1
|
Bjerkén A, Tomic H, Zackrisson S, Dustler M, Bakic PR, Tingberg A. Estimation of the absorbed dose in simultaneous digital breast tomosynthesis and mechanical imaging. J Med Imaging (Bellingham) 2025; 12:S13003. [PMID: 39055549 PMCID: PMC11266811 DOI: 10.1117/1.jmi.12.s1.s13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Use of mechanical imaging (MI) as complementary to digital mammography (DM), or in simultaneous digital breast tomosynthesis (DBT) and MI - DBTMI, has demonstrated the potential to increase the specificity of breast cancer screening and reduce unnecessary biopsies compared with DM. The aim of this study is to investigate the increase in the radiation dose due to the presence of an MI sensor during simultaneous image acquisition when automatic exposure control is used. Approach A radiation dose study was conducted on clinically available breast imaging systems with and without an MI sensor present. Our estimations were based on three approaches. In the first approach, exposure values were compared in paired clinical DBT and DBTMI acquisitions in 97 women. In the second approach polymethyl methacrylate (PMMA) phantoms of various thicknesses were used, and the average glandular dose (AGD) values were compared. Finally, a rectangular PMMA phantom with a 45 mm thickness was used, and the AGD values were estimated based on air kerma measurements with an electronic dosemeter. Results The relative increase in exposure estimated from digital imaging and communications in medicine headers when using an MI sensor in clinical DBTMI was 11.9 % ± 10.4 . For the phantom measurements of various thicknesses of PMMA, the relative increases in the AGD for DM and DBT measurements were, on average, 10.7 % ± 3.1 and 11.4 % ± 3.0 , respectively. The relative increase in the AGD using the electronic dosemeter was 11.2 % ± < 0.001 in DM and 12.2 % ± < 0.001 in DBT. The average difference in dose between the methods was 11.5 % ± 3.3 . Conclusions Our measurements suggest that the use of simultaneous breast radiography and MI increases the AGD by an average of 11.5 % ± 3.3 . The increase in dose is within the acceptable values for mammography screening recommended by European guidelines.
Collapse
Affiliation(s)
- Anna Bjerkén
- Lund University, Department of Translational Medicine, Faculty of Medicine, Medical Radiation Physics, Malmö, Sweden
- Skåne University Hospital, Department of Hematology, Oncology and Radiation Physics, Radiation Physics, Malmö, Sweden
| | - Hanna Tomic
- Lund University, Department of Translational Medicine, Faculty of Medicine, Diagnostic Radiology, Malmö, Sweden
| | - Sophia Zackrisson
- Lund University, Department of Translational Medicine, Faculty of Medicine, Diagnostic Radiology, Malmö, Sweden
| | - Magnus Dustler
- Lund University, Department of Translational Medicine, Faculty of Medicine, Medical Radiation Physics, Malmö, Sweden
- Lund University, Department of Translational Medicine, Faculty of Medicine, Diagnostic Radiology, Malmö, Sweden
| | - Predrag R. Bakic
- Lund University, Department of Translational Medicine, Faculty of Medicine, Medical Radiation Physics, Malmö, Sweden
- Lund University, Department of Translational Medicine, Faculty of Medicine, Diagnostic Radiology, Malmö, Sweden
| | - Anders Tingberg
- Lund University, Department of Translational Medicine, Faculty of Medicine, Medical Radiation Physics, Malmö, Sweden
- Skåne University Hospital, Department of Hematology, Oncology and Radiation Physics, Radiation Physics, Malmö, Sweden
| |
Collapse
|
2
|
Darbandi MR, Darbandi M, Darbandi S, Bado I, Hadizadeh M, Khorram Khorshid HR. Artificial intelligence breakthroughs in pioneering early diagnosis and precision treatment of breast cancer: A multimethod study. Eur J Cancer 2024; 209:114227. [PMID: 39053289 DOI: 10.1016/j.ejca.2024.114227] [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: 07/01/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
This article delves into the potential of artificial intelligence (AI) to enhance early breast cancer (BC) detection for improved treatment outcomes and patient care. Utilizing a multimethod approach comprising literature review and experiments, the study systematically reviewed 310 articles utilizing 30 diverse datasets. Among the techniques assessed, recurrent neural network (RNN) emerged as the most accurate, achieving 98.58 % accuracy, followed by genetic principles (GP), transfer learning (TL), and artificial neural networks (ANNs), with accuracies exceeding 96 %. While conventional machine learning (ML) methods demonstrated accuracies above 90 %, DL techniques outperformed them. Evaluation of BC diagnostic models using the Wisconsin breast cancer dataset (WBCD) highlighted logistic regression (LR) and support vector machine (SVM) as the most accurate predictors, with minimal errors for clinical data. Conversely, decision trees (DT) exhibited higher error rates due to overfitting, emphasizing the importance of algorithm selection for complex datasets. Analysis of ultrasound images underscored the significance of preprocessing, while histopathological image analysis using convolutional neural networks (CNNs) demonstrated robust classification capabilities. These findings underscore the transformative potential of ML and DL in BC diagnosis, offering automated, accurate, and accessible diagnostic tools. Collaboration among stakeholders is crucial for further advancements in BC detection methods.
Collapse
Affiliation(s)
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.
| | - Sara Darbandi
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran.
| | - Igor Bado
- Department of Oncological Sciences, Tisch Cancer Institute, New York, USA.
| | - Mohammad Hadizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Reza Khorram Khorshid
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Personalized Medicine and Genometabolics Research Center, Hope Generation Foundation, Tehran, Iran.
| |
Collapse
|
3
|
Coffey K, Dodelzon K, Dialani V, Joe BN, Omofoye TS, Thomas C, Grimm LJ. Survey on Current Utilization and Perception of Synthesized Mammography. JOURNAL OF BREAST IMAGING 2024:wbae045. [PMID: 39159200 DOI: 10.1093/jbi/wbae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To assess utilization and perceptions of 2D synthesized mammography (SM) for digital breast tomosynthesis (DBT) among practicing U.S. breast radiologists. METHODS An IRB-exempt 23-question anonymized survey was developed by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and emailed to practicing U.S. radiologist SBI members on October 9, 2023. Questions assessed respondents' demographics, current mammographic screening protocol, confidence interpreting SM for mammographic findings, and perceived advantages and disadvantages of SM. RESULTS Response rate was 13.4% (371/2771). Of 371 respondents, 208 were currently screening with DBT/SM (56.1%), 98 with DBT/SM/digital mammography (DM) (26.4%), 61 with DBT/DM (16.4%), and 4 with DM (1.1%). Most respondents felt confident using DBT/SM to evaluate masses (254/319, 79.6%), asymmetries (247/319, 77.4%), and distortions (265/318, 83.3%); however, confidence was mixed for calcifications (agreement 130/320, 40.6%; disagreement 156/320, 48.8%; neutral 34/320, 10.6%). The most frequently cited disadvantage and advantage of SM were reconstruction algorithm false-positive results (199/347, 57.4%) and lower radiation dose (281/346, 81.2%), respectively. Higher confidence and fewer disadvantages were reported by radiologists who had more SM experience, screened with DBT/SM, or exclusively used Hologic vendor (all P <.05). CONCLUSION For most survey respondents (56.1%), SM has replaced DM in DBT screening. Radiologists currently screening with DBT/SM or with more SM experience reported greater confidence in SM with fewer perceived disadvantages.
Collapse
Affiliation(s)
- Kristen Coffey
- D epartment of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Vandana Dialani
- Department of Radiology, Beth Israel Lahey Hospital, Harvard Medical School, Boston, MA, USA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Toma S Omofoye
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charlene Thomas
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
| |
Collapse
|
4
|
J W Partridge G, Darker I, J James J, Satchithananda K, Sharma N, Valencia A, Teh W, Khan H, Muscat E, J Michell M, Chen Y. How long does it take to read a mammogram? Investigating the reading time of digital breast tomosynthesis and digital mammography. Eur J Radiol 2024; 177:111535. [PMID: 38852330 DOI: 10.1016/j.ejrad.2024.111535] [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: 02/14/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE To analyse digital breast tomosynthesis (DBT) reading times in the screening setting, compared to 2D full-field digital mammography (FFDM), and investigate the impact of reader experience and professional group on interpretation times. METHOD Reading time data were recorded in the PROSPECTS Trial, a prospective randomised trial comparing DBT plus FFDM or synthetic 2D mammography (S2D) to FFDM alone, in the National Health Service (NHS) breast screening programme, from January 2019-February 2023. Time to read DBT+FFDM or DBT+S2D and FFDM alone was calculated per case and reading times were compared between modalities using dependent T-tests. Reading times were compared between readers from different professional groups (radiologists and radiographer readers) and experience levels using independent T-tests. The learning curve effect of using DBT in screening on reading time was investigated using a Kruskal-Wallis test. RESULTS Forty-eight readers interpreted 1,242 FFDM batches (34,210 FFDM cases) and 973 DBT batches (13,983 DBT cases). DBT reading time was doubled compared to FFDM (2.09 ± 0.64 min vs. 0.98 ± 0.30 min; p < 0.001), and DBT+S2D reading was longer than DBT + FFDM (2.24 ± 0.62 min vs. 2.04 ± 0.46 min; p = 0.006). No difference was identified in reading time between radiologists and radiographers (2.06 ± 0.71 min vs. 2.14 ± 0.46 min, respectively; p = 0.71). Readers with five or more years of experience reading DBT were quicker than those with less experience (1.86 ± 0.56 min vs. 2.37 ± 0.65 min; p = 0.008), and DBT reading time decreased after less than 9 months accrued screening experience (p = 0.01). CONCLUSIONS DBT reading times were double those of FFDM in the screening setting, but there was a short learning curve effect with readers showing significant improvements in reading times within the first nine months of DBT experience. CLINICALTRIALS gov Identifier: NCT03733106.
Collapse
Affiliation(s)
- George J W Partridge
- University of Nottingham, School of Medicine, Translational Medical Sciences, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, United Kingdom
| | - Iain Darker
- University of Nottingham, School of Medicine, Translational Medical Sciences, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, United Kingdom
| | - Jonathan J James
- Nottingham University Hospitals NHS Trust, Nottingham Breast Institute, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom
| | - Keshthra Satchithananda
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Nisha Sharma
- Leeds Breast Screening Unit, Leeds Teaching Hospital, York Road, Leeds, LS14 6UH, United Kingdom
| | - Alexandra Valencia
- Avon Breast Screening, Bristol Breast Care Centre, Bristol, BS10 5NB, United Kingdom
| | - William Teh
- North London Breast Screening Service, Edgware Community Hospital, London, HA8 9BA, United Kingdom
| | - Humaira Khan
- City, Sandwell and Walsall Breast Screening Service, Birmingham City Hospital, B18 7QH, United Kingdom
| | - Elizabeth Muscat
- South West London Breast Screening Service, St George's Hospital, London, SW17 0QT, United Kingdom
| | - Michael J Michell
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Yan Chen
- University of Nottingham, School of Medicine, Translational Medical Sciences, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, United Kingdom.
| |
Collapse
|
5
|
Keupers M, Woussen S, Postema S, Westerlinck H, Houbrechts K, Marshall N, Wildiers H, Cockmartin L, Bosmans H, Van Ongeval C. Limited impact of adding digital breast tomosynthesis to full field digital mammography in an elevated breast cancer risk population. Eur J Radiol 2024; 177:111540. [PMID: 38852327 DOI: 10.1016/j.ejrad.2024.111540] [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: 08/31/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE To investigate the impact of adding digital breast tomosynthesis (DBT) to full field digital mammography (FFDM) in screening asymptomatic women with an elevated breast cancer life time risk (BCLTR) but without known genetic mutation. METHODS This IRB-approved single-institution multi-reader study on prospectively acquired FFDM + DBT images included 429 asymptomatic women (39-69y) with an elevated BC risk on their request form. The BCLTR was calculated for each patient using the IBISrisk calculator v8.0b. The screening protocol and reader study consisted of 4-view FFDM + DBT, which were read by four independent radiologists using the BI-RADS lexicon. Standard of care (SOC) included ultrasound (US) and magnetic resonance imaging (MRI) for women with > 30 % BCLTR. Breast cancer detection rate (BCDR), sensitivity and positive predictive value were assessed for FFDM and FFDM + DBT and detection outcomes were compared with McNemar-test. RESULTS In total 7/429 women in this clinically elevated breast cancer risk group were diagnosed with BC using SOC (BCDR 16.3/1000) of which 4 were detected with FFDM. Supplemental DBT did not detect additional cancers and BCDR was the same for FFDM vs FFDM + DBT (9.3/1000, McNemar p = 1). Moderate inter-reader agreement for diagnostic BI-RADS score was found for both study arms (ICC for FFDM and FFDM + DBT was 0.43, resp. 0.46). CONCLUSION In this single institution study, supplemental screening with DBT in addition to standard FFDM did not increase BCDR in this higher-than-average BC risk group, objectively documented using the IBISrisk calculator.
