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Priyadarshani KN, Singh S. Ultra Sensitive Breast Cancer Cell Lines Detection Using Dual Nanocavities Engraved Junctionless FET. IEEE Trans Nanobioscience 2023; 22:889-896. [PMID: 37027544 DOI: 10.1109/tnb.2023.3246106] [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: 02/18/2023]
Abstract
This article reports breast cancer cell lines (Hs578T, MDA-MB-231, MCF-7, and T47D) and healthy breast cells (MCF-10A) detection based on the modulation of its electrical properties by deploying dual nanocavity engraved junctionless FET. The device has a dual gate to enhance gate control and has two nanocavities etched under both gates for breast cancer cell lines immobilization. As the cancer cells are immobilized in the engraved nanocavities, which were earlier filled with air, the dielectric constant of the nanocavities changes. This results in the modulation of the device's electrical parameters. This electrical parameters modulation is then calibrated to detect the breast cancer cell lines. The reported device demonstrates a higher sensitivity toward the detection of breast cancer cells. The JLFET device optimization is done for improving the performance by optimizing the nanocavity thickness and the SiO2 oxide length. The variation in the dielectric property of cell lines plays a key role in the detection technique of the reported biosensor. The sensitivity of the JLFET biosensor is analyzed in terms of ∆VTH, ∆ION, ∆gm , and ∆SS . The reported biosensor shows the maximum sensitivity for T47D ( κ = 32 ) breast cancer cell line with ∆VTH = 0.800 V, ∆ION = 0.165 mA/μm, ∆gm = 0.296 mA/V-μm , and ∆SS = 5.41 mV/decade. Moreover, the effect of variation in the occupancy of the cavity by the immobilized cell lines has also been studied and analyzed. With increased cavity occupancy the variation in the device performance parameter enhances Further, the sensitivity of the proposed biosensor is compared with the existing biosensors and it is reported to be highly sensitive as compared to the existing biosensors. Hence, the device can be utilized for array based screening of cell lines of breast cancer and diagnosis with the benefit of easier fabrication and cost effectiveness of the device.
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Kumar B, Chaujar R. Fin field-effect-transistor engineered sensor for detection of MDA-MB-231 breast cancer cells: A switching-ratio-based sensitivity analysis. Phys Rev E 2023; 108:034408. [PMID: 37849201 DOI: 10.1103/physreve.108.034408] [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: 02/07/2023] [Accepted: 09/01/2023] [Indexed: 10/19/2023]
Abstract
The present study describes the utilization of a gallium-arsenide gate-stack gate-all-around (GaAs-GS-GAA) fin field-effect transistor (FinFET) to accomplish the electrical identification of the breast cancer cell MDA-MB-231 by monitoring the device switching ratio. The proposed sensor uses four nanocavities carved beneath the gate electrodes for enhanced detection sensitivity. MDA-MB-231 (cancerous) and MCF-10A (healthy) breast cells have a distinct dielectric constant, and it changes when exposed to microwave frequencies spanning across 200 MHz and 13.6 GHz, which modifies the electrical characteristics, allowing for early diagnosis. First, a percentage shift in the primary DC characteristics is presented to demonstrate the advantage of GS-GAA FinFET over conventional FinFET. The sensor measures the switching-ratio-based sensitivity, which comes out to be 99.72% for MDA-MB-231 and 47.78% for MCF-10A. The sensor was tested for stability and reproducibility and found to be repeatable and sufficiently stable with settling times of 55.51, 60.80, and 71.58 ps for MDA-MB-231 cells, MCF-10A cells, and air, respectively. It can distinguish between viable and nonviable cells based on electrical response alterations. The possibility of early detection of cancerous breast cells using Bruggeman's model is also discussed. Further, the impact of biomolecule occupancy and frequency variations on the device sensitivity is carried out. This study also explains how to maximize the sensing performance by adjusting the fin height, fin width, work function, channel doping, temperature, and drain voltage. Lastly, this article compared the proposed breast cancer cell detectors to existing literature to evaluate their performance and found considerable improvement. The findings of this research have the potential to establish GaAs-GS-GAA FinFET as a promising contender for MDA-MB-231 breast cancer cell detection.
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Affiliation(s)
- Bhavya Kumar
- Department of Applied Physics, Delhi Technological University, Delhi 110042, India
| | - Rishu Chaujar
- Department of Applied Physics, Delhi Technological University, Delhi 110042, India
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Hovda T, Sagstad S, Larsen M, Chen Y, Hofvind S. Screening outcome for interpretation by the first and second reader in a population-based mammographic screening program with independent double reading. Acta Radiol 2023; 64:2371-2378. [PMID: 37246466 DOI: 10.1177/02841851231176272] [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] [Indexed: 05/30/2023]
Abstract
BACKGROUND Double reading of screening mammograms is associated with a higher rate of screen-detected cancer than single reading, but different strategies exist regarding reader pairing and blinding. Knowledge about these aspects is important when considering strategies for future use of artificial intelligence in mammographic screening. PURPOSE To investigate screening outcome, histopathological tumor characteristics, and mammographic features stratified by the first and the second reader in a population based screening program for breast cancer. MATERIAL AND METHODS The study sample consisted of data from 3,499,048 screening examinations from 834,691 women performed during 1996-2018 in BreastScreen Norway. All examinations were interpreted independently by two radiologists, 272 in total. We analyzed interpretation score, recall, and cancer detection, as well as histopathological tumor characteristics and mammographic features of the cancers, stratified by the first and second readers. RESULTS For Reader 1, the rate of positive interpretations was 4.8%, recall 2.3%, and cancer detection 0.5%. The corresponding percentages for Reader 2 were 4.9%, 2.5%, and 0.5% (P < 0.05 compared with Reader 1). No statistical difference was observed for histopathological tumor characteristics or mammographic features when stratified by Readers 1 and 2. Recall and cancer detection were statistically higher and histopathological tumor characteristics less favorable for cases detected after concordant positive compared with discordant interpretations. CONCLUSION Despite reaching statistical significance, mainly due to the large study sample, we consider the differences in interpretation scores, recall, and cancer detection between the first and second readers to be clinically negligible. For practical and clinical purposes, double reading in BreastScreen Norway is independent.
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Affiliation(s)
- Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Silje Sagstad
- Section for breast cancer screening, Cancer Registry of Norway, Oslo, Norway
| | - Marthe Larsen
- Section for breast cancer screening, Cancer Registry of Norway, Oslo, Norway
| | - Yan Chen
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Solveig Hofvind
- Section for breast cancer screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
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Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJL. Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14647. [PMID: 36429373 PMCID: PMC9691207 DOI: 10.3390/ijerph192214647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Isabelle Barnes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Centre for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
- Australian Longitudinal Study on Women’s Health, The University of Newcastle, Callaghan 2308, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J. L. Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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Hong R, Xu B. Breast cancer: an up-to-date review and future perspectives. CANCER COMMUNICATIONS (LONDON, ENGLAND) 2022; 42:913-936. [PMID: 36074908 PMCID: PMC9558690 DOI: 10.1002/cac2.12358] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022]
Abstract
Breast cancer is the most common cancer worldwide. The occurrence of breast cancer is associated with many risk factors, including genetic and hereditary predisposition. Breast cancers are highly heterogeneous. Treatment strategies for breast cancer vary by molecular features, including activation of human epidermal growth factor receptor 2 (HER2), hormonal receptors (estrogen receptor [ER] and progesterone receptor [PR]), gene mutations (e.g., mutations of breast cancer 1/2 [BRCA1/2] and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha [PIK3CA]) and markers of the immune microenvironment (e.g., tumor-infiltrating lymphocyte [TIL] and programmed death-ligand 1 [PD-L1]). Early-stage breast cancer is considered curable, for which local-regional therapies (surgery and radiotherapy) are the cornerstone, with systemic therapy given before or after surgery when necessary. Preoperative or neoadjuvant therapy, including targeted drugs or immune checkpoint inhibitors, has become the standard of care for most early-stage HER2-positive and triple-negative breast cancer, followed by risk-adapted post-surgical strategies. For ER-positive early breast cancer, endocrine therapy for 5-10 years is essential. Advanced breast cancer with distant metastases is currently considered incurable. Systemic therapies in this setting include endocrine therapy with targeted agents, such as CDK4/6 inhibitors and phosphoinositide 3-kinase (PI3K) inhibitors for hormone receptor-positive disease, anti-HER2 targeted therapy for HER2-positive disease, poly(ADP-ribose) polymerase inhibitors for BRCA1/2 mutation carriers and immunotherapy currently for part of triple-negative disease. Innovation technologies of precision medicine may guide individualized treatment escalation or de-escalation in the future. In this review, we summarized the latest scientific information and discussed the future perspectives on breast cancer.
