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Park EK, Kwak S, Lee W, Choi JS, Kooi T, Kim EK. Impact of AI for Digital Breast Tomosynthesis on Breast Cancer Detection and Interpretation Time. Radiol Artif Intell 2024; 6:e230318. [PMID: 38568095 PMCID: PMC11140510 DOI: 10.1148/ryai.230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
Purpose To develop an artificial intelligence (AI) model for the diagnosis of breast cancer on digital breast tomosynthesis (DBT) images and to investigate whether it could improve diagnostic accuracy and reduce radiologist reading time. Materials and Methods A deep learning AI algorithm was developed and validated for DBT with retrospectively collected examinations (January 2010 to December 2021) from 14 institutions in the United States and South Korea. A multicenter reader study was performed to compare the performance of 15 radiologists (seven breast specialists, eight general radiologists) in interpreting DBT examinations in 258 women (mean age, 56 years ± 13.41 [SD]), including 65 cancer cases, with and without the use of AI. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and reading time were evaluated. Results The AUC for stand-alone AI performance was 0.93 (95% CI: 0.92, 0.94). With AI, radiologists' AUC improved from 0.90 (95% CI: 0.86, 0.93) to 0.92 (95% CI: 0.88, 0.96) (P = .003) in the reader study. AI showed higher specificity (89.64% [95% CI: 85.34%, 93.94%]) than radiologists (77.34% [95% CI: 75.82%, 78.87%]) (P < .001). When reading with AI, radiologists' sensitivity increased from 85.44% (95% CI: 83.22%, 87.65%) to 87.69% (95% CI: 85.63%, 89.75%) (P = .04), with no evidence of a difference in specificity. Reading time decreased from 54.41 seconds (95% CI: 52.56, 56.27) without AI to 48.52 seconds (95% CI: 46.79, 50.25) with AI (P < .001). Interreader agreement measured by Fleiss κ increased from 0.59 to 0.62. Conclusion The AI model showed better diagnostic accuracy than radiologists in breast cancer detection, as well as reduced reading times. The concurrent use of AI in DBT interpretation could improve both accuracy and efficiency. Keywords: Breast, Computer-Aided Diagnosis (CAD), Tomosynthesis, Artificial Intelligence, Digital Breast Tomosynthesis, Breast Cancer, Computer-Aided Detection, Screening Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Bae in this issue.
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Affiliation(s)
- Eun Kyung Park
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - SooYoung Kwak
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Weonsuk Lee
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Joon Suk Choi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Thijs Kooi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Eun-Kyung Kim
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
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Burnside ES, Lasarev MR, Sprague BL, Miglioretti DL, Alexandridis RA, Lee JM, Pisano ED, Smith RA. The Importance of Outcomes Ascertainment for Accurate Assessment of the Mammography Screening Cancer Detection Rate: A Simulation Study. J Am Coll Radiol 2024; 21:376-386. [PMID: 37922974 DOI: 10.1016/j.jacr.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cancer detection rate (CDR), an important metric in the mammography screening audit, is designed to ensure adequate sensitivity. Most practices use biopsy results as the reference standard; however, commonly ascertainment of biopsy results is incomplete. We used simulation to determine the relationship between the cancer ascertainment rate of biopsy (AR-biopsy), CDR estimation, and associated error rates in classifying whether practices and radiologists meet the established ACR benchmark of 2.5 per 1,000. MATERIALS AND METHODS We simulated screening mammography volume, number of cancers detected, and CDR, using negative binomial and beta-binomial distributions, respectively. Simulations were performed at both the practice and radiologist level. Average CDR was based on linearly rescaling a published CDR by the AR-biopsy. CDR distributions were simulated for AR-biopsy between 5% and 100% in steps of five percentage points and were summarized with boxplots and smoothed histograms over the range of AR-biopsy, to quantify the proportion of practices and radiologists meeting the ACR benchmark at each level of AR-biopsy. RESULTS Decreasing AR-biopsy led to an increasing probability of categorizing CDR performance as being below the ACR benchmark. Our simulation predicts that at the practice level, an AR-biopsy of 65% categorizes 17.6% below the benchmark (compared to 1.6% at an AR-biopsy of 100%), and at the radiologist level, an AR-biopsy of 65% categorizes 34.7% as being below the benchmark (compared to 11.6% at an AR-biopsy of 100%). CONCLUSIONS Our simulation demonstrates that decreasing the AR-biopsy (in currently clinically relevant ranges) has the potential to artifactually lower the assessed CDR on both the practice and radiologist levels and may, in turn, increase the chance of erroneous categorization of underperformance per the ACR benchmark.
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Affiliation(s)
- Elizabeth S Burnside
- Associate Dean, Team Science and Interdisciplinary Research, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, Wisconsin.
| | | | - Brian L Sprague
- Director of the Vermont Breast Cancer Surveillance System, University of Vermont, Burlington, Vermont
| | - Diana L Miglioretti
- Division Chief of Biostatistics, Co-lead, Population Sciences and Health Disparities Program, Comprehensive Cancer Center, University of California, Davis, Davis, California
| | | | - Janie M Lee
- Section Chief of Breast Imaging, Department of Radiology, Director of Breast Imaging, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Etta D Pisano
- University of Pennsylvania, Philadelphia, Pennsylvania; and Chief Research Officer of the ACR
| | - Robert A Smith
- Senior Vice President of Early Cancer Detection Science, American Cancer Society
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Rahmat K, Ab Mumin N, Ng WL, Mohd Taib NA, Chan WY, Ramli Hamid MT. Automated Breast Ultrasound Provides Comparable Diagnostic Performance in Opportunistic Screening and Diagnostic Assessment. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:112-118. [PMID: 37839984 DOI: 10.1016/j.ultrasmedbio.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/10/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of the work described here was to assess the performance of automated breast ultrasound (ABUS) as an adjunct to digital breast tomosynthesis (DBT) in the screening and diagnostic setting. METHODS This cross-sectional study of women who underwent DBT and ABUS from December 2019 to March 2022 included opportunistic and targeted screening cases, as well as symptomatic women. Breast density, Breast Imaging Reporting and Data System categories and histopathology reports were collected and compared. The PPV3 (proportion of examinations with abnormal findings that resulted in a tissue diagnosis of cancer), biopsy rate (percentage of biopsies performed) and cancer detection yield (number of malignancies found by the diagnostic test given to the study sample) were calculated. RESULTS A total of 1089 ABUS examinations were performed (age range: 29-85 y, mean: 51.9 y). Among these were 909 screening (83.5%) and 180 diagnostic (16.5%) examinations. A total of 579 biopsies were performed on 407 patients, with a biopsy rate of 53.2%. There were 100 (9.2%) malignant lesions, 30 (5.2%) atypical/B3 lesions and 414 (71.5%) benign cases. In 9 cases (0.08%), ABUS alone detected malignancies, and in 19 cases (1.7%), DBT alone detected malignancies. The PPV3 in the screening group was 14.6%. CONCLUSION ABUS is useful as an adjunct to DBT in the opportunistic screening and diagnostic setting.
