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Pender K. Cracking open the eristic rhetoric of contralateral prophylactic mastectomy research or why surgeons should not be so certain about this controversial breast cancer treatment. MEDICAL HUMANITIES 2023; 49:378-389. [PMID: 36549858 DOI: 10.1136/medhum-2022-012460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Contralateral prophylactic mastectomy (CPM) is a controversial breast cancer treatment in which both breasts are removed when only one is affected by cancer. Rates of CPM have been rising since the late 1990s, despite surgeons' strong agreement that the procedure should not be performed for average-risk women. This essay analyses that agreement as it is demonstrated in the surgical literature on CPM, arguing that it forms a 'rhetoric of certainty' built on the stark epistemological divide between objective and subjective forms of knowledge that operates in some areas of medicine. Further, the essay argues that this rhetoric of certainty has the potential to function as a kind of eristic rhetoric in which the right conclusion is known prior to any rhetorical exchange. As a way to 'crack open' this certainty, the essay compares the rhetoric of the surgical literature on CPM to the rhetoric of uncertainty in the radiological literature on breast cancer screening for women with a personal history of the disease. The goal of this comparison is not to suggest surgeons should support all choices for CPM. Rather, the aim is to demonstrate that choices against the procedure are not as straightforward as the surgical literature indicates and that the uncertainty affecting women's preferences for CPM is not solely the result of patient misunderstanding and/or emotional instability.
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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Lee JM, Ichikawa LE, Wernli KJ, Bowles EJA, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer. Korean J Radiol 2023; 24:729-738. [PMID: 37500574 PMCID: PMC10400369 DOI: 10.3348/kjr.2022.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE When multiple surveillance mammograms are performed within an annual interval, the current guidance for one-year follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses. MATERIALS AND METHODS We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up). RESULTS Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%. CONCLUSION Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.
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Affiliation(s)
- Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Laura E Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer M Specht
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Veterans Affairs, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Nehmat Houssami
- The Daffodil Centre, University of Sydney and Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
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Ha SM, Lee JM, Kim SO, Moon WK, Chang JM. Semiannual Breast US or MRI Screening in Patients with a Personal History of Breast Cancer. Radiology 2023; 307:e221660. [PMID: 37158719 DOI: 10.1148/radiol.221660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background The wide variability of screening imaging use in patients with a personal history of breast cancer (PHBC) warrants investigation of its comparative clinical effectiveness. While more intensive screening with US or MRI at an interval of less than 1 year could increase early-stage breast cancer detection, its benefit has not been established. Purpose To investigate the outcomes of semiannual multimodality screening in patients with PHBC. Materials and Methods An academic medical center database was retrospectively searched for patients diagnosed with breast cancer between January 2015 and June 2018 who had undergone annual mammography with either semiannual incidence US or MRI screening from July 2019 to December 2019 and three subsequent semiannual screenings over a 2-year period. The primary outcome was second breast cancers diagnosed during follow-up. Examination-level cancer detection and interval cancer rates were calculated. Screening performances were compared with χ2 or Fisher exact tests or a logistic model with generalized estimating equations. Results Our final cohort included 2758 asymptomatic women (median age, 53 years; range, 20-84 years). Among 5615 US and 1807 MRI examinations, 18 breast cancers were detected after negative findings on a prior semiannual incidence US screening examination; 44% (eight of 18) were stage 0 (three detected with MRI; five, with US), and 39% (seven of 18) were stage I (three detected with MRI; four, with US). MRI had a cancer detection rate up to 17.1 per 1000 examinations (eight of 467; 95% CI: 8.7, 33.4), and the overall cancer detection rates of US and MRI were 1.8 (10 of 5615; 95% CI: 1.0, 3.3) and 4.4 (eight of 1807; 95% CI: 2.2, 8.8) per 1000 examinations, respectively (P = .11). Conclusion Supplemental semiannual US or MRI screening depicted second breast cancers after negative findings at prior semiannual incidence US examination in patients with PHBC. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Berg in this issue.