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Affiliation(s)
- Ruoxi Hong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, P. R. China
| | - Binghe Xu
- State Key Laboratory of Molecular Oncology and Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100006, P. R. China
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Pirchio R, Pérez GN, Ratto SS, Stefanic AM. DOSIMETRY IN DIGITAL BREAST TOMOSYNTHESIS: COST-EFFICIENT APPROACH FOR THE SOUTH AMERICAN PERSPECTIVES. RADIATION PROTECTION DOSIMETRY 2022; 198:393-404. [PMID: 35527472 DOI: 10.1093/rpd/ncac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
The measurement of air kerma in air (Kair) to estimate average glandular dose (AGD) received during digital breast tomosynthesis (DBT) studies is sometimes a difficult task. In this work, a novel methodology was implemented to measure Kair and half-value layer while the X-ray tube is rotating. A low economic cost support (LCS) was built to place aluminium sheets and a calibrated dosemeter. Three Fujifilm Innovality equipment were used and two dosemeters calibrated on W-Al energies. Validation of the new methodology was made against standard scheme and it was applied to estimate AGD for 300 patients and 7 phantoms. Validation analysis was satisfactory. The difference in the AGD calculated with the LCS and DICOM Header was lower than ±10%. AGD values ranged from 0.77 to 2.11 mGy and 0.85 to 2.15 mGy for phantoms and patients, respectively. The novel methodology has a potential use for DBT equipment without stationary mode.
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Affiliation(s)
- Rosana Pirchio
- Medical Physics Division, Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA Ezeiza, Buenos Aires, Argentina
| | - Gonzalo Nicolás Pérez
- Medical Physics Division, Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA Ezeiza, Buenos Aires, Argentina
| | - Santiago Scinardo Ratto
- Medical Physics Division, Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA Ezeiza, Buenos Aires, Argentina
| | - Amalia María Stefanic
- Medical Physics Division, Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA Ezeiza, Buenos Aires, Argentina
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Examining the Effectiveness of Supplementary Imaging Modalities for Breast Cancer Screening in Women with Dense Breasts: A Systematic Review and Meta-analysis. Eur J Radiol 2022; 154:110416. [DOI: 10.1016/j.ejrad.2022.110416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/15/2022]
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Singh S, Singh S. Dopingless Negative Capacitance Ferroelectric TFET for Breast Cancer Cells Detection: Design and Sensitivity Analysis. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1120-1129. [PMID: 34910631 DOI: 10.1109/tuffc.2021.3136099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current research article reports the electrical detection of breast cancer cell lines (MDA-MB-231, Hs578T, T47D, and MCF-7) by deploying dopingless negative capacitance (NC) ferroelectric (FE) tunnel field-effect transistor (DL-FE-TFET). This device has a double dual metal gate and two nanocavities engraved underneath both gate electrodes for higher detection sensitivity. Our work reports the detection of nontumorigenic cell (MCF-10A) and breast cancer cell lines by combining the NC effect of FE material and dopingless technology synergistically. Here, FE material amplifies the applied gate bias intrinsically. The in-depth electrostatic analysis in terms of surface potential, carrier concentration, energy band diagram, drive current, and electric field has been depicted. Variation of the dielectric constant of these breast cancerous cell lines dictates the detection mechanism in our reported biosensor. The sensitivity has been analyzed in terms of drive current, ION/IOFF ratio, [Formula: see text], and transconductance. The optimized cavity structure demonstrates significantly high drain current sensitivity of the order of 2.88×109 and ION/IOFF ratio sensitivity of the order of 3.2×105 . In addition, the effect of device geometry variation, such as cavity length and FE layer thickness on the drain current sensitivity and ION/IOFF sensitivity, transconductance sensitivity ( Sgm ), and threshold voltage sensitivity ( [Formula: see text]) of the device, has also been investigated. This device structure may be deployed for the array-based screening and diagnosis of breast cancer cells lines, with additional benefits including a simpler mechanism of transduction, cost effectiveness, technology compatibility with CMOS process, adjustable electrical response, and reproducibility.
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Teoh KC, Manan HA, Mohd Norsuddin N, Rizuana IH. Comparison of Mean Glandular Dose between Full-Field Digital Mammography and Digital Breast Tomosynthesis. Healthcare (Basel) 2021; 9:1758. [PMID: 34946484 PMCID: PMC8700789 DOI: 10.3390/healthcare9121758] [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: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/12/2021] [Indexed: 11/23/2022] Open
Abstract
Early detection of breast cancer is diagnosed using mammography, the gold standard in breast screening. However, its increased use also provokes radiation-induced breast malignancy. Thus, monitoring and regulating the mean glandular dose (MGD) is essential. The purpose of this study was to determine MGD for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in the radiology department of a single centre. We also analysed the exposure factors as a function of breast thickness. A total of 436 patients underwent both FFDM and DBT. MGD was auto calculated by the mammographic machine for each projection. Patients' data included compressed breast thickness (CBT), peak kilovoltage (kVp), milliampere-seconds (mAs) and MGD (mGy). Result analysis showed that there is a significant difference in MGD between the two systems, namely FFDM and DBT. However, the MGD values in our centre were comparable to other centres, as well as the European guideline (<2.5 mGy) for a standard breast. Although DBT improves the clinical outcome and quality of diagnosis, the risk of radiation-induced carcinogenesis should not be neglected. Regular quality control testing on mammography equipment must be performed for dose monitoring in women following a screening mammography in the future.
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Affiliation(s)
- Kar Choon Teoh
- Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Malaysia;
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Malaysia;
| | - Norhashimah Mohd Norsuddin
- Diagnostic Imaging & Radiotherapy Program, University Kebangsaan Malaysia, Kuala Lumpur 50586, Malaysia;
| | - Iqbal Hussain Rizuana
- Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Malaysia;
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Farber R, Houssami N, Wortley S, Jacklyn G, Marinovich ML, McGeechan K, Barratt A, Bell K. Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. J Natl Cancer Inst 2021; 113:16-26. [PMID: 32572492 PMCID: PMC7781455 DOI: 10.1093/jnci/djaa080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates. METHODS A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates. RESULTS The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = -3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with -0.02 per 1000 screens (95% CI = -0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes. CONCLUSIONS The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
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Affiliation(s)
- Rachel Farber
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Sally Wortley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Michael L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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Song SY, Hong S, Jun JK. Digital Mammography as a Screening Tool in Korea. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:2-11. [PMID: 36237465 PMCID: PMC9432404 DOI: 10.3348/jksr.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/09/2022]
Abstract
국가암검진사업에서 매년 400만 명 이상의 여성이 유방촬영술을 이용한 유방암 검진을 받고 있다. 2000년 디지털 유방촬영술의 도입 이후, 선행 연구들에 의하면 디지털 유방촬영술은 치밀유방을 가진 여성에서 제한적으로 기존의 필름 방식 또는 computed radiography (이하 CR)보다 높은 진단 정확도를 보고하였다. 최근 국가암검진사업에서 수행된 자료를 분석한 결과에 따르면 디지털 유방촬영술의 진단 정확도가 필름 또는 CR 방식에 비해서 치밀유방을 가진 여성뿐만 아니라 모든 연령대의 여성에서 검진 횟수와 상관없이 보다 정확하였다. 우리나라는 OECD 국가 중에서도 높은 유방촬영기기 보급률에도 불구하고 현재 디지털 유방촬영기기의 보급은 전체 유방촬영기기 중, 35% 정도 수준으로 더디기만 하다. 디지털 유방촬영기기로의 신속한 전환을 위하여 수가제도의 개선, 유방 영상 판독 교육 지원 등 관련법과 제도의 정비가 필요할 것이다. 아울러 국가암검진사업에서 보다 많은 여성이 디지털 유방촬영기기를 이용한 유방암 검진을 받을 수 있도록 장비 보급의 지역 간 격차 해소를 위해 노력해야 할 것이다.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Pal UM, Gk AV, Gogoi G, Rila S, Shroff S, Am G, Borah P, Varma M, Kurpad V, Baruah D, Vaidya JS, Pandya HJ. Towards a Portable Platform Integrated With Multispectral Noncontact Probes for Delineating Normal and Breast Cancer Tissue Based on Near-Infrared Spectroscopy. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:879-888. [PMID: 32746350 DOI: 10.1109/tbcas.2020.3005971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Currently, the confirmation of diagnosis of breast cancer is made by microscopic examination of an ultra-thin slice of a needle biopsy specimen. This slice is conventionally formalin-fixed and stained with hematoxylin-eosin and visually examined under a light microscope. This process is labor-intensive and requires highly skilled doctors (pathologists). In this paper, we report a novel tool based on near-infrared spectroscopy (Spectral-IRDx) which is a portable, non-contact, and cost-effective system and could provide a rapid and accurate diagnosis of cancer. The Spectral-IRDx tool performs absorption spectroscopy at near-infrared (NIR) wavelengths of 850, 935, and 1060 nm. We measure normalized detected voltage (Vdn) with the tool in 10 deparaffinized breast biopsy tissue samples, 5 of which were cancer (C) and 5 were normal (N) tissues. The difference in Vdn at 935 nm and 1060 nm between cancer and normal tissues is statistically significant with p-values of 0.0038 and 0.0022 respectively. Absorption contrast factor (N/C) of 1.303, 1.551, and 1.45 are observed for 850, 935, and 1060 nm respectively. The volume fraction contrast (N/C) of lipids and collagens are reported as 1.28 and 1.10 respectively. Higher absorption contrast factor (N/C) and volume fraction contrast (N/C) signifies higher concentration of lipids in normal tissues as compared to cancerous tissues, a basis for delineation. These preliminary results support the envisioned concept for noninvasive and noncarcinogenic NIR-based breast cancer diagnostic platform, which will be tested using a larger number of samples.