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Affiliation(s)
- Kartini Rahmat
- Department of Biomedical Imaging, Universiti Malaya Research Imaging Centre, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nazimah Ab Mumin
- Department of Biomedical Imaging, Universiti Malaya Research Imaging Centre, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
| | - Wei Lin Ng
- Department of Biomedical Imaging, Universiti Malaya Research Imaging Centre, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Cancer Research Institute, University Malaya, Kuala Lumpur, Malaysia
| | - Wai Yee Chan
- Imaging Department, Gleneagles Kuala Lumpur, Jalan Ampang, Kuala Lumpur, Malaysia
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Nishikawa RM, Lu AH. AI in Screening Mammography: Use One Radiologist and Improve Double Reads. Radiology 2023; 309:e232964. [PMID: 37987659 DOI: 10.1148/radiol.232964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Robert M Nishikawa
- From the Department of Radiology, University of Pittsburgh, Pittsburgh, Pa; and Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Ste C-316, Pittsburgh, PA 15213
| | - Amy H Lu
- From the Department of Radiology, University of Pittsburgh, Pittsburgh, Pa; and Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, Ste C-316, Pittsburgh, PA 15213
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Yuge S, Miyake KK, Ishimori T, Kataoka M, Matsumoto Y, Torii M, Yakami M, Isoda H, Takakura K, Morita S, Takada M, Toi M, Nakamoto Y. Performance of dedicated breast PET in breast cancer screening: comparison with digital mammography plus digital breast tomosynthesis and ultrasound. Ann Nucl Med 2023; 37:479-493. [PMID: 37280410 DOI: 10.1007/s12149-023-01846-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of dedicated breast positron emission tomography (dbPET) in breast cancer screening with digital mammography plus digital breast tomosynthesis (DM-DBT) and breast ultrasound (US). METHODS Women who participated in opportunistic whole-body PET/computed tomography cancer screening programs with breast examinations using dbPET, DM-DBT, and US between 2016-2020, whose results were determined pathologically or by follow-up for at least 1 year, were included. DbPET, DM-DBT, and US assessments were classified into four diagnostic categories: A (no abnormality), B (mild abnormality), C (need for follow-up), and D (recommend further examination). Category D was defined as screening positive. Each modality's recall rate, sensitivity, specificity, and positive predictive value (PPV) were calculated per examination to evaluate their diagnostic performance for breast cancer. RESULTS Out of 2156 screenings, 18 breast cancer cases were diagnosed during the follow-up period (10 invasive cancers and eight ductal carcinomas in situ [DCIS]). The recall rates for dbPET, DM-DBT, and US were 17.8%, 19.2%, and 9.4%, respectively. The recall rate of dbPET was highest in the first year and subsequently decreased to 11.4%. dbPET, DM-DBT, and US had sensitivities of 72.2%, 88.9%, and 83.3%; specificities of 82.6%, 81.4%, and 91.2%; and PPVs of 3.4%, 3.9%, and 7.4%, respectively. The sensitivities of dbPET, DM-DBT, and US for invasive cancers were 90%, 100%, and 90%, respectively. There were no significant differences between the modalities. One case of dbPET-false-negative invasive cancer was identified in retrospect. DbPET had 50% sensitivity for DCIS, while that of both DM-DBT and US was 75%. Furthermore, the specificity of dbPET in the first year was the lowest among all periods, and modalities increased over the years to 88.7%. The specificity of dbPET was significantly higher than that of DM-DBT (p < 0.01) in the last 3 years. CONCLUSIONS DbPET had a compatible sensitivity to DM-DBT and breast US for invasive breast cancer. The specificity of dbPET was improved and became higher than that of DM-DBT. DbPET may be a feasible screening modality.
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Affiliation(s)
- Shunsuke Yuge
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kanae K Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiaki Matsumoto
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masahiro Yakami
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Hiroyoshi Isoda
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Kyoko Takakura
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Sprague BL, Coley RY, Lowry KP, Kerlikowske K, Henderson LM, Su YR, Lee CI, Onega T, Bowles EJA, Herschorn SD, diFlorio-Alexander RM, Miglioretti DL. Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium. Radiology 2023; 307:e223142. [PMID: 37249433 PMCID: PMC10315524 DOI: 10.1148/radiol.223142] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 05/31/2023]
Abstract
Background Prior cross-sectional studies have observed that breast cancer screening with digital breast tomosynthesis (DBT) has a lower recall rate and higher cancer detection rate compared with digital mammography (DM). Purpose To evaluate breast cancer screening outcomes with DBT versus DM on successive screening rounds. Materials and Methods In this retrospective cohort study, data from 58 breast imaging facilities in the Breast Cancer Surveillance Consortium were collected. Analysis included women aged 40-79 years undergoing DBT or DM screening from 2011 to 2020. Absolute differences in screening outcomes by modality and screening round were estimated during the study period by using generalized estimating equations with marginal standardization to adjust for differences in women's risk characteristics across modality and round. Results A total of 523 485 DBT examinations (mean age of women, 58.7 years ± 9.7 [SD]) and 1 008 123 DM examinations (mean age, 58.4 years ± 9.8) among 504 863 women were evaluated. DBT and DM recall rates decreased with successive screening round, but absolute recall rates in each round were significantly lower with DBT versus DM (round 1 difference, -3.3% [95% CI: -4.6, -2.1] [P < .001]; round 2 difference, -1.8% [95% CI: -2.9, -0.7] [P = .003]; round 3 or above difference, -1.2% [95% CI: -2.4, -0.1] [P = .03]). DBT had significantly higher cancer detection (difference, 0.6 per 1000 examinations [95% CI: 0.2, 1.1]; P = .009) compared with DM only for round 3 and above. There were no significant differences in interval cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.24, 0.30] [P = .96]; round 2 or above difference, 0.04 [95% CI: -0.19, 0.31] [P = .76]) or total advanced cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.15, 0.19] [P = .94]; round 2 or above difference, -0.06 [95% CI: -0.18, 0.11] [P = .43]). Conclusion DBT had lower recall rates and could help detect more cancers than DM across three screening rounds, with no difference in interval or advanced cancer rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Skaane in this issue.