Collapse
Affiliation(s)
- Machteld Keupers
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Sofie Woussen
- Department of Radiology, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Sandra Postema
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hélène Westerlinck
- Department of Radiology, AZ Diest, Statiestraat 65, 3290 Diest, Belgium.
| | - Katrien Houbrechts
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nicholas Marshall
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hans Wildiers
- Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Lesley Cockmartin
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hilde Bosmans
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| |
Collapse
|
6
|
Li X, Li X, Zhang K, Guan Y, Fan M, Wu Q, Li Y, Holmdahl R, Lu S, Zhu W, Wang X, Meng L. Autoantibodies against Endophilin A2 as a novel biomarker are beneficial to early diagnosis of breast cancer. Clin Chim Acta 2024; 560:119748. [PMID: 38796051 DOI: 10.1016/j.cca.2024.119748] [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: 11/29/2023] [Revised: 03/24/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Due to the lack of early symptoms, breast cancer is frequently overlooked, leading to distant metastases and multi-organ lesions that directly threaten patients' lives. We have identified a novel tumor marker, antibodies to endophilin A2 (EA2), to improve early diagnosis of breast cancer. METHODS Antibody levels of EA2 were analyzed in sera of patients with cancers of different origins and stages by indirect enzyme-linked immunosorbent assay (ELISA). Diagnostic accuracy and reference range were determined by the area under the receiver operating curve and distribution curve. The levels of EA2 antigen in sera were determined by sandwich ELISA. RESULTS The levels of antibodies against EA2 were higher in sera of patients with breast cancer (P < 0.0001), liver cancer (P = 0.0005), gastric cancer (P = 0.0026), and colon cancer (P = 0.0349) than those in healthy controls, but not in patients with rectal cancer (P = 0.1151), leukemia (P = 0.7508), or lung cancer (P = 0.2247). The highest diagnostic value was for breast cancer, particularly in early cases (AUC = 0.8014) and those with distant metastases (AUC = 0.7885). The titers of EA2 antibodies in sera were correlated with levels of EA2 antigen in breast cancer patients. CONCLUSION Antibodies to EA2 are novel blood biomarkers for early diagnosis of breast cancer that warrants further study in larger-scale cohort studies.
Collapse
Affiliation(s)
- Xiaomeng Li
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Xiaowei Li
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Kaige Zhang
- School of Medical Technology, Xinxiang Medical University, Xinxiang, Henan 453003, China; Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yanglong Guan
- Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Meiyang Fan
- Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Qian Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yue Li
- Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Rikard Holmdahl
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Section for Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm 17177, Sweden
| | - Shemin Lu
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi 710061, China
| | - Wenhua Zhu
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China.
| | - Xiaoqin Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
| | - Liesu Meng
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; Institute of Molecular and Translational Medicine (IMTM), and Department of Biochemistry and Molecular Biology, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi 710061, China
| |
Collapse
|
7
|
Dhurandhar V, Bhola N, Chan M, Choi S, Chung TY, Giuffre B, Hunter N, Lee K, McKessar M, Reddy R, Roberts M, Shearman C, Kay M, Bruderlin K, Winarta N, Noakes J. Feasibility study comparing synthesized mammography with digital breast tomosynthesis and digital mammography for simulated first round screening in a single BreastScreen NSW centre. J Med Imaging Radiat Oncol 2024; 68:401-411. [PMID: 38698585 DOI: 10.1111/1754-9485.13664] [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: 11/24/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short-term outcomes. METHODS Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first-round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. RESULT Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. CONCLUSION In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy.
Collapse
Affiliation(s)
- Vikrant Dhurandhar
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nalini Bhola
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Mico Chan
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Sarah Choi
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Tzu-Yun Chung
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Bruno Giuffre
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Nigel Hunter
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Katelyn Lee
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Merran McKessar
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Ranjani Reddy
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Marian Roberts
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Christine Shearman
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Meredith Kay
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Ken Bruderlin
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Niko Winarta
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Jennifer Noakes
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Nguyen DL, Grimm LJ, Nelson JS, Johnson KS, Ghate SV. Screening the Implant-Augmented Breast with Digital Breast Tomosynthesis: Is Tomosynthesis Necessary for Non-implant-Displaced Views? JOURNAL OF BREAST IMAGING 2024; 6:261-270. [PMID: 38703091 PMCID: PMC11129616 DOI: 10.1093/jbi/wbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To determine cancer visualization utility and radiation dose for non-implant-displaced (ID) views using standard protocol with digital breast tomosynthesis (DBT) vs alternative protocol with 2D only when screening women with implant augmentation. METHODS This retrospective cohort study identified women with implants who underwent screening DBT examinations that had abnormal findings from July 28, 2014, to December 31, 2021. Three fellowship-trained breast radiologists independently reviewed examinations retrospectively to determine if the initially identified abnormalities could be visualized on standard protocol (DBT with synthesized 2D (S2D) for ID and non-ID views) and alternate protocol (DBT with S2D for ID and only the S2D images for non-ID views). Estimated exam average glandular dose (AGD) and associations between cancer visualization with patient and implant characteristics for both protocols were evaluated. RESULTS The study included 195 patients (mean age 55 years ± 10) with 223 abnormal findings. Subsequent biopsy was performed for 86 abnormalities: 59 (69%) benign, 8 (9%) high risk, and 19 (22%) malignant. There was no significant difference in malignancy visualization rate between standard (19/223, 8.5%) and alternate (18/223, 8.1%) protocols (P = .92), but inclusion of the DBT for non-ID views found one additional malignancy. Total examination AGD using standard protocol (21.9 mGy ± 5.0) was significantly higher than it would be for estimated alternate protocol (12.6 mGy ± 5.0, P <.001). This remained true when stratified by breast thickness: 6.0-7.9 cm, 8.0-9.9 cm, >10.0 cm (all P <.001). CONCLUSION The inclusion of DBT for non-ID views did not significantly increase the cancer visualization rate but did significantly increase overall examination AGD.
Collapse
Affiliation(s)
- Derek L Nguyen
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Jeffrey S Nelson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Karen S Johnson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Sujata V Ghate
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| |
Collapse
|
9
|
Mäntylä VM, Lehtonen AJ, Korhonen V, Srbova L, Pokki J. Quantifying the Influence of X-Ray Irradiation on Cell-Size-Scale Viscoelasticity of Collagen Type 1. J Biomech Eng 2024; 146:044501. [PMID: 38183220 DOI: 10.1115/1.4064404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
X-rays are widely used in mammography and radiotherapy of breast cancer. The research has focused on the effects of X-rays on cells in breast tissues, instead of the tissues' nonliving material, extracellular matrix. It is unclear what the influence of X-ray irradiation is on the matrix's mechanical cues, known to regulate malignant cancer-cell behaviors. Here, we developed a technique based on magnetic microrheology that can quantify the influence of X-ray irradiation on matrix viscoelasticity--or (solid-like) elastic and (liquid-like) viscous characteristics--at cell-size scales. To model breast-tissue extracellular matrix, we used the primary component of the tissue matrix, collagen type 1, as it is for control, and as irradiated by X-rays (tube voltage 50 kV). We used a magnetic microrheometer to measure collagen matrices using 10-μm-diameter magnetic probes. In each matrix, the probes were nanomanipulated using controlled magnetic forces by the microrheometer while the probes' displacements were detected to measure the viscoelasticity. The collagen-matrix data involve with a typical spatial variation in viscoelasticity. We find that higher irradiation doses (320 Gy) locally reduce stiffness (soften) collagen matrices and increase their loss tangent, indicating an elevated liquid-like nature. For lower, clinically relevant irradiation doses (54 Gy), we find insignificant matrix-viscoelasticity changes. We provide this irradiation-related technique for detection, and modification, of matrix viscoelastic cues at cell-size scales. The technique enables enhanced characterization of irradiated tissue constituents in a variety of breast-cancer radiotherapy types.
Collapse
Affiliation(s)
- Väinö Mikael Mäntylä
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Arttu Juhani Lehtonen
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Vesa Korhonen
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Linda Srbova
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Juho Pokki
- ASME Professional Mem. Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| |
Collapse
|
10
|
Freitas V, Li X, Scaranelo A, Au F, Kulkarni S, Ghai S, Taeb S, Bubon O, Baldassi B, Komarov B, Parker S, Macsemchuk CA, Waterston M, Olsen KO, Reznik A. Breast Cancer Detection Using a Low-Dose Positron Emission Digital Mammography System. Radiol Imaging Cancer 2024; 6:e230020. [PMID: 38334470 PMCID: PMC10988332 DOI: 10.1148/rycan.230020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024]
Abstract
Purpose To investigate the feasibility of low-dose positron emission mammography (PEM) concurrently to MRI to identify breast cancer and determine its local extent. Materials and Methods In this research ethics board-approved prospective study, participants newly diagnosed with breast cancer with concurrent breast MRI acquisitions were assigned independently of breast density, tumor size, and histopathologic cancer subtype to undergo low-dose PEM with up to 185 MBq of fluorine 18-labeled fluorodeoxyglucose (18F-FDG). Two breast radiologists, unaware of the cancer location, reviewed PEM images taken 1 and 4 hours following 18F-FDG injection. Findings were correlated with histopathologic results. Detection accuracy and participant details were examined using logistic regression and summary statistics, and a comparative analysis assessed the efficacy of PEM and MRI additional lesions detection (ClinicalTrials.gov: NCT03520218). Results Twenty-five female participants (median age, 52 years; range, 32-85 years) comprised the cohort. Twenty-four of 25 (96%) cancers (19 invasive cancers and five in situ diseases) were identified with PEM from 100 sets of bilateral images, showcasing comparable performance even after 3 hours of radiotracer uptake. The median invasive cancer size was 31 mm (range, 10-120). Three additional in situ grade 2 lesions were missed at PEM. While not significant, PEM detected fewer false-positive additional lesions compared with MRI (one of six [16%] vs eight of 13 [62%]; P = .14). Conclusion This study suggests the feasibility of a low-dose PEM system in helping to detect invasive breast cancer. Though large-scale clinical trials are essential to confirm these preliminary results, this study underscores the potential of this low-dose PEM system as a promising imaging tool in breast cancer diagnosis. ClinicalTrials.gov registration no. NCT03520218 Keywords: Positron Emission Digital Mammography, Invasive Breast Cancer, Oncology, MRI Supplemental material is available for this article. © RSNA, 2024 See also commentary by Barreto and Rapelyea in this issue.
