image quality for analysis. An image selection process is incorporated to better target problematic images. The processed images show improved mammographic appearances not only in the breast periphery but also across the mammograms. Mammographic segmentation and risk/density classification were performed to facilitate a quantitative and qualitative evaluation. When using the processed images, the results indicated more anatomically correct segmentation in tissue specific areas, and subsequently better classification accuracies were achieved. Visual assessments were conducted in a clinical environment to determine the quality of the processed images and the resultant segmentation. The developed method has shown promising results. It is expected to be useful in early breast cancer detection, risk-stratified screening, and aiding radiologists in the process of decision making prior to surgery and/or treatment.

Criteria for identifying radiologists with acceptable screening mammography interpretive performance on basis of multiple performance measures.

Using a combination of performance measures, we updated previously proposed criteria for identifying physicians whose performance interpreting screening mammography may indicate suboptimal interpretation skills. In this study, six expert breast imagers used a method based on the Angoff approach to update criteria for acceptable mammography performance on the basis of two sets of combined performance measures: set 1, sensitivity and specificity for facilities with complete capture of false-negative cancers; and set 2, cancer detection rate (CDR), recall rate, and positive predictive value of a recall (PPV1) for facilities that cannot capture false-negative cancers but have reliable cancer follow-up information for positive mammography results. Decisions were informed by normative data from the Breast Cancer Surveillance Consortium (BCSC). Updated combined ranges for acceptable sensitivity and specificity of screening mammography are sensitivity≥80% and specificity≥85% or sensitivity 75-79% and specificity 88-97%. Updated ranges for CDR, recall rate, and PPV1 are: CDR≥6 per 1000, recall rate 3-20%, and any PPV1; CDR 4-6 per 1000, recall rate 3-15%, and PPV1≥3%; or CDR 2.5-4.0 per 1000, recall rate 5-12%, and PPV1 3-8%. Using the original criteria, 51% of BCSC radiologists had acceptable sensitivity and specificity; 40% had acceptable CDR, recall rate, and PPV1. Using the combined criteria, 69% had acceptable sensitivity and specificity and 62% had acceptable CDR, recall rate, and PPV1. The combined criteria improve previous criteria by considering the interrelationships of multiple performance measures and broaden the acceptable performance ranges compared with previous criteria based on individual measures.

The sensitivity and specificity of screening mammography in primary care setting in Saudi Arabia.

e12551 Background: Breast cancer is the leading cancer diagnosed in women in Saudi Arabia, accounting for 25% of all cancers diagnosed in women. The mammogram screening program at King Faisal Specialist Hospital and Research Center (KFSHRC) is the only structured screening program in the country. KFSHRC provides primary care services for a catchment population of 30,000 patients. This program covers all women above the age of 40 within this catchment population. Methods: A retrospective review of electronic and paper records were reviewed for mammograms done between January 2002- January 2012. Summary statistics were used to describe patient and examination characteristics. Results from mammograms were reported using the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology. The stage of diagnosis was reported using the American Joint Committee on Cancer (AJCC) system using stages one through four. ACR BIRADS classification and cancer status definitions mammograms were linked with cancer outcomes to identify true-positive, true-negative, false-positive, and false-negative examinations. On the basis of these classifications, sensitivity, specificity, positive predictive value, and negative predictive value were estimated. All mammograms and tissue biopsies were read by board certified specialists. Results: During the first round of screening 1694 mammograms were analyzed, and 12 cases of cancer were diagnosed. Cancer detection rate (per 1000 examination) was 7.1. Biopsy rate was 3.7 per 100 mammograms. Follow up ultrasounds rate was 2.7 per 100 mammograms. Sensitivity of mammogram screening was 80%, and specificity was 76%. Conclusions: The yield of a structured mammogram screening program in Saudi Arabia is high. There is a need to implement a national program for breast cancer screening in Arabian world in general and within Saudi Arabia in particular.