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Affiliation(s)
- Brian L. Sprague
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Rebecca Yates Coley
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Kathryn P. Lowry
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Karla Kerlikowske
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Louise M. Henderson
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Yu-Ru Su
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Christoph I. Lee
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Tracy Onega
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Erin J. A. Bowles
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Sally D. Herschorn
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Roberta M. diFlorio-Alexander
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
| | - Diana L. Miglioretti
- From the Departments of Surgery (B.L.S.) and Radiology (B.L.S., S.D.H.), University of Vermont Cancer Center, University of Vermont Larner College of Medicine, UHC Bldg, Room 4425, 1 S Prospect St, Burlington, VT 05401; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (R.Y.C., Y.R.S., E.J.A.B., D.L.M.); Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Wash (K.P.L., C.I.L.); Departments of Medicine and Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah (T.O.); Department of Radiology, Giesel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.F.A.); and Division of Biostatistics, Department of Public Health Sciences, University of California–Davis, Davis, Calif (D.L.M.)
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7
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La Forgia D, Signorile R, Bove S, Arezzo F, Cormio G, Daniele A, Dellino M, Fanizzi A, Gatta G, Lafranceschina M, Massafra R, Rizzo A, Zito FA, Neri E, Faggioni L. Impact of the systematic introduction of tomosynthesis on breast biopsies: 10 years of results. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01640-7. [PMID: 37198373 DOI: 10.1007/s11547-023-01640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Digital Breast Tomosynthesis (DBT) is a cutting-edge technology introduced in recent years as an in-depth analysis of breast cancer diagnostics. Compared with 2D Full-Field Digital Mammography, DBT has demonstrated greater sensitivity and specificity in detecting breast tumors. This work aims to quantitatively evaluate the impact of the systematic introduction of DBT in terms of Biopsy Rate and Positive Predictive Values for the number of biopsies performed (PPV-3). For this purpose, we collected 69,384 mammograms and 7894 biopsies, of which 6484 were Core Biopsies and 1410 were stereotactic Vacuum-assisted Breast Biopsies (VABBs), performed on female patients afferent to the Breast Unit of the Istituto Tumori "Giovanni Paolo II" of Bari from 2012 to 2021, thus, in the period before, during and after the systematic introduction of DBT. Linear regression analysis was then implemented to investigate how the Biopsy Rate had changed over the 10 year screening. The next step was to focus on VABBs, which were generally performed during in-depth examinations of mammogram detected lesions. Finally, three radiologists from the institute's Breast Unit underwent a comparative study to ascertain their performances in terms of breast cancer detection rates before and after the introduction of DBT. As a result, it was demonstrated that both the overall Biopsy Rate and the VABBs Biopsy Rate significantly decreased following the introduction of DBT, with the diagnosis of an equal number of tumors. Besides, no statistically significant differences were observed among the three operators evaluated. In conclusion, this work highlights how the systematic introduction of DBT has significantly impacted the breast cancer diagnostic procedure, by improving the diagnostic quality and thereby reducing needless biopsies, resulting in a consequent reduction in costs.
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Affiliation(s)
- Daniele La Forgia
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Rahel Signorile
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Samantha Bove
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Francesca Arezzo
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, 70121, Bari, Italy
| | - Gennaro Cormio
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, 70121, Bari, Italy
| | - Antonella Daniele
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Miriam Dellino
- Clinic of Obstetrics and Gynecology, San Paolo Hospital, 70123, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70100, Bari, Italy
| | - Annarita Fanizzi
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy.
| | - Gianluca Gatta
- Breast Unit, Department of Clinical and Experimental Internship, University of Campania Luigi Vanvitelli, Via De Crecchio 7, 80138, Naples, Italy
| | - Miria Lafranceschina
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | - Raffaella Massafra
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy.
| | - Alessandro Rizzo
- Istituto Tumori Giovanni Paolo II, I.R.C.C.S, Via Orazio Flacco 65, 70124, Bari, Italy
| | | | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Lorenzo Faggioni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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8
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Lee CI, Abraham L, Miglioretti DL, Onega T, Kerlikowske K, Lee JM, Sprague BL, Tosteson ANA, Rauscher GH, Bowles EJA, diFlorio-Alexander RM, Henderson LM. National Performance Benchmarks for Screening Digital Breast Tomosynthesis: Update from the Breast Cancer Surveillance Consortium. Radiology 2023; 307:e222499. [PMID: 37039687 PMCID: PMC10323294 DOI: 10.1148/radiol.222499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
Background It is important to establish screening mammography performance benchmarks for quality improvement efforts. Purpose To establish performance benchmarks for digital breast tomosynthesis (DBT) screening and evaluate performance trends over time in U.S. community practice. Materials and Methods In this retrospective study, DBT screening examinations were collected from five Breast Cancer Surveillance Consortium (BCSC) registries between 2011 and 2018. Performance measures included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR) and were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition, and compared with concurrent BCSC DM screening examinations, previously published BCSC and National Mammography Database benchmarks, and expert opinion acceptable performance ranges. Benchmarks were derived from the distribution of performance measures across radiologists (n = 84 or n = 73 depending on metric) and were presented as percentiles. Results A total of 896 101 women undergoing 2 301 766 screening examinations (458 175 DBT examinations [median age, 58 years; age range, 18-111 years] and 1 843 591 DM examinations [median age, 58 years; age range, 18-109 years]) were included in this study. DBT screening performance measures were as follows: AIR, 8.3% (95% CI: 7.5, 9.3); CDR per 1000 screens, 5.8 (95% CI: 5.4, 6.1); sensitivity, 87.4% (95% CI: 85.2, 89.4); specificity, 92.2% (95% CI: 91.3, 93.0); and FNR per 1000 screens, 0.8 (95% CI: 0.7, 1.0). When compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks, all performance measures were higher for DBT except sensitivity and FNR, which were similar to concurrent and prior DM performance measures. The following proportions of radiologists achieved acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity. Conclusion In U.S. community practice, large proportions of radiologists met acceptable performance ranges for screening performance metrics with DBT. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee and Moy in this issue.