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Choi BH, Lee EH, Jun JK, Kim KW, Park YM, Kim HW, Kim YM, Shin DR, Lim HS, Park JS, Kim HJ. Effect of Different Types of Mammography Equipment on Screening Outcomes: A Report by the Alliance for Breast Cancer Screening in Korea. Korean J Radiol 2020; 20:1638-1645. [PMID: 31854151 PMCID: PMC6923210 DOI: 10.3348/kjr.2019.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/29/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM). Materials and Methods We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value1 (PPV1), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology. Results The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV1 (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003). Conclusion In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV1, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.
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Affiliation(s)
- Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keum Won Kim
- Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hye Won Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Rock Shin
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University College of Medicine, Daegu, Korea
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Sankatsing VDV, Ravesteyn NT, Heijnsdijk EAM, Broeders MJM, Koning HJ. Risk stratification in breast cancer screening: Cost‐effectiveness and harm‐benefit ratios for low‐risk and high‐risk women. Int J Cancer 2020; 147:3059-3067. [DOI: 10.1002/ijc.33126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/31/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Valérie D. V. Sankatsing
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nicolien T. Ravesteyn
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Eveline A. M. Heijnsdijk
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Mireille J. M. Broeders
- Department for Health Evidence Radboud University Medical Center Nijmegen The Netherlands
- Dutch Expert Centre for Screening Nijmegen The Netherlands
| | - Harry J. Koning
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
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15
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Sechopoulos I, Teuwen J, Mann R. Artificial intelligence for breast cancer detection in mammography and digital breast tomosynthesis: State of the art. Semin Cancer Biol 2020; 72:214-225. [PMID: 32531273 DOI: 10.1016/j.semcancer.2020.06.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
Screening for breast cancer with mammography has been introduced in various countries over the last 30 years, initially using analog screen-film-based systems and, over the last 20 years, transitioning to the use of fully digital systems. With the introduction of digitization, the computer interpretation of images has been a subject of intense interest, resulting in the introduction of computer-aided detection (CADe) and diagnosis (CADx) algorithms in the early 2000's. Although they were introduced with high expectations, the potential improvement in the clinical realm failed to materialize, mostly due to the high number of false positive marks per analyzed image. In the last five years, the artificial intelligence (AI) revolution in computing, driven mostly by deep learning and convolutional neural networks, has also pervaded the field of automated breast cancer detection in digital mammography and digital breast tomosynthesis. Research in this area first involved comparison of its capabilities to that of conventional CADe/CADx methods, which quickly demonstrated the potential of this new technology. In the last couple of years, more mature and some commercial products have been developed, and studies of their performance compared to that of experienced breast radiologists are showing that these algorithms are on par with human-performance levels in retrospective data sets. Although additional studies, especially prospective evaluations performed in the real screening environment, are needed, it is becoming clear that AI will have an important role in the future breast cancer screening realm. Exactly how this new player will shape this field remains to be determined, but recent studies are already evaluating different options for implementation of this technology. The aim of this review is to provide an overview of the basic concepts and developments in the field AI for breast cancer detection in digital mammography and digital breast tomosynthesis. The pitfalls of conventional methods, and how these are, for the most part, avoided by this new technology, will be discussed. Importantly, studies that have evaluated the current capabilities of AI and proposals for how these capabilities should be leveraged in the clinical realm will be reviewed, while the questions that need to be answered before this vision becomes a reality are posed.
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Affiliation(s)
- Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands; Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands.
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands; Department of Radiology, Netherlands Cancer Institute (NKI), Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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16
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Zhou TJ, Raza S, Nelson KP. Methods of assessing categorical agreement between correlated screening tests in clinical studies. J Appl Stat 2020; 48:1861-1881. [PMID: 34305250 DOI: 10.1080/02664763.2020.1777394] [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: 10/24/2022]
Abstract
Advances in breast imaging and other screening tests have prompted studies to evaluate and compare the consistency between experts' ratings of existing with new screening tests. In clinical settings, medical experts make subjective assessments of screening test results such as mammograms. Consistency between experts' ratings is evaluated by measures of inter-rater agreement or association. However, conventional measures, such as Cohen's and Fleiss' kappas, are unable to be applied or may perform poorly when studies consist of many experts, unbalanced data, or dependencies between experts' ratings exist. Here we assess the performance of existing approaches including recently developed summary measures for assessing the agreement between experts' binary and ordinal ratings when patients undergo two screening procedures. Methods to assess consistency between repeated measurements by the same experts are also described. We present applications to three large-scale clinical screening studies. Properties of these agreement measures are illustrated via simulation studies. Generally, a model-based approach provides several advantages over alternative methods including the ability to flexibly incorporate various measurement scales (i.e. binary or ordinal), large numbers of experts and patients, sparse data, and robustness to prevalence of underlying disease.
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Affiliation(s)
- Thomas J Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Sughra Raza
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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17
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Wang J, Phi XA, Greuter MJW, Daszczuk AM, Feenstra TL, Pijnappel RM, Vermeulen KM, Buls N, Houssami N, Lu W, de Bock GH. The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program. Eur Radiol 2020; 30:5437-5445. [PMID: 32382844 PMCID: PMC7476964 DOI: 10.1007/s00330-020-06812-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. METHODS In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50-75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). RESULTS For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8-10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7-18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. CONCLUSION DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. KEY POINTS • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Xuan-Anh Phi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alicja M Daszczuk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Talitha L Feenstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Healy NA, O'Brien A, Knox M, Hargaden G, Smith C, Fenlon H, McNicholas M, Phelan N, Flanagan F. Consensus Review of Discordant Imaging Findings after the Introduction of Digital Screening Mammography: Irish National Breast Cancer Screening Program Experience. Radiology 2020; 295:35-41. [PMID: 32043946 DOI: 10.1148/radiol.2020181454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background When there are discordant results between individual readers interpreting screening mammograms, consensus by independent readers may reduce unnecessary recalls for further work-up. Few studies have looked at consensus outcomes following the introduction of full-field digital mammography (FFDM). Purpose To determine outcomes of women discussed at consensus meetings during a 5-year period after introduction of FFDM, including recall rates, cancer detection, and interval cancers. Materials and Methods In this retrospective study from January 2010 to December 2014, the authors reviewed all screening mammograms from a single unit of a biennial Irish national breast screening program after the introduction of FFDM. Screening mammograms were double reported. Abnormalities detected at discordant screening mammography readings were discussed at biweekly consensus meetings. Outcomes of consensus meetings were reviewed in terms of referral for assessment, biopsy rates, cancer detection, and outcomes from later rounds of screening. Statistical analysis was performed by using a χ2 test to compare recall rate and cancer detection rates between FFDM and screen-film mammography based on a previously published study from the authors' institution. Results A total of 2565 women (age range, 50-64 years) with discordant mammographic findings were discussed at consensus meetings. Of these 2565 women, 1037 (40%) were referred for further assessment; 108 cancers were detected in these women. Of the 1285 women who returned to biennial screening, malignancy was detected at the site of original concern in 12 women at a further round of screening. Three true interval cancers were identified. Sensitivity (88.5% [108 of 122]; 95% confidence interval [CI]: 81.5%, 93.6%) and negative predictive value (99.1% [1528 of 1542]; 95% CI: 98.5%, 99.4%) of consensus review remained stable after the introduction of FFDM. Specificity of consensus review increased from 57.6% (729 of 1264; 95% CI: 54.9%, 60.4%) to 62.2% (1528 of 2457; 95% CI: 60.2%, 64.1%) (P = .008). Conclusion Consensus review of discordant mammographic screening-detected abnormalities remains a valuable tool after introduction of full-field digital mammography as it reduces recall for assessment and demonstrates persistently high sensitivity and negative predictive values. © RSNA, 2020 See also the editorial by Hofvind and Lee in this issue.
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Affiliation(s)
- Nuala A Healy
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Angela O'Brien
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Mark Knox
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Gormlaith Hargaden
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Clare Smith
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Helen Fenlon
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Michelle McNicholas
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Niall Phelan
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
| | - Fidelema Flanagan
- From the Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom (N.A.H.); BreastCheck (The Irish National Breast Screening Program), Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (A.O., M.K., G.H., C.S., H.F., M.M., N.P., F.F.)
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Taylor-Phillips S, Stinton C. Double reading in breast cancer screening: considerations for policy-making. Br J Radiol 2020; 93:20190610. [PMID: 31617741 PMCID: PMC7055445 DOI: 10.1259/bjr.20190610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 01/04/2023] Open
Abstract
In this article, we explore the evidence around the relative benefits and harms of breast cancer screening using a single radiologist to examine each female's mammograms for signs of cancer (single reading), or two radiologists (double reading). First, we briefly explore the historical evidence using film-screen mammography, before providing an in-depth description of evidence using digital mammography. We classify studies according to which exact version of double reading they use, because the evidence suggests that effectiveness of double reading is contingent on whether the two radiologists are blinded to one another's decisions, and how the decisions of the two radiologists are integrated. Finally, we explore the implications for future mammography, including using artificial intelligence as the second reader, and applications to more complex three-dimensional imaging techniques such as tomosynthesis.