Full‐field acoustomammography using an acousto‐optic sensor

In this Letter the authors introduce a wide-field transmission ultrasound approach to breast imaging based on the use of a large area acousto-optic (AO) sensor. Accompanied by a suitable acoustic source, such a detector could be mounted on a traditional mammography system and provide a mammographylike ultrasound projection image of the compressed breast in registration with the x-ray mammogram. The authors call the approach acoustography. The hope is that this additional information could improve the sensitivity and specificity of screening mammography. The AO sensor converts ultrasound directly into a visual image by virtue of the acousto-optic effect of the liquid crystal layer contained in the AO sensor. The image is captured with a digital video camera for processing, analysis, and storage. In this Letter, the authors perform a geometrical resolution analysis and also present images of a multimodality breast phantom imaged with both mammography and acoustography to demonstrate the feasibility of the approach. The geometric resolution analysis suggests that the technique could readily detect tumors of diameter of 3 mm using 8.5 MHz ultrasound, with smaller tumors detectable with higher frequency ultrasound, though depth penetration might then become a limiting factor. The preliminary phantom images show high contrast and compare favorably to digital mammograms of the same phantom. The authors have introduced and established, through phantom imaging, the feasibility of a full-field transmission ultrasound detector for breast imaging based on the use of a large area AO sensor. Of course variations in attenuation of connective, glandular, and fatty tissues will lead to images with more cluttered anatomical background than those of the phantom imaged here. Acoustic coupling to the mammographically compressed breast, particularly at the margins, will also have to be addressed.

Factors Affecting Sensitivity and Specificity of Screening Mammography and MRI in Women with an Inherited Risk for Breast Cancer

The MRISC study is a screening study, in which women with an increased risk of hereditary breast cancer are screened by a yearly mammography and MRI, and half-yearly clinical breast examination. The sensitivity found in this study was 40% for mammography and 71% for MRI and the specificity was 95 and 90%, respectively. In the current subsequent study we investigated whether these results are influenced by age, a BRCA1/2 mutation, menopausal status and breast density. From November 1999 to October 2003, 1909 eligible women were screened and 50 breast cancers were detected. For the current analysis, data of 4134 screening rounds and 45 detected breast cancers were used. For both imaging modalities, screening parameters, receiver operating characteristic (ROC) curves and uni- and multivariate odds ratios (ORs) were calculated. All analyses were separately performed for age at entry (< 40, 40-49, > or =50), mutation status, menopausal status and breast density. Sensitivity of MRI was decreased in women with high breast density (adjusted OR 0.08). False-positive rates of both mammography (OR(adj) 1.67) and MRI (OR(adj) 1.21) were increased by high breast density, that of MRI by pre-menopausal status (OR(adj) 1.70), young age (OR(adj) 1.58 for women 40-49 years versus women > or =50 years) and decreased in BRCA1/2 mutation carriers (OR(adj) 0.74). In all investigated subgroups the discriminating capacity (measured by the area under the ROC-curve) was higher for MRI than for mammography, with the largest differences for BRCA1/2 mutation carriers (0.237), for women between 40 and 49 years (0.227) and for women with a low breast density (0.237). This report supports the earlier recommendation that MRI should be a standard screening method for breast cancer in BRCA1/2 mutation carriers.

Screening mammography in old women saves lives: A simulation model

10561 Background: Screening mammography has shown to decrease breast cancer specific death rate by 20–25% and has been recommended in women aged 40 and above, nevertheless, some country service screen programs stop screening in women older than 69, even though the sensitivity and specificity of screening mammography is highest in older women, especially those older than 80 years. The size of the older population is growing exponentially and old women have the highest incidence of breast cancer; one third of breast cancer diagnosis and half the deaths of breast cancer in USA occurred in women aged 70 and above in the year 2000. The aim of this study is to estimate the impact of mammographic screening in women aged 70 and above on breast cancer mortality. Methods: US Census, SEER, CISNET, CDC, HMD, ULTD databases were searched to obtain population data and rates of incidence and mortality of breast cancer by age. In addition, mammography screening bibliography from randomized clinical trials, meta-analysis, and service health programs publications were reviewed to estimate the impact of screening mammography on results for different strata. Analytical and simulation methods were applied for modeling the data with the aid of Mathematica to calculate breast cancer reduction rate. Results: A reduction in breast cancer mortality was observed with a magnitude proportional to age, even after taking into account competing risks of death by other causes in the aging population. Simulation of different scenarios revealed a decrease in breast cancer mortality in the range of 5 to15% for women younger than 50 years, 15 to 25% in the group of women aged 50 to 69, and 25 to 35% in women older than 69. Factors such as population life expectancy, breast cancer incidence, attrition rate in screening or cross-over, overall specificity of mammographic detection, interval of screening, impact the estimations, explaining in part some of the negative results of prevention trials. Conclusions: Reduction of breast cancer mortality by mammographic screening is proportional to age. Women aged 70 and above benefit more from mammographic screening than younger women. No significant financial relationships to disclose.