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Affiliation(s)
- Christoph I. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Linn Abraham
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Tracy Onega
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Janie M. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Garth H. Rauscher
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Roberta M. diFlorio-Alexander
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Louise M. Henderson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - for the Breast Cancer Surveillance Consortium
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
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Elhatw A, Chung HL, Kamal RM, De Jesus C, Jean S, Vishwanath V, Ferreira Dalla Pria HR, Patel MM, Guirguis MS, Moseley TW. Advanced Breast Imaging Modalities — DBT, CEM, MBI, PEM, MRI, AI. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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10
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Faria RA, Leal LB, Thebit MM, Pereira SWA, Serafim NR, Barauna VG, da Chagas E Silva Carvalho LF, Sartório CL, Gouvea SA. Potential Role of Fourier Transform Infrared Spectroscopy as a Screening Approach for Breast Cancer. APPLIED SPECTROSCOPY 2023; 77:405-417. [PMID: 36703259 DOI: 10.1177/00037028231156194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Breast cancer is a heterogeneous disease, and its spread involves a succession of clinical and pathological stages. Screening is predominantly based on mammography, which has critical limitations related to the effectiveness and production of false-positive or false-negative results, generating discomfort and low adherence. In this context, infrared with attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy emerges as a non-destructive sample tool, which is non-invasive, label-free, has a low operating-cost, and requires only a small amount of sample, including liquid plasma samples. We sought to evaluate the clinical applicability of ATR FT-IR in breast cancer screening. ATR FT-IR spectroscopy through its highest potential spectral biomarker could distinguish, by liquid plasma biopsy, breast cancer patients and healthy controls, obtaining a sensitivity of 97%, specificity of 93%, a receiver operating characteristic ROC curve of 97%, and a prediction accuracy of 94%. The main variance between the groups was mainly in the band 1511 cm-1 of the control group, 1502 and 1515 cm-1 of the cancer group, which are the peaks of the bands referring to proteins and amide II. ATR FT-IR spectroscopy has demonstrated to be a promising tool for breast cancer screening, given its time efficiency, cost of approach, and its high ability to distinguish between the liquid plasma samples of breast cancer patients and healthy controls.
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Affiliation(s)
- Rodrigo A Faria
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | - Leonardo B Leal
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | - Marcela M Thebit
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | - Sergio W A Pereira
- Mastology Service Evangelical Hospital of Vila Velha, Vila Velha, Brazil
| | - Neuzimar R Serafim
- Mastology Service Evangelical Hospital of Vila Velha, Vila Velha, Brazil
| | - Valerio G Barauna
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | | | - Carmem L Sartório
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
| | - Sonia A Gouvea
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitória, Brazil
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11
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Conant EF, Talley MM, Parghi CR, Sheh BC, Liang SY, Pohlman S, Rane A, Jung Y, Stevens LAS, Paulus JK, Alsheik N. Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings. Radiology 2023; 307:e221571. [PMID: 36916891 DOI: 10.1148/radiol.221571] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background The use of digital breast tomosynthesis (DBT) is increasing over digital mammography (DM) following studies demonstrating lower recall rates (RRs) and higher cancer detection rates (CDRs). However, inconsistent interpretation of evidence on the risks and benefits of mammography has resulted in varying screening mammography recommendations. Purpose To evaluate screening outcomes among women in the United States who underwent routine DM or DBT mammographic screening. Materials and Methods This retrospective cohort study included women aged 40-79 years who underwent DM or DBT screening mammograms between January 2014 and December 2020. Outcomes of RR, CDR, positive predictive value of recall (PPV1), biopsy rate, and positive predictive value of biopsy (PPV3) were compared between DM and DBT with use of adjusted multivariable logistic regression models. Results A total of 2 528 063 screening mammograms from 1 100 447 women (mean age, 57 years ± 10 [SD]) were included. In crude analyses, DBT (1 693 727 screening mammograms vs 834 336 DM screening mammograms) demonstrated lower RR (10.3% [95% CI: 10.3, 10.4] for DM vs 8.9% [95% CI: 8.9, 9.0] for DBT; P < .001) and higher CDR (4.5 of 1000 screening mammograms [95% CI: 4.3, 4.6] vs 5.3 of 1000 [95% CI: 5.2, 5.5]; P < .001), PPV1 (4.3% [95% CI: 4.2, 4.5] vs 5.9% [95% CI: 5.7, 6.0]; P < .001), and biopsy rates (14.5 of 1000 screening mammograms [95% CI: 14.2, 14.7] vs 17.6 of 1000 [95% CI: 17.4, 17.8]; P < .001). PPV3 was similar between cohorts (30.0% [95% CI: 29.2, 30.9] for DM vs 29.3% [95% CI: 28.7, 29.9] for DBT; P = .16). After adjustment for age, breast density, site, and index year, associations remained stable with respect to statistical significance. Conclusion Women undergoing digital breast tomosynthesis had improved screening mammography outcomes compared with women who underwent digital mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bae and Seo in this issue.
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Affiliation(s)
- Emily F Conant
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Melinda M Talley
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Chirag R Parghi
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Bryant C Sheh
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Su-Ying Liang
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Scott Pohlman
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Amey Rane
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Yoojin Jung
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Lauren A S Stevens
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Jessica K Paulus
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
| | - Nila Alsheik
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (E.F.C.); Sanford Health, Sioux Falls, SD (M.M.T.); Solis Mammography, Houston, Tex (C.R.P.); Sutter Health, Fremont, Calif (B.C.S.); Sutter Health, Palo Alto, Calif (S.Y.L.); Hologic, Marlborough, Mass (S.P., A.R.); OM1, Boston, Mass (Y.J., L.A.S.S., J.K.P.); and Department of Radiology, Advocate Caldwell Breast Center, Park Ridge, Ill (N.A.)
