1
|
Tensor-Based Learning for Detecting Abnormalities on Digital Mammograms. Diagnostics (Basel) 2022; 12:diagnostics12102389. [PMID: 36292078 PMCID: PMC9601228 DOI: 10.3390/diagnostics12102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, we propose a tensor-based learning model to efficiently detect abnormalities on digital mammograms. Due to the fact that the availability of medical data is limited and often restricted by GDPR (general data protection regulation) compliance, the need for more sophisticated and less data-hungry approaches is urgent. Accordingly, our proposed artificial intelligence framework utilizes the canonical polyadic decomposition to decrease the trainable parameters of the wrapped Rank-R FNN model, leading to efficient learning using small amounts of data. Our model was evaluated on the open source digital mammographic database INBreast and compared with state-of-the-art models in this domain. The experimental results show that the proposed solution performs well in comparison with the other deep learning models, such as AlexNet and SqueezeNet, achieving 90% ± 4% accuracy and an F1 score of 84% ± 5%. Additionally, our framework tends to attain more robust performance with small numbers of data and is computationally lighter for inference purposes, due to the small number of trainable parameters.
Collapse
|
2
|
He Z, Li Y, Zeng W, Xu W, Liu J, Ma X, Wei J, Zeng H, Xu Z, Wang S, Wen C, Wu J, Feng C, Ma M, Qin G, Lu Y, Chen W. Can a Computer-Aided Mass Diagnosis Model Based on Perceptive Features Learned From Quantitative Mammography Radiology Reports Improve Junior Radiologists' Diagnosis Performance? An Observer Study. Front Oncol 2021; 11:773389. [PMID: 34976817 PMCID: PMC8719464 DOI: 10.3389/fonc.2021.773389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Radiologists' diagnostic capabilities for breast mass lesions depend on their experience. Junior radiologists may underestimate or overestimate Breast Imaging Reporting and Data System (BI-RADS) categories of mass lesions owing to a lack of diagnostic experience. The computer-aided diagnosis (CAD) method assists in improving diagnostic performance by providing a breast mass classification reference to radiologists. This study aims to evaluate the impact of a CAD method based on perceptive features learned from quantitative BI-RADS descriptions on breast mass diagnosis performance. We conducted a retrospective multi-reader multi-case (MRMC) study to assess the perceptive feature-based CAD method. A total of 416 digital mammograms of patients with breast masses were obtained from 2014 through 2017, including 231 benign and 185 malignant masses, from which we randomly selected 214 cases (109 benign, 105 malignant) to train the CAD model for perceptive feature extraction and classification. The remaining 202 cases were enrolled as the test set for evaluation, of which 51 patients (29 benign and 22 malignant) participated in the MRMC study. In the MRMC study, we categorized six radiologists into three groups: junior, middle-senior, and senior. They diagnosed 51 patients with and without support from the CAD model. The BI-RADS category, benign or malignant diagnosis, malignancy probability, and diagnosis time during the two evaluation sessions were recorded. In the MRMC evaluation, the average area under the curve (AUC) of the six radiologists with CAD support was slightly higher than that without support (0.896 vs. 0.850, p = 0.0209). Both average sensitivity and specificity increased (p = 0.0253). Under CAD assistance, junior and middle-senior radiologists adjusted the assessment categories of more BI-RADS 4 cases. The diagnosis time with and without CAD support was comparable for five radiologists. The CAD model improved the radiologists' diagnostic performance for breast masses without prolonging the diagnosis time and assisted in a better BI-RADS assessment, especially for junior radiologists.
Collapse
Affiliation(s)
- Zilong He
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Li
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Weixiong Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weimin Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jialing Liu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangyuan Ma
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
- Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou, China
| | - Jun Wei
- Perception Vision Medical Technologies Ltd. Co., Guangzhou, China
| | - Hui Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zeyuan Xu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sina Wang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chanjuan Wen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiefang Wu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chenya Feng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengwei Ma
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Genggeng Qin
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Key Laboratory of Computational Science, Sun Yat-sen University, Guangzhou, China
| | - Weiguo Chen
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
3
|
Lameijer JRC, Voogd AC, Broeders MJM, Pijnappel RM, Setz-Pels W, Strobbe LJ, Jansen FH, Tjan-Heijnen VCG, Duijm LEM. Trends in delayed breast cancer diagnosis after recall at screening mammography. Eur J Radiol 2021; 136:109517. [PMID: 33421886 DOI: 10.1016/j.ejrad.2020.109517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the extent and characteristics of delay in breast cancer diagnosis in women recalled at screening mammography. METHODS We included a consecutive series of 817,656 screens of women who received biennial screening mammography in a Dutch breast cancer screening region between 1997 and 2016. During at least 3.5 years follow-up, radiological reports and biopsy reports were collected of all recalled women. The inclusion period was divided into four cohorts of four years each. We determined the number of screen-detected cancers and their characteristics, and assessed the proportion of recalled women who experienced a diagnostic delay of at least 4 months in breast cancer confirmation. RESULTS The proportion of recalled women who experienced diagnostic delay decreased from 7.5 % in 1997-2001 (47/623) to 3.0 % in 2012-2016 (67/2223, P < 0.001). The proportion of women with a delay of at least two years increased from 27.7 % (13/47) in 1997-2001 to 75.7 % (53/70) in 2012-2016 (P < 0.001). Cancers with a diagnostic delay > 2 years were more frequently invasive (P = 0.009) than cancers with a diagnostic delay of 4-24 months. The most frequent cause of diagnostic delays was incorrect radiological classifications by clinical radiologists (55.2 % overall) after recall. CONCLUSIONS The proportion of recalled women with a delayed breast cancer diagnosis has more than halved during two decades of screening mammography. Delays in breast cancer diagnosis are characterized by longer delay intervals, although the proportion of these delays among all screen-detected cancers has not increased. Preventing longer delays in breast cancer confirmation may help improve breast cancer survival.
Collapse
Affiliation(s)
- J R C Lameijer
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - A C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - M J M Broeders
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - R M Pijnappel
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - W Setz-Pels
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - L J Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - F H Jansen
- Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - V C G Tjan-Heijnen
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, P Debyelaan 1, 6229 HA, Maastricht, the Netherlands
| | - L E M Duijm
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands; Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| |
Collapse
|
4
|
Patterns of treatment and outcome of ductal carcinoma in situ in the Netherlands. Breast Cancer Res Treat 2021; 187:245-254. [PMID: 33385265 PMCID: PMC8062340 DOI: 10.1007/s10549-020-06055-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 01/03/2023]
Abstract
Purpose To spare DCIS patients from overtreatment, treatment de-escalated over the years. This study evaluates the influence of these developments on the patterns of care in the treatment of DCIS with particular interest in the use of breast conserving surgery (BCS), radiotherapy following BCS and the use and type of axillary staging. Methods In this large population-based cohort study all women, aged 50–74 years diagnosed with DCIS from January 1989 until January 2019, were analyzed per two-year cohort. Results A total of 30,417 women were diagnosed with DCIS. The proportion of patients undergoing BCS increased from 47.7% in 1995–1996 to 72.7% in 2017–2018 (p < 0.001). Adjuvant radiotherapy following BCS increased from 28.9% (1995–1996) to 89.6% (2011–2012) and subsequently decreased to 74.9% (2017–2018; p < 0.001). Since its introduction, the use of sentinel lymph node biopsy (SLNB) increased to 63.1% in 2013–2014 and subsequently decreased to 52.8% in 2017–2018 (p < 0.001). Axillary surgery is already omitted in 55.8% of the patients undergoing BCS nowadays. The five-year invasive relapse-free survival (iRFS) for BCS with adjuvant radiotherapy in the period 1989–2010, was 98.7% [CI 98.4% – 99.0%], compared to 95.0% [CI 94.1% –95.8%] for BCS only (p < 0.001). In 2011–2018, this was 99.3% [CI 99.1% – 99.5%] and 98.8% [CI 98.2% – 99.4%] respectively (p = 0.01). Conclusions This study shows a shift toward less extensive treatment. DCIS is increasingly treated with BCS and less often followed by additional radiotherapy. The absence of radiotherapy still results in excellent iRFS. Axillary surgery is increasingly omitted in DCIS patients.