Collapse
Affiliation(s)
- Vivianne Freitas
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Xuan Li
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Anabel Scaranelo
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Frederick Au
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Supriya Kulkarni
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Sandeep Ghai
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Samira Taeb
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Oleksandr Bubon
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Brandon Baldassi
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Borys Komarov
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Shayna Parker
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Craig A. Macsemchuk
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Michael Waterston
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Kenneth O. Olsen
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Alla Reznik
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| |
Collapse
|
11
|
Nguyen A, Mirchandani A, Joseph S, Mapkar Z, Singh E. Digital Breast Tomosynthesis With Synthetic Mammography: Are We Missing Calcifications That Matter? JOURNAL OF BREAST IMAGING 2023; 5:666-674. [PMID: 38141240 DOI: 10.1093/jbi/wbad073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To determine whether there are differences in the biopsy outcomes for suspicious calcifications detected with screening mammography using the digital breast tomosynthesis and synthetic 2D (DBT/SM) technique compared to calcifications detected using the full-field digital (DM) technique. METHODS This retrospective study was IRB approved. The records for all stereotactic biopsies performed for suspicious calcifications detected on screening mammograms using DM in 2011-2014 and DBT/SM in 2017-2020 were reviewed. We collected patient, imaging, and pathology data from the breast imaging database and from retrospective review of a subset of mammograms. The biopsy outcome results were categorized as benign, benign with upgrade potential (BWUP), and malignant based on final pathology. Frequencies and proportions of outcomes were calculated and compared using Mann-Whitney U tests and Wilcoxson signed-rank tests with P-values and 95% confidence intervals (95% CIs). RESULTS From 2011 to 2014 (DM), 1274 stereotactic biopsies of calcifications yielded 74.2% (945/1274) benign, 11.5% (147/1274) BWUP, and 14.3% (182/1274) malignant outcomes. From 2017 to 2020 (DBT/SM), 1049 stereotactic biopsies yielded 65.2% (684/1049) benign, 15.6% (164/1049) BWUP, and 19.2% (201/1049) malignant outcomes. With DBT/SM, benign biopsy outcomes decreased (9.0%, 95% CI 0.87-11.53, P < 0.05), whereas malignant biopsy outcomes increased (4.9%, 95% CI 0.94-8.36, P < 0.05). There was no significant difference in BWUP biopsy outcomes and total biopsy rates between techniques (P > 0.05). CONCLUSION Calcifications detected with screening DBT/SM technique were significantly more likely to be malignant than those found using DM. These results support using the DBT/SM technique without obtaining concurrent DM images.
Collapse
Affiliation(s)
- Adrien Nguyen
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Anicia Mirchandani
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Sumita Joseph
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Zaiba Mapkar
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Evita Singh
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| |
Collapse
|
12
|
Vedantham S, Tseng HW, Fu Z, Chow HHS. Dedicated Cone-Beam Breast CT: Reproducibility of Volumetric Glandular Fraction with Advanced Image Reconstruction Methods. Tomography 2023; 9:2039-2051. [PMID: 37987346 PMCID: PMC10661286 DOI: 10.3390/tomography9060160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
Dedicated cone-beam breast computed tomography (CBBCT) is an emerging modality and provides fully three-dimensional (3D) images of the uncompressed breast at an isotropic voxel resolution. In an effort to translate this modality to breast cancer screening, advanced image reconstruction methods are being pursued. Since radiographic breast density is an established risk factor for breast cancer and CBBCT provides volumetric data, this study investigates the reproducibility of the volumetric glandular fraction (VGF), defined as the proportion of fibroglandular tissue volume relative to the total breast volume excluding the skin. Four image reconstruction methods were investigated: the analytical Feldkamp-Davis-Kress (FDK), a compressed sensing-based fast, regularized, iterative statistical technique (FRIST), a fully supervised deep learning approach using a multi-scale residual dense network (MS-RDN), and a self-supervised approach based on Noise-to-Noise (N2N) learning. Projection datasets from 106 women who participated in a prior clinical trial were reconstructed using each of these algorithms at a fixed isotropic voxel size of (0.273 mm3). Each reconstructed breast volume was segmented into skin, adipose, and fibroglandular tissues, and the VGF was computed. The VGF did not differ among the four reconstruction methods (p = 0.167), and none of the three advanced image reconstruction algorithms differed from the standard FDK reconstruction (p > 0.862). Advanced reconstruction algorithms developed for low-dose CBBCT reproduce the VGF to provide quantitative breast density, which can be used for risk estimation.
Collapse
Affiliation(s)
- Srinivasan Vedantham
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85724, USA; (H.W.T.); (Z.F.)
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85724, USA
| | - Hsin Wu Tseng
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85724, USA; (H.W.T.); (Z.F.)
| | - Zhiyang Fu
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85724, USA; (H.W.T.); (Z.F.)
| | | |
Collapse
|
13
|
Chikarmane SA, Offit LR, Giess CS. Synthetic Mammography: Benefits, Drawbacks, and Pitfalls. Radiographics 2023; 43:e230018. [PMID: 37768863 DOI: 10.1148/rg.230018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Digital breast tomosynthesis (DBT) allows three-dimensional assessment of breast tissue; however, DBT requires a two-dimensional (2D) image for comparison with prior mammograms and accurate interpretation of calcifications. Traditionally, full-field digital mammography (FFDM) has been performed after the DBT image acquisition. Synthetic mammography (SM), the 2D reconstruction of the tomosynthesis slice dataset, has been designed to replace FFDM. Advantages of SM include decreased image acquisition time and decreased radiation exposure, with maintained or improved screening performance metrics. Because SM algorithms give extra weight to lesion-like characteristics (eg, calcifications and architectural distortions), they may enable increased visibility of these characteristics relative to that at FFDM. Although SM algorithms were designed to improve lesion identification, they have led to varied outcomes in studies reported in the literature. Compared with FFDM, SM has been reported to be associated with a higher false-positive rate for calcifications, decreased conspicuity of asymmetries, lower breast density assessments, and imaging artifacts (eg, metallic artifact, bright-band artifact, blurring of the axilla, and truncation artifact). The authors review the literature on SM, including its implementation, benefits, and artifacts. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Sona A Chikarmane
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
| | - Lily R Offit
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
| | - Catherine S Giess
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
| |
Collapse
|
14
|
Tsarouchi MI, Hoxhaj A, Mann RM. New Approaches and Recommendations for Risk-Adapted Breast Cancer Screening. J Magn Reson Imaging 2023; 58:987-1010. [PMID: 37040474 DOI: 10.1002/jmri.28731] [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: 01/19/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
Population-based breast cancer screening using mammography as the gold standard imaging modality has been in clinical practice for over 40 years. However, the limitations of mammography in terms of sensitivity and high false-positive rates, particularly in high-risk women, challenge the indiscriminate nature of population-based screening. Additionally, in light of expanding research on new breast cancer risk factors, there is a growing consensus that breast cancer screening should move toward a risk-adapted approach. Recent advancements in breast imaging technology, including contrast material-enhanced mammography (CEM), ultrasound (US) (automated-breast US, Doppler, elastography US), and especially magnetic resonance imaging (MRI) (abbreviated, ultrafast, and contrast-agent free), may provide new opportunities for risk-adapted personalized screening strategies. Moreover, the integration of artificial intelligence and radiomics techniques has the potential to enhance the performance of risk-adapted screening. This review article summarizes the current evidence and challenges in breast cancer screening and highlights potential future perspectives for various imaging techniques in a risk-adapted breast cancer screening approach. EVIDENCE LEVEL: 1. TECHNICAL EFFICACY: Stage 5.
Collapse
Affiliation(s)
- Marialena I Tsarouchi
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alma Hoxhaj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Gerlach KE, Phalak KA, Cohen EO, Chang KN, Bassett R, Whitman GJ. Stepwise Implementation of 2D Synthesized Screening Mammography and Its Effect on Stereotactic Biopsy of Microcalcifications. Diagnostics (Basel) 2023; 13:2232. [PMID: 37443627 DOI: 10.3390/diagnostics13132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
RATIONALE AND OBJECTIVES Information evaluating the efficacy of 2D synthesized mammography (2Ds) reconstructions in microcalcification detection is limited. This study used stereotactic biopsy data for microcalcifications to evaluate the stepwise implementation of 2Ds in screening mammography. The study aim was to identify whether 2Ds + digital breast tomosynthesis (DBT) is non-inferior to 2D digital mammography (2DM) + 2Ds + DBT, 2DM + DBT, and 2DM in identifying microcalcifications undergoing further diagnostic imaging and stereotactic biopsy. MATERIALS AND METHODS Retrospective stereotactic biopsy data were extracted following 151,736 screening mammograms of healthy women (average age, 56.3 years; range, 30-89 years), performed between 2012 and 2019. The stereotactic biopsy data were separated into 2DM, 2DM + DBT, 2DM + 2Ds + DBT, and 2Ds + DBT arms and examined using Fisher's exact test to compare the detection rates of all cancers, invasive cancers, DCIS, and ADH between modalities for patients undergoing stereotactic biopsy of microcalcifications. RESULTS No statistical significance in cancer detection was seen for 2Ds + DBT among those calcifications that underwent stereotactic biopsy when comparing the 2Ds + DBT to 2DM, 2DM + DBT, and 2DM + 2Ds + DBT imaging combinations. CONCLUSION These data suggest that 2Ds + DBT is non-inferior to 2DM + DBT in detecting microcalcifications that will undergo stereotactic biopsy.
Collapse
Affiliation(s)
- Karen E Gerlach
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Kanchan Ashok Phalak
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Ethan O Cohen
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Kiran N Chang
- Department of Radiology, University of Texas Health Science Center, 6431 Fannin St, Houston, TX 77030, USA
| | - Roland Bassett
- Biostatistics Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Gary J Whitman
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| |
Collapse
|
16
|
Nicosia L, Bozzini AC, Pesapane F, Rotili A, Marinucci I, Signorelli G, Frassoni S, Bagnardi V, Origgi D, De Marco P, Abiuso I, Sangalli C, Balestreri N, Corso G, Cassano E. Breast Digital Tomosynthesis versus Contrast-Enhanced Mammography: Comparison of Diagnostic Application and Radiation Dose in a Screening Setting. Cancers (Basel) 2023; 15:cancers15092413. [PMID: 37173880 PMCID: PMC10177523 DOI: 10.3390/cancers15092413] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
This study aims to evaluate the Average Glandular Dose (AGD) and diagnostic performance of CEM versus Digital Mammography (DM) as well as versus DM plus one-view Digital Breast Tomosynthesis (DBT), which were performed in the same patients at short intervals of time. A preventive screening examination in high-risk asymptomatic patients between 2020 and 2022 was performed with two-view Digital Mammography (DM) projections (Cranio Caudal and Medio Lateral) plus one Digital Breast Tomosynthesis (DBT) projection (mediolateral oblique, MLO) in a single session examination. For all patients in whom we found a suspicious lesion by using DM + DBT, we performed (within two weeks) a CEM examination. AGD and compression force were compared between the diagnostic methods. All lesions identified by DM + DBT were biopsied; then, we assessed whether lesions found by DBT were also highlighted by DM alone and/or by CEM. We enrolled 49 patients with 49 lesions in the study. The median AGD was lower for DM alone than for CEM (3.41 mGy vs. 4.24 mGy, p = 0.015). The AGD for CEM was significantly lower than for the DM plus one single projection DBT protocol (4.24 mGy vs. 5.55 mGy, p < 0.001). We did not find a statistically significant difference in the median compression force between the CEM and DM + DBT. DM + DBT allows the identification of one more invasive neoplasm one in situ lesion and two high-risk lesions, compared to DM alone. The CEM, compared to DM + DBT, failed to identify only one of the high-risk lesions. According to these results, CEM could be used in the screening of asymptomatic high-risk patients.