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12
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Sprague BL, Chen S, Miglioretti DL, Gard CC, Tice JA, Hubbard RA, Aiello Bowles EJ, Kaufman PA, Kerlikowske K. Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency. JAMA Netw Open 2023; 6:e230166. [PMID: 36808238 PMCID: PMC9941892 DOI: 10.1001/jamanetworkopen.2023.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Detection of ductal carcinoma in situ (DCIS) by mammography screening is a controversial outcome with potential benefits and harms. The association of mammography screening interval and woman's risk factors with the likelihood of DCIS detection after multiple screening rounds is poorly understood. OBJECTIVE To develop a 6-year risk prediction model for screen-detected DCIS according to mammography screening interval and women's risk factors. DESIGN, SETTING, AND PARTICIPANTS This Breast Cancer Surveillance Consortium cohort study assessed women aged 40 to 74 years undergoing mammography screening (digital mammography or digital breast tomosynthesis) from January 1, 2005, to December 31, 2020, at breast imaging facilities within 6 geographically diverse registries of the consortium. Data were analyzed between February and June 2022. EXPOSURES Screening interval (annual, biennial, or triennial), age, menopausal status, race and ethnicity, family history of breast cancer, benign breast biopsy history, breast density, body mass index, age at first birth, and false-positive mammography history. MAIN OUTCOMES AND MEASURES Screen-detected DCIS defined as a DCIS diagnosis within 12 months after a positive screening mammography result, with no concurrent invasive disease. RESULTS A total of 916 931 women (median [IQR] age at baseline, 54 [46-62] years; 12% Asian, 9% Black, 5% Hispanic/Latina, 69% White, 2% other or multiple races, and 4% missing) met the eligibility criteria, with 3757 screen-detected DCIS diagnoses. Screening round-specific risk estimates from multivariable logistic regression were well calibrated (expected-observed ratio, 1.00; 95% CI, 0.97-1.03) with a cross-validated area under the receiver operating characteristic curve of 0.639 (95% CI, 0.630-0.648). Cumulative 6-year risk of screen-detected DCIS estimated from screening round-specific risk estimates, accounting for competing risks of death and invasive cancer, varied widely by all included risk factors. Cumulative 6-year screen-detected DCIS risk increased with age and shorter screening interval. Among women aged 40 to 49 years, the mean 6-year screen-detected DCIS risk was 0.30% (IQR, 0.21%-0.37%) for annual screening, 0.21% (IQR, 0.14%-0.26%) for biennial screening, and 0.17% (IQR, 0.12%-0.22%) for triennial screening. Among women aged 70 to 74 years, the mean cumulative risks were 0.58% (IQR, 0.41%-0.69%) after 6 annual screens, 0.40% (IQR, 0.28%-0.48%) for 3 biennial screens, and 0.33% (IQR, 0.23%-0.39%) after 2 triennial screens. CONCLUSIONS AND RELEVANCE In this cohort study, 6-year screen-detected DCIS risk was higher with annual screening compared with biennial or triennial screening intervals. Estimates from the prediction model, along with risk estimates of other screening benefits and harms, could help inform policy makers' discussions of screening strategies.
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Affiliation(s)
- Brian L. Sprague
- Office of Health Promotion Research, University of Vermont, Burlington
- Department of Surgery, University of Vermont, Burlington
- University of Vermont Cancer Center, Burlington
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Charlotte C. Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Peter A. Kaufman
- Division of Hematology/Oncology, University of Vermont Cancer Center, Burlington
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
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13
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Clinical assessment of image quality, usability and patient comfort in dedicated spiral breast computed tomography. Clin Imaging 2022; 90:50-58. [DOI: 10.1016/j.clinimag.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
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14
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Kuhl CK. Whether Forced Marriage or Loving Union, Marrying Breast and Lung Cancer Screening Practices Would Help Prevent Death From Lung Cancer. JAMA Netw Open 2022; 5:e2237647. [PMID: 36178695 DOI: 10.1001/jamanetworkopen.2022.37647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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Diagnostic Efficacy across Dense and Non-Dense Breasts during Digital Breast Tomosynthesis and Ultrasound Assessment for Recalled Women. Diagnostics (Basel) 2022; 12:diagnostics12061477. [PMID: 35741287 PMCID: PMC9222054 DOI: 10.3390/diagnostics12061477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: To compare the diagnostic efficacy of digital breast tomosynthesis (DBT) and ultrasound across breast densities in women recalled for assessment. Methods: A total of 482 women recalled for assessment from January 2017 to December 2019 were selected for the study. Women met the inclusion criteria if they had undergone DBT, ultrasound and had confirmed biopsy results. We calculated sensitivity, specificity, PPV, and AUC for DBT and ultrasound. Results: In dense breasts, DBT showed significantly higher sensitivity than ultrasound (98.2% vs. 80%; p < 0.001), but lower specificity (15.4% vs. 55%; p < 0.001), PPV (61.3% vs. 71%; p = 0.04) and AUC (0.568 vs. 0.671; p = 0.001). In non-dense breasts, DBT showed significantly higher sensitivity than ultrasound (99.2% vs. 84%; p < 0.001), but no differences in specificity (22% vs. 33%; p = 0.14), PPV (69.2% vs. 68.8%; p = 0.93) or AUC (0.606 vs. 0.583; p = 0.57). Around 73% (74% dense and 71% non-dense) and 77% (81% dense and 72% non-dense) of lesions assigned a RANZCR 3 by DBT and ultrasound, respectively, were benign. Conclusion: DBT has higher sensitivity, but lower specificity and PPV than ultrasound in women with dense breasts recalled for assessment. Most lesions rated RANZCR 3 on DBT and ultrasound are benign and may benefit from short interval follow-up rather than biopsy.