Collapse
|
5
|
Ghazi P. Reduction of scatter in breast CT yields improved microcalcification visibility. Phys Med Biol 2020; 65:235047. [PMID: 33274730 DOI: 10.1088/1361-6560/abae07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The inadequate visibility of microcalcifications-small calcium deposits that cue radiologists to early stages of cancer-is a major limitation in current designs of dedicated breast computed tomography (bCT). This limitation has previously been attributed to the constituent components, spatial resolution, and utilized dose. Scattered radiation has been considered an occurrence with low-frequency impacts that can be compensated for in post-processing. We hypothesized, however, that the acquisition of scattered radiation has a far more detrimental impact on clinically relevant features than has previously been understood. Critically, acquisition of scatter leads to the reduced visibility of microcalcifications. This hypothesis was investigated and supported via mathematical derivations and simulation studies. We conducted a series of comparative studies in which four bCT systems were simulated under iso-dose and iso-resolution conditions, characterizing the dependencies of microcalcification contrast on accumulated scatter. Included among the simulated systems is a novel bCT design-narrow beam bCT (NB-bCT)-that captures nearly zero scatter. We find that current bCT systems suffer from significant levels of scatter. As validated in theory, depending on the system and size of microcalcifications, between 25% and over 70% of contrast resolution is lost due to scatter. The results in NB-bCT, however, provide evidence that by removing scatter build-up in projections, the contrast of microcalcifications in a bCT image is preserved, regardless of their size or location in the breast.
Collapse
Affiliation(s)
- Peymon Ghazi
- Malcova LLC, 3000 Falls Rd Suite 400, Baltimore, MD 21211, United States of America
| |
Collapse
|
6
|
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.
Collapse
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
| | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Can we reduce the workload of mammographic screening by automatic identification of normal exams with artificial intelligence? A feasibility study. Eur Radiol 2019; 29:4825-4832. [PMID: 30993432 PMCID: PMC6682851 DOI: 10.1007/s00330-019-06186-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022]
Abstract
Purpose To study the feasibility of automatically identifying normal digital mammography (DM) exams with artificial intelligence (AI) to reduce the breast cancer screening reading workload. Methods and materials A total of 2652 DM exams (653 cancer) and interpretations by 101 radiologists were gathered from nine previously performed multi-reader multi-case receiver operating characteristic (MRMC ROC) studies. An AI system was used to obtain a score between 1 and 10 for each exam, representing the likelihood of cancer present. Using all AI scores between 1 and 9 as possible thresholds, the exams were divided into groups of low- and high likelihood of cancer present. It was assumed that, under the pre-selection scenario, only the high-likelihood group would be read by radiologists, while all low-likelihood exams would be reported as normal. The area under the reader-averaged ROC curve (AUC) was calculated for the original evaluations and for the pre-selection scenarios and compared using a non-inferiority hypothesis. Results Setting the low/high-likelihood threshold at an AI score of 5 (high likelihood > 5) results in a trade-off of approximately halving (− 47%) the workload to be read by radiologists while excluding 7% of true-positive exams. Using an AI score of 2 as threshold yields a workload reduction of 17% while only excluding 1% of true-positive exams. Pre-selection did not change the average AUC of radiologists (inferior 95% CI > − 0.05) for any threshold except at the extreme AI score of 9. Conclusion It is possible to automatically pre-select exams using AI to significantly reduce the breast cancer screening reading workload. Key Points • There is potential to use artificial intelligence to automatically reduce the breast cancer screening reading workload by excluding exams with a low likelihood of cancer. • The exclusion of exams with the lowest likelihood of cancer in screening might not change radiologists’ breast cancer detection performance. • When excluding exams with the lowest likelihood of cancer, the decrease in true-positive recalls would be balanced by a simultaneous reduction in false-positive recalls.
Collapse
|
9
|
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.
Collapse
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.)
| |
Collapse
|
10
|
|
11
|
|
12
|
Aarts AMWM, Duffy SW, Geurts SME, Vulkan DP, Otten JDM, Hsu CY, Chen THH, Verbeek ALM, Broeders MJM. Test sensitivity of mammography and mean sojourn time over 40 years of breast cancer screening in Nijmegen (The Netherlands). J Med Screen 2018; 26:147-153. [DOI: 10.1177/0969141318814869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives We investigated whether changes in mammographic technique and screening policy have improved mammographic sensitivity, and elongated the mean sojourn time, since the introduction of biennial breast cancer screening in Nijmegen, the Netherlands, in 1975. Methods Maximum likelihood estimation, non-linear regression, and Markov Chain Monte Carlo simulation were used to estimate test sensitivity, mean sojourn time, and underlying breast cancer incidence in four time periods, covering 40 years of breast cancer screening in Nijmegen (1975–2012). Results Maximum likelihood estimation generated an estimated test sensitivity of approximately 90% and a mean sojourn time around three years, while the estimates based on non-linear regression and Markov Chain Monte Carlo simulation were 80% and four years, respectively. All three methods estimated a rise in the underlying breast cancer incidence over time, with approximately one case more per 1000 women per year in the final period compared with the first period. Conclusions The three methods showed a slightly higher mammographic sensitivity and a longer mean sojourn time in the last period, after the introduction of digital mammography. Estimates were more realistic for the more sophisticated methods, non-linear regression and Markov Chain Monte Carlo simulation, while the simple closed form approximation of maximum likelihood estimation led to rather high estimates for sensitivity in the early periods.
Collapse
Affiliation(s)
- AMWM Aarts
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - SW Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - SME Geurts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - DP Vulkan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - JDM Otten
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C-Y Hsu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei
| | - THH Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei
| | - ALM Verbeek
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - MJM Broeders
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Bria A, Marrocco C, Borges LR, Molinara M, Marchesi A, Mordang JJ, Karssemeijer N, Tortorella F. Improving the Automated Detection of Calcifications Using Adaptive Variance Stabilization. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:1857-1864. [PMID: 29994062 DOI: 10.1109/tmi.2018.2814058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this paper, we analyze how stabilizing the variance of intensity-dependent quantum noise in digital mammograms can significantly improve the computerized detection of microcalcifications (MCs). These lesions appear on mammograms as tiny deposits of calcium smaller than 20 pixels in diameter. At this scale, high frequency image noise is dominated by quantum noise, which in raw mammograms can be described with a square-root noise model. Under this assumption, we derive an adaptive variance stabilizing transform (VST) that stabilizes the noise to unitary standard deviation in all the images. This is achieved by estimating the noise characteristics from the image at hand. We tested the adaptive VST as a preprocessing stage for four existing computerized MC detection methods on three data sets acquired with mammographic units from different manufacturers. In all the test cases considered, MC detection performance on transformed mammograms was statistically significantly higher than on unprocessed mammograms. Results were also superior in comparison with a "fixed" (nonparametric) VST previously proposed for digital mammograms.