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Affiliation(s)
| | - Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
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20
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Pirchio R, Stefanic A, Rojas RR. CHARACTERISATION OF TLDS-200 AND OSLDS AT LOW X-RAY ENERGIES AND DETERMINATION OF EYE LENS DOSE, THYROID DOSE AND MEAN GLANDULAR DOSE DURING STANDARD MAMMOGRAPHY AND TOMOSYNTHESIS. RADIATION PROTECTION DOSIMETRY 2019; 186:469-478. [PMID: 31329992 DOI: 10.1093/rpd/ncz052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to characterise thermoluminescent (TLDs) and optically stimulated luminescent dosimeters (OSLDs) at low X-ray energies and estimate the eye lens (DL), thyroid (DT) and mean glandular (DG) doses received during Full-Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT). The dosimeters were characterised in mammography energies. DL, DT and DG were estimated in FFDM and DBT mode taping dosimeters on the skin of the thyroid gland and on the left eye lens of an Alderson phantom. Dosimeters were also placed on the top of a NORMI PAS phantom simulating a compressed breast. The accuracy, precision and lower limit of detection (LLD) for TLDs and OSLDs were 5 and 8%, 6 and 3%, and 38 and 11 μSv, respectively. The linearity of the kerma response had an R2 > 0.99 and energy dependence was lower than 40%. DT ranged from 0.40 to 2.87 μGy for FFDM and 1.27 to 5.99 μGy for DBT. DG was between 0.50 and 1.27 mGy for FFDM and 1.07 and 1.60 mGy for DBT. DL was below the LLD. Dosimeters showed good performance. DG values were lower than those found in the literature, whereas DT value agreed with references. Differences between DG and DT determined with OSLDs and TLDs were lower than 10% and 200%.
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Affiliation(s)
- R Pirchio
- Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA, Ezeiza, Buenos Aires, Argentina
| | - A Stefanic
- Comisión Nacional de Energía Atómica, Av. Pro González y Aragón 15, B1802AYA, Ezeiza, Buenos Aires, Argentina
| | - R R Rojas
- Centro de Diagnóstico Rojas, Laprida 1810, C1425EKP, CABA, Buenos Aires, Argentina
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Hong S, Song SY, Park B, Suh M, Choi KS, Jung SE, Kim MJ, Lee EH, Lee CW, Jun JK. Effect of Digital Mammography for Breast Cancer Screening: A Comparative Study of More than 8 Million Korean Women. Radiology 2019; 294:247-255. [PMID: 31793847 DOI: 10.1148/radiol.2019190951] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Full-field digital mammography (FFDM) has been accepted as a superior modality for breast cancer screening compared with conventional screen-film mammography (SFM), especially in women younger than 50 years or with dense breasts. Purpose To evaluate the accuracy of FFDM for breast cancer screening. Materials and Methods Data from January 1, 2011 to December 31, 2013 in the database from a nationwide breast cancer screening program linked with the national cancer registry were retrospectively analyzed. The study included Korean women aged 40-79 years who had undergone screening mammography with SFM, computed radiography (CR), or FFDM. The sensitivity, specificity, positive predictive value (PPV), and absolute and relative differences among these modalities were calculated, followed by pairwise comparison tests with multiple testing corrections. The areas under the receiver operating characteristic curve (AUCs) were also estimated and compared by using the DeLong method with Bonferroni correction. Results Among the 8 482 803 women included (mean age, 55 years ± 10), 34.4% (2 920 279 of 8 482 803), 51.7% (4 385 807 of 8 482 803), and 13.9% (1 176 717 of 8 482 803) underwent SFM, CR, and FFDM, respectively. The sensitivity and PPV were higher for FFDM than for SFM (adjusted odds ratio, 1.77 [95% confidence interval {CI}: 1.62, 1.95] for sensitivity and 1.36 [95% CI: 1.29, 1.43] for PPV) and CR (adjusted odds ratio, 1.70 [95% CI: 1.56, 1.85] for sensitivity and 1.26 [95% CI: 1.20, 1.32] for PPV), whereas specificity was lower with FFDM. The overall AUC for FFDM was 0.80 (95% CI: 0.80, 0.81), which was higher than that for SFM (0.75 [95% CI: 0.75, 0.76]) and CR (0.76 [95% CI: 0.75, 0.76]). P < .05 was found for differences in sensitivity, PPV, and AUC among modalities overall and in most of the subgroups of age, breast density, and screening round. Conclusion Full-field digital mammography allows better discrimination or prediction of breast cancer in the general female population than screen-film mammography or computed radiography, regardless of age, breast density, or screening round. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Seri Hong
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Soo Yeon Song
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Boyoung Park
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Mina Suh
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Kui Son Choi
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Seung Eun Jung
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Min Jung Kim
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Eun Hye Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Chan Wha Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Jae Kwan Jun
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
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22
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Hoff SR, Myklebust TÅ, Lee CI, Hofvind S. Influence of Mammography Volume on Radiologists’ Performance: Results from BreastScreen Norway. Radiology 2019; 292:289-296. [DOI: 10.1148/radiol.2019182684] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Should women with a BRCA1/2 mutation aged 60 and older be offered intensified breast cancer screening? – A cost-effectiveness analysis. Breast 2019; 45:82-88. [DOI: 10.1016/j.breast.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 11/24/2022] Open
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24
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Song SY, Park B, Hong S, Kim MJ, Lee EH, Jun JK. Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis. J Breast Cancer 2019; 22:311-325. [PMID: 31281732 PMCID: PMC6597401 DOI: 10.4048/jbc.2019.22.e24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Digital mammography (DM) has replaced screen-film mammography (SFM). However, findings of comparisons between the performance indicators of DM and SFM for breast-cancer screening have been inconsistent. Moreover, the summarized results from studies comparing the performance of screening mammography according to device type vary over time. Therefore, this study aimed to compare the performance of DM and SFM using recently published data. Methods The MEDLINE, Embase, and Cochrane Library databases were searched for paired studies, cohorts, and randomized controlled trials published through 2018 that compared the performance of DM and SFM. All studies comparing the diagnostic accuracy of DM and SFM in asymptomatic, average-risk women aged 40 years and older were included. Two reviewers independently assessed the study quality and extracted the data. Results Thirteen studies were included in the meta-analysis. The pooled sensitivity (DM, 0.76 [95% confidence interval {CI}, 0.70–0.81]; SFM, 0.76 [95% CI, 0.70–0.81]), specificity (DM, 0.96 [95% CI, 0.94–0.97]; SFM, 0.97 [95% CI, 0.94–0.98]), and area under the receiver-operating characteristic curve (DM, 0.94 [95% CI, 0.92–0.96]; SFM, 0.92 [95% CI, 0.89–0.94]) were similar for both DM and SFM. The pooled screening performance indicators reinforced superior accuracy of full-field DM, which is a more advanced type of mammography, than SFM. The advantage of DM appeared greater among women aged 50 years or older. There was high heterogeneity among studies in the pooled sensitivity, specificity, and overall diagnostic accuracy estimates. Stratifying by study design (prospective or retrospective) and removing studies with a 2-year or greater follow-up period resulted in homogeneous overall diagnostic accuracy estimates. Conclusion The breast-cancer screening performance of DM is similar to that of SFM. The diagnostic performance of DM depends on the study design, and, in terms of performance, full-field DM is superior to SFM, unlike computed radiography systems.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Medicine, Hanyang University College of Medicine, Seoul, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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25
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Blanks RG, Wallis MG, Alison R, Kearins O, Jenkins J, Patnick J, Given-Wilson RM. Impact of Digital Mammography on Cancer Detection and Recall Rates: 11.3 Million Screening Episodes in the English National Health Service Breast Cancer Screening Program. Radiology 2019; 290:629-637. [PMID: 30526360 DOI: 10.1148/radiol.2018181426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To report the impact of changing from screen-film mammography to digital mammography (DM) in a large organized national screening program. Materials and Methods A retrospective analysis of prospectively collected annual screening data from 2009-2010 to 2015-2016 for the 80 facilities of the English National Health Service Breast Cancer Screening Program, together with estimates of DM usage for three time periods, enabled the effect of DM to be measured in a study of 11.3 million screening episodes in women aged 45-70 years (mean age, 59 years). Regression models were used to estimate percentage and absolute change in detection rates due to DM. Results The overall cancer detection rate was 14% greater with DM (P < .001). There were higher rates of detection of grade 1 and 2 invasive cancers (both ductal and lobular), but no change in the detection of grade 3 invasive cancers. The recall rate was almost unchanged by the introduction of DM. At prevalent (first) screening episodes for women aged 45-52 years, DM increased the overall detection rate by 19% (P < .001) and for incident screening episodes in women aged 53-70 years by 13% (P < .001). Conclusion The overall cancer detection rate was 14% greater with digital mammography with no change in recall rates and without confounding by changes in other factors. There was a substantially higher detection of grade 1 and grade 2 invasive cancers, including both ductal and lobular cancers, but no change in the detection of grade 3 invasive cancers. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by C.I. Lee and J.M. Lee in this issue.
