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Raichand S, Blaya-Novakova V, Berber S, Livingstone A, Noguchi N, Houssami N. Digital breast tomosynthesis for breast cancer diagnosis in women with dense breasts and additional breast cancer risk factors: A systematic review. Breast 2024; 77:103767. [PMID: 38996609 PMCID: PMC11296044 DOI: 10.1016/j.breast.2024.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
INTRODUCTION Digital breast tomosynthesis (DBT) may improve sensitivity in population screening. However, evidence is currently limited on the performance of DBT in patients at a higher risk of breast cancer. This systematic review compares the clinical effectiveness and cost-effectiveness of DBT, digital mammography (DM), and ultrasound, for breast cancer detection in women with dense breasts and additional risk factors. METHODS Medline, Embase, and Evidence-Based Medicine Reviews via OvidSP were searched to identify literature from 2010 to August 21, 2023. Selection of studies, data extraction, and quality assessment (using QUADAS-2 and CHEERS) were completed in duplicate. Findings were summarised descriptively and narratively. RESULTS Twenty-six studies met pre-specified inclusion criteria. In women with breast symptoms or recalled for investigation of screen-detected findings (19 studies), DBT may be more accurate than DM. For example, in symptomatic women, the sensitivity of DBT + DM ranged from 82.8 % to 92.5 % versus 56.8 %-81.3 % for mammography (DM/synthesised images). However, most studies had a high risk of bias due to participant selection. Evidence regarding DBT in women with a personal or family history of breast cancer, for DBT versus ultrasound alone, and cost-effectiveness of DBT was limited. CONCLUSIONS In women with dense breasts and additional risk factors for breast cancer, evidence is limited about the accuracy of DBT compared to other imaging modalities, particularly in those with personal or family history of breast cancer. Future research in this population should consider head-to-head comparisons of imaging modalities to determine the relative effectiveness of these imaging tests. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42021236470.
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Affiliation(s)
- Smriti Raichand
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Vendula Blaya-Novakova
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Slavica Berber
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Ann Livingstone
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Naomi Noguchi
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Nehmat Houssami
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; The Daffodil Centre, The University of Sydney - a Joint Venture with Cancer Council NSW, NSW, Australia.
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Lin S, Li H, Li Y, Chen Q, Ye J, Lin S, Cai S, Sun J. Diagnostic performance of contrast-enhanced mammography for suspicious findings in dense breasts: A systematic review and meta-analysis. Cancer Med 2024; 13:e7128. [PMID: 38659408 PMCID: PMC11043676 DOI: 10.1002/cam4.7128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Contrast-enhanced spectral imaging (CEM) is a new mammography technique, but its diagnostic value in dense breasts is still inconclusive. We did a systematic review and meta-analysis of studies evaluating the diagnostic performance of CEM for suspicious findings in dense breasts. MATERIALS AND METHODS The PubMed, Embase, and Cochrane Library databases were searched systematically until August 6, 2023. Prospective and retrospective studies were included to evaluate the diagnostic performance of CEM for suspicious findings in dense breasts. The QUADAS-2 tool was used to evaluate the quality and risk of bias of the included studies. STATA V.16.0 and Review Manager V.5.3 were used to meta-analyze the included studies. RESULTS A total of 10 studies (827 patients, 958 lesions) were included. These 10 studies reported the diagnostic performance of CEM for the workup of suspicious lesions in patients with dense breasts. The summary sensitivity and summary specificity were 0.95 (95% CI, 0.92-0.97) and 0.81 (95% CI, 0.70-0.89), respectively. Enhanced lesions, circumscribed margins, and malignancy were statistically correlated. The relative malignancy OR value of the enhanced lesions was 28.11 (95% CI, 6.84-115.48). The relative malignancy OR value of circumscribed margins was 0.17 (95% CI, 0.07-0.45). CONCLUSION CEM has high diagnostic performance in the workup of suspicious findings in dense breasts, and when lesions are enhanced and have irregular margins, they are often malignant.