Collapse
|
14
|
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.
Collapse
Affiliation(s)
| | | | | | - Nestor de Barros
- MD, PhD, Tenured Professor, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| |
Collapse
|
15
|
Visser LL, Elshof LE, Schaapveld M, van de Vijver K, Groen EJ, Almekinders MM, Bierman C, van Leeuwen FE, Rutgers EJ, Schmidt MK, Lips EH, Wesseling J. Clinicopathological Risk Factors for an Invasive Breast Cancer Recurrence after Ductal Carcinoma In Situ-A Nested Case-Control Study. Clin Cancer Res 2018; 24:3593-3601. [PMID: 29685879 DOI: 10.1158/1078-0432.ccr-18-0201] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/30/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Ductal carcinoma in situ (DCIS) is treated to prevent progression to invasive breast cancer. Yet, most lesions will never progress, implying that overtreatment exists. Therefore, we aimed to identify factors distinguishing harmless from potentially hazardous DCIS using a nested case-control study.Experimental Design: We conducted a case-control study nested in a population-based cohort of patients with DCIS treated with breast-conserving surgery (BCS) alone (N = 2,658) between 1989 and 2005. We compared clinical, pathologic, and IHC DCIS characteristics of 200 women who subsequently developed ipsilateral invasive breast cancer (iIBC; cases) and 474 women who did not (controls), in a matched setting. Median follow-up time was 12.0 years (interquartile range, 9.0-15.3). Conditional logistic regression models were used to assess associations of various factors with subsequent iIBC risk after primary DCIS.Results: High COX-2 protein expression showed the strongest association with subsequent iIBC [OR = 2.97; 95% confidence interval (95% CI), 1.72-5.10]. In addition, HER2 overexpression (OR = 1.56; 95% CI, 1.05-2.31) and presence of periductal fibrosis (OR = 1.44; 95% CI, 1.01-2.06) were associated with subsequent iIBC risk. Patients with HER2+/COX-2high DCIS had a 4-fold higher risk of subsequent iIBC (vs. HER2-/COX-2low DCIS), and an estimated 22.8% cumulative risk of developing subsequent iIBC at 15 years.Conclusions: With this unbiased study design and representative group of patients with DCIS treated by BCS alone, COX-2, HER2, and periductal fibrosis were revealed as promising markers predicting progression of DCIS into iIBC. Validation will be done in independent datasets. Ultimately, this will aid individual risk stratification of women with primary DCIS. Clin Cancer Res; 24(15); 3593-601. ©2018 AACR.
Collapse
Affiliation(s)
- Lindy L Visser
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lotte E Elshof
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Koen van de Vijver
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Emma J Groen
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mathilde M Almekinders
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Carolien Bierman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Emiel J Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. .,Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Sankatsing VDV, Fracheboud J, de Munck L, Broeders MJM, van Ravesteyn NT, Heijnsdijk EAM, Verbeek ALM, Otten JDM, Pijnappel RM, Siesling S, de Koning HJ. Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening. BMC Cancer 2018; 18:256. [PMID: 29506487 PMCID: PMC5839006 DOI: 10.1186/s12885-018-4122-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/12/2018] [Indexed: 12/29/2022] Open
Abstract
Background Between 2003 and 2010 digital mammography (DM) gradually replaced screen-film mammography (SFM) in the Dutch breast cancer screening programme (BCSP). Previous studies showed increases in detection rate (DR) after the transition to DM. However, national interval cancer rates (ICR) have not yet been reported. Methods We assessed programme sensitivity and specificity during the transition period to DM, analysing nationwide data on screen-detected and interval cancers. Data of 7.3 million screens in women aged 49–74, between 2004 and 2011, were linked to the Netherlands Cancer Registry to obtain data on interval cancers. Age-adjusted DRs, ICRs and recall rates (RR) per 1000 screens and programme sensitivity and specificity were calculated by year, age and screening modality. Results 41,662 screen-detected and 16,160 interval cancers were analysed. The DR significantly increased from 5.13 (95% confidence interval (CI):5.00–5.30) in 2004 to 6.34 (95% CI:6.15–6.47) in 2011, for both in situ (2004:0.73;2011:1.24) and invasive cancers (2004:4.42;2011:5.07), whereas the ICR remained stable (2004: 2.16 (95% CI2.06–2.25);2011: 2.13 (95% CI:2.04–2.22)). The RR changed significantly from 14.0 to 21.4. Programme sensitivity significantly increased, mainly between ages 49–59, from 70.0% (95% CI:68.9–71.2) to 74.4% (95% CI:73.5–75.4) whereas specificity slightly declined (2004:99.1% (95% CI:99.09–99.13);2011:98.5% (95% CI:98.45–98.50)). The overall DR was significantly higher for DM than for SFM (6.24;5.36) as was programme sensitivity (73.6%;70.1%), the ICR was similar (2.19;2.20) and specificity was significantly lower for DM (98.5%;98.9%). Conclusions During the transition from SFM to DM, there was a significant rise in DR and a stable ICR, leading to increased programme sensitivity. Although the recall rate increased, programme specificity remained high compared to other countries. These findings indicate that the performance of DM in a nationwide screening programme is not inferior to, and may be even better, than that of SFM. Electronic supplementary material The online version of this article (10.1186/s12885-018-4122-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Valérie D V Sankatsing
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands.
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.,Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands
| | | | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Ruud M Pijnappel
- Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands.,Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, Enschede, 7500, AE, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | | |
Collapse
|
17
|
The importance of early detection of calcifications associated with breast cancer in screening. Breast Cancer Res Treat 2017; 167:451-458. [PMID: 29043464 PMCID: PMC5790861 DOI: 10.1007/s10549-017-4527-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/27/2017] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to assess how often women with undetected calcifications in prior screening mammograms are subsequently diagnosed with invasive cancer. METHODS From a screening cohort of 63,895 women, exams were collected from 59,690 women without any abnormalities, 744 women with a screen-detected cancer and a prior negative exam, 781 women with a false positive exam based on calcifications, and 413 women with an interval cancer. A radiologist identified cancer-related calcifications, selected by a computer-aided detection system, on mammograms taken prior to screen-detected or interval cancer diagnoses. Using this ground truth and the pathology reports, the sensitivity for calcification detection and the proportion of lesions with visible calcifications that developed into invasive cancer were determined. RESULTS The screening sensitivity for calcifications was 45.5%, at a specificity of 99.5%. A total of 68.4% (n = 177) of cancer-related calcifications that could have been detected earlier were associated with invasive cancer when diagnosed. CONCLUSIONS Screening sensitivity for detection of malignant calcifications is low. Improving the detection of these early signs of cancer is important, because the majority of lesions with detectable calcifications that are not recalled immediately but detected as interval cancer or in the next screening round are invasive at the time of diagnosis.