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Kerlikowske K, Su YR, Sprague BL, Tosteson ANA, Buist DSM, Onega T, Henderson LM, Alsheik N, Bissell MCS, O’Meara ES, Lee CI, Miglioretti DL. Association of Screening With Digital Breast Tomosynthesis vs Digital Mammography With Risk of Interval Invasive and Advanced Breast Cancer. JAMA 2022; 327:2220-2230. [PMID: 35699706 PMCID: PMC9198754 DOI: 10.1001/jama.2022.7672] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/21/2022] [Indexed: 12/15/2022]
Abstract
Importance Digital breast tomosynthesis (DBT) was developed with the expectation of improving cancer detection in women with dense breasts. Studies are needed to evaluate interval invasive and advanced breast cancer rates, intermediary outcomes related to breast cancer mortality, by breast density and breast cancer risk. Objective To evaluate whether DBT screening is associated with a lower likelihood of interval invasive cancer and advanced breast cancer compared with digital mammography by extent of breast density and breast cancer risk. Design, Setting, and Participants Cohort study of 504 427 women aged 40 to 79 years who underwent 1 003 900 screening digital mammography and 375 189 screening DBT examinations from 2011 through 2018 at 44 US Breast Cancer Surveillance Consortium (BCSC) facilities with follow-up for cancer diagnoses through 2019 by linkage to state or regional cancer registries. Exposures Breast Imaging Reporting and Data System (BI-RADS) breast density; BCSC 5-year breast cancer risk. Main Outcomes and Measures Rates per 1000 examinations of interval invasive cancer within 12 months of screening mammography and advanced breast cancer (prognostic pathologic stage II or higher) within 12 months of screening mammography, both estimated with inverse probability weighting. Results Among 504 427 women in the study population, the median age at time of mammography was 58 years (IQR, 50-65 years). Interval invasive cancer rates per 1000 examinations were not significantly different for DBT vs digital mammography (overall, 0.57 vs 0.61, respectively; difference, -0.04; 95% CI, -0.14 to 0.06; P = .43) or among all the 836 250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk) or all the 413 061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories. Advanced cancer rates were not significantly different for DBT vs digital mammography among women at low to average risk or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts. Advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography for the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13 291 examinations in the DBT group and 31 300 in the digital mammography group; 0.27 vs 0.80 per 1000 examinations; difference, -0.53; 95% CI, -0.97 to -0.10) but not for women at low to average risk (10 611 examinations in the DBT group and 37 796 in the digital mammography group; 0.54 vs 0.42 per 1000 examinations; difference, 0.12; 95% CI, -0.09 to 0.32). Conclusions and Relevance Screening with DBT vs digital mammography was not associated with a significant difference in risk of interval invasive cancer and was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer. No significant difference was observed in the 96.4% of women with nondense breasts, heterogeneously dense breasts, or with extremely dense breasts not at high risk.
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Affiliation(s)
- Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Brian L. Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Salt Lake City
- Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Nila Alsheik
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago
| | | | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | | | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Public Health Sciences, University of California, Davis
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Comparative Effectiveness of Digital Breast Tomosynthesis and Mammography in Older Women. J Gen Intern Med 2022; 37:1870-1876. [PMID: 34595682 PMCID: PMC8483166 DOI: 10.1007/s11606-021-07132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women. OBJECTIVE To assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D) mammography among women 67-74 and women 75 and older. DESIGN Cohort study. PARTICIPANTS Medicare fee-for-service beneficiaries aged 67 years and older with no history of prior cancer who received a screening mammogram in 2015. MAIN MEASURES Use of subsequent imaging (ultrasound and diagnostic mammography) as an indication of recall, breast cancer detection, and characteristics of breast cancer at the time of diagnosis. Analyses used weighted logistic regression to adjust for potential confounders. KEY RESULTS Our study included 26,406 women aged 67-74 and 17,001 women 75 and older who were screened for breast cancer. Among women 75 and older, the rate of subsequent imaging among women screened with DBT did not differ significantly from 2-D mammography (91.8 versus 97.0 per 1,000 screening mammograms, p=0.37). In this age group, DBT was associated with 2.1 additional cancers detected per 1,000 screening mammograms compared to 2D (11.5 versus 9.4, p=0.003), though these additional cancers were almost exclusively in situ and stage I invasive cancers. For women 67-74 years old, DBT was associated with a higher rate of subsequent imaging than 2-D mammography (113.9 versus 100.3, p=0.004) and a higher rate of stage I invasive cancer detection (4.7 versus 3.7, p=0.002), but not other stages. CONCLUSIONS Breast cancer screening with DBT was not associated with lower rates of subsequent imaging among older women. Most additional cancers detected with DBT were early stage. Whether detecting these additional early-stage cancers among older women improves health outcomes remains uncertain.
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Community-Based Breast Cancer Screening Using Digital Breast Tomosynthesis Versus Digital Mammography: Comparison of Screening Performance and Tumor Characteristics. AJR Am J Roentgenol 2021; 218:249-257. [PMID: 34523954 DOI: 10.2214/ajr.21.26384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Prior studies comparing screening by digital breast tomosynthesis (DBT) and digital mammography (DM) have largely entailed prospective trials and investigations at tertiary academic centers, which may encounter high risk patient populations and lack heterogeneity among interpreting radiologists. Thus, results may not generalize across real-world community settings in the United States. Objective: To compare DBT and DM in terms of screening performance and tumor characteristics of screen-detected cancers, in a community practice setting. Methods: Data were retrospectively retrieved for all screening mammograms performed by DBT or DM at four outpatient private practice facilities from 1/1/2012 to 7/10/2019. Examinations were interpreted by one of 26 radiologists (21 breast radiologists, 5 general radiologists). Further detailed information was recorded from radiology and pathology reports for all screen-detected cancers. Statistical comparisons were performed between DBT and DM in terms of screening performance and tumor characteristics of screen-detected cancers. Results: A total of 310 cancers were detected in 47,096 screening DBT examinations and 83,200 screening DM examinations. Cancer detection rate was higher (p<.001) for DBT (3.4 per 1000 women) than DM (1.8 per 1000 women). PPV1 was higher (p<.001) for DBT [3.5% (161/4641)] than DM [2.1% (149/7116)]. Age was lower (p=.02) for patients with screen-detected cancer by DBT (mean, 61 years; range, 40-87 years) than DM (mean, 64 years; range, 37-88 years). A greater percentage of DBT-detected than DM-detected cancers were invasive [85.1% (137/161) vs 72.5% (108/149), respectively; p=.006], grade 1 when invasive [27.9% (38/136) vs 17.8% (19/107), respectively; p=.04], and node negative [92.2% (71/77) vs 78.4% (58/74), respectively; p=.02]. Cancers detected by DBT and DM were not significantly different in histologic subtype, molecular subtype, or mean size (all p>.05). Conclusion: DBT demonstrated a higher cancer detection rate and PPV1 than DM; patients were younger at cancer diagnosis for DBT. Cancers detected on DBT were more often invasive, grade 1, and node-negative. Clinical Impact: The findings support the generalizability of insights into DBT-based screening, which previously have been investigated primarily in academic settings.