Collapse
Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Irene Marinucci
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Signorelli
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Daniela Origgi
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Paolo De Marco
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ida Abiuso
- Radiology Department, Università Degli Studi di Torino, 10124 Turin, Italy
| | - Claudia Sangalli
- Data Management, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Nicola Balestreri
- Department of Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- European Cancer Prevention Organization, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| |
Collapse
|
17
|
Optimization of breast treatment planning towards lower dose rate: A Monte Carlo simulation study. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
|
18
|
Li Y, He Z, Pan J, Zeng W, Liu J, Zeng Z, Xu W, Xu Z, Wang S, Wen C, Zeng H, Wu J, Ma X, Chen W, Lu Y. Atypical architectural distortion detection in digital breast tomosynthesis: a computer-aided detection model with adaptive receptive field. Phys Med Biol 2023; 68. [PMID: 36595312 DOI: 10.1088/1361-6560/acaba7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/14/2022] [Indexed: 12/15/2022]
Abstract
Objective. In digital breast tomosynthesis (DBT), architectural distortion (AD) is a breast lesion that is difficult to detect. Compared with typical ADs, which have radial patterns, identifying a typical ADs is more difficult. Most existing computer-aided detection (CADe) models focus on the detection of typical ADs. This study focuses on atypical ADs and develops a deep learning-based CADe model with an adaptive receptive field in DBT.Approach. Our proposed model uses a Gabor filter and convergence measure to depict the distribution of fibroglandular tissues in DBT slices. Subsequently, two-dimensional (2D) detection is implemented using a deformable-convolution-based deep learning framework, in which an adaptive receptive field is introduced to extract global features in slices. Finally, 2D candidates are aggregated to form the three-dimensional AD detection results. The model is trained on 99 positive cases with ADs and evaluated on 120 AD-positive cases and 100 AD-negative cases.Main results. A convergence-measure-based model and deep-learning model without an adaptive receptive field are reproduced as controls. Their mean true positive fractions (MTPF) ranging from 0.05 to 4 false positives per volume are 0.3846 ± 0.0352 and 0.6501 ± 0.0380, respectively. Our proposed model achieves an MTPF of 0.7148 ± 0.0322, which is a significant improvement (p< 0.05) compared with the other two methods. In particular, our model detects more atypical ADs, primarily contributing to the performance improvement.Significance. The adaptive receptive field helps the model improve the atypical AD detection performance. It can help radiologists identify more ADs in breast cancer screening.
Collapse
Affiliation(s)
- Yue Li
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zilong He
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiawei Pan
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weixiong Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jialing Liu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhaodong Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Weimin Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zeyuan Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Sina Wang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Chanjuan Wen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hui Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiefang Wu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xiangyuan Ma
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, People's Republic of China.,Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weiguo Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, People's Republic of China.,Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| |
Collapse
|
19
|
Arlan K, Meretoja TJ, Hukkinen K. Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification. Acta Radiol 2023; 64:479-488. [PMID: 35317642 DOI: 10.1177/02841851221078931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical planning depends on precise preoperative assessment of the radiological extent of ductal carcinoma in situ (DCIS). Despite different modalities used, reoperation rates for DCIS due to involved margins are high. PURPOSE To evaluate the impact of additional imaging views (spot magnification, tomosynthesis) on surgical reoperation rate of DCIS. MATERIAL AND METHODS The retrospective single institute study includes 157 patients with biopsy-proven pure DCIS seen on mammogram as microcalcifications and treated with breast-conserving surgery. Patients have been divided into three groups according to additional imaging performed: spot magnification, tomosynthesis, and none. All breast images (mammograms, spot magnification, tomosynthesis) were reviewed and the maximum extent of pathological microcalcifications was recorded. Radiological size was compared to final histopathological size. Reoperation rate due to inadequate margins was recorded. RESULTS Reoperation rates (25%) due to inadequate margins were as follows: spot (18%), tomosynthesis (27%), none (31%); P = 0.488. Spot magnification, tomosynthesis, and digital zoom of full-field digital mammography predicted similarly the final histopathological size. Reoperation group had a significantly greater preoperative radiological median size (26 mm vs. 20 mm; P = 0.014) as well as median size of disease on final histopathological report (29 mm vs. 14 mm; P < 0.001). Discrepancy between radiological and final histopathological size became greater with increasing DCIS extent. CONCLUSION The main factors for reoperations are DCIS size and discordance between radiological and histopathological sizes. The use of additional imaging views (spot magnification, tomosynthesis) did not reduce reoperation rate.
Collapse
Affiliation(s)
- Kirill Arlan
- Radiology, HUS Diagnostic Center, 159841University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomo J Meretoja
- Breast Surgery Unit, Comprehensive Cancer Center, 3836University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katja Hukkinen
- Radiology, HUS Diagnostic Center, 159841University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
20
|
Jiang G, He Z, Zhou Y, Wei J, Xu Y, Zeng H, Wu J, Qin G, Chen W, Lu Y. Multi-scale cascaded networks for synthesis of mammogram to decrease intensity distortion and increase model-based perceptual similarity. Med Phys 2023; 50:837-853. [PMID: 36196045 DOI: 10.1002/mp.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/25/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Synthetic digital mammogram (SDM) is a 2D image generated from digital breast tomosynthesis (DBT) and used as a substitute for a full-field digital mammogram (FFDM) to reduce the radiation dose for breast cancer screening. The previous deep learning-based method used FFDM images as the ground truth, and trained a single neural network to directly generate SDM images with similar appearances (e.g., intensity distribution, textures) to the FFDM images. However, the FFDM image has a different texture pattern from DBT. The difference in texture pattern might make the training of the neural network unstable and result in high-intensity distortion, which makes it hard to decrease intensity distortion and increase perceptual similarity (e.g., generate similar textures) at the same time. Clinically, radiologists want to have a 2D synthesized image that feels like an FFDM image in vision and preserves local structures such as both mass and microcalcifications (MCs) in DBT because radiologists have been trained on reading FFDM images for a long time, while local structures are important for diagnosis. In this study, we proposed to use a deep convolutional neural network to learn the transformation to generate SDM from DBT. METHOD To decrease intensity distortion and increase perceptual similarity, a multi-scale cascaded network (MSCN) is proposed to generate low-frequency structures (e.g., intensity distribution) and high-frequency structures (e.g., textures) separately. The MSCN consist of two cascaded sub-networks: the first sub-network is used to predict the low-frequency part of the FFDM image; the second sub-network is used to generate a full SDM image with textures similar to the FFDM image based on the prediction of the first sub-network. The mean-squared error (MSE) objective function is used to train the first sub-network, termed low-frequency network, to generate a low-frequency SDM image. The gradient-guided generative adversarial network's objective function is to train the second sub-network, termed high-frequency network, to generate a full SDM image with textures similar to the FFDM image. RESULTS 1646 cases with FFDM and DBT were retrospectively collected from the Hologic Selenia system for training and validation dataset, and 145 cases with masses or MC clusters were independently collected from the Hologic Selenia system for testing dataset. For comparison, the baseline network has the same architecture as the high-frequency network and directly generates a full SDM image. Compared to the baseline method, the proposed MSCN improves the peak-to-noise ratio from 25.3 to 27.9 dB and improves the structural similarity from 0.703 to 0.724, and significantly increases the perceptual similarity. CONCLUSIONS The proposed method can stabilize the training and generate SDM images with lower intensity distortion and higher perceptual similarity.
Collapse
Affiliation(s)
- Gongfa Jiang
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, P. R. China
| | - Zilong He
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Yuanpin Zhou
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, P. R. China
| | - Jun Wei
- Perception Vision Medical Technology Company Ltd., Guangzhou, P. R. China.,Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuesheng Xu
- Department of Mathematics and Statistics, Old Dominion University, Norfolk, Virginia, USA
| | - Hui Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Jiefang Wu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Genggeng Qin
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Weiguo Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, P. R. China.,Key Laboratory of Machine Intelligence and Advanced Computing, Ministry of Education, Guangzhou, P. R. China
| |
Collapse
|
21
|
Comparison of Diagnostic Mammography-Guided Biopsy and Digital Breast Tomosynthesis-Guided Biopsy of Suspicious Breast Calcifications: Results in 1354 Biopsies. AJR Am J Roentgenol 2023; 220:212-223. [PMID: 36102725 DOI: 10.2214/ajr.22.28320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Studies have shown improved targeting and sampling of noncalcified lesions (asymmetries, masses, and architectural distortion) with digital breast tomosynthesis (DBT)-guided biopsy in comparison with digital mammography (DM)-guided stereotactic biopsy. Literature that compares the two techniques specifically for sampling calcifications has been scarce. OBJECTIVE. The purpose of this study was to compare the performance and outcomes of DM- and DBT-guided biopsy of suspicious calcifications. METHODS. This retrospective study included 1310 patients (mean age, 58 ± 12 [SD] years) who underwent a total of 1354 9-gauge vacuum-assisted core biopsies of suspicious calcifications performed at a single institution from May 22, 2017, to December 31, 2021. The decision to use a DM-guided or DBT-guided technique was made at the discretion of the radiologist performing the biopsy. Procedure time, the number of exposures during the procedure, and the histopathologic outcomes were recorded. The two techniques were compared using a two-sample t test for continuous variables and a chi-square test for categoric variables. Additional tests were performed using generalized estimating equations to control for the effect of the individual radiologist performing the biopsy. RESULTS. A total of 348 (26%) biopsies used DM guidance, and 1006 (74%) used DBT guidance. The mean procedure time was significantly lower for DBT-guided biopsy (14.9 ± 8.0 [SD] minutes) than for DM-guided biopsy (24.7 ± 14.3 minutes) (p < .001). The mean number of exposures was significantly lower for DBT-guided biopsy (4.1 ± 1.0 [SD] exposures) than for DM-guided biopsy (9.1 ± 3.3 exposures) (p < .001). The differences in procedure time and number of exposures remained significant (both p < .001) when controlling for the effect of the radiologist performing the biopsy. There were no significant differences (all p > .05) between DM-guided and DBT-guided biopsy in terms of the malignancy rate on initial biopsy (20% vs 19%), the rate of high-risk lesion upgrading (14% vs 22%), or the final malignancy rate (23% vs 22%). CONCLUSION. DBT-guided biopsy of suspicious calcifications can be performed with shorter procedure time and fewer exposures compared with DM-guided biopsy, without a significant difference in rates of malignancy or high-risk lesion upgrading. CLINICAL IMPACT. The use of a DBT-guided, rather than a DM-guided, biopsy technique for suspicious calcifications can potentially reduce patient discomfort and radiation exposure without affecting clinical outcomes.
