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Bell KJ, Nickel B, Pathirana T, Blennerhassett M, Carter S. Breast cancer screening from age 40 in the US. BMJ 2024; 385:q1353. [PMID: 38914429 DOI: 10.1136/bmj.q1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Katy Jl Bell
- Sydney School of Public Health, University of Sydney, NSW, Australia
- Wiser Healthcare Research Collaboration, Australia
| | - Brooke Nickel
- Sydney School of Public Health, University of Sydney, NSW, Australia
- Wiser Healthcare Research Collaboration, Australia
| | - Thanya Pathirana
- Wiser Healthcare Research Collaboration, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, QLD, Australia
| | | | - Stacy Carter
- Wiser Healthcare Research Collaboration, Australia
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, NSW, Australia
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Katsika L, Boureka E, Kalogiannidis I, Tsakiridis I, Tirodimos I, Lallas K, Tsimtsiou Z, Dagklis T. Screening for Breast Cancer: A Comparative Review of Guidelines. Life (Basel) 2024; 14:777. [PMID: 38929759 PMCID: PMC11204612 DOI: 10.3390/life14060777] [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: 05/26/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.
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Affiliation(s)
- Laskarina Katsika
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Eirini Boureka
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ilias Tirodimos
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Zoi Tsimtsiou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
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Bahadori P, Molina-Recalde AP, Saleh Alruwaili A, Alanazy A, Tilahun WT, Ayub G, Haq ZU, Bashir MB. Assessment of medical students' knowledge regarding radiation associated risk and its protection: finding from a cross-sectional study. Ir J Med Sci 2024; 193:1515-1519. [PMID: 38041750 DOI: 10.1007/s11845-023-03583-4] [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: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE The current study assessed the knowledge of the medical students regarding the nature of radiation, associated risks, and protective measures. METHOD A cross-sectional study was conducted among international students enrolled in different medical colleges/universities in Xian, PR China. A self-developed and self-reported questionnaire was used for the current study. The descriptive statistics was carried out to summarize the finding of the study. Chi-square and Fisher exact tests were conducted to assess the association of the demographics with knowledge level. RESULTS A total of 796 students responded among 980. Most of the participants fell in the age range of 20-25 years (42.6%), being male (67.1%) and having bachelor's education (56.7%). Participants with previous experience was 58.7%. The age group of 20-25 years (p < 0.001), being male (p < 0.001), having bachelor education (p < 0.001), and previous experience (p = 0.009) was significantly associated with moderate to good knowledge. The overall knowledge about the nature of radiation (96%) and associated risk (82%) was good, but regarding protection, 59% of the participants showed good knowledge. CONCLUSION Most of the participants showed satisfactory result. However, the knowledge regarding protection measures was poor in almost half of the population.
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Affiliation(s)
- Pardis Bahadori
- Xi'an Jiaotong University School of Medicine, Xi'an Shaanxi, People's Republic of China
| | | | - Abdullah Saleh Alruwaili
- Emergency Medical Services Program, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- Ministry of National Guard - Health Affairs, Al Ahsa, Saudi Arabia
- School of Health, University of New England, Armidale, NSW, Australia
| | - Ahmed Alanazy
- Emergency Medical Services Program, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- Ministry of National Guard - Health Affairs, Al Ahsa, Saudi Arabia
| | | | - Gulsanga Ayub
- Department of Radiology, Combined Military Hospital, Peshawar, Pakistan
| | - Zia Ul Haq
- Xi'an Jiaotong University School of Medicine, Xi'an Shaanxi, People's Republic of China
| | - Musa Bin Bashir
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, China.