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Affiliation(s)
- Su Min Ha
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Janie M Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Seon-Ok Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Woo Kyung Moon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Jung Min Chang
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
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Madani M, Behzadi MM, Nabavi S. The Role of Deep Learning in Advancing Breast Cancer Detection Using Different Imaging Modalities: A Systematic Review. Cancers (Basel) 2022; 14:5334. [PMID: 36358753 PMCID: PMC9655692 DOI: 10.3390/cancers14215334] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
Abstract
Breast cancer is among the most common and fatal diseases for women, and no permanent treatment has been discovered. Thus, early detection is a crucial step to control and cure breast cancer that can save the lives of millions of women. For example, in 2020, more than 65% of breast cancer patients were diagnosed in an early stage of cancer, from which all survived. Although early detection is the most effective approach for cancer treatment, breast cancer screening conducted by radiologists is very expensive and time-consuming. More importantly, conventional methods of analyzing breast cancer images suffer from high false-detection rates. Different breast cancer imaging modalities are used to extract and analyze the key features affecting the diagnosis and treatment of breast cancer. These imaging modalities can be divided into subgroups such as mammograms, ultrasound, magnetic resonance imaging, histopathological images, or any combination of them. Radiologists or pathologists analyze images produced by these methods manually, which leads to an increase in the risk of wrong decisions for cancer detection. Thus, the utilization of new automatic methods to analyze all kinds of breast screening images to assist radiologists to interpret images is required. Recently, artificial intelligence (AI) has been widely utilized to automatically improve the early detection and treatment of different types of cancer, specifically breast cancer, thereby enhancing the survival chance of patients. Advances in AI algorithms, such as deep learning, and the availability of datasets obtained from various imaging modalities have opened an opportunity to surpass the limitations of current breast cancer analysis methods. In this article, we first review breast cancer imaging modalities, and their strengths and limitations. Then, we explore and summarize the most recent studies that employed AI in breast cancer detection using various breast imaging modalities. In addition, we report available datasets on the breast-cancer imaging modalities which are important in developing AI-based algorithms and training deep learning models. In conclusion, this review paper tries to provide a comprehensive resource to help researchers working in breast cancer imaging analysis.
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Affiliation(s)
- Mohammad Madani
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Mohammad Mahdi Behzadi
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Sheida Nabavi
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
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Ukwuoma CC, Hossain MA, Jackson JK, Nneji GU, Monday HN, Qin Z. Multi-Classification of Breast Cancer Lesions in Histopathological Images Using DEEP_Pachi: Multiple Self-Attention Head. Diagnostics (Basel) 2022; 12:1152. [PMID: 35626307 PMCID: PMC9139754 DOI: 10.3390/diagnostics12051152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND BACKGROUND Despite fast developments in the medical field, histological diagnosis is still regarded as the benchmark in cancer diagnosis. However, the input image feature extraction that is used to determine the severity of cancer at various magnifications is harrowing since manual procedures are biased, time consuming, labor intensive, and error-prone. Current state-of-the-art deep learning approaches for breast histopathology image classification take features from entire images (generic features). Thus, they are likely to overlook the essential image features for the unnecessary features, resulting in an incorrect diagnosis of breast histopathology imaging and leading to mortality. METHODS This discrepancy prompted us to develop DEEP_Pachi for classifying breast histopathology images at various magnifications. The suggested DEEP_Pachi collects global and regional features that are essential for effective breast histopathology image classification. The proposed model backbone is an ensemble of DenseNet201 and VGG16 architecture. The ensemble model extracts global features (generic image information), whereas DEEP_Pachi extracts spatial information (regions of interest). Statistically, the evaluation of the proposed model was performed on publicly available dataset: BreakHis and ICIAR 2018 Challenge datasets. RESULTS A detailed evaluation of the proposed model's accuracy, sensitivity, precision, specificity, and f1-score metrics revealed the usefulness of the backbone model and the DEEP_Pachi model for image classifying. The suggested technique outperformed state-of-the-art classifiers, achieving an accuracy of 1.0 for the benign class and 0.99 for the malignant class in all magnifications of BreakHis datasets and an accuracy of 1.0 on the ICIAR 2018 Challenge dataset. CONCLUSIONS The acquired findings were significantly resilient and proved helpful for the suggested system to assist experts at big medical institutions, resulting in early breast cancer diagnosis and a reduction in the death rate.