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Enlarged Parathyroid Glands on Trauma Computed Tomography: Frequency and Assessment for Possible Primary Hyperparathyroidism. J Comput Assist Tomogr 2021; 45:926-931. [PMID: 34407058 DOI: 10.1097/rct.0000000000001214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to determine the frequency of enlarged parathyroid glands among patients undergoing trauma computed tomography (CT) who fall within the typical primary hyperparathyroidism (PHPT) age range and to assess for evidence of PHPT. METHODS For this retrospective study of 336 emergency department patients, concurrent cervical spine CT and neck CT angiography (CTA) examinations were reviewed for visible parathyroid glands. When visible, estimated weight was calculated, and a PHPT likelihood category was assigned after medical record review. RESULTS At least 1 parathyroid gland was visible in 17 patients (5%) and enlarged (estimated weight > 60 mg) in 11 (3%). Patients classified as "highly likely" or "likely" of having PHPT exhibited larger glands (median, 355 mg) than those classified as "unlikely" or "highly unlikely" (median, 47 mg; P = 0.01). CONCLUSIONS Parathyroid glands were enlarged in 3% of our cohort. Although PHPT likelihood seems to increase with gland size, definitive determination requires both serum calcium and serum parathyroid hormone.
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Clauser P, Baltzer PAT, Kapetas P, Woitek R, Weber M, Leone F, Bernathova M, Helbich TH. One view or two views for wide-angle tomosynthesis with synthetic mammography in the assessment setting? Eur Radiol 2021; 32:661-670. [PMID: 34324025 PMCID: PMC8660729 DOI: 10.1007/s00330-021-08079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/14/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the diagnostic performance in the assessment setting of three protocols: one-view wide-angle digital breast tomosynthesis (WA-DBT) with synthetic mammography (SM), two-view WA-DBT/SM, and two-view digital mammography (DM). Methods Included in this retrospective study were patients who underwent bilateral two-view DM and WA-DBT. SM were reconstructed from the WA-DBT data. The standard of reference was histology and/or 2 years follow-up. Included were 205 women with 179 lesions (89 malignant, 90 benign). Four blinded readers randomly evaluated images to assess density, lesion type, and level of suspicion according to BI-RADS. Three protocols were evaluated: two-view DM, one-view (mediolateral oblique) WA-DBT/SM, and two-view WA-DBT/SM. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Reading time was assessed. Results The detection rate was higher with two-view WA-DBT/SM (p = 0.063). Sensitivity was higher for two-view WA-DBT/SM compared to two-view DM (p = 0.001) and one-view WA-DBT/SM (p = 0.058). No significant differences in specificity were found. Accuracy was higher with both one-view WA-DBT/SM and two-view WA-DBT/SM compared to DM (p = 0.003 and > 0.001, respectively). Accuracy did not differ between one- and two-view WA-DBT/SM. Two-view WA-DBT/SM performed better for masses and asymmetries. Reading times were significantly longer when WA-DBT was evaluated. Conclusions One-view and two-view WA-DBT/SM can achieve a higher diagnostic performance compared to two-view DM. The detection rate and sensitivity were highest with two-view WA-DBT/SM. Two-view WA-DBT/SM appears to be the most appropriate tool for the assessment of breast lesions. Key Points • Detection rate with two-view wide-angle digital breast tomosynthesis (WA-DBT) is significantly higher than with two-view digital mammography in the assessment setting. • Diagnostic accuracy of one-view and two-view WA-DBT with synthetic mammography (SM) in the assessment setting is higher than that of two-view digital mammography. • Compared to one-view WA-DBT with SM, two-view WA-DBT with SM seems to be the most appropriate tool for the assessment of breast lesions.
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Affiliation(s)
- Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Ramona Woitek
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Michael Weber
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Federica Leone
- Ospedale Luigi Sacco - Polo Universitario, via G.B. Grassi 74, 20157, Milan, Italy
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, Vienna, Austria
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21
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Wolfe JM, Wu CC, Li J, Suresh SB. What do experts look at and what do experts find when reading mammograms? J Med Imaging (Bellingham) 2021; 8:045501. [PMID: 34277890 DOI: 10.1117/1.jmi.8.4.045501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose: Radiologists sometimes fail to report clearly visible, clinically significant findings. Eye tracking can provide insight into the causes of such errors. Approach: We tracked eye movements of 17 radiologists, searching for masses in 80 mammograms (60 with masses). Results: Errors were classified using the Kundel et al. (1978) taxonomy: search errors (target never fixated), recognition errors (fixated < 500 ms ), or decision errors (fixated > 500 ms ). Error proportions replicated Krupinski (1996): search 25%, recognition 25%, and decision 50%. Interestingly, we found few differences between experts and residents in accuracy or eye movement metrics. Error categorization depends on the definition of the useful field of view (UFOV) around fixation. We explored different UFOV definitions, based on targeting saccades and search saccades. Targeting saccades averaged slightly longer than search saccades. Of most interest, we found that the probability that the eyes would move to the target on the next saccade or even on one of the next three saccades was strikingly low ( ∼ 33 % , even when the eyes were < 2 deg from the target). This makes it clear that observers do not fully process everything within a UFOV. Using a probabilistic UFOV, we find, unsurprisingly, that observers cover more of the image when no target is present than when it is found. Interestingly, we do not find evidence that observers cover too little of the image on trials when they miss the target. Conclusions: These results indicate that many errors in mammography reflect failed deployment of attention; not failure to fixate clinically significant locations.
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Affiliation(s)
- Jeremy M Wolfe
- Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Cambridge, Massachusetts, United States
| | - Chia-Chien Wu
- Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Cambridge, Massachusetts, United States
| | - Jonathan Li
- Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sneha B Suresh
- Brigham and Women's Hospital, Boston, Massachusetts, United States
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22
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Hadadi I, Rae W, Clarke J, McEntee M, Ekpo E. Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts. Radiography (Lond) 2021; 27:1027-1032. [PMID: 33906803 DOI: 10.1016/j.radi.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Breast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT). METHODS Eleven breast readers with 1-39 years of experience reading mammograms and 0-4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT. RESULTS DBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3-6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years' experience in reading DBT (p = 0.02), particularly in non-dense breasts. CONCLUSION Diagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT. IMPLICATIONS FOR PRACTICE The benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.