Factors affecting sensitivity and specificity of screening mammography and MRI in women with a hereditary risk for breast cancer

Factors affecting sensitivity and specificity of screening mammography and MRI in women with a hereditary risk for breast cancer

Impact of computer-aided detection prompts on the sensitivity and specificity of screening mammography

To determine the value of computer-aided detection (CAD) for breast cancer screening. Two sets of mammograms with known outcomes were used in two studies. Participants in both studies read the films with and without the benefit of a computer aid. In both studies, the order of reading sessions was randomised separately for each reader. The first set of 180 films, used in study 1, included 20 false-negative interval cancers and 40 screen-detected cancers. The second set of 120 films, used in study 2, was designed to be favourable to CAD: all 44 cancer cases had previously been missed by a film reader and cancers prompted by CAD were preferentially included. The studies were conducted at five UK screening centres between January 2001 and April 2003. Thirty radiologists, five breast clinicians and 15 radiographers participated. All cases in the trial were digitised and analysed using the R2 ImageChecker version 2.2. Participants all received training on the use of CAD. In the intervention condition, participants interpreted cases with a prompt sheet on which regions of potential abnormality were indicated. The sensitivity and specificity of participants were measured in both intervention and control conditions. No significant difference was found for readers' sensitivity or specificity between the prompted and unprompted conditions in study 1 [95% confidence index (CI) for sensitivity with and without CAD is 0.76 to 0.80, for specificity it is 0.81 to 0.86 without CAD and 0.81 to 0.87 with CAD]. No statistically significant difference was found between the sensitivity and specificity of different groups of film reader (95% CI for unprompted sensitivity of radiologists was 0.75 to 0.81, for radiographers it was 0.71 to 0.81, prompted sensitivity was 0.76 to 0.81 for radiologists and 0.69 to 0.79 for radiographers). Thirty-five readers participated in study 2. Sensitivity was improved in the prompted condition (0.81 from 0.78) but the difference was slightly below the threshold for statistical significance (95% CI for the difference -0.003 to 0.064). Specificity also improved (0.87 from 0.86); again, the difference was not significant at 0.05 (95% CI -0.003 to 0.034). A cost-effectiveness analysis showed that computer prompting increases cost. No significant improvement in film readers' sensitivity or specificity or gain in cost-effectiveness was established in either study. This may be due to the system's low specificity, its relatively poor sensitivity for subtle cancers or the fact the prompts cannot serve as aids to decision-making. Readers may have been better able to make use of the prompts after becoming more accustomed to working with them. Prompts may have an impact in routine use that is not detectable in an experimental setting. Although the case for CAD as an element of the NHS Breast Screening Programme is not made here, further research is required. Evaluations of new CAD tools in routine use are underway and their results should be given careful attention.