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Affiliation(s)
- Chiagoziem C. Ukwuoma
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China; (J.K.J.); (G.U.N.)
| | - Md Altab Hossain
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu 610054, China;
| | - Jehoiada K. Jackson
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China; (J.K.J.); (G.U.N.)
| | - Grace U. Nneji
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China; (J.K.J.); (G.U.N.)
| | - Happy N. Monday
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China;
| | - Zhiguang Qin
- School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu 610054, China; (J.K.J.); (G.U.N.)
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Pender K, Covington B. How Contralateral Prophylactic Mastectomy Does the Body, or Why Epistemology Alone Cannot Explain this Controversial Breast Cancer Treatment. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:141-158. [PMID: 32043198 DOI: 10.1007/s10912-020-09614-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since the late 1990s, the use of contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer has been on the rise. Over the past two decades, dozens of studies have been conducted in order to understand this trend, which has puzzled and frustrated physicians who find it at odds with efforts to curb the surgical overtreatment of breast cancer, as well as with evidence-based medicine, which has established that the procedure has little oncologic benefit for most patients. Based on the work of Annemarie Mol and John Law, this paper argues that these efforts to understand increased CPM use are limited by the "epistemology problem" in medicine, or, in other words, the tendency to view healthcare controversies and decision making exclusively through the lenses of objective and subjective forms of knowledge. Drawing on public discourse about rationales for choosing CPM, we argue that this surgical trend cannot adequately be understood in terms of what doctors and patients know about breast cancer risk and how CPM affects that risk. In addition, it must be recognized as the outcome of how specific practices of screening, detection, and treatment do or enact the bodies of patients, producing tensions in their lives that cannot be remedied with better or better communicated information. Recognizing the embodied realities of these enactments and their effects on patient decision making, we maintain, is essential for physicians who want to avoid the paternalism that haunts breast cancer treatment in the US.
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Affiliation(s)
- Kelly Pender
- Virginia Tech, 232 Shanks Hall (0112), 181 Turner St. NW, Blacksburg, VA, 24061, USA.
| | - Brooke Covington
- Virginia Tech, 232 Shanks Hall (0112), 181 Turner St. NW, Blacksburg, VA, 24061, USA
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Shah SM, Khan RA, Arif S, Sajid U. Artificial intelligence for breast cancer analysis: Trends & directions. Comput Biol Med 2022; 142:105221. [PMID: 35016100 DOI: 10.1016/j.compbiomed.2022.105221] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
Breast cancer is one of the leading causes of death among women. Early detection of breast cancer can significantly improve the lives of millions of women across the globe. Given importance of finding solution/framework for early detection and diagnosis, recently many AI researchers are focusing to automate this task. The other reasons for surge in research activities in this direction are advent of robust AI algorithms (deep learning), availability of hardware that can run/train those robust and complex AI algorithms and accessibility of large enough dataset required for training AI algorithms. Different imaging modalities that have been exploited by researchers to automate the task of breast cancer detection are mammograms, ultrasound, magnetic resonance imaging, histopathological images or any combination of them. This article analyzes these imaging modalities and presents their strengths and limitations. It also enlists resources from where their datasets can be accessed for research purpose. This article then summarizes AI and computer vision based state-of-the-art methods proposed in the last decade to detect breast cancer using various imaging modalities. Primarily, in this article we have focused on reviewing frameworks that have reported results using mammograms as it is the most widely used breast imaging modality that serves as the first test that medical practitioners usually prescribe for the detection of breast cancer. Another reason for focusing on mammogram imaging modalities is the availability of its labelled datasets. Datasets availability is one of the most important aspects for the development of AI based frameworks as such algorithms are data hungry and generally quality of dataset affects performance of AI based algorithms. In a nutshell, this research article will act as a primary resource for the research community working in the field of automated breast imaging analysis.