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Affiliation(s)
- Roger G Blanks
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Matthew G Wallis
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Rupert Alison
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Olive Kearins
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Jacquie Jenkins
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Julietta Patnick
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
| | - Rosalind M Given-Wilson
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, England (R.G.B., J.P., R.A.); Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, England (M.G.W.); Screening QA Service, Public Health England, London, England (O.K.); Breast Screening Programme, Public Health England, London, England (J.J.); and Department of Radiology, St George's University Hospital Foundation Trust, London, England (R.M.G.W.)
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26
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Choi JS, Han BK, Ko EY, Kim GR, Ko ES, Park KW. Comparison of synthetic and digital mammography with digital breast tomosynthesis or alone for the detection and classification of microcalcifications. Eur Radiol 2018; 29:319-329. [PMID: 29931560 DOI: 10.1007/s00330-018-5585-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the performance of synthetic mammography (SM) and digital mammography (DM) with digital breast tomosynthesis (DBT) or alone for the evaluation of microcalcifications. METHODS This retrospective study includes 198 mammography cases, all with DM, SM, and DBT images, from January to October 2013. Three radiologists interpreted images and recorded the presence of microcalcifications and their conspicuity scores and final BI-RADS categories (1, 2, 3, 4a, 4b, 4c, 5). Readers' area under the ROC curves (AUCs) were analyzed for SM plus DBT vs. DM plus DBT and SM alone vs. DM alone using the BI-RADS categories for the overall group and dense breast subgroup. RESULTS Conspicuity scores of detected microcalcifications were neither significantly different between SM and DM with DBT nor alone (p>0.05). In predicting malignancy of detected microcalcifications, no significant difference was found between readers' AUCs for SM and DM with DBT or alone in the overall group or dense breast subgroup (p>0.05). CONCLUSIONS Diagnostic performances of SM and DM for the evaluation of microcalcifications are not significantly different, whether performed with DBT or alone. KEY POINTS • In DBT-imaging, SM and DM show comparable performances when evaluating microcalcifications. • For BI-RADS classification of microcalcifications, SM and DM show similar AUCs. • DBT with SM may be sufficient for diagnosing microcalcifications, without DM.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea.
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Ga Ram Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
| | - Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea
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27
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Ferreira VCCDS, Etchebehere ECSDC, Bevilacqua JLB, de Barros N. Suspicious amorphous microcalcifications detected on full-field digital mammography: correlation with histopathology. Radiol Bras 2018; 51:87-94. [PMID: 29743735 PMCID: PMC5935401 DOI: 10.1590/0100-3984.2017.0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate suspicious amorphous calcifications diagnosed on full-field
digital mammography (FFDM) and establish correlations with histopathology
findings. Materials and Methods This was a retrospective study of 78 suspicious amorphous calcifications (all
classified as BI-RADS® 4) detected on FFDM.
Vacuum-assisted breast biopsy (VABB) was performed. The histopathological
classification of VABB core samples was as follows: pB2 (benign); pB3
(uncertain malignant potential); pB4 (suspicion of malignancy); and pB5
(malignant). Treatment was recommended for pB5 lesions. To rule out
malignancy, surgical excision was recommended for pB3 and pB4 lesions.
Patients not submitted to surgery were followed for at least 6 months. Results Among the 78 amorphous calcifications evaluated, the histopathological
analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as
pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2).
The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were
precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat
epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions,
the underestimation rate was zero. Conclusion The diagnosis of precursor lesions (excluding atypical ductal hyperplasia,
which can be pB4 depending on the severity and extent of the lesion) should
not necessarily be considered indicative of underestimation of malignancy.
Suspicious amorphous calcifications correlated more often with precursor
lesions than with malignant lesions, at a ratio of 3:1.
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Affiliation(s)
| | | | | | - Nestor de Barros
- MD, PhD, Tenured Professor, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Zhang L, Jiang S, Zhao Y, Feng J, Pogue BW, Paulsen KD. Direct Regularization From Co-Registered Contrast MRI Improves Image Quality of MRI-Guided Near-Infrared Spectral Tomography of Breast Lesions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:1247-1252. [PMID: 29727287 PMCID: PMC5987778 DOI: 10.1109/tmi.2018.2794548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
An approach using direct regularization from co-registered dynamic contrast enhanced magnetic reson- ance images was used to reconstruct near-infrared spectral tomography patient images, which does not need image segmentation. 20 patients with mammography/ultrasound confirmed breast abnormalities were involved in this paper, and the resulting images indicated that tumor total hemoglobin concentration contrast differentiated malignant from benign cases (p-value = 0.021). The approach prod- uced reconstructed images, which significantly reduced surface artifacts near the source-detector locations (p-value = 4.16e-6).
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29
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A modelling study to evaluate the costs and effects of lowering the starting age of population breast cancer screening. Maturitas 2018; 109:81-88. [DOI: 10.1016/j.maturitas.2017.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/09/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
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30
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The Reproducibility of Changes in Diagnostic Figures of Merit Across Laboratory and Clinical Imaging Reader Studies. Acad Radiol 2017; 24:1436-1446. [PMID: 28666723 DOI: 10.1016/j.acra.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/28/2017] [Accepted: 05/01/2017] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES In this paper we examine which comparisons of reading performance between diagnostic imaging systems made in controlled retrospective laboratory studies may be representative of what we observe in later clinical studies. The change in a meaningful diagnostic figure of merit between two diagnostic modalities should be qualitatively or quantitatively comparable across all kinds of studies. MATERIALS AND METHODS In this meta-study we examine the reproducibility of relative measures of sensitivity, false positive fraction (FPF), area under the receiver operating characteristic (ROC) curve, and expected utility across laboratory and observational clinical studies for several different breast imaging modalities, including screen film mammography, digital mammography, breast tomosynthesis, and ultrasound. RESULTS Across studies of all types, the changes in the FPFs yielded very small probabilities of having a common mean value. The probabilities of relative sensitivity being the same across ultrasound and tomosynthesis studies were low. No evidence was found for different mean values of relative area under the ROC curve or relative expected utility within any of the study sets. CONCLUSION The comparison demonstrates that the ratios of areas under the ROC curve and expected utilities are reproducible across laboratory and clinical studies, whereas sensitivity and FPF are not.
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Abstract
Advances in imaging of the female breast have substantially influenced the diagnosis and probably also the therapy and prognosis of breast cancer in the past few years. This article gives an overview of the most important imaging modalities in the diagnosis of breast cancer. Digital mammography is considered to be the gold standard for the early detection of breast cancer. Digital breast tomosynthesis can increase the diagnostic accuracy of mammography and is used for the assessment of equivocal or suspicious mammography findings. Other modalities, such as ultrasound and contrast-enhanced magnetic resonance imaging (MRI) play an important role in the diagnostics, staging and follow-up of breast cancer. Percutaneous needle biopsy is a rapid and minimally invasive method for the histological verification of breast cancer. New breast imaging modalities, such as contrast-enhanced spectral mammography, diffusion-weighted MRI and MR spectroscopy can possibly further improve breast cancer diagnostics; however, further studies are necessary to prove the advantages of these methods so that they cannot yet be recommended for routine clinical use.
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Affiliation(s)
- M Funke
- Radiologische Klinik, Klinikum Baden-Baden, Balger Str. 50, 76532, Baden-Baden, Deutschland.
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32
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Posso M, Puig T, Carles M, Rué M, Canelo-Aybar C, Bonfill X. Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis. Eur J Radiol 2017; 96:40-49. [PMID: 29103474 DOI: 10.1016/j.ejrad.2017.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Double reading is the strategy of choice for mammogram interpretation in screening programmes. It remains, however, unknown whether double reading is still the strategy of choice in the context of digital mammography. Our aim was to determine the effectiveness and cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes. METHODS We performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases up to April 2017. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist to assess the methodological quality of the diagnostic studies and economic evaluations, respectively. A proportion's meta-analysis approach, 95% Confidence Intervals (95% CI) and test of heterogeneity (P values) were used for pooled results. Costs are expressed US$ PPP (United States Dollar purchasing power parities). The PROSPERO ID of this Systematic Review's protocol is CRD42014013804. RESULTS Of 1473 potentially relevant hits, four high-quality studies were included. The pooled cancer detection rate of double reading was 6.01 per 1000 screens (CI: 4.47‰-7.77‰), and it was 5.65 per 1000 screens (CI: 3.95‰-7.65‰) for single reading (P=0.76). The pooled proportion of false-positives of double reading was 47.03 per 1000 screens (CI: 39.13‰-55.62‰) and it was 40.60 per 1000 screens (CI: 38.58‰-42.67‰) for single reading (P=0.12). One study reported, for double reading, an ICER (Incremental Cost-Effectiveness Ratio) of 16,684 Euros (24,717 US$ PPP; 2015 value) per detected cancer. Single reading+CAD (computer-aided-detection) was cost-effective in Japan. CONCLUSION The evidence of benefit for double reading compared to single reading for digital mammography interpretation is scarce. Double reading seems to increase operational costs, have a not significantly higher false-positive rate, and a similar cancer detection rate.