Collapse
|
18
|
Jacklyn G, McGeechan K, Irwig L, Houssami N, Morrell S, Bell K, Barratt A. Trends in stage-specific breast cancer incidence in New South Wales, Australia: insights into the effects of 25 years of screening mammography. Breast Cancer Res Treat 2017; 166:843-854. [PMID: 28822001 DOI: 10.1007/s10549-017-4443-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Screening mammography aims to improve breast cancer (BC) prognosis by increasing the incidence of early-stage tumours in order to decrease the incidence of late-stage cancer, but no reports have investigated these potential effects in an Australian population. Therefore we aimed to identify temporal trends in stage-specific BC in New South Wales (NSW), Australia, between 1972 and 2012. METHODS An observational study of women who received a diagnosis of BC from 1972-2012 as recorded in the NSW Cancer Registry, a population-based registry with almost complete coverage and high rates of histological verification. We analysed trends in stage-specific incidence before screening and compared them to periods after screening began. Our primary group of interest was women in the target age range of 50-69 years, though trends in women outside the target age were also assessed. RESULTS Screening was not associated with lower incidence of late-stage BC at diagnosis. Incidence for all stages remained higher than prescreening levels. In women aged 50-69 years, the incidence of carcinoma in situ (CIS), localised and regional BC has more than doubled compared to the prescreening era, with incidence rate ratios ranging from 2.0 for regional (95% CI 1.95-2.13) to 121.8 for CIS (95% CI 82.58-179.72). Before the introduction of screening, there was a downward trend in distant metastatic BC incidence, and after the introduction of screening there was an increase (IRR 1.8; 95% CI 1.62-2.00). In women too young to screen the incidence of late-stage BC at diagnosis also increased, whereas localised disease was stable. CONCLUSIONS The incidence of all stages of BC has increased over the past 40 years, with the greatest rise seen during the established screening period for women aged 50-69 years. Our findings suggest that some of the expected benefits of screening may not have been realised and are consistent with overdiagnosis.
Collapse
Affiliation(s)
- Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Kevin McGeechan
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Les Irwig
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katy Bell
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
19
|
Trends in incidence and tumour grade in screen-detected ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res Treat 2017; 166:307-314. [PMID: 28748346 DOI: 10.1007/s10549-017-4412-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In a biennial screening mammography programme, we analysed the trends in incidence of screen-detected DCIS and invasive breast cancers in the era of screen-film mammography (SFM) screening, the period of the transition to full-field digital mammography (FFDM) screening and the period of FFDM screening. We also investigated a possible association between the incidence and grading of screen-detected DCIS and invasive breast cancer. METHODS In the southern part of the Netherlands, FFDM screening gradually replaced SFM screening between May 2009 and April 2010. We included a consecutive series of 484, 422 screens obtained between July 2005 and July 2015 and divided these screens into three groups; SFM-only cohort, transition cohort and FFDM-only cohort. RESULTS A total of 3059 referred women were diagnosed with DCIS (n = 623) or invasive breast cancer (n = 2436). The majority of DCIS were high-grade (48.2%), whereas the majority of the invasive breast cancers were low-grade (45.4%) or intermediate-grade (41.6%). The cancer detection rate (CDR) per 1000 screened women showed the same distribution by grade in both groups. The transition to FFDM was characterised by an increased overall detection rate of invasive cancers. CONCLUSIONS Screening mammography detects mostly high-grade DCIS and low- or intermediate-grade invasive cancers. The grade distribution as well as the CDR in the years after the introduction of FFDM remained stable compared to the era of SFM screening. By diagnosing and treating high-grade DCIS, which otherwise may develop into high-grade invasive carcinoma, our findings provide new evidence for the beneficial value of screening mammography programmes.
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Rahman MT, Codlin AJ, Rahman MM, Nahar A, Reja M, Islam T, Qin ZZ, Khan MAS, Banu S, Creswell J. An evaluation of automated chest radiography reading software for tuberculosis screening among public- and private-sector patients. Eur Respir J 2017; 49:1602159. [PMID: 28529202 PMCID: PMC5460641 DOI: 10.1183/13993003.02159-2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022]
Abstract
Computer-aided reading (CAR) of medical images is becoming increasingly common, but few studies exist for CAR in tuberculosis (TB). We designed a prospective study evaluating CAR for chest radiography (CXR) as a triage tool before Xpert MTB/RIF (Xpert).Consecutively enrolled adults in Dhaka, Bangladesh, with TB symptoms received CXR and Xpert. Each image was scored by CAR and graded by a radiologist. We compared CAR with the radiologist for sensitivity and specificity, area under the receiver operating characteristic curve (AUC), and calculated the potential Xpert tests saved.A total of 18 036 individuals were enrolled. TB prevalence by Xpert was 15%. The radiologist graded 49% of CXRs as abnormal, resulting in 91% sensitivity and 58% specificity. At a similar sensitivity, CAR had a lower specificity (41%), saving fewer (36%) Xpert tests. The AUC for CAR was 0.74 (95% CI 0.73-0.75). CAR performance declined with increasing age. The radiologist grading was superior across all sub-analyses.Using CAR can save Xpert tests, but the radiologist's specificity was superior. Differentiated CAR thresholds may be required for different populations. Access to, and costs of, human readers must be considered when deciding to use CAR software. More studies are needed to evaluate CAR using different screening approaches.
Collapse
Affiliation(s)
- Md Toufiq Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Md Mahfuzur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ayenun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mehdi Reja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tariqul Islam
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | | | | | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | |
Collapse
|
22
|
Mordang JJ, Gubern-Mérida A, Bria A, Tortorella F, den Heeten G, Karssemeijer N. Improving computer-aided detection assistance in breast cancer screening by removal of obviously false-positive findings. Med Phys 2017; 44:1390-1401. [DOI: 10.1002/mp.12152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 01/11/2017] [Accepted: 02/01/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jan-Jurre Mordang
- Diagnostic Image Analysis Group; Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Albert Gubern-Mérida
- Diagnostic Image Analysis Group; Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| | - Alessandro Bria
- Department of Electrical and Information Engineering; University of Cassino and Southern Lazio; Cassino Italy
| | - Francesco Tortorella
- Department of Electrical and Information Engineering; University of Cassino and Southern Lazio; Cassino Italy
| | - Gerard den Heeten
- Department of Radiology; Amsterdam Medical Center; Amsterdam The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group; Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen The Netherlands
| |
Collapse
|
23
|
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.
Collapse
|
24
|
Quantification of masking risk in screening mammography with volumetric breast density maps. Breast Cancer Res Treat 2017; 162:541-548. [PMID: 28161786 PMCID: PMC5332492 DOI: 10.1007/s10549-017-4137-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
Purpose Fibroglandular tissue may mask breast cancers, thereby reducing the sensitivity of mammography. Here, we investigate methods for identification of women at high risk of a masked tumor, who could benefit from additional imaging. Methods The last negative screening mammograms of 111 women with interval cancer (IC) within 12 months after the examination and 1110 selected normal screening exams from women without cancer were used. From the mammograms, volumetric breast density maps were computed, which provide the dense tissue thickness for each pixel location. With these maps, three measurements were derived: (1) percent dense volume (PDV), (2) percent area where dense tissue thickness exceeds 1 cm (PDA), and (3) dense tissue masking model (DTMM). Breast density was scored by a breast radiologist using BI-RADS. Women with heterogeneously and extremely dense breasts were considered at high masking risk. For each masking measure, mammograms were divided into a high- and low-risk category such that the same proportion of the controls is at high masking risk as with BI-RADS. Results Of the women with IC, 66.1, 71.9, 69.2, and 63.0% were categorized to be at high masking risk with PDV, PDA, DTMM, and BI-RADS, respectively, against 38.5% of the controls. The proportion of IC at high masking risk is statistically significantly different between BI-RADS and PDA (p-value 0.022). Differences between BI-RADS and PDV, or BI-RADS and DTMM, are not statistically significant. Conclusion Measures based on density maps, and in particular PDA, are promising tools to identify women at high risk for a masked cancer.