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Affiliation(s)
- Shahid Munir Shah
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Rizwan Ahmed Khan
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan.
| | - Sheeraz Arif
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Unaiza Sajid
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
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Rahbar H, Lee JM, Lee CI. Optimal Screening in Breast Cancer Survivors With Dense Breasts on Mammography. J Clin Oncol 2020; 38:3833-3840. [PMID: 32706641 PMCID: PMC7676885 DOI: 10.1200/jco.20.01641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/16/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
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Abstract
Breast cancer screening is a recognized tool for early detection of the disease in asymptomatic women, improving treatment efficacy and reducing the mortality rate. There is raised awareness that a "one-size-fits-all" approach cannot be applied for breast cancer screening. Currently, despite specific guidelines for a minority of women who are at very high risk of breast cancer, all other women are still treated alike. This article reviews the current recommendations for breast cancer risk assessment and breast cancer screening in average-risk and higher-than-average-risk women. Also discussed are new developments and future perspectives for personalized breast cancer screening.
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Affiliation(s)
- Carolina Rossi Saccarelli
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Radiology, Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil
| | - Almir G V Bitencourt
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Imaging, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, São Paulo, SP 01509-010, Brazil
| | - Elizabeth A Morris
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Emiroglu M, Karaali C, Oztop MB, Gulluoglu BM. National Consensus on Oncoplastic Breast Conserving Surgery in Turkey: Position Paper for the Standardization of Surgical Practice. Turk J Surg 2020; 36:271-277. [PMID: 33778382 DOI: 10.47717/turkjsurg.2020.4639] [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: 10/09/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
Objectives The algorithms that define most of the application of oncoplastic breast conserving surgery (OBCS) in breast cancer patients are not clearly defined. Therefore, a consensus survey was conducted between the leading and experienced breast surgeons and oncoplastic breast surgeons in Turkey on the controversial areas of oncoplastic breast surgery. Material and Methods This consensus survey was carried out on-line through the Consensus software program (www.consensuss.com) under the roof of Turkish Federation of National Societies for Breast Diseases (TFNSBD). After finalizing each proposition, web-based remote access consensus process was performed on the Likert scale using Delphi method with the Consensus (www.consensuss.com) software program. Through the related software, an invitation was sent to 111 people who had at least 5 years of general surgery expertise in Turkey, and who devoted more than 50% of their daily clinical practice to the treatment and surgery of breast diseases. Results Sixty-two out of 111 people accepted to participate in the panel and made an on-line evaluation. According to the consensus results; Lumpectomy area should be done by placing the clips on at least four walls of the cavity, if the margin of the tumor is clear in central tumors, the distance between the tumor and the nipple is not significantly important, oncoplastic techniques may be used in patients with locally advanced breast cancer after neoadjuvant chemotherapy, in patients who have macromastia with ductal carcinoma in situ or breast cancer, OBCS techniques can be performed, and OBCS should be evaluated in terms of breast aesthetics. After OBCS, re-excision can be performed at a re-do setting in cases with involved surgical margins. Conclusion Our consensus results may provide a basis for the development of some standards in OBCS.