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Affiliation(s)
- Margarita Posso
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Iberoamerican Cochrane Centre, Barcelona, Spain.
| | - Teresa Puig
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | | | - Montserrat Rué
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Universitat de Lleida, Lleida, Spain.
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Barcelona, Spain; School of Medicine, Peruvian University of Applied Sciences, Lima, Peru.
| | - Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Iberoamerican Cochrane Centre, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain.
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van Bommel RMG, Weber R, Voogd AC, Nederend J, Louwman MWJ, Venderink D, Strobbe LJA, Rutten MJC, Plaisier ML, Lohle PN, Hooijen MJH, Tjan-Heijnen VCG, Duijm LEM. Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography. BMC Cancer 2017; 17:315. [PMID: 28476109 PMCID: PMC5420149 DOI: 10.1186/s12885-017-3294-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background To determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). Methods We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult (“true”) interval cancer. Results A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult (“true”) interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM. Conclusions An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Roy Weber
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Matthieu J C Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW, 's-Hertogenbosch, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Marianne J H Hooijen
- Department of Radiology, St Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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Review of the evidence on the use of arbitration or consensus within breast screening: A systematic scoping review. Radiography (Lond) 2017; 23:171-176. [DOI: 10.1016/j.radi.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 11/23/2022]
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Timmermans L, Bleyen L, Bacher K, Van Herck K, Lemmens K, Van Ongeval C, Van Steen A, Martens P, De Brabander I, Goossens M, Thierens H. Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme. Eur Radiol 2017; 27:3810-3819. [PMID: 28289944 DOI: 10.1007/s00330-017-4757-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities. METHODS The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry. RESULTS Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR. CONCLUSIONS DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration. KEY POINTS • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
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Affiliation(s)
- Lore Timmermans
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
| | - Luc Bleyen
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
| | - Koen Van Herck
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Kim Lemmens
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Andre Van Steen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Hubert Thierens
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
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Impact of the Introduction of Digital Mammography in an Organized Screening Program on the Recall and Detection Rate. J Digit Imaging 2017; 29:235-42. [PMID: 26537932 DOI: 10.1007/s10278-015-9843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In 2012, the Reggio Emilia Breast Cancer Screening Program introduced digital mammography in all its facilities at the same time. The aim of this work is to analyze the impact of digital mammography introduction on the recall rate, detection rate, and positive predictive value. The program actively invites women aged 45-74 years. We included women screened in 2011, all of whom underwent film-screen mammography, and all women screened in 2012, all of whom underwent digital mammography. Double reading was used for all mammograms, with arbitration in the event of disagreement. A total of 42,240 women underwent screen-film mammography and 45,196 underwent digital mammography. The recall rate increased from 3.3 to 4.4% in the first year of digital mammography (relative recall adjusted by age and round 1.46, 95% CI = 1.37-1.56); the positivity rate for each individual reading, before arbitration, rose from 3 to 5.7%. The digital mammography recall rate decreased during 2012: after 12 months, it was similar to the recall rate with screen-film mammography. The detection rate was similar: 5.9/1000 and 5.2/1000 with screen-film and digital mammography, respectively (adjusted relative detection rate 0.95, 95% CI = 0.79-1.13). The relative detection rate for ductal carcinoma in situ remained the same. The introduction of digital mammography to our organized screening program had a negative impact on specificity, thereby increasing the recall rate. The effect was limited to the first 12 months after introduction and was attenuated by the double reading with arbitration. We did not observe any relevant effects on the detection rate.
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Rößler AC, Kalender W, Kolditz D, Steiding C, Ruth V, Preuss C, Peter SC, Brehm B, Hammon M, Schulz-Wendtland R, Wenkel E. Performance of Photon-Counting Breast Computed Tomography, Digital Mammography, and Digital Breast Tomosynthesis in Evaluating Breast Specimens. Acad Radiol 2017; 24:184-190. [PMID: 27888024 DOI: 10.1016/j.acra.2016.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers. MATERIALS AND METHODS A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves. RESULTS Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT. CONCLUSIONS pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.
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An RNA-based signature enables high specificity detection of circulating tumor cells in hepatocellular carcinoma. Proc Natl Acad Sci U S A 2017; 114:1123-1128. [PMID: 28096363 DOI: 10.1073/pnas.1617032114] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Circulating tumor cells (CTCs) are shed into the bloodstream by invasive cancers, but the difficulty inherent in identifying these rare cells by microscopy has precluded their routine use in monitoring or screening for cancer. We recently described a high-throughput microfluidic CTC-iChip, which efficiently depletes hematopoietic cells from blood specimens and enriches for CTCs with well-preserved RNA. Application of RNA-based digital PCR to detect CTC-derived signatures may thus enable highly accurate tissue lineage-based cancer detection in blood specimens. As proof of principle, we examined hepatocellular carcinoma (HCC), a cancer that is derived from liver cells bearing a unique gene expression profile. After identifying a digital signature of 10 liver-specific transcripts, we used a cross-validated logistic regression model to identify the presence of HCC-derived CTCs in nine of 16 (56%) untreated patients with HCC versus one of 31 (3%) patients with nonmalignant liver disease at risk for developing HCC (P < 0.0001). Positive CTC scores declined in treated patients: Nine of 32 (28%) patients receiving therapy and only one of 15 (7%) patients who had undergone curative-intent ablation, surgery, or liver transplantation were positive. RNA-based digital CTC scoring was not correlated with the standard HCC serum protein marker alpha fetoprotein (P = 0.57). Modeling the sequential use of these two orthogonal markers for liver cancer screening in patients with high-risk cirrhosis generates positive and negative predictive values of 80% and 86%, respectively. Thus, digital RNA quantitation constitutes a sensitive and specific CTC readout, enabling high-throughput clinical applications, such as noninvasive screening for HCC in populations where viral hepatitis and cirrhosis are prevalent.
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de Munck L, de Bock GH, Otter R, Reiding D, Broeders MJM, Willemse PHB, Siesling S. Digital vs screen-film mammography in population-based breast cancer screening: performance indicators and tumour characteristics of screen-detected and interval cancers. Br J Cancer 2016; 115:517-24. [PMID: 27490807 PMCID: PMC4997549 DOI: 10.1038/bjc.2016.226] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/13/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Full-field digital mammography (FFDM) has replaced screen-film mammography (SFM) in most breast cancer screening programs due to technological advantages such as possibilities to adjust contrast, better image quality and transfer capabilities. This study describes the performance indicators during the transition from SFM to FFDM and the characteristics of screen-detected and interval cancers. METHODS Data of the Dutch breast cancer screening program, region North from 2004 to 2010 were linked to The Netherlands Cancer Registry (N=902 868). Performance indicators and tumour characteristics of screen-detected and interval cancers were compared between FFDM and SFM. RESULTS After initial screens, recall rates were 2.1% (SFM) and 3.0% (FFDM; P<0.001). The positive predictive values (PPV) were 25.6% (SFM) and 19.9% (FFDM; P=0.002). Detection rates were similar, as were all performance indicators after subsequent screens. Similar percentages of low-grade ductal carcinoma in situ (DCIS) were found for SFM and FFDM. Invasive cancers diagnosed after subsequent screens with FFDM were more often of high-grade (P=0.024) and ductal type (P=0.030). The incidence rates of interval cancers were similar for SFM and FFDM after initial (2.69/1000 vs 2.51/1000; P=0.787) and subsequent screens (2.30 vs 2.41; P=0.652), with similar tumour characteristics. CONCLUSIONS FFDM resulted in similar rates of screen-detected and interval cancers, indicating that FFDM performs as well as SFM in a breast cancer screening program. No signs of an increase in low-grade DCIS (which might connote possible overdiagnosis) were seen. Nonetheless, after initial screening, which accounts for 12% of all screens, FFDM resulted in higher recall rate and lower PPV that requires attention.
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Affiliation(s)
- Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Renée Otter
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Dick Reiding
- National Cancer Screening Programme, region North, PO Box 425, Groningen 9700 AK, The Netherlands
| | - Mireille JM Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands
- Dutch Reference Centre for Screening, PO Box 6873, Nijmegen 6503 GJ, The Netherlands
| | - Pax HB Willemse
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
- Department of Health Technology & Services Research, University of Twente, PO Box 217, Enschede 7500 AE, The Netherlands
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Mackenzie A, Warren LM, Wallis MG, Cooke J, Given-Wilson RM, Dance DR, Chakraborty DP, Halling-Brown MD, Looney PT, Young KC. Breast cancer detection rates using four different types of mammography detectors. Eur Radiol 2016; 26:874-83. [PMID: 26105023 PMCID: PMC4691226 DOI: 10.1007/s00330-015-3885-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the performance of different types of detectors in breast cancer detection. METHODS A mammography image set containing subtle malignant non-calcification lesions, biopsy-proven benign lesions, simulated malignant calcification clusters and normals was acquired using amorphous-selenium (a-Se) detectors. The images were adapted to simulate four types of detectors at the same radiation dose: digital radiography (DR) detectors with a-Se and caesium iodide (CsI) convertors, and computed radiography (CR) detectors with a powder phosphor (PIP) and a needle phosphor (NIP). Seven observers marked suspicious and benign lesions. Analysis was undertaken using jackknife alternative free-response receiver operating characteristics weighted figure of merit (FoM). The cancer detection fraction (CDF) was estimated for a representative image set from screening. RESULTS No significant differences in the FoMs between the DR detectors were measured. For calcification clusters and non-calcification lesions, both CR detectors' FoMs were significantly lower than for DR detectors. The calcification cluster's FoM for CR NIP was significantly better than for CR PIP. The estimated CDFs with CR PIP and CR NIP detectors were up to 15% and 22% lower, respectively, than for DR detectors. CONCLUSION Cancer detection is affected by detector type, and the use of CR in mammography should be reconsidered. KEY POINTS The type of mammography detector can affect the cancer detection rates. CR detectors performed worse than DR detectors in mammography. Needle phosphor CR performed better than powder phosphor CR. Calcification clusters detection is more sensitive to detector type than other cancers.