Collapse
|
22
|
Fiaschetti V, Ubaldi N, De Fazio S, Ricci A, Maspes F, Cossu E. Digital tomosynthesis spot view in architectural distortions: outcomes in management and radiation dose. LA RADIOLOGIA MEDICA 2023; 128:35-48. [PMID: 36534241 PMCID: PMC9931797 DOI: 10.1007/s11547-022-01570-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate if digital breast tomosynthesis spot compression view (DBT-SCV) could be an additional projection to confirm or deny architectural distortions (ADs) detected by digital breast tomosynthesis (DBT) while assessing the average glandular radiation dose. METHODS This is a retrospective cohort study enrolling 8864 DBT exams, of which only cases detecting primary AD and with BI-RADS 2-5 score were considered. Seventy-one AD cases examined with DBT-SCV, US and MRI were evaluated for correlation in terms of BI-RADS score; variables among exams were assessed for inter-relationships. RESULTS Of all ADs identified at DBT, biopsy yielded malignancy in only 38%. PPV in identifying malignancy of ADs was higher for DBT-SCV than DBT (p < 0.05); the NPV of DBT-SCV was 94%. The difference between DBT and DBT-SCV in the detection of benign ADs was statistically significant (p < 0.05). AD without US or MRI confirmation was less likely to represent malignancy (p < 0.05). In detecting malignant cases of ADs, both DBT and DBT-SCV were strongly correlated with US and RM (Kappa > 0.90). In identifying benign cases of ADs, DBT-SCV was poorly/moderately correlated with US and RM (Kappa 0.25 and 0.66); DBT was negatively correlated with US and MRI. CONCLUSION DBT-SCV could be useful to better characterize AD firstly identified by DBT, keeping dose levels within the reference limits. If AD is detected by DBT without an US or MRI correlate, that is not confirmed by DBT-SCV, a "wait and see" approach can be applied to reduce unnecessary biopsy.
Collapse
Affiliation(s)
- Valeria Fiaschetti
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy. .,European Hospital, Rome, Italy.
| | - Nicolo’ Ubaldi
- grid.7841.aDepartment of Medical Surgical Sciences and Translational Medicine, Sapienza - University of Rome, Radiology Unit – Sant’Andrea Hospital, 1035 Via Di Grottarossa, 00189 Rome, Italy
| | | | - Aurora Ricci
- grid.413009.fUOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | | | - Elsa Cossu
- grid.413009.fUOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| |
Collapse
|
23
|
Khanani S, Hruska C, Lazar A, Hoernig M, Hebecker A, Obuchowski N. Performance of Wide-Angle Tomosynthesis with Synthetic Mammography in Comparison to Full Field Digital Mammography. Acad Radiol 2023; 30:3-13. [PMID: 35491345 DOI: 10.1016/j.acra.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to test for superiority of wide-angle digital breast tomosynthesis plus synthetic mammography (Insight 2D) in comparison to full-field digital mammography (FFDM). MATERIALS AND METHODS In this study, twenty readers interpreted 350 screening and diagnostic cases of wide-angle digital breast tomosynthesis (DBT) plus Insight 2D and FFDM in two separate reading sessions separated by at least a 6-week washout period. Breast-level estimates of the area under the curve and sensitivity along with subject-level recall rate were measured and compared between wide-angle DBT plus Insight 2D and FFDM. The same measures were also assessed for dense breasts. A hierarchical analysis plan was used to control the study's type I error rate at 0.05. RESULTS The mean breast-level area under the curve for distinguishing breasts with cancer from non-cancer breasts was 0.893 with DBT plus Insight 2D versus 0.837 with FFDM, showing superiority of DBT plus Insight 2D (p < 0.001). Breast-level sensitivity was significantly superior for DBT plus Insight 2D in comparison to FFDM (0.852 vs. 0.805, p = 0.043). Subject-level recall rate for DBT plus Insight 2D was significantly lower in comparison to FFDM (0.344 vs. 0.473, p < 0.001). For dense breasts, the readers' accuracy with DBT plus Insight 2D was superior to their accuracy with FFDM (0.875 vs. 0.830, p = 0.026), and their recall rate was significantly lower for DBT plus Insight 2D in comparison to FFDM (0.338 vs. 0.441, p = 0.003). CONCLUSION Reader performance with wide-angle DBT plus Insight 2D is superior to that with FFDM, showing significantly higher breast-level accuracy and sensitivity and significantly lower recall rates.
Collapse
Affiliation(s)
- Sadia Khanani
- Department of Radiology, Mayo Clinic, 200 First street SW, Rochester, MN 55905.
| | - Carrie Hruska
- Department of Radiology, Mayo Clinic, 200 First street SW, Rochester, MN 55905
| | - Agnes Lazar
- Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania
| | | | | | - Nancy Obuchowski
- Quantitative Health Science, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
24
|
Goldberg JE, Reig B, Lewin AA, Gao Y, Heacock L, Heller SL, Moy L. New Horizons: Artificial Intelligence for Digital Breast Tomosynthesis. Radiographics 2023; 43:e220060. [DOI: 10.1148/rg.220060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julia E. Goldberg
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Beatriu Reig
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Alana A. Lewin
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Laura Heacock
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| |
Collapse
|
25
|
Magni V, Cozzi A, Schiaffino S, Colarieti A, Sardanelli F. Artificial intelligence for digital breast tomosynthesis: Impact on diagnostic performance, reading times, and workload in the era of personalized screening. Eur J Radiol 2023; 158:110631. [PMID: 36481480 DOI: 10.1016/j.ejrad.2022.110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
The ultimate goals of the application of artificial intelligence (AI) to digital breast tomosynthesis (DBT) are the reduction of reading times, the increase of diagnostic performance, and the reduction of interval cancer rates. In this review, after outlining the journey from computer-aided detection/diagnosis systems to AI applied to digital mammography (DM), we summarize the results of studies where AI was applied to DBT, noting that long-term advantages of DBT screening and its crucial ability to decrease the interval cancer rate are still under scrutiny. AI has shown the capability to overcome some shortcomings of DBT in the screening setting by improving diagnostic performance and by reducing recall rates (from -2 % to -27 %) and reading times (up to -53 %, with an average 20 % reduction), but the ability of AI to reduce interval cancer rates has not yet been clearly investigated. Prospective validation is needed to assess the cost-effectiveness and real-world impact of AI models assisting DBT interpretation, especially in large-scale studies with low breast cancer prevalence. Finally, we focus on the incoming era of personalized and risk-stratified screening that will first see the application of contrast-enhanced breast imaging to screen women with extremely dense breasts. As the diagnostic advantage of DBT over DM was concentrated in this category, we try to understand if the application of AI to DM in the remaining cohorts of women with heterogeneously dense or non-dense breast could close the gap in diagnostic performance between DM and DBT, thus neutralizing the usefulness of AI application to DBT.
Collapse
Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Anna Colarieti
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Italy.
| |
Collapse
|
26
|
Marshall NW, Bosmans H. Performance evaluation of digital breast tomosynthesis systems: physical methods and experimental data. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
Abstract
Digital breast tomosynthesis (DBT) has become a well-established breast imaging technique, whose performance has been investigated in many clinical studies, including a number of prospective clinical trials. Results from these studies generally point to non-inferiority in terms of microcalcification detection and superior mass-lesion detection for DBT imaging compared to digital mammography (DM). This modality has become an essential tool in the clinic for assessment and ad-hoc screening but is not yet implemented in most breast screening programmes at a state or national level. While evidence on the clinical utility of DBT has been accumulating, there has also been progress in the development of methods for technical performance assessment and quality control of these imaging systems. DBT is a relatively complicated ‘pseudo-3D’ modality whose technical assessment poses a number of difficulties. This paper reviews methods for the technical performance assessment of DBT devices, starting at the component level in part one and leading up to discussion of system evaluation with physical test objects in part two. We provide some historical and basic theoretical perspective, often starting from methods developed for DM imaging. Data from a multi-vendor comparison are also included, acquired under the medical physics quality control protocol developed by EUREF and currently being consolidated by a European Federation of Organisations for Medical Physics working group. These data and associated methods can serve as a reference for the development of reference data and provide some context for clinical studies.
Collapse
|
27
|
Breast Cancer Screening Modalities, Recommendations, and Novel Imaging Techniques. Surg Clin North Am 2022; 103:63-82. [DOI: 10.1016/j.suc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
28
|
Local Diagnostic Reference Levels for Full-Field Digital Mammography and Digital Breast Tomosynthesis in a Tertiary Hospital in Malaysia. Healthcare (Basel) 2022; 10:healthcare10101917. [PMID: 36292364 PMCID: PMC9601326 DOI: 10.3390/healthcare10101917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
A set of national diagnostic reference levels (DRLs) was established in Malaysia for a range of breast thicknesses in 2013, but no updates for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT). Due to the increasing number of DBTs used and concern over radiation exposure, this study aimed to explore and establish local diagnostic reference levels for FFDM and DBT in Malaysia health facilities at different compressed breast thickness (CBT) ranges. The CBT, kilovoltage peak (kVp), Entrance surface dose (ESD), and average glandular dose (AGD) were retrospectively extracted from the mammography Digital Imaging and Communications in Medicine (DICOM) header. The 75th and 95th percentile values were obtained for the AGD distribution of each mammography projection for three sets of CBT range. The difference in AGD values between FFDM and DBT at three CBT ranges was determined. The DRLs for FFDM were 1.13 mGy, 1.52 mGy, and 2.87 mGy, while DBT were 1.18 mGy, 1.88 mGy, and 2.78 mGy at CBT ranges of 20−39 mm, 40−59 mm, and 60−99 mm, respectively. The AGD of DBT was significantly higher than FFDM for both mammographic views (p < 0.005). All three CBT groups showed a significant difference in AGD values for FFDM and DBT (p < 0.005). The local DRLs from this study were lower than the national DRLs, with the AGD of FFDM significantly lower than DBT.
Collapse
|
29
|
Shin J, Woo OH, Shin HS, Song SE, Cho KR, Seo BK. Diagnostic Performance of Digital Breast Tomosynthesis with the Two-Dimensional Synthesized Mammogram for Suspicious Breast Microcalcifications Compared to Full-Field Digital Mammography in Stereotactic Breast Biopsy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1090-1103. [PMID: 36276204 PMCID: PMC9574291 DOI: 10.3348/jksr.2021.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/02/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) with the two-dimensional synthesized mammogram (2DSM), compared to full-field digital mammography (FFDM), for suspicious microcalcifications in the breast ahead of stereotactic biopsy and to assess the diagnostic image visibility of the images. Materials and Methods This retrospective study involved 189 patients with microcalcifications, which were histopathologically verified by stereotactic breast biopsy, who underwent DBT with 2DSM and FFDM between January 8, 2015, and January 20, 2020. Two radiologists assessed all cases of microcalcifications based on Breast Imaging Reporting and Data System (BI-RADS) independently. They were blinded to the histopathologic outcome and additionally evaluated lesion visibility using a five-point scoring scale. Results Overall, the inter-observer agreement was excellent (0.9559). Under the setting of category 4A as negative due to the low possibility of malignancy and to avoid the dilution of malignancy criteria in our study, McNemar tests confirmed no significant difference between the performances of the two modalities in detecting microcalcifications with a high potential for malignancy (4B, 4C, or 5; p = 0.1573); however, the tests showed a significant difference between their performances in detecting microcalcifications with a high potential for benignancy (4A; p = 0.0009). DBT with 2DSM demonstrated superior visibility and diagnostic performance than FFDM in dense breasts. Conclusion DBT with 2DSM is superior to FFDM in terms of total diagnostic accuracy and lesion visibility for benign microcalcifications in dense breasts. This study suggests a promising role for DBT with 2DSM as an accommodating tool for stereotactic biopsy in female with dense breasts and suspicious breast microcalcifications.