Collapse
|
25
|
Wanders JOP, Holland K, Veldhuis WB, Mann RM, Pijnappel RM, Peeters PHM, van Gils CH, Karssemeijer N. Volumetric breast density affects performance of digital screening mammography. Breast Cancer Res Treat 2016; 162:95-103. [PMID: 28012087 PMCID: PMC5288416 DOI: 10.1007/s10549-016-4090-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine to what extent automatically measured volumetric mammographic density influences screening performance when using digital mammography (DM). METHODS We collected a consecutive series of 111,898 DM examinations (2003-2011) from one screening unit of the Dutch biennial screening program (age 50-75 years). Volumetric mammographic density was automatically assessed using Volpara. We determined screening performance measures for four density categories comparable to the American College of Radiology (ACR) breast density categories. RESULTS Of all the examinations, 21.6% were categorized as density category 1 ('almost entirely fatty') and 41.5, 28.9, and 8.0% as category 2-4 ('extremely dense'), respectively. We identified 667 screen-detected and 234 interval cancers. Interval cancer rates were 0.7, 1.9, 2.9, and 4.4‰ and false positive rates were 11.2, 15.1, 18.2, and 23.8‰ for categories 1-4, respectively (both p-trend < 0.001). The screening sensitivity, calculated as the proportion of screen-detected among the total of screen-detected and interval tumors, was lower in higher density categories: 85.7, 77.6, 69.5, and 61.0% for categories 1-4, respectively (p-trend < 0.001). CONCLUSIONS Volumetric mammographic density, automatically measured on digital mammograms, impacts screening performance measures along the same patterns as established with ACR breast density categories. Since measuring breast density fully automatically has much higher reproducibility than visual assessment, this automatic method could help with implementing density-based supplemental screening.
Collapse
Affiliation(s)
- Johanna O P Wanders
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Katharina Holland
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Dutch Reference Centre for Screening, Postbus 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, St. Mary's Campus, Norfolk Place W2 1PG, London, UK
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| |
Collapse
|
26
|
Mordang JJ, Gubern-Mérida A, den Heeten G, Karssemeijer N. Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications. Med Phys 2016; 43:1676. [PMID: 27036566 DOI: 10.1118/1.4943376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In the past decades, computer-aided detection (CADe) systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists' detection rate. However, due to the high number of false positives marked by these CADe systems, they are not yet suitable as an independent reader. Breast arterial calcifications (BACs) are one of the most frequent false positives marked by CADe systems. In this study, a method is proposed for the elimination of BACs as positive findings. Removal of these false positives will increase the performance of the CADe system in finding malignant microcalcifications. METHODS A multistage method is proposed for the removal of BAC findings. The first stage consists of a microcalcification candidate selection, segmentation and grouping of the microcalcifications, and classification to remove obvious false positives. In the second stage, a case-based selection is applied where cases are selected which contain BACs. In the final stage, BACs are removed from the selected cases. The BACs removal stage consists of a GentleBoost classifier trained on microcalcification features describing their shape, topology, and texture. Additionally, novel features are introduced to discriminate BACs from other positive findings. RESULTS The CADe system was evaluated with and without BACs removal. Here, both systems were applied on a validation set containing 1088 cases of which 95 cases contained malignant microcalcifications. After bootstrapping, free-response receiver operating characteristics and receiver operating characteristics analyses were carried out. Performance between the two systems was compared at 0.98 and 0.95 specificity. At a specificity of 0.98, the sensitivity increased from 37% to 52% and the sensitivity increased from 62% up to 76% at a specificity of 0.95. Partial areas under the curve in the specificity range of 0.8-1.0 were significantly different between the system without BACs removal and the system with BACs removal, 0.129 ± 0.009 versus 0.144 ± 0.008 (p<0.05), respectively. Additionally, the sensitivity at one false positive per 50 cases and one false positive per 25 cases increased as well, 37% versus 51% (p<0.05) and 58% versus 67% (p<0.05) sensitivity, respectively. Additionally, the CADe system with BACs removal reduces the number of false positives per case by 29% on average. The same sensitivity at one false positive per 50 cases in the CADe system without BACs removal can be achieved at one false positive per 80 cases in the CADe system with BACs removal. CONCLUSIONS By using dedicated algorithms to detect and remove breast arterial calcifications, the performance of CADe systems can be improved, in particular, at false positive rates representative for operating points used in screening.
Collapse
Affiliation(s)
- Jan-Jurre Mordang
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Albert Gubern-Mérida
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Gerard den Heeten
- The National Training Centre for Breast Cancer Screening, Nijmegen 6503 GJ, The Netherlands and Department of Radiology, Amsterdam Medical Center, Amsterdam 1100 DD, The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| |
Collapse
|
27
|
Singh D, Pitkäniemi J, Malila N, Anttila A. Cumulative risk of false positive test in relation to breast symptoms in mammography screening: a historical prospective cohort study. Breast Cancer Res Treat 2016; 159:305-13. [PMID: 27496148 PMCID: PMC5012157 DOI: 10.1007/s10549-016-3931-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 12/29/2022]
Abstract
Mammography has been found effective as the primary screening test for breast cancer. We estimated the cumulative probability of false positive screening test results with respect to symptom history reported at screen. A historical prospective cohort study was done using individual screening data from 413,611 women aged 50-69 years with 2,627,256 invitations for mammography screening between 1992 and 2012 in Finland. Symptoms (lump, retraction, and secretion) were reported at 56,805 visits, and 48,873 visits resulted in a false positive mammography result. Generalized linear models were used to estimate the probability of at least one false positive test and true positive at screening visits. The estimates were compared among women with and without symptoms history. The estimated cumulative probabilities were 18 and 6 % for false positive and true positive results, respectively. In women with a history of a lump, the cumulative probabilities of false positive test and true positive were 45 and 16 %, respectively, compared to 17 and 5 % with no reported lump. In women with a history of any given symptom, the cumulative probabilities of false positive test and true positive were 38 and 13 %, respectively. Likewise, women with a history of a 'lump and retraction' had the cumulative false positive probability of 56 %. The study showed higher cumulative risk of false positive tests and more cancers detected in women who reported symptoms compared to women who did not report symptoms at screen. The risk varies substantially, depending on symptom types and characteristics. Information on breast symptoms influences the balance of absolute benefits and harms of screening.
Collapse
Affiliation(s)
- Deependra Singh
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland.
- School of Health Sciences, University of Tampere, Arvo Building, Lääkärinkatu 1, 33014, Tampere, Finland.
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
- School of Health Sciences, University of Tampere, Arvo Building, Lääkärinkatu 1, 33014, Tampere, Finland
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland
| |
Collapse
|
28
|
Le MT, Mothersill CE, Seymour CB, McNeill FE. Is the false-positive rate in mammography in North America too high? Br J Radiol 2016; 89:20160045. [PMID: 27187600 PMCID: PMC5124917 DOI: 10.1259/bjr.20160045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.