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Affiliation(s)
- Mustafa Emiroglu
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Cem Karaali
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Mehmet B Oztop
- Izmir Provincial Health Directorate, Health Directorate, İzmir, Turkey
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Sella T, Dowton AA, Meyer ME, Ruddy KJ, Yeh ED, Barry WT, Partridge AH. The utility of magnetic resonance imaging in early-stage breast cancer survivors-An institutional experience and literature review. Breast J 2020; 26:1673-1679. [PMID: 32754998 DOI: 10.1111/tbj.13997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022]
Abstract
The role of breast magnetic resonance imaging (MRI) in the screening of breast cancer survivors with remaining breast tissue is not well studied. We sought to evaluate the outcomes of screening breast MRI in a cohort of breast cancer survivors. A population of patients with history of stage I-IIIa breast cancer and ≥1 MRI a year or later from diagnosis between 2006-2008 were identified using the National Comprehensive Cancer Network data base from two large Boston-area cancer centers. Patient and disease characteristics were obtained from the data base, and medical records were reviewed to identify the index MRI (first eligible), indications, and two-year outcomes. Overall, 647 patients had breast MRI scans during the study period including 342 eligible patients whose index MRIs were done for breast screening purposes. 47/342 (13.7%) were abnormal, and 3.8% (13/342) underwent biopsy, resulting in the detection of 3 cases of locoregional recurrence or new primary breast cancer (0.9%, 95% CI = 0.2%-2.5%). Of 295 patients with a normal index screening MRI, 12 had a breast cancer recurrence diagnosed within 2 years (4.1% 95%CI = 2.1%-7.0%), and 5 of these recurrences were limited to MRI-screened breast tissue. No statistically significant difference in the rate of 2-year locoregional or distant recurrence was observed between patients with an abnormal screening MRI and those with a normal scan. Adjunct single breast MRI surveillance in a general population of breast cancer survivors one year after diagnosis detected few recurrences, and its effect on short-term outcomes was unclear.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anne A Dowton
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan E Meyer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathryn J Ruddy
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eren D Yeh
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William T Barry
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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Alonso Roca S, Delgado Laguna A, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): Pros and cons of MRI screening. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Brunetti N, De Giorgis S, Zawaideh J, Rossi F, Calabrese M, Tagliafico AS. Comparison between execution and reading time of 3D ABUS versus HHUS. Radiol Med 2020; 125:1243-1248. [PMID: 32367322 DOI: 10.1007/s11547-020-01209-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/20/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Breast density is an independent risk factor for breast cancer. Mammography is supplemented with handheld ultrasound (HHUS) to increase sensitivity. Automatic breast ultrasound (ABUS) is an alternative to HHUS. Our study wanted to assess the difference in execution and reading time between ABUS and HHUS. METHODS AND MATERIALS N = 221 women were evaluated consecutively between January 2019 and June 2019 (average age 53 years; range 24-89). The execution and reading time of ABUS and HHUS was calculated with an available stopwatch. Time started for both procedures when the patient was ready on the examination table to be examined to the end of image acquisition and interpretation. RESULTS No patients interrupted the exam due to pain or discomfort. N = 221 women underwent ABUS and HHUS; N = 11 patients refused to undergo both procedures due to time constraints and refused ABUS; therefore, 210 patients were enrolled with both ABUS and HHUS available. The average time to perform and read the exam was 5 min for HHUS (DS ± 1.5) with a maximum time of 11 min and a minimum of 2 min. The average time with ABUS was 17 min (DS ± 3.8, with a maximum time of 31 min and a minimum time of 9 min). The ABUS technique took longer to be performed in all patients, with an average difference of 11 min (range 3-23 min) per patient, P < 0,001. Separating ABUS execution from reading time we highlighted as ABUS execution is more time-consuming respect HHUS. In addition, we can underline that time required by radiologists is longer for ABUS even only considering the interpretation time of the exam. CONCLUSION A significant difference was observed in the execution and reading time of the two exams, where the HHUS method was more rapid and tolerated.