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Uomori T, Horimoto Y, Ueki Y, Ishizuka Y, Onagi H, Hayashi T, Watanabe J, Shikama N. Efficacy of radiation therapy in Japanese patients with positive margins after breast-conserving surgery. Jpn J Clin Oncol 2024; 54:556-561. [PMID: 38251759 DOI: 10.1093/jjco/hyad196] [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: 10/06/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Additional surgical resection is recommended after breast-conserving surgery if the surgical margin is pathologically positive. However, in clinical practice, radiation therapy is sometimes used instead for several reasons. Irradiation may be appropriate for some patients, but real-world data is still insufficient to establish it as standard treatment. We retrospectively investigated the status of local control in patients who received irradiation for positive margins. METHODS We investigated 85 patients with positive margins after curative partial mastectomy who were treated with irradiation instead of additional excision during the period 2006-2013. The patients received whole-breast irradiation (43.2-50 Gy) using photon beams and additional tumour-bed boost (8.1-16 Gy) using electron beams. Intrabreast tumour recurrence was defined as secondary cancer within the ipsilateral conserved breast. Surgical margin was defined as positive if tumour cell exposure was pathologically confirmed on the margin. RESULTS Seven patients (8.2%) developed intrabreast tumour recurrence during a mean observation period of 119 months. As to components of positive margin, 76 cases were positive for an intraductal component, of which seven (9.2%) developed intrabreast tumour recurrence. Meanwhile, all nine cases positive for an invasive component were free from intrabreast tumour recurrence. Two of the intrabreast tumour recurrence cases seemed to develop new lesions rather than recurrence, considering tumour location. The cumulative incidence of intrabreast tumour recurrence over 10 years was 6.1%. Limited to true recurrence, intrabreast tumour recurrence incidence was 4.9%. CONCLUSION Our real-world data supports irradiation as an alternative to additional surgical intervention for positive margins after breast-conserving surgery and offers a basis for further research.
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Affiliation(s)
- Toshitaka Uomori
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiya Horimoto
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Breast Surgery and Oncology, Tokyo Medical University, 6-1-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Yuko Ueki
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yumiko Ishizuka
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroko Onagi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takuo Hayashi
- Faculty of Medicine, Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Junichiro Watanabe
- Faculty of Medicine, Department of Breast Oncology, Juntendo University,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Naoto Shikama
- Faculty of Medicine, Department of Radiation Oncology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One 2024; 19:e0297048. [PMID: 38271392 PMCID: PMC10810469 DOI: 10.1371/journal.pone.0297048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. METHODS A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening-NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. RESULTS AND CONCLUSIONS The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50-69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom.
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Affiliation(s)
- Arn Migowski
- Professional Master’s Program in Health Technology Assessment, Teaching and Research Coordination, Instituto Nacional de Cardiologia (INC), Ministry of Health, Rio de Janeiro, Brazil
- Division of Clinical Research and Technological Development, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola Nacional de Saúde Pública (ENSP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cid Manso de Mello Vianna
- Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Mori R, Okawa M, Tokumaru Y, Niwa Y, Matsuhashi N, Futamura M. Application of an artificial intelligence-based system in the diagnosis of breast ultrasound images obtained using a smartphone. World J Surg Oncol 2024; 22:2. [PMID: 38167161 PMCID: PMC10759682 DOI: 10.1186/s12957-023-03286-1] [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: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Breast ultrasound (US) is useful for dense breasts, and the introduction of artificial intelligence (AI)-assisted diagnoses of breast US images should be considered. However, the implementation of AI-based technologies in clinical practice is problematic because of the costs of introducing such approaches to hospital information systems (HISs) and the security risk of connecting HIS to the Internet to access AI services. To solve these problems, we developed a system that applies AI to the analysis of breast US images captured using a smartphone. METHODS Training data were prepared using 115 images of benign lesions and 201 images of malignant lesions acquired at the Division of Breast Surgery, Gifu University Hospital. YOLOv3 (object detection models) was used to detect lesions on US images. A graphical user interface (GUI) was developed to predict an AI server. A smartphone application was also developed for capturing US images displayed on the HIS monitor with its camera and displaying the prediction results received from the AI server. The sensitivity and specificity of the prediction performed on the AI server and via the smartphone were calculated using 60 images spared from the training. RESULTS The established AI showed 100% sensitivity and 75% specificity for malignant lesions and took 0.2 s per prediction with the AI sever. Prediction using a smartphone required 2 s per prediction and showed 100% sensitivity and 97.5% specificity for malignant lesions. CONCLUSIONS Good-quality predictions were obtained using the AI server. Moreover, the quality of the prediction via the smartphone was slightly better than that on the AI server, which can be safely and inexpensively introduced into HISs.