Collapse
Affiliation(s)
- Michelle T Le
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel E Mothersill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Colin B Seymour
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Fiona E McNeill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Théberge I, Vandal N, Langlois A, Pelletier É, Brisson J. Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program. Can Assoc Radiol J 2016; 67:330-338. [PMID: 27451910 DOI: 10.1016/j.carj.2016.02.001] [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: 08/17/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
Collapse
Affiliation(s)
- Isabelle Théberge
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada.
| | - Nathalie Vandal
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - André Langlois
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Éric Pelletier
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada
| |
Collapse
|
31
|
Characteristics and prognosis of interval cancers after biennial screen-film or full-field digital screening mammography. Breast Cancer Res Treat 2016; 158:471-83. [DOI: 10.1007/s10549-016-3882-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
|
32
|
van Bommel R, Voogd AC, Louwman MW, Strobbe LJ, Venderink D, Duijm LEM. Screening outcome in women repeatedly recalled for the same mammographic abnormality before, during and after the transition from screen-film to full-field digital screening mammography. Eur Radiol 2016; 27:553-561. [PMID: 27180183 DOI: 10.1007/s00330-016-4399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/08/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively determine screening outcome in women recalled twice for the same mammographic lesion before, during, and after transition from screen-film (SFM) to full-field digital screening mammography (FFDM). METHODS We included women with a repeated recall for the same mammographic abnormality (37 at subsequent SFM-screening, obtained between January 2000-April 2010; respectively 54 and 65 women with a prior SFM-screen or FFDM-screen followed by subsequent FFDM-screening, obtained between May 2009-July 2013). RESULTS At SFM-screening, repeated recalls for the same lesion comprised 1.2 % of recalls (37/3217), including 13 malignancies (positive predictive value (PPV), 35.1 %). During the SFM to FFDM transition (SFM-screen followed by FFDM-screen), FFDM recalls comprised more repeated recalls for the same lesion (2.2 %, P = 0.002), with a lower PPV (14.8 %, P = 0.02). This proportion increased to 2.8 % after transition to FFDM (i.e., two successive FFDM-screens), with 16 malignancies (PPV, 24.6 %). Invasive cancers at repeated recall were smaller than interval cancers (T1a-c, 79.4 versus 46.8 %, P = 0.001), with less lymph node involvement (20.6 versus 46.5 %, P = 0.007). CONCLUSIONS More women are repeatedly recalled for the same mammographic abnormality during and after the transition from SFM to FFDM-screening, with comparable cancer risks before and after the transition. These cancers show better prognostic characteristics than interval cancers. KEY POINTS • FFDM-screening increases the number of repeated recalls for the same mammographic abnormality. • The PPV of these recalls is comparable before and after transition to FFDM-screening. • Cancers diagnosed after a repeated recall are smaller than interval cancers. • These cancers also show less lymph node involvement than interval cancers.
Collapse
Affiliation(s)
- Rob van Bommel
- Department of Radiology, Catharina Hospital, PO Box 1530, 5602 ZA, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Marieke W Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, PO Box 9015, 6500 GS, Nijmegen, The Netherlands. .,Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands.
| |
Collapse
|
33
|
Breast Cancer Characteristics Associated With Digital Versus Film-Screen Mammography for Screen-Detected and Interval Cancers. AJR Am J Roentgenol 2015; 205:676-84. [PMID: 26295657 DOI: 10.2214/ajr.14.13904] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether pathologic findings of screen-detected and interval cancers differ for digital versus film mammography. MATERIALS AND METHODS Breast Cancer Surveillance Consortium data from 2003-2011 on 3,021,515 screening mammograms (40.3% digital, 59.7% film) of women 40-89 years old were reviewed. Cancers were considered screen detected if diagnosed within 12 months of an examination with positive findings and interval if diagnosed within 12 months of an examination with negative findings. Tumor characteristics for screen-detected and interval cancers were compared for digital versus film mammography by use of logistic regression models to estimate the odds ratio and 95% CI with adjustment for age, race and ethnicity, hormone therapy use, screening interval, examination year, and registry. Generalized estimating equations were used to account for correlation within facilities. RESULTS Among 15,729 breast cancers, 85.3% were screen detected and 14.7% were interval. Digital and film mammography had similar rates of screen-detected (4.47 vs 4.42 per 1000 examinations) and interval (0.73 vs 0.79 per 1000 examinations) cancers for digital versus film. In adjusted analyses, interval cancers diagnosed after digital examinations with negative findings were less likely to be American Joint Committee on Cancer stage IIB or higher (odds ratio, 0.69; 95% CI, 0.52-0.93), have positive nodal status (odds ratio, 0.78; 95% CI, 0.64-0.95), or be estrogen receptor negative (odds ratio, 0.71; 95% CI, 0.56-0.91) than were interval cancers diagnosed after a film examination with negative findings. CONCLUSION Screen-detected cancers diagnosed after digital and film mammography had similar rates of unfavorable tumor characteristics. Interval-detected cancers diagnosed after a digital examination were less likely to have unfavorable tumor features than those diagnosed after film mammography, but the absolute differences were small.
Collapse
|
34
|
Chamming's F, Chopier J, Mathelin C, Chéreau E. [Explorations of breast microcalcifications: Guidelines]. ACTA ACUST UNITED AC 2015; 44:960-9. [PMID: 26527023 DOI: 10.1016/j.jgyn.2015.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess imaging performances for the detection, characterization and biopsy of breast microcalcifications and make recommendations. MATERIALS AND METHODS French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. RESULTS Digital mammography (DR [Direct Radiography] and CR [Computed Radiography]) and screen-film mammography demonstrate good performances for the detection and the characterization of breast microcalcifications. Systematic use of the 2013 edition of the BI-RADS lexicon is recommended for description and characterization of microcalcifications. Faced with BI-RADS 4 or 5 microcalcifications, breast ultrasound is recommended but a normal result does not eliminate the diagnosis of cancer and other examination should be performed. Literature review does not allow recommending digital breast tomosynthesis, elastography or MRI to analyze microcalcifications. In case of probably benign microcalcifications (BI-RADS 3), six months, one year and at least two years follow-up are recommended. In case a biopsy is indicated, it is recommended to use a vacuum-assisted macrobiopsy system with 11-gauges needles or bigger. If no calcification is visible on the radiography of the specimen, it is recommended to obtain additional samples.
Collapse
Affiliation(s)
- F Chamming's
- Service de radiologie, hôpital européen George-Pompidou AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - E Chéreau
- Service de chirurgie oncologique, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| |
Collapse
|
35
|
Muralidhar GS, Bovik AC, Markey MK. Disparity Estimation on Stereo Mammograms. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2015; 24:2851-2863. [PMID: 25974940 DOI: 10.1109/tip.2015.2432714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We consider the problem of depth estimation on digital stereo mammograms. Being able to elucidate 3D information from stereo mammograms is an important precursor to conducting 3D digital analysis of data from this promising new modality. The problem is generally much harder than the classic stereo matching problem on visible light images of the natural world, since nearly all of the 3D structural information of interest exists as complex network of multilayered, heavily occluded curvilinear structures. Toward addressing this difficult problem, we formulate a new stereo model that minimizes a global energy functional to densely estimate disparity on stereo mammogram images, by introducing a new singularity index as a constraint to obtain better estimates of disparity along critical curvilinear structures. Curvilinear structures, such as vasculature and spicules, are particularly salient structures in the breast, and being able to accurately position them in 3D is a valuable goal. Experiments on synthetic images with known ground truth and on real stereo mammograms highlight the advantages of the proposed stereo model over the canonical stereo model.