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Affiliation(s)
- Alistair Mackenzie
- National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford, GU2 7XX, UK.
- Department of Physics, University of Surrey, Guildford, GU2 7XH, UK.
| | - Lucy M Warren
- National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
- Department of Physics, University of Surrey, Guildford, GU2 7XH, UK
| | - Matthew G Wallis
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Julie Cooke
- Jarvis Breast Screening and Diagnostic Centre, Guildford, UK
| | | | - David R Dance
- National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
- Department of Physics, University of Surrey, Guildford, GU2 7XH, UK
| | - Dev P Chakraborty
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark D Halling-Brown
- Scientific Computing, Department of Medical Physics, Royal Surrey County Hospital, Guildford, UK
| | - Padraig T Looney
- National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
| | - Kenneth C Young
- National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford, GU2 7XX, UK
- Department of Physics, University of Surrey, Guildford, GU2 7XH, UK
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Elizalde A, Pina L, Etxano J, Slon P, Zalazar R, Caballeros M. Additional US or DBT after digital mammography: which one is the best combination? Acta Radiol 2016; 57:13-8. [PMID: 25523063 DOI: 10.1177/0284185114563641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Digital mammography (DM) is widespread used for the detection of breast cancer, but its sensitivity drops in dense breasts. It is well known that additional breast ultrasound (US) and digital breast tomosynthesis (DBT) increase the sensitivity of DM. However, to our knowledge, there are no articles comparing the role of both additional techniques. PURPOSE To assess the diagnostic performance of DM and the different combinations of DM + additional DBT and DM + additional US in an enriched sample of patients. MATERIAL AND METHODS Retrospective study in an enriched sample of 1042 patients. Out of them, 84 patients had histologically proven malignant lesions and 258 patients had benign lesions. Finally 700 patients with normal explorations or benign lesions without biopsy confirmation (but stable for at least 12 months) were included. All of them underwent DM, US, and DBT examinations that were retrospectively reviewed by one expert radiologist, blinded to the final diagnoses. The DBT examinations were performed using one single view with wide angle (50°). The reader categorized the cases as benign (BI-RADS 1 or 2) or malignant (BI-RADS 3-5) for DM and the different combination of techniques. The sensitivity (SE) and specificity (SP) were calculated with the PEPI software and the ROC curves of the different techniques and combinations were calculated by using the SPSS 15.0 software. RESULTS The SE and SP of DM were 69.05% and 88.20%, respectively. Additional DBT significantly increased the AUC of DM as well as additional US or the combination DM + DBT + US (P < 0.05). However there were no significant differences between the AUC of DM + US and DM + DBT (P = 0.7). CONCLUSION Additional US, DBT, or both, in combination with DM, significantly increased the AUC of DM. However, there were no significant differences between DM + DBT and DM + US.
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Affiliation(s)
- Arlette Elizalde
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis Pina
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jon Etxano
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pedro Slon
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Romina Zalazar
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Meylin Caballeros
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
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Pauwels EK, Foray N, Bourguignon MH. Breast Cancer Induced by X-Ray Mammography Screening? A Review Based on Recent Understanding of Low-Dose Radiobiology. Med Princ Pract 2016; 25:101-9. [PMID: 26571215 PMCID: PMC5588356 DOI: 10.1159/000442442] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 11/15/2015] [Indexed: 12/28/2022] Open
Abstract
Screening mammography offers the possibility of discovering malignant diseases at an early stage, which is consequently treated early, thereby reducing the mortality rate. However, ionizing radiation as used in low-dose X-ray mammography may be associated with a risk of radiation-induced carcinogenesis. In the context of the harmful effects of ionizing radiation, this article reviewed novel radiobiological data and provided a simulation of the relative incidence of radiation-induced breast cancer due to screening against a background baseline incidence in a population of 100,000 individuals. The use of modern digital mammographic technology was assumed, giving rise to a glandular dose of 2.5 mGy from a 2-view per breast image. Assuming no latency time, this led to a ratio of induced incidence rate over baseline incidence rate of about 1.6‰ for biennial screening in women aged 50-74 years, although it cannot be excluded that the dose and dose rate effectiveness factor values relying on new radiobiological insights may lower this number to about 0.7‰. This carcinogenic risk is considered small in relation to the potential beneficial effects of screening, especially as latency time was not taken into consideration. However, individuals who are known to be carriers of risk-increasing genetic variations and/or have an inherited disposition of breast cancer should avoid ionizing radiation as much as possible and should be referred to ultrasound or magnetic resonance imaging. In addition, a significant, but difficult to quantify, risk of cancer is present for individuals who suffer from hypersusceptibility to ionizing radiation.
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Affiliation(s)
- Ernest K.J. Pauwels
- Department of Radiology, University Medical Center Leiden, Leiden
- Department of Nuclear Medicine, University Medical School Pisa, Pisa, Italy
- *Prof. emer. Dr. E.K.J. Pauwels, Department of Radiology and Nuclear Medicine, Via di San Gennaro 79B, IT—55010 Capannori (Italy), E-Mail
| | - Nicolas Foray
- Department of Radiobiology INSERM, UMR1052, Cancer Research Centre of Lyon, Lyon
| | - Michel H. Bourguignon
- Department of Biophysics, University of Versailles, Paris, France
- Institut de Radioprotection et de Sureté Nucléaire, Fontenay-aux-Roses, France
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Gillman J, Toth HK, Moy L. The role of dynamic contrast-enhanced screening breast MRI in populations at increased risk for breast cancer. ACTA ACUST UNITED AC 2015; 10:609-22. [PMID: 25482488 DOI: 10.2217/whe.14.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Breast MRI is more sensitive than mammography in detecting breast cancer. However, MRI as a screening tool is limited to high-risk patients due to cost, low specificity and insufficient evidence for its use in intermediate-risk populations. Nonetheless, in the past decade, there has been a dramatic increase in the use of breast-screening MRI in the community setting. In this review, we set to describe the current literature on the use of screening MRI in high- and intermediate-risk populations. We will also describe novel applications of breast MRI including abbreviated breast MRI protocols, background parenchymal enhancement and diffusion-weighted imaging.
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Affiliation(s)
- Jennifer Gillman
- New York University School of Medicine, Laura & Isaac Perlmutter Cancer Center, 160 East 34th Street, New York, NY 10016, USA
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Moshina N, Ursin G, Roman M, Sebuødegård S, Hofvind S. Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program. Eur J Radiol 2015; 85:248-254. [PMID: 26724673 DOI: 10.1016/j.ejrad.2015.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the probability of breast cancer among women recalled due to abnormal findings on the screening mammograms (PPV-1) and among women who underwent an invasive procedure (PPV-2) by mammographic density (MD), screening mode and age. METHODS We used information about 28,826 recall examinations from 26,951 subsequently screened women in the Norwegian Breast Cancer Screening Program, 1996-2010. The radiologists who performed the recall examinations subjectively classified MD on the mammograms into three categories: fatty (<30% fibroglandular tissue); medium dense (30-70%) and dense (>70%). Screening mode was defined as screen-film mammography (SFM) and full-field digital mammography (FFDM). We examined trends of PPVs by MD, screening mode and age. We used logistic regression to estimate odds ratio (OR) of screen-detected breast cancer associated with MD among women recalled, adjusting for screening mode and age. RESULTS PPV-1 and PPV-2 decreased by increasing MD, regardless of screening mode (p for trend <0.05 for both PPVs). PPV-1 and PPV-2 were statistically significantly higher for FFDM compared with SFM for women with fatty breasts. Among women recalled, the adjusted OR of breast cancer decreased with increasing MD. Compared with women with fatty breasts, the OR was 0.90 (95% CI: 0.84-0.96) for those with medium dense breasts and 0.85 (95% CI: 0.76-0.95) for those with dense breasts. CONCLUSION PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010.
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Affiliation(s)
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, CA, USA.
| | - Marta Roman
- Cancer Registry of Norway, Oslo, Norway; Department of Women and Children's Health, Oslo University Hospital, Oslo, Norway.
| | | | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway.