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Affiliation(s)
- Nicole Brunetti
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy.
| | - Sara De Giorgis
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Jeries Zawaideh
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Federica Rossi
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy
| | - Massimo Calabrese
- IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi. 10, 16132, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL)- Radiology Section, University of Genova, Via L.B. Alberti 2, 16132, Genoa, Italy.,IRCCS - Ospedale Policlinico San Martino, Largo Rosanna Benzi. 10, 16132, Genoa, Italy
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Alonso Roca S, Delgado Laguna AB, Arantzeta Lexarreta J, Cajal Campo B, Santamaría Jareño S. Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening. RADIOLOGIA 2020; 62:252-265. [PMID: 32241593 DOI: 10.1016/j.rx.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/23/2019] [Accepted: 01/30/2020] [Indexed: 12/31/2022]
Abstract
Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.
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Affiliation(s)
- S Alonso Roca
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A B Delgado Laguna
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J Arantzeta Lexarreta
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - B Cajal Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - S Santamaría Jareño
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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16
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Kim SY, Cho N, Kim SY, Choi Y, Kim ES, Ha SM, Lee SH, Chang JM, Moon WK. Supplemental Breast US Screening in Women with a Personal History of Breast Cancer: A Matched Cohort Study. Radiology 2020; 295:54-63. [PMID: 32096704 DOI: 10.1148/radiol.2020191691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is limited research on supplemental screening breast US in women with a personal history of breast cancer (PHBC). Purpose To compare the performance of supplemental screening breast US in women with and women without a PHBC by using a matched cohort. Materials and Methods Consecutive asymptomatic women who underwent radiologist-performed supplemental breast US and mammography between January 2013 and December 2013 at a tertiary referral university hospital were retrospectively identified. Inclusion criteria were negative or benign findings at mammography, follow-up data for at least 1 year, first cancer stage of 0 to II in women with a PHBC, and incidence screening in women without a PHBC. The two groups were matched 1:1 according to age and breast density. Performance measures were compared with McNemar test, generalized estimating equation, or penalized likelihood logistic regression. Results A total of 3226 women with a PHBC were matched with 3226 women without a PHBC (mean age ± standard deviation, 52 years ± 9; mammographic breast density, fatty in 603 and dense in 2623). Fourteen cancers (six screen-detected, eight interval cancers) were found in women with a PHBC and 13 cancers (12 screen-detected, one interval cancer) in women without a PHBC. Supplemental US in women with a PHBC compared with women without a PHBC showed lower sensitivity (43% [95% confidence interval {CI}: 18%, 71%; six of 14 cancers] vs 92% [95% CI: 64%, 100%; 12 of 13 cancers]; P = .03), higher interval cancer rates (2.5 [95% CI: 1.1, 4.9; eight of 3226 women] vs 0.3 [95% CI: 0, 1.7; one of 3226 women] per 1000; P = .02), and higher specificity (92.8% [95% CI: 91.9%, 93.7%; 2982 of 3212 women] vs 89.3% [95% CI: 88.2%, 90.4%; 2870 of 3213 women]; P < .001), respectively. Conclusion Supplemental US screening in women with a personal history of breast cancer had lower sensitivity and higher interval cancer rate but higher specificity relative to women without a personal history of breast cancer. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Lee and Lee in this issue.
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Affiliation(s)
- Soo-Yeon Kim
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Nariya Cho
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Soo Yeon Kim
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Yunhee Choi
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Eun Sil Kim
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Min Ha
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Hyun Lee
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Jung Min Chang
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Woo Kyung Moon
- From the Department of Radiology (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.) and Medical Research Collaborating Center (Y.C.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (Soo-Yeon Kim, N.C., Soo Yeon Kim, E.S.K., S.M.H., S.H.L., J.M.C., W.K.M.)