Collapse
|
36
|
Subhedar P, Olcese C, Patil S, Morrow M, Van Zee KJ. Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years. Ann Surg Oncol 2015. [PMID: 26215193 DOI: 10.1245/s10434-015-4740-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Randomized trials of radiation after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) found substantial rates of recurrence, with half of the recurrences being invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed and are largely attributed to improvements in systemic therapy. In this study, we examine recurrence rates after BCS for DCIS over 3 decades at one institution. METHODS We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010. Cox proportional hazard models were used to investigate the association between the treatment period and recurrence, controlling for other variables. RESULTS Overall, 363 (12%) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0-30 years); 732 patients were followed for ≥10 years. The 5-year recurrence rate for the period 1978-1998 was 13.6 versus 6.6% for the period 1999-2010 [hazard ratio (HR) 0.62, p < 0.0001]. Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p = 0.003). CONCLUSIONS Recurrence rates for DCIS have fallen over time, with increases in screen detection, negative margins, and use of adjuvant therapies only partially explaining this decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy but may be due to improvements in radiologic detection and pathologic assessment.
Collapse
Affiliation(s)
- Preeti Subhedar
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | |
Collapse
|
37
|
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.
Collapse
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
| | | |
Collapse
|
38
|
Geertse TD, Holland R, Timmers JMH, Paap E, Pijnappel RM, Broeders MJM, den Heeten GJ. Value of audits in breast cancer screening quality assurance programmes. Eur Radiol 2015; 25:3338-47. [DOI: 10.1007/s00330-015-3744-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 11/29/2022]
|
39
|
Sherman ME, Mies C, Gierach GL. Opportunities for molecular epidemiological research on ductal carcinoma in-situ and breast carcinogenesis: interdisciplinary approaches. Breast Dis 2015; 34:105-16. [PMID: 24225267 DOI: 10.3233/bd-130359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most invasive breast cancers arise from ductal carcinoma in-situ (DCIS), a non-obligate precursor of invasive breast cancer. Given that the natural history of individual DCIS lesions is unpredictable, many women with DCIS receive extensive treatments, which may include surgery, radiation and endocrine therapy, even though many of these lesions may have limited potential to progress to invasion and metastasize. In contrast to valid concerns about overtreatment, the fact that invasive breast cancers outnumber DCIS lesions by more than three-to-one, suggests that many cancer precursors (particularly DCIS, but LCIS also) progress to invasion prior to detection. Thus, DCIS poses a dual problem of overdiagnosis among some women and failure of early detection among others. These concerns are heightened by the multifold increase in rates of DCIS in conjunction with widespread use of mammographic screening and access to outpatient radiologically-guided biopsies. Accordingly, methods are needed to both specifically detect and identify DCIS lesions with potential to progress to invasive cancer and to discover techniques to triage and conservatively manage indolent cases of DCIS.
Collapse
Affiliation(s)
- Mark E Sherman
- National Cancer Institute, Division of Cancer Prevention, Bethesda, MD, USA
| | - Carolyn Mies
- University of Pennsylvania, Philadelphia, PA, USA
| | - Gretchen L Gierach
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| |
Collapse
|
40
|
Knox M, O'Brien A, Szabó E, Smith CS, Fenlon HM, McNicholas MM, Flanagan FL. Impact of full field digital mammography on the classification and mammographic characteristics of interval breast cancers. Eur J Radiol 2015; 84:1056-61. [PMID: 25816990 DOI: 10.1016/j.ejrad.2015.03.007] [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] [Received: 01/19/2015] [Revised: 02/20/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Full field digital mammography (FFDM) is increasingly replacing screen film mammography (SFM) in breast screening programs. Interval breast cancers are an issue in all screening programs and the purpose of our study is to assess the impact of FFDM on the classification of interval breast cancers at independent blind review and to compare the mammographic features of interval cancers at FFDM and SFM. MATERIALS AND METHODS This study included 138 cases of interval breast cancer, 76 following an FFDM screening examination and 62 following screening with SFM. The prior screening mammogram was assessed by each of five consultant breast radiologists who were blinded to the site of subsequent cancer. Subsequent review of the diagnostic mammogram was performed and cases were classified as missed, minimal signs, occult or true interval. Mammographic features of the interval cancer at diagnosis and any abnormality identified on the prior screening mammogram were recorded. RESULTS The percentages of cancers classified as missed at FFDM and SFM did not differ significantly, 10.5% (8 of 76) at FFDM and 8.1% (5 of 62) at SFM (p=.77). There were significantly less interval cancers presenting as microcalcifications (alone or in association with another abnormality) following screening with FFDM, 16% (12 of 76) than following a SFM examination, 32% (20 of 62) (p=.02). CONCLUSION Interval breast cancers continue to pose a problem at FFDM. The switch to FFDM has changed the mammographic presentation of interval breast cancer, with less interval cancers presenting in association with microcalcifications.
Collapse
Affiliation(s)
- Mark Knox
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Angela O'Brien
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Endre Szabó
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Clare S Smith
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Helen M Fenlon
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Michelle M McNicholas
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Fidelma L Flanagan
- BreastCheck (The Irish National Breast Screening Program) and the Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| |
Collapse
|
41
|
Allison KH, Abraham LA, Weaver DL, Tosteson ANA, Nelson HD, Onega T, Geller BM, Kerlikowske K, Carney PA, Ichikawa LE, Buist DSM, Elmore JG. Trends in breast biopsy pathology diagnoses among women undergoing mammography in the United States: a report from the Breast Cancer Surveillance Consortium. Cancer 2015; 121:1369-78. [PMID: 25603785 DOI: 10.1002/cncr.29199] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/14/2014] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Current data on the pathologic diagnoses of breast biopsy after mammography can inform patients, clinicians, and researchers about important population trends. METHODS Breast Cancer Surveillance Consortium data on 4,020,140 mammograms between 1996 and 2008 were linked to 76,567 pathology specimens. Trends in diagnoses in biopsies by time and risk factors (patient age, breast density, and family history of breast cancer) were examined for screening and diagnostic mammography (performed for a breast symptom or short-interval follow-up). RESULTS Of the total mammograms, 88.5% were screening and 11.5% diagnostic; 1.2% of screening and 6.8% of diagnostic mammograms were followed by biopsies. The frequency of biopsies over time was stable after screening mammograms, but increased after diagnostic mammograms. For biopsies obtained after screening, frequencies of invasive carcinoma increased over time for women ages 40-49 and 60-69, Ductal carcinoma in situ (DCIS) increased for those ages 40-69, whereas benign diagnoses decreased for all ages. No trends in pathology diagnoses were found following diagnostic mammograms. Dense breast tissue was associated with high-risk lesions and DCIS relative to nondense breast tissue. Family history of breast cancer was associated with DCIS and invasive cancer. CONCLUSIONS Although the frequency of breast biopsy after screening mammography has not changed over time, the percentages of biopsies with DCIS and invasive cancer diagnoses have increased. Among biopsies following mammography, women with dense breasts or family history of breast cancer were more likely to have high-risk lesions or invasive cancer. These findings are relevant to breast cancer screening and diagnostic practices.