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Affiliation(s)
- Shu‐ting Lin
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Hong‐jiang Li
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Yi‐zhong Li
- Department of BoneThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Qian‐qian Chen
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jia‐yi Ye
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Shu Lin
- Center of Neurological and Metabolic ResearchThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
- Department of Neuroendocrinology, Group of NeuroendocrinologyGarvan Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Si‐qing Cai
- Department of RadiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
| | - Jian‐guo Sun
- Department of Urinary SurgeryThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouFujianChina
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Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. Br J Radiol 2024; 97:695-704. [PMID: 38374651 PMCID: PMC11027262 DOI: 10.1093/bjr/tqae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Contrast-enhanced mammography (CEM) is an emerging breast imaging technology with promise for breast cancer screening, diagnosis, and procedural guidance. However, best uses of CEM in comparison with other breast imaging modalities such as tomosynthesis, ultrasound, and MRI remain inconclusive in many clinical settings. This review article summarizes recent peer-reviewed literature, emphasizing retrospective reviews, prospective clinical trials, and meta-analyses published from 2020 to 2023. The intent of this article is to supplement prior comprehensive reviews and summarize the current state-of-the-art of CEM.
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Affiliation(s)
- Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, UT, 84112, United States
| | - Samantha Salmon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
| | - Bradley D Weaver
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, 84112, United States
| | - Laurie L Fajardo
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84112, United States
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Gauci SL, Couto JG, Mizzi D. Survey of knowledge and awareness of breast density amongst Maltese Women undergoing mammography screening. Radiography (Lond) 2023; 29:911-917. [PMID: 37473492 DOI: 10.1016/j.radi.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION The ratio of breast glandular tissue to fatty tissue is known as breast density. This study assessed the knowledge and awareness of breast density of Maltese women undergoing mammography screening at the National Screening Unit. Increased breast density knowledge may lead to an increase in supplementary imaging attendance. In Europe, there are very limited studies assessing the knowledge and awareness of breast density, providing a solid rationale for this study to be done locally. METHODS Women aged 50 to 69 who were eligible for breast cancer screening at the National Screening Unit were given a validated closed-ended questionnaire as part of a quantitative, prospective, cross-sectional, and descriptive study. The questionnaire was designed to achieve the aims of the study. Using IBM-SPSS (v28) software, the data was analysed using the Friedman and Kruskal Wallis tests. RESULTS A total of 127 surveys were gathered, with a maximum margin of error of 8.66% based on a 95% confidence range. Breast density and the risks associated with it were not well known or understood (average scores ranging from 2.80 to 3.34 out of 5), but supplemental screening was more widely known (3.65). Participants' knowledge and awareness were correlated with their age, profession, and degree of education. Leaflets (40%) and medical experts (40%) were respondents' favourite sources of information. CONCLUSION The population under study lacks knowledge and awareness of breast density and the risks it entails. It's important to provide women more details about breast density. With this information, women will be empowered to seek the finest care. IMPLICATIONS FOR PRACTICE Although some socio-demographic parameters were linked to women's knowledge and awareness, it is advised that more research be done using a bigger sample size through interviews and other studies. Moreover, more information regarding breast density must be provided to women undergoing breast cancer screening in Malta to increase their knowledge and awareness.
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Affiliation(s)
- S L Gauci
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - J G Couto
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - D Mizzi
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
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Kamal EF, Kamal RM, Mahmoud AM, Mekhaimar MI, Hanafy MM. Comparative study between conventional ultrasound strain elastography and an AI-enabled elastography software in differentiating breast masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Conventional ultrasound elastography is a relatively novel noninvasive imaging study that assesses tissue stiffness and helps in the characterization of breast lesions. However, strain elastography is not available in some ultrasound machines especially those before 2003 and is susceptible by motion artifacts. Our aim was to compare the results of conventional ultrasound elastography and the results of an advanced intelligence-enabled elastography software. Also, we aimed to assess the feasibility of the AI-enabled elastography software to overcome the unavailability of the conventional elastography software in some new ultrasound machines.
Results
The study included 53 patients, who had breast lesions either clinically felt or detected during screening. All patients were subjected to both grayscale US imaging and conventional ultrasound elastography; quasi-static compression was applied during acquiring one of the cine-loops of the grayscale US imaging. Also, the cine-loops of the grayscale US imaging while quasi-static compression were processed by an AI-enabled elastography software. Then, the results of the strain ratio (SR) calculated by conventional elastography software and those by AI-enabled elastography software were compared. The strain ratio calculated using the AI-enabled elastography software showed better results than conventional ultrasound elastography strain ratio. The AI-enabled software shows better specificity, sensitivity, positive predictive values, and negative predictive values than the conventional ultrasound elastography.
Conclusion
The AI-enabled elastography software shows promising results compared to the conventional US elastography. Elastography does not have the potential to replace conventional B-mode US for the detection of breast cancer but may complement the conventional US to improve diagnostic performance.
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Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
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Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
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