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Van De Merckt C. Anomalie clinique et seins traités : comment répondre clairement aux cliniciens ? IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fan KL, Yang S, Park S, Park TH, Song SY, Lee N, Lew DH, Kim MJ, Lee DW. Postoperative Cancer Surveillance Following Oncoplastic Surgery with Latissimus Dorsi Flap: a Matched Case-Control Study. Ann Surg Oncol 2019; 26:4681-4691. [PMID: 31605343 DOI: 10.1245/s10434-019-07898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The latissimus dorsi (LD) myocutaneous flap is a widely used local option in oncoplastic surgery for avoiding breast deformities; however, concerns exist regarding its influence in monitoring recurrence. In this study, we evaluated the impact of this flap on postoperative cancer surveillance. METHODS Each patient receiving oncoplastic surgery with LD flap after partial mastectomy were matched in age, cancer stage, and body mass index with patients receiving partial mastectomy alone. Twenty-nine patients with the oncoplastic LD flap received 99 mammograms and 139 ultrasonograms, while 29 patients with partial mastectomy alone underwent 92 mammograms and 129 ultrasonograms. Mammographic and ultrasonographic findings were classified by Breast Imaging Reporting and Data System (BI-RADS) category and reviewed. Any recommendations for additional evaluation and recurrence were documented. RESULTS During an average follow-up period of 44 months, although the oncoplastic group demonstrated more newly developed benign calcifications (control 14% vs. oncoplastic 41%; p = 0.019) on mammography, the percentage of recall for additional imaging in category 0, and the short-interval follow-up in category 3, was not different between the control and oncoplastic group. Regarding ultrasonography, BI-RADS category was also not different between the two groups; however, the control group showed more fluid collections than the oncoplastic group (control 21% vs. oncoplastic 0%; p = 0.023). One case of local recurrence was observed in the control group. CONCLUSION Although there was an increase in benign calcifications in the oncoplastic group, there were no additional abnormal findings requiring further intervention. We concluded that the LD flap for oncoplastic surgery does not interfere with cancer surveillance, and even decreases the rate of fluid collection.
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Affiliation(s)
- Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Simon Yang
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Nara Lee
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
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Metaxa L, Healy NA, O'Keeffe SA. Breast microcalcifications: the UK RCR 5-point breast imaging system or BI-RADS; which is the better predictor of malignancy? Br J Radiol 2019; 92:20190177. [PMID: 31365279 DOI: 10.1259/bjr.20190177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In the UK RCR 5-point breast imaging system (UKS), radiologists grade mammograms from 1 to 5 according to suspicion for malignancy, however unlike BI-RADS, no lexicon of descriptors is published. The aim of this study was to determine whether strict categorisation of microcalcifications (MCC) according to BI-RADS was a better predictor of malignancy than the UKS and whether these descriptors could be used within the UKS. METHODS A retrospective review of 241 cases, with MCC on mammography, who underwent biopsy was performed. Morphology, distribution, extent, UKS score, BI-RADS category and pathology were recorded. The positive predictive value (PPV) of each classification system for malignancy was calculated. RESULTS 28.6% were diagnosed with DCIS/IDC. The PPV for malignancy using the UKS was 18.9%, 69.4%, 100% for M3-5 respectively (p < 0.001) and using ΒI-RADS morphology was amorphous: 7.1%, coarse heterogeneous: 33.3%, fine pleomorphic: 48.1% and fine linear/fine linear branching: 85.2% (p < 0.001). The PPV based on distribution was grouped: 14.2%, regional: 32.3%, diffuse: 33.3% and linear/segmental: 77.8% (p < 0.001). Combining all cases of benign-appearing, amorphous and grouped coarse heterogenous and grouped fine pleomorphic MCC gave a PPV of 12.8%. Combining regional, linear or segmental coarse heterogenous and fine pleomorphic and all fine linear/branching MCC resulted in a PPV of 83.3% for malignancy. CONCLUSION Combining morphology and distribution of MCC is accurate in malignancy prediction. Use of BI-RADS descriptors could help standardise reporting within the UKS and an algorithm using these within the UKS is proposed. Better prediction would enable more appropriate counselling and help to identify discrepancies. ADVANCES IN KNOWLEDGE No guidance exists on scoring of suspicious MCC in the UK breast imaging system. Use of BI-RADS morphologic/distribution descriptors can aid malignancy prediction. Findings other than morphology of MCC are important in malignancy prediction. An algorithm for use by the UK radiologist when evaluating MCC is provided.