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Affiliation(s)
- Ryutaro Mori
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Mai Okawa
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshihisa Tokumaru
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshimi Niwa
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery Pediatric Surgery, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Manabu Futamura
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
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Xu H, Xu B. Breast cancer: Epidemiology, risk factors and screening. Chin J Cancer Res 2023; 35:565-583. [PMID: 38204449 PMCID: PMC10774137 DOI: 10.21147/j.issn.1000-9604.2023.06.02] [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: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally, epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer. This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography, ultrasound, magnetic resonance imaging (MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.
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Affiliation(s)
- Hangcheng Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Pleasant V. Patient counseling for breast cancer screening: Taking changes to USPSTF recommendations into account. OBG MANAGEMENT 2023; 35:43-49. [PMID: 38835939 PMCID: PMC11148851 DOI: 10.12788/obgm.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The US Preventive Services Task Force now recommends mammography screening every other year starting at age 40 to decrease the risk of dying from breast cancer, but questions remain regarding biennial versus annual screening as well as disparities in risk factors and outcomes among Black people.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Bonometto JVB, Sette CVDM, Santi PX, Maselli-Schoueri JH, Giglio AD, Cubero DDIG. Critical assessment of resource waste in staging and follow-up of breast cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230565. [PMID: 38055451 DOI: 10.1590/1806-9282.20230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Breast cancer is a public health problem with both high incidence and cure rates. After treatment, patients are monitored for long periods of time due to the risk of recurrence. Thus, staging and follow-up strategies should consider not only the best results for the patient but also its costs for the public health system. OBJECTIVE The objective of this study was to quantify the waste of resources on breast cancer follow-up and evaluate its impact on the public health system. METHODS This is a retrospective analysis of consecutive medical records to identify the intervals between consultations and tests used for staging and during the first 2 years of follow-up of patients with breast cancer treated at a public hospital in Brazil. Data were compared with the guidelines of the main international consensus. RESULTS Medical records of 60 consecutive patients treated in 2018 were selected, of whom 52 had 2 or more years of follow-up, and 8 had only 1 year of complete follow-up. A total of 34 patients (56.67%) underwent excessive examinations for stating. During follow-up, 125 surplus consultations were performed (33.6%). In this phase, 111 surplus exams were also performed, representing an increase of 100.9%. A total of 423 laboratory tests were performed for 18 patients in the first year and 229 tests for 14 patients in the second year. CONCLUSION Excessive tests and consultations significantly burdened the Unified Health System without any benefit to patients. Better adherence to staging and follow-up recommendations could reduce costs and optimize the limited resources used in the public health system.
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Affiliation(s)
| | - Claudia Vaz de Melo Sette
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
| | - Patricia Xavier Santi
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
| | | | - Auro Del Giglio
- Centro Universitário Faculdade de Medicina do ABC, Department of Oncology - Santo André (SP), Brazil
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Álvarez Sánchez-Bayuela D, Giovanetti González R, Aguilar Angulo PM, Cruz Hernández LM, Sánchez-Camacho González-Carrato MDP, Rodríguez Sánchez A, Tiberi G, Romero Castellano C. Integrating clinical research in an operative screening and diagnostic breast imaging department: First experience, results and perspectives using microwave imaging. Heliyon 2023; 9:e21904. [PMID: 38027895 PMCID: PMC10661199 DOI: 10.1016/j.heliyon.2023.e21904] [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: 07/27/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale and objectives Clinical research is crucial for evaluating new medical procedures and devices. It is important for healthcare units and hospitals to minimize the disruptions caused by conducting clinical studies; however, complex clinical pathways require dedicated recruitment and study designs.This work presents the effective introduction of novel microwave breast imaging (MBI), via MammoWave apparatus, into the clinical routine of an operative screening and diagnostic breast imaging department for conducting a multicentric clinical study. Materials and methods Microwave breast imaging, using MammoWave apparatus, was performed on volunteers coming from different clinical pathways. Clinical data, comprising demographics and conventional radiologic reports (used as reference standard), was collected; a satisfaction questionnaire was filled by every volunteer. Microwave images were analyzed by an automatic clinical decision support system, which quantified their corresponding features to discriminate between breasts with no relevant radiological findings (NF) and breasts with described findings (WF). Results Conventional breast imaging (DBT, US, MRI) and MBI were performed and adapted to assure best clinical practices and optimum pathways. 180 volunteers, both symptomatic and asymptomatic, were enrolled in the study. After microwave images' quality assessment, 48 NF (15 dense) and 169 WF (88 dense) breasts were used for the prospective study; 48 (18 dense) breasts suffered from a histology-confirmed carcinoma. An overall sensitivity of 85.8 % in breasts lesions' detection was achieved by the microwave imaging apparatus. Conclusion An optimum recruitment strategy was implemented to assess MBI. Future trials may show the clinical usefulness of microwave imaging, which may play an important role in breast screening.