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Prummel MV, Muradali D, Shumak R, Majpruz V, Brown P, Jiang H, Done SJ, Yaffe MJ, Chiarelli AM. Digital Compared with Screen-Film Mammography: Measures of Diagnostic Accuracy among Women Screened in the Ontario Breast Screening Program. Radiology 2015; 278:365-73. [PMID: 26334680 DOI: 10.1148/radiol.2015150733] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare measures of diagnostic accuracy between large concurrent cohorts of women screened with digital computed radiography (CR), direct radiography (DR), and screen-film mammography (SFM). MATERIALS AND METHODS This study was approved by the University of Toronto Research Ethics Board; informed consent was not required. Three concurrent cohorts of women aged 50-74 years who were screened from 2008-2009 in the Ontario Breast Screening Program with SFM (487,334 screening examinations, 403,688 women), DR (254,758 screening examinations, 220,520 women), or CR (74,140 screening examinations, 64,210 women) were followed for 2 years or until breast cancer diagnosis. Breast cancers were classified as screening-detected or interval on the basis of the woman's final screening and assessment results. Interval cancer rate (per 10 000 negative screening examinations), sensitivity, and specificity were compared across the cohorts by using mixed-effects logistic regression analysis. RESULTS Interval cancer rates were higher, although not significantly so, for CR (15.2 per 10,000; 95% confidence interval [CI]: 12.8, 17.8) and were similar for DR (13.7 per 10,000; 95% CI: 12.4, 15.0) compared with SFM (13.0 per 10,000; 95% CI: 12.1, 13.9). For CR versus SFM, specificity was similar while sensitivity was significantly lower (odds ratio [OR] = 0.62; 95% CI: 0.47, 0.83; P = .001), particularly for invasive cancers detected at a rescreening examination, for women with breast density of less than 75%, for women with no family history, and for postmenopausal women. For DR versus SFM, sensitivity was similar while specificity was lower (OR = 0.92; 95% CI: 0.87, 0.98; P = .01), particularly for rescreening examinations, for women aged 60-74 years, for women with breast density of less than 75%, for women with a family history, and for women who were postmenopausal. CONCLUSION Given the 38% lower sensitivity of CR imaging systems compared with SFM, programs should assess the continued use of this technology for breast screening.
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Affiliation(s)
- Maegan V Prummel
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Derek Muradali
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Rene Shumak
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Vicky Majpruz
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Patrick Brown
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Hedy Jiang
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Susan J Done
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Martin J Yaffe
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Anna M Chiarelli
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
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Weber RJP, Klompenhouwer EG, Voogd AC, Strobbe LJA, Broeders MJM, Duijm LEM. Comparison of the diagnostic workup of women referred at non-blinded or blinded double reading in a population-based screening mammography programme in the south of the Netherlands. Br J Cancer 2015; 113:1094-8. [PMID: 26284336 PMCID: PMC4651120 DOI: 10.1038/bjc.2015.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/16/2015] [Accepted: 07/13/2015] [Indexed: 11/09/2022] Open
Abstract
Background: To determine whether referred women experience differences in diagnostic workup at non-blinded or blinded double reading of screening mammograms. Methods: We included a consecutive series of respectively 42.996 and 44.491 screens, double read either in a non-blinded or blinded manner between 2009 and 2011. This reading strategy was alternated on a monthly basis. Results: The overall ultrasound-guided core needle biopsy (CNB) rate and stereotactic CNB (SCNB) rate per 1000 screens were higher at blinded than at non-blinded reading (7.5 vs 6.0, P=0.008 and 8.1 vs 6.6, P=0.009). Among women with benign workup, these rates were higher at blinded reading (2.6 vs 1.4, P<0.001 and 5.9 vs 4.7, P=0.013). The benign biopsy rates were higher at blinded double reading (P<0.001), whereas the positive predictive value of biopsy did not differ (P=0.103). Conclusions: Blinded double-reading results in higher overall CNB and SCNB rates than non-blinded double reading, as well as a higher benign biopsy rate.
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Affiliation(s)
- Roy J P Weber
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
| | | | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 231, 5600 AE Eindhoven, The Netherlands.,Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
| | - Mireille J M Broeders
- National Expert and Training Centre for Breast Cancer Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands
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Kemp Jacobsen K, O'Meara ES, Key D, S M Buist D, Kerlikowske K, Vejborg I, Sprague BL, Lynge E, von Euler-Chelpin M. Comparing sensitivity and specificity of screening mammography in the United States and Denmark. Int J Cancer 2015; 137:2198-207. [PMID: 25944711 DOI: 10.1002/ijc.29593] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/06/2022]
Abstract
Delivery of screening mammography differs substantially between the United States (US) and Denmark. We evaluated whether there are differences in screening sensitivity and specificity. We included screens from women screened at age 50-69 years during 1996-2008/2009 in the US Breast Cancer Surveillance Consortium (BCSC) (n = 2,872,791), and from two population-based mammography screening programs in Denmark (Copenhagen, n = 148,156 and Funen, n = 275,553). Women were followed-up for 1 year. For initial screens, recall rate was significantly higher in BCSC (17.6%) than in Copenhagen (4.3%) and Funen (3.1%). Sensitivity was fairly similar in BCSC (91.8%) and Copenhagen (90.5%) and Funen (92.5%). At subsequent screens, recall rates were 8.8%, 1.8% and 1.4% in BCSC, Copenhagen and Funen, respectively. The BCSC sensitivity (82.3%) was lower compared with that in Copenhagen (88.9%) and Funen (86.9%), but when stratified by time since last screen, the sensitivity was similar. For both initial and subsequent screenings, the specificity of screening in BCSC (83.2% and 91.6%) was significantly lower than that in Copenhagen (96.6% and 98.8%) and Funen (97.9% and 99.2%). By taking time since last screen into account, it was found that American and Danish women had the same probability of having their asymptomatic cancers detected at screening. However, the majority of women free of asymptomatic cancers experienced more harms in terms of false-positive findings in the US than in Denmark.
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Affiliation(s)
- Katja Kemp Jacobsen
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Dustin Key
- Group Health Research Institute, Seattle, WA, USA
| | | | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Ilse Vejborg
- Center of Diagnostic Imaging, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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48
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Cockmartin L, Marshall NW, Van Ongeval C, Aerts G, Stalmans D, Zanca F, Shaheen E, De Keyzer F, Dance DR, Young KC, Bosmans H. Comparison of digital breast tomosynthesis and 2D digital mammography using a hybrid performance test. Phys Med Biol 2015; 60:3939-58. [PMID: 25909596 DOI: 10.1088/0031-9155/60/10/3939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This paper introduces a hybrid method for performing detection studies in projection image based modalities, based on image acquisitions of target objects and patients. The method was used to compare 2D mammography and digital breast tomosynthesis (DBT) in terms of the detection performance of spherical densities and microcalcifications. The method starts with the acquisition of spheres of different glandular equivalent densities and microcalcifications of different sizes immersed in a homogeneous breast tissue simulating medium. These target objects are then segmented and the subsequent templates are fused in projection images of patients and processed or reconstructed. This results in hybrid images with true mammographic anatomy and clinically relevant target objects, ready for use in observer studies. The detection study of spherical densities used 108 normal and 178 hybrid 2D and DBT images; 156 normal and 321 hybrid images were used for the microcalcifications. Seven observers scored the presence/absence of the spheres/microcalcifications in a square region via a 5-point confidence rating scale. Detection performance in 2D and DBT was compared via ROC analysis with sub-analyses for the density of the spheres, microcalcification size, breast thickness and z-position. The study was performed on a Siemens Inspiration tomosynthesis system using patient acquisitions with an average age of 58 years and an average breast thickness of 53 mm providing mean glandular doses of 1.06 mGy (2D) and 2.39 mGy (DBT). Study results showed that breast tomosynthesis (AUC = 0.973) outperformed 2D (AUC = 0.831) for the detection of spheres (p < 0.0001) and this applied for all spherical densities and breast thicknesses. By way of contrast, DBT was worse than 2D for microcalcification detection (AUC2D = 0.974, AUCDBT = 0.838, p < 0.0001), with significant differences found for all sizes (150-354 µm), for breast thicknesses above 40 mm and for heights above the detector of 20 mm and above. In conclusion, the hybrid method was successfully used to produce images for a detection study; results showed breast tomosynthesis outperformed 2D for spherical densities while further optimization of DBT for microcalcifications is suggested.
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Affiliation(s)
- Lesley Cockmartin
- Department of Imaging and Pathology, Division of Medical Physics & Quality Assessment, KU Leuven, Herestraat 49 Box 7003, 3000 Leuven, Belgium. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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49
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Sankatsing VD, Heijnsdijk EA, van Luijt PA, van Ravesteyn NT, Fracheboud J, de Koning HJ. Cost-effectiveness of digital mammography screening before the age of 50 in The Netherlands. Int J Cancer 2015; 137:1990-9. [DOI: 10.1002/ijc.29572] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/20/2015] [Accepted: 03/24/2015] [Indexed: 11/07/2022]
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50
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Abstract
Routine screening mammography is recommended by most groups issuing breast cancer screening guidelines, especially for women 50 years of age and older. However, both the potential benefits and risks of screening should be discussed with individual patients to allow for shared decision making regarding their participation in screening, age of commencement and conclusion, and interval of mammography screening.
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Affiliation(s)
- Mackenzie S Fuller
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA
| | - Christoph I Lee
- Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 825 Eastlake Avenue East, G3-200, Seattle, WA 98109, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA.
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