Collapse
|
30
|
Khanani S, Xiao L, Jensen MR, Conners AL, Fazzio RT, Hruska CB, Winham S, Wu FF, Scott CG, Vachon CM. Comparison of breast density assessments between synthesized C-View™ & intelligent 2D™ mammography. Br J Radiol 2022; 95:20211259. [PMID: 35230159 PMCID: PMC10996406 DOI: 10.1259/bjr.20211259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare breast density assessments between C-View™ and Intelligent 2D™, different generations of synthesized mammography (SM) from Hologic. METHODS In this retrospective study, we identified a subset of females between March 2017 and December 2019 who underwent screening digital breast tomosynthesis (DBT) with C-View followed by DBT with Intelligent 2D. Clinical Breast Imaging Reporting and Database System breast density was obtained along with volumetric breast density measures (including density grade, breast volume, percentage volumetric density, dense volume) using VolparaTM. Differences in density measures by type of synthesized image were calculated using the pairwise t-test or McNemar's test, as appropriate. RESULTS 67 patients (avg age 62.7; range 40-84) were included with an average of 13.3 months between the two exams. No difference was found in Breast Imaging Reporting and Database System density between the SM reconstructions (p = 0.74). Similarly, there was no difference in VolparaTM mean density grade (p = 0.71), mean breast volume (p = 0.48), mean dense volume (p = 0.43) or mean percent volumetric density (p = 0.12) between the exams. CONCLUSION We found no significant differences in clinical and automated breast density assessments between these two versions of SM. ADVANCES IN KNOWLEDGE Lack of differences in density estimates between the two SM reconstructions is important as density assignment impacts risk stratification and adjunct screening recommendations.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Stacey Winham
- Department of Quantitative Health Sciences,
Rochester, MN
| | - Fang Fang Wu
- Department of Quantitative Health Sciences,
Rochester, MN
| | | | | |
Collapse
|
31
|
Chikarmane S. Synthetic Mammography: Review of Benefits and Drawbacks in Clinical Use. JOURNAL OF BREAST IMAGING 2022; 4:124-134. [PMID: 38417004 DOI: 10.1093/jbi/wbac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 03/01/2024]
Abstract
Digital breast tomosynthesis (DBT) has been widely adopted as a breast cancer screening tool, demonstrating decreased recall rates and other improved screening performance metrics when compared to digital mammography (DM) alone. Drawbacks of DBT when added to 2D DM include the increased radiation dose and longer examination time. Synthetic mammography (SM), a 2D reconstruction from the tomosynthesis slices, has been introduced to eliminate the need for a separate acquisition of 2D DM. Data show that the replacement of 2D DM by SM, when used with DBT, maintains the benefits of DBT, such as decreased recall rates, improved cancer detection rates, and similar positive predictive values. Key differences between SM and 2D DM include how the image is acquired, assessment of breast density, and visualization of mammographic findings, such as calcifications. Although SM is approved by the Food and Drug Administration and has been shown to be non-inferior when used with DBT, concerns surrounding SM include image quality and artifacts. The purpose of this review article is to review the benefits, drawbacks, and screening performance metrics of SM versus DBT.
Collapse
Affiliation(s)
- Sona Chikarmane
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| |
Collapse
|
32
|
Sarno A, Mettivier G, Bliznakova K, Hernandez AM, Boone JM, Russo P. Comparisons of glandular breast dose between digital mammography, tomosynthesis and breast CT based on anthropomorphic patient-derived breast phantoms. Phys Med 2022; 97:50-58. [PMID: 35395535 DOI: 10.1016/j.ejmp.2022.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the bias to the mean glandular dose (MGD) estimates introduced by the homogeneous breast models in digital breast tomosynthesis (DBT) and to have an insight into the glandular dose distributions in 2D (digital mammography, DM) and 3D (DBT and breast dedicated CT, BCT) x-ray breast imaging by employing breast models with realistic glandular tissue distribution and organ silhouette. METHODS A Monte Carlo software for DM, DBT and BCT simulations was adopted for the evaluation of glandular dose distribution in 60 computational anthropomorphic phantoms. These computational phantoms were derived from 3D breast images acquired via a clinical BCT scanner. RESULTS g·c·s·T conversion coefficients based on homogeneous breast model led to a MGD overestimate of 18% in DBT when compared to MGD estimated via anthropomorphic phantoms; this overestimate increased up to 21% for recently computed DgNDBT conversion coefficients. The standard deviation of the glandular dose distribution in BCT resulted 60% lower than in DM and 55% lower than in DBT. The glandular dose peak - evaluated as the average value over the 5% of the gland receiving the highest dose - is 2.8 times the MGD in DM, this factor reducing to 2.6 and 1.6 in DBT and BCT, respectively. CONCLUSIONS Conventional conversion coefficients for MGD estimates based on homogeneous breast models overestimate MGD by 18%, when compared to MGD estimated via anthropomorphic phantoms. The ratio between the peak glandular dose and the MGD is 2.8 in DM. This ratio is 8% and 75% higher than in DBT and BCT, respectively.
Collapse
Affiliation(s)
- Antonio Sarno
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy.
| | - Giovanni Mettivier
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy
| | | | | | - John M Boone
- University of California Davis Medical Center, Sacramento, CA, USA
| | - Paolo Russo
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy
| |
Collapse
|
33
|
Pérez Fuentes JA, Roldán Sánchez VS, Gordillo Ledesma AK, Mena AF, Brito S, Soteldo C. Mean glandular dose in the mammary gland and dose of radiation in the thyroid gland and lens in women with and without breast implants during different modalities of mammography. RADIOLOGIA 2022; 64 Suppl 1:11-19. [PMID: 35428461 DOI: 10.1016/j.rxeng.2020.10.013] [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: 04/24/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022]
Abstract
There have always been concerns about the secondary effects of diagnostic methods that use ionizing radiation. During mammography, the parameters to be concerned about are the mean glandular dose and the scatter dose. We evaluated the dose of radiation to the breast, thyroid gland, and lens in digital mammography in women with and without implants, in tomosynthesis in women with and without implants, and in contrast-enhanced mammography. MATERIALS AND METHODS The study included 212 women with and without disease who were attended at the Centro Clínico de Estereotaxia, CECLINES, in Caracas, Venezuela, between June 2017 and August 2017; the women were classified into five groups according to the mammographic modality used to evaluate them and whether or not they had implants. The statistical analysis included descriptive statistics for the study population. We used the Mann-Whitney U to compare the mean glandular dose and dose in the thyroid gland and lens between groups. RESULTS The mean glandular dose and the dose of radiation received in the thyroid and lens were within the acceptable range. In a few exceptions, the mean glandular dose per view was slightly higher than 3 mGy. The scatter dose to the thyroid gland and the lens during mammography has a very small contribution to the annual dose equivalent. CONCLUSION The mean glandular dose and the scatter dose to the thyroid gland and lens delivered during tomosynthesis and 2D mammography in women with implants were higher than those delivered during other mammographic techniques in women without implants.
Collapse
Affiliation(s)
| | - V S Roldán Sánchez
- Instituto Venezolano de Investigaciones Científicas, Edo, Miranda, Venezuela
| | | | - A F Mena
- Centro Clínico de Estereotaxia - CECLINES, Caracas, Venezuela
| | - S Brito
- Centro Clínico de Estereotaxia - CECLINES, Caracas, Venezuela
| | - C Soteldo
- Instituto Venezolano de Investigaciones Científicas, Edo, Miranda, Venezuela
| |
Collapse
|
34
|
Associating Automated Breast Ultrasound (ABUS) and Digital Breast Tomosynthesis (DBT) with Full-Field Digital Mammography (FFDM) in Clinical Practice in Cases of Women with Dense Breast Tissue. Diagnostics (Basel) 2022; 12:diagnostics12020459. [PMID: 35204550 PMCID: PMC8871137 DOI: 10.3390/diagnostics12020459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of the present study was to evaluate the value of full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in the diagnosis of breast cancer compared to FFDM associated with digital breast tomosynthesis (DBT). Methods: This retrospective study included 50 female patients with a denser framework of connective tissue fibers, characteristic of young women who underwent FFDM, DBT, handheld ultrasound (HHUS), and ABUS between January 2017 and October 2018. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of FFDM+ABUS were 81.82% (95% CI [48.22–97.72]), 89.74% (95% CI [75.78–97.13]), 69.23% (95% CI [46.05–85.57]), 94.59% (95% CI [83.26–98.40]), and 88% (95% CI [75.69–95.47]), while for FFDM+DBT, the values were as follows: 91.67% (95% CI [61.52–99.79]), 71.79% (95% CI [55.13–85.00]), 50% (95% CI [37.08–62.92]), 96.55% (95% CI [80.93–99.46]), 76.47% (95% CI [62.51–87.21]). We found an almost perfect agreement between the two readers regarding FFDM associated with ABUS, and substantial agreement regarding FFDM+DBT, with a kappa coefficient of 0.896 and 0.8, respectively; p < 0.001. Conclusions: ABUS and DBT are suitable as additional diagnostic imaging techniques to FFDM in women at an intermediate risk of developing breast cancer through the presence of dense breast tissue. In this study, DBT reduced the number of false negative results, while the use of ABUS resulted in an increase in specificity.
Collapse
|
35
|
Opitz M, Zensen S, Breuckmann K, Bos D, Forsting M, Hoffmann O, Stuschke M, Wetter A, Guberina N. Breast Radiation Exposure of 3D Digital Breast Tomosynthesis Compared to Full-Field Digital Mammography in a Clinical Follow-Up Setting. Diagnostics (Basel) 2022; 12:diagnostics12020456. [PMID: 35204547 PMCID: PMC8871344 DOI: 10.3390/diagnostics12020456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 02/04/2023] Open
Abstract
According to a position paper of the European Commission Initiative on Breast Cancer (ECIBC), DBT is close to being introduced in European breast cancer screening programmes. Our study aimed to examine radiation dose delivered by digital breast tomosynthesis (DBT) and digital mammography (FFDM) in comparison to sole FFDM in a clinical follow-up setting and in an identical patient cohort. Retrospectively, 768 breast examinations of 96 patients were included. Patients received both DBT and FFDM between May 2015 and July 2019: (I) FFDM in cranio-caudal (CC) and DBT in mediolateral oblique (MLO) view, as well as a (II) follow-up examination with FFDM in CC and MLO view. The mean glandular dose (MGD) was determined by the mammography system according to Dance’s model. The MGD (standard deviation (SD), interquartile range (IQR)) was distributed as follows: (I) (CCFFDM+MLODBT) (a) left FFDMCC 1.40 mGy (0.36 mGy, 1.13–1.59 mGy), left DBTMLO 1.62 mGy (0.51 mGy, 1.27–1.82 mGy); (b) right FFDMCC 1.36 mGy (0.34 mGy, 1.14–1.51 mGy), right DBTMLO 1.59 mGy (0.52 mGy, 1.27–1.62 mGy). (II) (CCFFDM+MLOFFDM) (a) left FFDMCC 1.35 mGy (0.35 mGy, 1.10–1.60 mGy), left FFDMMLO 1.40 mGy (0.39 mGy, 1.12–1.59 mGy), (b) right FFDMCC 1.35 mGy (0.33 mGy, 1.12–1.48 mGy), right FFDMMLO 1.40 mGy (0.36 mGy, 1.14–1.58 mGy). MGD was significantly higher for DBT mlo views compared to FFDM (p < 0.001). Radiation dose was significantly higher for DBT in MLO views compared to FFDM. However, the MGD of DBT MLO lies below the national diagnostic reference level of 2 mGy for an FFDM view. Hence, our results support the use of either DBT or FFDM as suggested in the ECIBC’s Guidelines.
Collapse
Affiliation(s)
- Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
- Correspondence: (M.O.); (S.Z.)
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
- Correspondence: (M.O.); (S.Z.)
| | - Katharina Breuckmann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
| | - Oliver Hoffmann
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany;
| | - Martin Stuschke
- West German Cancer Center, Department of Radiotherapy, University Hospital Essen, 45147 Essen, Germany;
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, 21075 Hamburg, Germany
| | - Nika Guberina
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; (K.B.); (D.B.); (M.F.); (A.W.); (N.G.)