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Affiliation(s)
- I Hadadi
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Khalid University, Saudi Arabia.
| | - W Rae
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - J Clarke
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - M McEntee
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; University College Cork, Discipline of Diagnostic Radiography, UG 12 Áras Watson, Brookfield Health Sciences, College Road, Cork, T12 AK54, Ireland
| | - E Ekpo
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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23
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Richman IB, Long JB, Hoag JR, Upneja A, Hooley R, Xu X, Kunst N, Aminawung JA, Kyanko KA, Busch SH, Gross CP. Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening among Women 40-64 Years Old. J Natl Cancer Inst 2021; 113:1515-1522. [PMID: 33822120 DOI: 10.1093/jnci/djab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/27/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) may have a higher cancer detection rate and lower recall compared to 2 D mammography for breast cancer screening. The goal of this study was to evaluate screening outcomes with DBT in a real-world cohort, and to characterize the population health impact of DBT as it is widely adopted. METHODS This was an observational study evaluating breast cancer screening outcomes among women screened with 2 D mammography versus DBT. We used deidentified administrative data from a large, private health insurer and included women 40-64 screened between January 2015 to December 2017. Outcomes included recall, biopsy, and incident cancers detected. We used two complementary techniques a patient-level analysis using multivariable logistic regression and an area-level analysis evaluating the relationship between population-level adoption of DBT use and outcomes. All statistical tests were 2-sided. RESULTS Our sample included 7,602,869 mammograms in 4,580,698 women, 27.5% of whom received DBT. DBT was associated with modestly lower recall compared to 2 D mammography (113.6 [99% CI = 113.0-114.2] vs 115.4 [99% CI = 115.0-115.8] per 1,000 screens, p < .001), although younger women ages 40-44 had a larger reduction in recall (153 [99% CI = 151-15] vs 164 [99% CI = 163-166] per 1000 screens, p < .001). DBT was associated with higher biopsy rates than 2 D mammography (19.6 [99% CI = 19.3-19.8] vs 15.2 [99% CI = 15.1-15.4] per 1,000 screens, p < .001) and a higher cancer detection rate (4.9 [99% CI = 4.7-5.0] vs 3.8 [99% CI = 3.7-3.9] per 1,000, p < .001). Point estimates from the area-level analysis generally supported these findings. CONCLUSIONS In a large population of privately insured women, DBT was associated with a slightly lower recall rate than 2 D mammography and a higher cancer detection rate. Whether this increased cancer detection improves clinical outcomes remains unknown.
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Affiliation(s)
- Ilana B Richman
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | - Jessica B Long
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | | | | | - Regina Hooley
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Xiao Xu
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Natalia Kunst
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jenerius A Aminawung
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | - Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Susan H Busch
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Cary P Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
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24
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Wright CM, Moorin RE, Saunders C, Marinovich ML, Taylor DB. Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer. Br J Surg 2021; 108:843-850. [PMID: 33638646 DOI: 10.1093/bjs/znaa160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. METHODS This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). RESULTS The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. CONCLUSION Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.
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Affiliation(s)
- C M Wright
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - R E Moorin
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Centre for Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - C Saunders
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - M L Marinovich
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - D B Taylor
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,BreastScreen Western Australia, Perth, Western Australia, Australia
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25
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Lee CI, Zhu W, Onega T, Henderson LM, Kerlikowske K, Sprague BL, Rauscher GH, O’Meara ES, Tosteson ANA, Haas JS, diFlorio-Alexander R, Kaplan C, Miglioretti DL. Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women's Race/Ethnicity and Socioeconomic Status. JAMA Netw Open 2021; 4:e2037546. [PMID: 33606032 PMCID: PMC7896194 DOI: 10.1001/jamanetworkopen.2020.37546] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/27/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Digital breast tomosynthesis (DBT) has reduced recall and increased cancer detection compared with digital mammography (DM), depending on women's age and breast density. Whether DBT screening access and use are equitable across groups of women based on race/ethnicity and socioeconomic characteristics is uncertain. Objective To determine women's access to and use of DBT screening based on race/ethnicity, educational attainment, and income. Design, Setting, and Participants This cross-sectional study included 92 geographically diverse imaging facilities across 5 US states, at which a total of 2 313 118 screening examinations were performed among women aged 40 to 89 years from January 1, 2011, to December 31, 2017. Data were analyzed from June 13, 2019, to August 18, 2020. Exposures Women's race/ethnicity, educational level, and community-level household income. Main Outcomes and Measures Access to DBT (on-site access) at time of screening by examination year and actual use of DBT vs DM screening by years since facility-level DBT adoption (≤5 years). Results Among the 2 313 118 screening examinations included in the analysis, the proportion of women who had DBT access at the time of their screening appointment increased from 11 558 of 354 107 (3.3%) in 2011 to 194 842 of 235 972 (82.6%) in 2017. In 2012, compared with White women, Black (relative risk [RR], 0.05; 95% CI, 0.03-0.11), Asian American (RR, 0.28; 95% CI, 0.11-0.75), and Hispanic (RR, 0.38; 95% CI, 0.18-0.80) women had significantly less DBT access, and women with less than a high school education had lower DBT access compared with college graduates (RR, 0.18; 95% CI, 0.10-0.32). Among women attending facilities with both DM and DBT available at the time of screening, Black women experienced lower DBT use compared with White women attending the same facility (RRs, 0.83 [95% CI, 0.82-0.85] to 0.98 [95% CI, 0.97-0.99]); women with lower educational level experienced lower DBT use (RRs, 0.79 [95% CI, 0.74-0.84] to 0.88 [95% CI, 0.85-0.91] for non-high school graduates and 0.90 [95% CI, 0.89-0.92] to 0.96 [95% CI, 0.93-0.99] for high school graduates vs college graduates); and women within the lowest income quartile experienced lower DBT use vs women in the highest income quartile (RRs, 0.89 [95% CI, 0.87-0.91] to 0.99 [95% CI, 0.98-1.00]) regardless of the number of years after facility-level DBT adoption. Conclusions and Relevance In this cross-sectional study, women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early adoption period and persistently lower DBT use when available over time. Future efforts should address racial/ethnic, educational, and financial barriers to DBT screening.
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Affiliation(s)
- Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Department of Health Services, University of Washington School of Public Health, Seattle
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Tracy Onega
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Louise M. Henderson
- Department of Radiology, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, Burlington
- Department of Radiology, University of Vermont Cancer Center, Burlington
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Celia Kaplan
- Department of Medicine, University of California, San Francisco
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
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26
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Bublak R. [Not Available]. MMW Fortschr Med 2020; 162:24-25. [PMID: 32662016 DOI: 10.1007/s15006-020-0678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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