Collapse
Affiliation(s)
- Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Weber RJ, Nederend J, Voogd AC, Strobbe LJ, Duijm LE. Screening outcome and surgical treatment during and after the transition from screen-film to digital screening mammography in the south of The Netherlands. Int J Cancer 2014; 137:135-43. [DOI: 10.1002/ijc.29354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/11/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Roy J.P. Weber
- Department of Radiology; Catharina Hospital; Eindhoven The Netherlands
| | - Joost Nederend
- Department of Radiology; Catharina Hospital; Eindhoven The Netherlands
| | - Adri C. Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry; Eindhoven The Netherlands
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
| | - Luc J. Strobbe
- Department of Surgery; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Lucien E.M. Duijm
- Department of Radiology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| |
Collapse
|
43
|
Outcomes of patients with lobular in situ neoplasia of the breast: The role of vacuum-assisted biopsy. Breast 2014; 23:651-5. [DOI: 10.1016/j.breast.2014.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/17/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
|
44
|
Is the Upgrade Rate of Atypical Ductal Hyperplasia Diagnosed by Core Needle Biopsy of Calcifications Different for Digital and Film-Screen Mammography? AJR Am J Roentgenol 2014; 203:917-22. [DOI: 10.2214/ajr.13.11862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
45
|
Klompenhouwer EG, Duijm LEM, Voogd AC, den Heeten GJ, Strobbe LJ, Louwman MW, Coebergh JW, Venderink D, Broeders MJM. Re-attendance at biennial screening mammography following a repeated false positive recall. Breast Cancer Res Treat 2014; 145:429-37. [DOI: 10.1007/s10549-014-2959-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
|
46
|
Hofvind S, Skaane P, Elmore JG, Sebuødegård S, Hoff SR, Lee CI. Mammographic performance in a population-based screening program: before, during, and after the transition from screen-film to full-field digital mammography. Radiology 2014; 272:52-62. [PMID: 24689858 DOI: 10.1148/radiol.14131502] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare performance measures before, during, and after the transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) in a population-based screening program. MATERIALS AND METHODS No institutional review board approval was required for this analysis involving anonymized data for women aged 50-69 years enrolled in the Norwegian Breast Cancer Screening Program during 1996-2010. The χ(2) test was used to examine the equality of proportions of recall rates, positive predictive value of recall examinations and of invasive procedures, in addition to rates of screening-detected and interval cancers in women initially screened with SFM and FFDM and for women subsequently screened with SFM after SFM, FFDM after SFM, and FFDM after FFDM. RESULTS The recall rate was 3.4% (47 091 of 1 391 188) for SFM and 2.9% (13 130 of 446 172) for FFDM (P < .001). The biopsy rate was 1.4% (19 776 of 1 391 188) for SFM and 1.1% (5108 of 446 172) for FFDM (P < .001). The rate of screening-detected ductal carcinoma in situ was higher (P = .019) while the rate of invasive breast cancer was lower (P < .001) for FFDM compared with those for SFM. The rate of both invasive screening-detected and interval breast cancer remained stable during the transition from SFM to FFDM (when the previous examination was SFM) and after FFDM was firmly established (when the previous examination was FFDM, >25 months after FFDM adoption) (P < .05). The positive predictive value of recall examinations and of invasive procedures increased from 19.3% (4559 of 23 598) and 48.3% (4651 of 9623) to 22.7% (681 of 2995) and 57.5% (689 of 1198), respectively, after adoption of FFDM (P < .001). CONCLUSION After the initial transitional phase from SFM to FFDM, population-based screening with FFDM is associated with less harm because of lower recall and biopsy rates and higher positive predictive values after biopsy than screening with SFM.
Collapse
Affiliation(s)
- Solveig Hofvind
- From the Department of Research, Cancer Registry of Norway, PO Box 5313, 0304 Oslo, Norway (S.H., S.S.); Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (S.H.); Department of Radiology, Oslo University Hospital, University of Oslo, Norway (P.S.); Departments of Medicine (J.G.E.) and Radiology (C.I.L.), School of Medicine, and Department of Epidemiology, School of Public Health (J.G.E.), University of Washington, Seattle, Wash; and Department of Radiology, Aalesund Hospital, Møre og Romsdal, Norway (S.R.H.)
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Advances in methods used to diagnose breast cancer have resulted in the increased detection of ductal carcinoma in situ; most of these are detected by screening mammograms and are confirmed by core needle biopsy. Currently, classification schemas are moving toward a molecular approach. Treatment options for patients with ductal carcinoma in situ are multiple and take into consideration end points such as local, regional or distant recurrence, overall survival and quality of life. Treatment methods continue to be controversial and debated in the oncology community. The quality of local control is multifactorial and depends on adequate surgical clearance, biological characteristics of the tumor, clinical presentation and the possibility of radiation therapies.
Collapse
Affiliation(s)
- Shivani Duggal
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA
| | | | | |
Collapse
|
48
|
Variations in screening outcome among pairs of screening radiologists at non-blinded double reading of screening mammograms: a population-based study. Eur Radiol 2014; 24:1097-104. [PMID: 24500086 DOI: 10.1007/s00330-014-3102-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/10/2013] [Accepted: 01/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Substantial inter-observer variability in screening mammography interpretation has been reported at single reading. However, screening results of pairs of screening radiologists have not yet been published. We determined variations in screening performances among pairs of screening radiologists at non-blinded double reading. METHODS We included pairs of screening radiologists with at least 7,500 screening examinations per pair, obtained between 1997 and 2011. During 2-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women and interval cancers. Referral rate, cancer detection rate, positive predictive value and sensitivity were calculated for each pair. RESULTS A total of 310,906 screening mammograms, read by 26 pairs of screening radiologists, were included for analysis. The referral rate ranged from 1.0 % (95 % CI 0.8 %-1.2 %) to 1.5 % (95 % CI 1.3 %-1.8 %), the cancer detection rate from 4.0 (95 % CI 2.8-5.2) to 6.3 (95 % CI 4.5-8.0) per 1,000 screens. The programme sensitivity and positive predictive value of referral ranged from 55.1 % (95 % CI 45.1 %-65.1 %) to 81.5 % (95 % CI 73.4 %-89.6 %) and from 28.7 % (95 % CI 20.8 %-36.6 %) to 49.5 % (95 % CI 39.7 %-59.3 %), respectively. CONCLUSION We found significant variations in screening outcomes among pairs of screening radiologists at non-blinded double reading. This stresses the importance of monitoring screening results on a local scale. KEY POINTS • Substantial inter-observer variability in screening mammography interpretation is known at single reading • Population-based study showed significant variations in outcomes among pairs of screening radiologists • Local monitoring and regular feedback are important to optimise screening outcome.
Collapse
|
49
|
Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, Domingo L, Rue M. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer. PLoS One 2014; 9:e86858. [PMID: 24498285 PMCID: PMC3911927 DOI: 10.1371/journal.pone.0086858] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 12/16/2013] [Indexed: 12/29/2022] Open
Abstract
The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.
Collapse
Affiliation(s)
- Ester Vilaprinyo
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
| | - Carles Forné
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
| | - Misericordia Carles
- Economics Department and Research Centre on Industrial and Public Economics (CREIP), Rovira i Virgili University, Reus, Catalonia, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
| | - Roger Pla
- Surgery Department, Rovira i Virgili University, Reus, Catalonia, Spain
- General and Digestive Surgery Department, Joan XXIII Teaching Hospital, Tarragona, Catalonia, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
| | - Montserrat Rue
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
- * E-mail:
| | | |
Collapse
|
50
|
Bria A, Karssemeijer N, Tortorella F. Learning from unbalanced data: A cascade-based approach for detecting clustered microcalcifications. Med Image Anal 2014; 18:241-52. [DOI: 10.1016/j.media.2013.10.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/18/2013] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
|