FDA approves system for digital mammography

Intraoperative evaluation of surgical margins in breast cancer

Achieving clear resection margins at the time of lumpectomy is essential for optimal patient outcomes. Margin status is traditionally determined by pathologic evaluation of the specimen and often is difficult or impossible for the surgeon to definitively know at the time of surgery, resulting in the need for re-operation to obtain clear surgical margins. Numerous techniques have been investigated to enhance the accuracy of intraoperative margin and are reviewed in this manuscript.

History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century

Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.

Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model

Objective

To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program.

Methods

A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared.

Results

Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10^th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20^th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term.

Conclusions

Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.

AAPM/RSNA Physics Tutorial for Residents

Recent advances in digital detector technology have paved the way to full-field digital mammography (FFDM) systems. The performance of these systems has evolved to the point where replacement of screen-film mammography (SFM) systems is becoming realistic. Despite some commonality between the two techniques, there are fundamental differences in how images are recorded, displayed, and stored. These differences necessitate an understanding of the principles of detection and the characteristics of digital images. Several approaches have been taken in the development of FFDM systems: (a) slot scanning with a scintillator and a charge-coupled device (CCD) array, (b) a flat-panel scintillator and an amorphous silicon diode array, (c) a flat-panel amorphous selenium array, (d) a tiled scintillator with fiberoptic tapers and a CCD array, and (e) photostimulable phosphor plates (computed radiography). Although the initial cost of an FFDM system is high compared with that of an SFM system, digital mammography has inherent advantages, such as wide dynamic range, reduction in recall rates, potential for reduction in radiation dose, increased patient throughput, postprocessing capability, and digital acquisition. These advantages and the rapidly occurring technologic developments will help establish FFDM as a mainstay of breast evaluation.

New modalities in breast imaging: digital mammography, positron emission tomography, and sestamibi scintimammography

Digital mammography, PET, and sestamibi scintimammography are three new modalities in breast imaging. DM has advantages over film-screen mammography in image storage, retrieval, and processing and may lower the recall rate. Computer-aided detection may increase the sensitivity of mammographic screening without a substantial reduction in specificity. Whereas PET and sestambi scintimammography are not useful in breast cancer screening, PET may play a role in detecting nodal metastases and monitoring treatment response, and sestamibi scintimammography in selected cases may serve as an adjunct to conventional imaging. The cost-effectiveness of these new modalities remains to be evaluated, but all have the potential to significantly advance the diagnosis and management of women with breast cancer.