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Affiliation(s)
- Linda Metaxa
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nuala A Healy
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Sylvia A O'Keeffe
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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20
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Chao C, Bhatia S, Xu L, Cannavale KL, Wong FL, Huang PYS, Cooper R, Armenian SH. Incidence, Risk Factors, and Mortality Associated With Second Malignant Neoplasms Among Survivors of Adolescent and Young Adult Cancer. JAMA Netw Open 2019; 2:e195536. [PMID: 31173129 PMCID: PMC6563559 DOI: 10.1001/jamanetworkopen.2019.5536] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Detailed data describing the epidemiology of second malignant neoplasms (SMN) are needed for survivors of adolescent and young adult (AYA) cancer to inform the development of age-appropriate survivorship care guidelines. OBJECTIVE To describe the incidence, risk factors, and mortality for SMN in survivors of AYA cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched cohort study included 10 574 two-year survivors diagnosed with cancer between January 1, 1990, and December 31, 2012, at age 15 to 39 years in an integrated health care delivery system in Southern California. A comparison cohort without a history of cancer was individually matched 13:1 to survivors of AYA cancer by age, sex, and calendar year. Data analysis was completed in July 2018. EXPOSURES Secondary malignant neoplasm risk factors of interest included age, stage, and calendar year at first cancer diagnosis; sex; race/ethnicity; radiation therapy; and chemotherapy. MAIN OUTCOMES AND MEASURES Diagnoses of SMN were ascertained using cancer registries from the National Cancer Institute Surveillance, Epidemiology, and End Results Program through December 31, 2014. Poisson regression was used to evaluate the association between cancer survivor status and developing SMN and risk factors for SMN, while risk of all-cause mortality by SMN status was examined in Cox regression. RESULTS A total of 10 574 survivors of AYA cancer (6853 [64.8%] female; median [range] age, 33 [15-39] years; 622 with SMN) and 136 683 participants in the comparison cohort (88 513 [64.8%] female; median [range] age, 33 [15-39] years; 3437 with first cancer) were included. In survivors of AYA cancer, 20-year cumulative incidence of SMN was 12.5%. The incidence rate ratio (IRR) of developing SMN in survivors of AYA cancer was 2.6 (95% CI, 2.4-2.9) compared with the comparison cohort. Survivors of breast cancer, melanoma, and testicular cancer had substantially elevated risk for SMN of the same organ (IRR, 5.6 [95% CI, 4.6-6.8], 11.2 [95% CI, 7.3-17.2], and 16.2 [95% CI, 6.8-38.4], respectively). Among survivors of AYA cancer, older age (IRR for age 30-39 years, 1.79 [95% CI, 1.21-2.65]), female sex (IRR, 1.31 [95% CI, 1.09-1.57]), white race/ethnicity (IRR for Asian race, 0.61 [95% CI, 0.43-0.87]), advanced stage at first cancer diagnosis (IRR for stage II, 1.29 [95% CI, 1.11-1.65]), and use of radiotherapy (IRR, 1.50 [95% CI, 1.26-1.79]) were associated with increased risk of SMN. Survivors of AYA cancer who developed SMN had an all-cause mortality rate 7.2 (95% CI, 6.1-8.5) times greater than survivors without SMN. CONCLUSIONS AND RELEVANCE This study suggests that SMN risk is elevated in survivors of AYA cancer and varies across survivor subgroups. Survival following SMN may be significantly compromised. These data may form the basis for identifying individuals at high risk, as well as informing screening for SMN.
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Affiliation(s)
- Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc, Solon, Ohio
| | - Kimberly L. Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California
| | - Po-Yin Samuel Huang
- Department of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
| | - Robert Cooper
- Department of Pediatric Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
| | - Saro H. Armenian
- Department of Population Sciences, City of Hope, Duarte, California
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