- West German Cancer Center, Department of Radiotherapy, University Hospital Essen, 45147 Essen, Germany;
| |
Collapse
|
36
|
Rahman WT, Helvie MA. Breast cancer screening in average and high-risk women. Best Pract Res Clin Obstet Gynaecol 2021; 83:3-14. [PMID: 34903436 DOI: 10.1016/j.bpobgyn.2021.11.007] [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: 10/27/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most common cancer among females worldwide with rising incidence. In the United States, screening mammography and advances in therapy have lowered mortality by 41% since 1990. Screening mammography is supported by randomized control trials (RCT), observational studies, and computer model data. Digital breast tomosynthesis is a new technology that addresses limitations in mammography resulting from overlapping breast tissue, improving its sensitivity and specificity. Patients at high risk for breast cancer include those with a ≥20% lifetime risk, high-risk germline mutation, or history of thoracic radiation treatment between 10-30 years of age. Such patients are recommended to undergo annual screening mammography and adjunctive annual screening breast MRI. Patients unable to undergo MRI may undergo whole breast ultrasound or contrast-enhanced mammography. Pregnant and lactating patients at average risk for breast cancer are recommended to undergo age-appropriate screening mammography.
Collapse
Affiliation(s)
- W Tania Rahman
- Department of Radiology, Division of Breast Imaging, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Mark A Helvie
- Department of Radiology, Division of Breast Imaging, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| |
Collapse
|
37
|
Hande PC, Desai SS, Arneja SK, Sathian S. Utility of Digital Breast Tomosynthesis with Two-Dimensional Synthesized Mammography Images: A Pictorial Essay. Indian J Radiol Imaging 2021; 31:678-688. [PMID: 34790314 PMCID: PMC8590550 DOI: 10.1055/s-0041-1734378] [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] [Indexed: 11/12/2022] Open
Abstract
Background
Mammography has been established as the key modality in the detection and diagnosis of breast cancers. Digital breast tomosynthesis (DBT) has emerged as a mammographic technique which allows improved visualization of abnormalities by reducing the effect of overlapping breast tissue.
Purpose
This article is a pictorial essay which highlights the advantages of DBT with two-dimensional (2D) synthesized mammography (2DSM) images, its clinical applications, and its role in breast imaging.
Materials and Methods
Selenia Dimensions HD mammography machine performs DBT which acquires a series of low-dose digital mammographic images of the compressed breast followed by full-field digital mammography. Software using specialized algorithms helps to create a 2DSM image reconstructed from the DBT data set. The images are interpreted on a dedicated work station on high-resolution monitors by the radiologist. American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) lexicon is used for reporting. High-resolution breast ultrasound which includes evaluation of the axilla is done for all cases.
Conclusion
DBT improves detection and better characterization of lesions which thereby increases confidence of interpretation of mammograms and assigning BI-RADS categories for further management.
Collapse
Affiliation(s)
- Pradipta C Hande
- Division of Radiology, Department of Imaging, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | - Sabita S Desai
- Department of Radiology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | - Sarabjeet K Arneja
- Department of Surgical Pathology and Cytology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | - Sreedevi Sathian
- Department of Radiodiagnosis, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| |
Collapse
|
38
|
Digital Breast Tomosynthesis Complements Two-Dimensional Synthetic Mammography for Secondary Examination of Breast Cancer. J Belg Soc Radiol 2021; 105:63. [PMID: 34786534 PMCID: PMC8570192 DOI: 10.5334/jbsr.2457] [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: 02/26/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: To compare the performance of two-dimensional synthetic mammography (SM) combined with digital breast tomosynthesis (DBT) (SM/DBT) and full-field digital mammography (FFDM) including women with DBT (FFDM/DBT) undergoing secondary examination for breast cancer. Material and Methods: Out of 186 breasts, including 52 with breast cancers; FFDM/DBT and SM/DBT findings were interpreted by four expert clinicians. Radiation doses of FFDM, SM/DBT, and FFDM/DBT were determined. Inter-rater reliabilities were analyzed between readers and between FFDM/DBT and SM/DBT by Cohen’s Kappa coefficients. Diagnostic accuracy was compared between SM/DBT and FFDM/DBT by Fisher’s exact tests. Two representative cancer cases were examined for differences in the interpretation between FFDM and SM. Results: A higher radiation dose was required in FFDM/DBT than in SM/DBT (median: 1.50 mGy vs. 2.95 mGy). Inter-rater reliabilities were similar between both readers and modalities. Both sensitivity and specificity were equivalent in FFDM/DBT and SM/DBT (p = 0.874–1.00). Compared with FFDM, SM did not clearly show abnormalities with subtle margins in the two representative cancer cases. Conclusion: SM/DBT had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation. DBT complements SM to improve accuracy to a level equivalent to that of FFDM. Taken together, SM/DBT may be a good substitute for FFDM/DBT for the secondary examination of breast cancer.
Collapse
|
39
|
Vu NQ, Bice C, Garrett J, Longhurst C, Belden D, Haerr C, Prue L, Woods RW. Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants. JOURNAL OF BREAST IMAGING 2021; 3:694-700. [PMID: 38424937 DOI: 10.1093/jbi/wbab073] [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: 06/04/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols. METHODS This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013, and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test. RESULTS The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P < 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P < 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48). CONCLUSION The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.
Collapse
Affiliation(s)
- Nhu Q Vu
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Curran Bice
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - John Garrett
- UW Health, Department of Radiology, Madison, WI, USA
| | - Colin Longhurst
- University of Wisconsin, Department of Statistics, Madison, WI, USA
| | - Daryn Belden
- UW Health, Department of Radiology, Madison, WI, USA
| | - Carolyn Haerr
- UW Health, Department of Radiology, Madison, WI, USA
| | - Lucinda Prue
- UnityPoint Health-Meriter, Department of Radiology, Madison, WI, USA
| | - Ryan W Woods
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
- UW Health, Department of Radiology, Madison, WI, USA
| |
Collapse
|
40
|
Huang JL, Lin Q. Benefit of digital breast tomosynthesis in symptomatic young women (≤30 years) diagnosed with BI-RADS category 4 or 5 on ultrasound. Clin Radiol 2021; 77:e55-e63. [PMID: 34763818 DOI: 10.1016/j.crad.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the addition of digital breast tomosynthesis (DBT) in the diagnosis of breast lesions in symptomatic young Chinese women (≤30 years) diagnosed with Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 on ultrasound, and demonstrate the potential use of combining DBT with ultrasound. MATERIALS AND METHODS This retrospective analysis included 5 years of digital mammography (DM) and DBT data (January 2015 to July 2020). In total, 768 DBT and DM examinations were performed in 713 young women. The results were determined by pathological assessment. Diagnostic performance was measured based on the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic area under the curve (AUC). RESULTS Compared with DM alone, DBT + DM increased the sensitivity from 82.5% to 93.2%, specificity from 70.8% to 84%, accuracy from 74% to 86.5%, NPV from 93.6% to 97.4% (all p<0.01). The AUC of DBT + DM (0.946, 95% confidence interval [CI]: 0.927-0.960) was greater than that of DM (0.884, 95% CI: 0.859-0.905; p<0.001). The differences in the BI-RADS category distributions of malignant and benign lesions were both statistically significant (p<0.001). DM alone led to 36 false-negative diagnoses, whereas the inclusion of DBT identified breast cancer in 22 of those cases. There were 4.9% (10/206) false-negative diagnoses in ultrasound. After adding DBT, four breast cancers were detected. An additional six breast cancers were diagnosed by biopsy based on an assessment of BI-RADS 4A by DBT/DM. CONCLUSION DBT + DM significantly improves the diagnostic performance in this young population, especially in young people with higher breast density. Moreover, DBT is an effective supplementary examination to ultrasound.
Collapse
Affiliation(s)
- J L Huang
- Department of Breast Radiology, Affiliated Hospital of Qingdao University, The Qingdao University, No. 16, Jiangsu Road, Qingdao 266100, Shandong province, China
| | - Q Lin
- Department of Breast Radiology, Affiliated Hospital of Qingdao University, The Qingdao University, No. 16, Jiangsu Road, Qingdao 266100, Shandong province, China.
| |
Collapse
|
41
|
Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis. Eur Radiol 2021; 32:2301-2312. [PMID: 34694451 PMCID: PMC8921114 DOI: 10.1007/s00330-021-08308-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
Objectives Digital breast tomosynthesis (DBT) plus digital mammography (DM) in screening is problematic due to increased radiation by the double exposure. Synthesised two-dimensional mammography (s2D) calculated from DBT datasets at no additional dose appears a sensible alternative compared to adding DM. This systematic review and meta-analysis focuses on screening performance outcomes in women screened with DBT plus s2D compared to DM alone. Methods PubMed was searched from January 1, 2010, to September 2, 2020. Studies comparing DBT plus s2D to DM alone in breast cancer screening were included. Pooled risk ratios (RR) were estimated for cancer detection rates (CDR), recall rates, interval cancer rates (ICR), biopsy rates, and positive predictive values for recalls (PPV-1), for biopsies recommended (PPV-2), and for biopsies performed (PPV-3). Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Results Twelve papers covering 414,281 women were included from 766 records identified. CDR is increased ([RR, 95% CI] 1.35, 1.20–1.52), recall rates are decreased (0.79, 0.64–0.98), and PPV-1 is increased (1.69, 1.45–1.96) when using DBT plus s2D compared to DM alone. ICR and biopsy rates did not differ, but PPV-2 respectively PPV-3 increased with DBT plus s2D (1.57, 1.08–2.28 respectively 1.36, 1.17–1.58). Overall RoB of studies was assessed to be low. Conclusion Results show improved diagnostic outcomes with DBT plus s2D compared to DM alone and underline the value of DBT in combination with s2D in breast cancer screening. Key Points • DBT plus s2D is associated with higher CDR, lower recall rates, and a higher PPV-1 compared to DM alone in breast cancer screening. • No differences in biopsy rates were found between screening modalities, but PPV-2 and PPV-3 were higher in women screened with DBT plus s2D compared to DM alone. • We identified inconsistent results of ICR in two studies comparing DBT plus s2D to DM alone—resulting in no differences when pooling ICR in meta-analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08308-8.
Collapse
|
42
|
Svahn TM, Gordon R, Ast JC, Riffel J, Hartbauer M. COMPARISON OF PHOTON-COUNTING AND FLAT-PANEL DIGITAL MAMMMOGRAPHY FOR THE PURPOSE OF 3D IMAGING USING A NOVEL IMAGE PROCESSING METHOD. RADIATION PROTECTION DOSIMETRY 2021; 195:454-461. [PMID: 34323279 DOI: 10.1093/rpd/ncab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
The purpose of the present work was to compare the quality of low-dose projections from a photon-counting with a flat-panel system, and to evaluate a novel image processing method. Images were acquired of phantoms in both systems at average glandular doses ranging from ~ 0.15 to 1.4 mGy. Automated detection of low-contrast features and modulation transfer functions were evaluated in phantom images. The novel image processing method was compared with standard processing in a series of clinical cases. At low-doses (~0.15) the photon-counting system out-performed the flat-panel system with a much higher detectability of low-contrast features. The novel algorithm was superior to both manufacturers' processing in terms of conspicuity of soft-tissue lesions (p > 0.05), whereas it was not significantly different in calcification conspicuity. Photon-counting should allow more low-dose projections to be acquired at the same total dose. The novel image enhancer can help to further increase the image quality.