Screening Mammography in Finland - 1.5 Million Examinations with 97 percent Specificity

A nationwide mammography screening program including women aged 50-59 years at the time of the first invitation and involving more than 100 radiologists was started in Finland in January, 1987. From 1987 through 1997, a total of 1690496 invitations to biennial two-view mammography screening was sent out. The compliance for screening was 88.5% with 1 495744 screening examinations performed during this 11-year period. There were 49020 recalls (3.28% of those attending) for further work-up studies and 9689 women (0.65% of those attending) were referred for surgery. The total number of screening-detected breast cancers was 5595, giving a detection rate of 3.7 cancers per 1000 screening studies. More than half (57.7%) of all surgical biopsies revealed breast cancer and 67.8% of the invasive cancers were at Stage I. The positive predictive value of referral to surgical biopsy increased from 33.2% in 1987 to 65.5% in 1997, and the ratio of malignant to benign biopsies more than tripled from the first to the fifth year of screening. The observed/expected ratio of invasive cancer detection was 2.44. Only 0.27% (1 out of every 372) of all screening mammograms were followed by a benign biopsy, and 2.90% (1 out of every 34) of all screening mammograms were followed by the women being recalled for further studies and not found to have breast cancer. This gave a specificity of recall after screening mammography greater than 97.0% and a specificity of referral to surgical biopsy greater than 99.7%. Measures of specificity improved considerably during the first three years of the screening program. The high specificity of screening mammography can be attributed to the nature of the screening process as well as to the opportunity for individual radiologists to attain a greater level of experience and competence. The decision to recall appears to have been crucial in determining the specificity.

Screening mammography: Sensitivity and specificity in relation to hormone replacement therapy

PURPOSE: To evaluate the possible effects of hormone replacement therapy (HRT) on the sensitivity and specificity of screening mammography. MATERIALS AND METHODS: Twenty thousand women aged 50 years or older were interviewed about use of HRT during the second round of screening mammography; of these, 3,126 were currently using, 2,158 had previously used, and 14,716 had never used HRT. Women with breasts known to be composed of predominantly fatty tissue were examined with one-view mammography; otherwise, two-view mammography was used. RESULTS: The sensitivity of screening mammography was 96% (95% confidence interval, 81.0%, 99.1%) in women currently using, 92% (61.5%, 99.8%) in women who had previously used, and 91% (85.7%, 96.8%) in women who had never used HRT. The specificity was 94% (93.3%, 95.0%), 95% (93.7%, 95.6%), and 95% (94.8%, 95.5%), respectively. There was a slight decrease in specificity with duration of treatment for the current-user group. However, specificity in women treated with continu...

Long term breast cancer screening in Nijmegen, The Netherlands: the nine rounds from 1975-92.

To assess the performance of breast cancer screening in different age categories over two decades. Important determinants of reduced breast cancer mortality such as attendance, mammography performance, cancer detection, and disease stage were recorded. Nijmegen, The Netherlands, 1975-92. Since 1975 more than 40,000 women aged 35 years and older have been invited biennially for breast screening in a population based project in Nijmegen. Rates of attendance, referral, detection, and disease stage were calculated, as well as the specificity of screening mammography and the predictive value of referral and biopsy. From round 3 onwards, the attendance rate of women younger than 50 years stabilised at 70%, in women of 50-69 years it was 62%, and in women aged 70 and over it was 22%. In these three age categories, the referral rates of a positive screening mammography per 1000 screened women were 4.9, 6.2, and 11.8, respectively. Specificity rates were between 99% and 100%. Current predictive values of referral were high: in the specific age categories 39%, 59%, and 68% of the referred women had cancer. Detection rates remained fairly stable over the rounds 4-9, at 1.9, 3.6, and 8.0 cancers per 1000 screened women. In the two year period between screening the numbers of interval cancers per 1000 screened women were 2.2, 2.2, and 2.9, for the three age categories respectively. With regard to invasive cancers detected during screening, the percentage of small tumours (< or = 20 mm on the mammogram) was 84% in each age category. For women younger than 50 years, the proportion of intraductal carcinoma in all the cancers detected at screening was 40%, while it was 15% in the other age categories. Throughout the nine rounds, the screening outcomes were found to be adequate, particularly considering the high specificity rate and the predictive value of referral without the interference of a low detection rate. Although the occurrence of interval cancers seemed high, it was similar to other screening programmes. Despite a relatively low referral rate, the ratios of screen detected versus interval cancer cases were favourable. Well organised screening programmes can achieve good mammography results without too many false positives. It is important that women continue to participate in a screening programme because cancer can still be detected even after several successive negative screening examinations.