Collapse
Affiliation(s)
- T M Svahn
- Centre for Research and Development, Uppsala University/Region Gävleborg, 801 88 Gävle, Sweden
| | - R Gordon
- Gulf Marine Specimen Laboratory, Panacea, FL 32346, USA
- C.S. Mott Center for Human Growth & Development, Department of Obstetrics & Gynecology, Wayne State University, Detroit, MI 48201, USA
| | - J C Ast
- Department of Organismal Biology, 752 36 Uppsala University, Uppsala, Sweden
| | - J Riffel
- Department of Clinical Radiology and Nuclear Medicine, 68167 Mannheim, University of Heidelberg, Germany
| | - M Hartbauer
- Institute of Biology, Universitätsplatz 2, University of Graz, 8010 Graz, Austria
| |
Collapse
|
43
|
Alkhawari HA, Asbeutah AM, Almajran AA, AlKandari LA. Kuwait National Mammography Screening Program: outcomes of 5 years of screening in Kuwaiti women. Ann Saudi Med 2021; 41:257-267. [PMID: 34618610 PMCID: PMC8497004 DOI: 10.5144/0256-4947.2021.257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy among women in Kuwait, representing 39.8% of all female cancer cases. OBJECTIVES Report the data of the Kuwait National Mammography Screening Program (KNMSP) for a 5-year period. DESIGN Prospective data collection. SETTING Population-based screening. SUBJECTS AND METHODS We included mammography screens done for Kuwaiti women (age 40 years and older) who attended the KNMSP from 2014 to 2019 to screen for breast cancer. A full-field digital mammography system was used to acquire the mammographic images in craniocaudal and mediolateral oblique projections. Independent double-blind reading of the mammograms was performed by two radiologists. MAIN OUTCOME MEASURE Early detection of breast cancer. SAMPLE SIZE 14 773 asymptomatic women met inclusion criteria (mean [SD] age, 51.8 (8.2). RESULTS Lesions were detected in 551 women (3.7%). These included 233 malignant lesions (233/551, 42.3%), 57 high-risk lesions (10.3%) and 261 benign lesions (47.4%). The participation rate was 7.8% of the target population of women 40-69 years of age. The majority of breast cancer cases were reported in the age group 45-49 years (23.2%). The KNMSP study recall rate for 5 consecutive years was in a range of 11.9-16.5% (mean, 14.3%). The detection rate of ductal/lobular carcinoma in situ and invasive breast cancer were 2.5 and 13.6 per 1000 screened women, respectively. Invasive ductal carcinoma was the most common type. Only 4314 women followed up within 12-15 months of the first mammography for a retention rate of 29.2%. CONCLUSIONS Screening mammography improves early detection of breast cancer in women older than 40 years but poor participation is a limitation. We are aiming to increase the participation rate to 70% of the population. LIMITATIONS Lack of participation by women. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
| | - Akram Mahmoud Asbeutah
- From the Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University Health Sciences Centre, Sulaibikhat, Kuwait
| | - Abdullah Abdulaziz Almajran
- From the Department of Community Medicine and Behavioral Sciences, Kuwait University Health Sciences Centre, Safat, Kuwait
| | | |
Collapse
|
44
|
Jiang G, Wei J, Xu Y, He Z, Zeng H, Wu J, Qin G, Chen W, Lu Y. Synthesis of Mammogram From Digital Breast Tomosynthesis Using Deep Convolutional Neural Network With Gradient Guided cGANs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2080-2091. [PMID: 33826513 DOI: 10.1109/tmi.2021.3071544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Synthetic digital mammography (SDM), a 2D image generated from digital breast tomosynthesis (DBT), is used as a potential substitute for full-field digital mammography (FFDM) in clinic to reduce the radiation dose for breast cancer screening. Previous studies exploited projection geometry and fused projection data and DBT volume, with different post-processing techniques applied on re-projection data which may generate different image appearance compared to FFDM. To alleviate this issue, one possible solution to generate an SDM image is using a learning-based method to model the transformation from the DBT volume to the FFDM image using current DBT/FFDM combo images. In this study, we proposed to use a deep convolutional neural network (DCNN) to learn the transformation to generate SDM using current DBT/FFDM combo images. Gradient guided conditional generative adversarial networks (GGGAN) objective function was designed to preserve subtle MCs and the perceptual loss was exploited to improve the performance of the proposed DCNN on perceptual quality. We used various image quality criteria for evaluation, including preserving masses and MCs which are important in mammogram. Experiment results demonstrated progressive performance improvement of network using different objective functions in terms of those image quality criteria. The methodology we exploited in the SDM generation task to analyze and progressively improve image quality by designing objective functions may be helpful to other image generation tasks.
Collapse
|
45
|
Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2021; 217:314-325. [DOI: 10.2214/ajr.20.24204] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Zeng B, Yu K, Gao L, Zeng X, Zhou Q. Breast cancer screening using synthesized two-dimensional mammography: A systematic review and meta-analysis. Breast 2021; 59:270-278. [PMID: 34329948 PMCID: PMC8333340 DOI: 10.1016/j.breast.2021.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose We conducted a systematic review and meta-analysis to compare the screening performance of synthesized mammography (SM) plus digital breast tomosynthesis (DBT) with digital mammography (DM) plus DBT or DM alone. Methods Medline, Embase, Web of Science, and the Cochrane Library databases were searched from January 2010 to January 2021. Eligible population-based studies on breast cancer screening comparing SM/DBT with DM/DBT or DM in asymptomatic women were included. A random-effect model was used in this meta-analysis. Data were summarized as risk differences (RDs), with 95 % confidence intervals (CIs). Results Thirteen studies involving 1,370,670 participants were included. Compared with DM/DBT, screening using SM/DBT had similar breast cancer detection rate (CDR) (RD = −0.1/1000 screens, 95 % CI = −0.4 to 0.2, p = 0.557, I2 = 0 %), but lower recall rate (RD = −0.56 %, 95 % CI = −1.03 to −0.08, p = 0.022, I2 = 90 %) and lower biopsy rate (RD = −0.33 %, 95 % CI = −0.56 to −0.10, p = 0.005, I2 = 78 %). Compared with DM, SM/DBT improved CDR (RD = 2.0/1000 screens, 95 % CI = 1.4 to 2.6, p < 0.001, I2 = 63 %) and reduced recall rate (RD = −0.95 %, 95 % CI = −1.91 to −0.002, p = 0.049, I2 = 99 %). However, SM/DBT and DM had similar interval cancer rate (ICR) (RD = 0.1/1000 screens, 95 % CI = −0.6 to 0.8, p = 0.836, I2 = 71 %) and biopsy rate (RD = −0.05 %, 95 % CI = −0.35 to 0.24, p = 0.727, I2 = 93 %). Conclusions Screening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. SM/DBT improves CDR when compared with DM, but they have little difference in ICR. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose. Screening using SM/DBT has similar breast cancer detection but reduces recall and biopsy when compared with DM/DBT. Screening using SM/DBT improves cancer detection rate when compared with DM/DBT alone. There was no significant difference in interval cancer rate between SM/DBT and DM. SM/DBT could replace DM/DBT in breast cancer screening to reduce radiation dose.
Collapse
Affiliation(s)
- Baoqi Zeng
- Department of Science and Education, Peking University Binhai Hospital, Tianjin, China.
| | - Kai Yu
- Department of Science and Education, Peking University Binhai Hospital, Tianjin, China
| | - Le Gao
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Xueyang Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Qingxin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| |
Collapse
|
48
|
Alves MS, Belinato W, Santos WS, Galeano DC, Neves LP, Perini AP, N Souza D. Dosimetry in Digital Breast Tomosynthesis Evaluated by Monte Carlo Technique. HEALTH PHYSICS 2021; 121:18-29. [PMID: 33867436 DOI: 10.1097/hp.0000000000001407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT The influence of the angular deviation of the tube during digital breast tomosynthesis (DBT) acquisition to the dose in the examined breast and in other organs and tissues is not well known. In this work, the Monte Carlo method was used with an adult female virtual anthropomorphic phantom to investigate the impact of this angular variation on the breast dose. The absorbed dose in the examined breast was normalized by the air kerma, which resulted in an absorbed dose coefficient (DT/Kair) for the breast. The absorbed dose in each organ was normalized by the glandular dose in the breast, resulting in the relative organ dose (ROD). An adult female virtual anthropomorphic phantom (FSTA_M50_H50) was incorporated into a scenario containing tomosynthesis equipment with Mo/Mo, Mo/Rh, and W/Rh target/filter combinations and tube voltages of 28 kV. The comparison between the results of the simulations considering digital mammography (DM) and DBT data showed that the DT/Kair values for the examined breast obtained with the DBT parameters were up to 24 times higher than with the DT/Kair obtained with DM parameters. A DT/Kair of 0.97 × 10-1 mGy mGy-1 was obtained in a DBT exam of the right breast. Considering the other organs, the highest ROD values were observed in the thyroid (6.45 × 10-4), eyes (3.87 × 10-4), liver (1.95 × 10-5), and eye lenses (3.21 × 10-3). A variation in the absorbed dose values for the breast and other organs was observed for all projections different from 0°.
Collapse
Affiliation(s)
- Marcos S Alves
- Departamento de Física, Universidade Federal de Sergipe (UFS), São Cristóvão, Sergipe, Brazil
| | - Walmir Belinato
- Instituto Federal da Bahia (IFBA), Vitória da Conquista, BA, Brazil
| | - William S Santos
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Diego C Galeano
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
| | | | | | - Divanizia N Souza
- Departamento de Física, Universidade Federal de Sergipe (UFS), São Cristóvão, Sergipe, Brazil
| |
Collapse
|
49
|
Alabousi M, Wadera A, Kashif Al-Ghita M, Kashef Al-Ghetaa R, Salameh JP, Pozdnyakov A, Zha N, Samoilov L, Dehmoobad Sharifabadi A, Sadeghirad B, Freitas V, McInnes MDF, Alabousi A. Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2021; 113:680-690. [PMID: 33372954 PMCID: PMC8168096 DOI: 10.1093/jnci/djaa205] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone. METHODS MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided. RESULTS Forty-two studies reporting on 2 606 296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%). CONCLUSIONS Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.
Collapse
Affiliation(s)
- Mostafa Alabousi
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Akshay Wadera
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | | | - Rayeh Kashef Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Alex Pozdnyakov
- Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nanxi Zha
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Lucy Samoilov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | | | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (HEI), The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Matthew DF McInnes
- Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
50
|
Dhamija E, Gulati M, Deo SVS, Gogia A, Hari S. Digital Breast Tomosynthesis: an Overview. Indian J Surg Oncol 2021; 12:315-329. [PMID: 34295076 DOI: 10.1007/s13193-021-01310-y] [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: 01/07/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is emerging as the most common malignancy in Indian women. Mammography is one of the few screening modalities available to the modern world that has proved itself of much use by aiding early detection and treatment of non-palpable, node-negative breast cancers. However, due to its two-dimensional nature, many cases of malignancies are still missed, to be detected at a later date or by an alternate modality. In 2011, FDA approved the supplemental use of digital breast tomosynthesis (DBT) in screening and diagnostic set ups. The acquisition of multiple low-dose projection images of the compressed parenchyma provided a 'third' dimension to the mammogram whereby the breast tissue could be seen layer by layer on the workstation. It improves cancer detection rate, and reduces recall rate and false-positive findings by improving lesion characterization. The current review discusses the principle of DBT with a comprehensive study of the literature. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-021-01310-y.
Collapse
Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Malvika Gulati
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - S V S Deo
- Department of Surgical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ajay Gogia
- Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Smriti Hari
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029 India
| |
Collapse
|