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Affiliation(s)
- Daniel Álvarez Sánchez-Bayuela
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
- Faculty of Chemical Science and Technology, Instituto Regional de Investigación Científica Aplicada, University of Castilla, La Mancha, 13001, Ciudad Real, Spain
| | - Rubén Giovanetti González
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
| | - Paul Martín Aguilar Angulo
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
| | - Lina Marcela Cruz Hernández
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
| | | | - Ana Rodríguez Sánchez
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
| | - Gianluigi Tiberi
- UBT—Umbria Bioengineering Technologies, 06081, Perugia, Italy
- School of Engineering, London South Bank University, London, SE1 0AA, United Kingdom
| | - Cristina Romero Castellano
- Breast Imaging Department, Radiology Service, Complejo Hospitalario Universitario de Toledo, 45007, Toledo, Spain
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Abstract
Breast cancer is the most common cancer among U.S. women and its incidence increases with age. Endogenous estrogen exposure, proliferative benign breast disease, breast density, and family history may also indicate increased risk for breast cancer. Early detection with screening mammography reduces breast cancer mortality, but the net benefits vary by age. Assessing a patient's individual breast cancer risk can guide decisions regarding breast cancer screening. All women benefit from healthy behaviors which may reduce breast cancer risk. Some women at increased risk for breast cancer may benefit from risk-reducing medications. Use of screening measures remains suboptimal, especially for uninsured women.
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Affiliation(s)
- Amy H Farkas
- Medical College of Wisconsin, Milwaukee, Wisconsin (A.H.F., A.B.N.)
| | - Ann B Nattinger
- Medical College of Wisconsin, Milwaukee, Wisconsin (A.H.F., A.B.N.)
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12
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Eijkelboom AH, Larsen M, Siesling S, Nygård JF, Hofvind S, de Munck L. Prolonged screening interval due to the COVID-19 pandemic and its association with tumor characteristics and treatment; a register-based study from BreastScreen Norway. Prev Med 2023; 175:107723. [PMID: 37820746 DOI: 10.1016/j.ypmed.2023.107723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic Norway had to suspend its national breast cancer screening program. We aimed to investigate the effect of the pandemic-induced suspension on the screening interval, and its subsequent association with the tumor characteristics and treatment of screen-detected (SDC) and interval breast cancer (IC). METHODS Information about women aged 50-69, participating in BreastScreen Norway, and diagnosed with a SDC (N = 3799) or IC (N = 1806) between 2018 and 2021 was extracted from the Cancer Registry of Norway. Logistic regression was used to investigate the association between COVID-19 induced prolonged screening intervals and tumor characteristics and treatment. RESULTS Women with a SDC and their last screening exam before the pandemic had a median screening interval of 24.0 months (interquartile range: 23.8-24.5), compared to 27.0 months (interquartile range: 25.8-28.5) for those with their last screening during the pandemic. The tumor characteristics and treatment of women with a SDC, last screening during the pandemic, and a screening interval of 29-31 months, did not differ from those of women with a SDC, last screening before the pandemic, and a screening interval of 23-25 months. ICs detected 24-31 months after screening, were more likely to be histological grade 3 compared to ICs detected 0-23 months after screening (odds ratio: 1.40, 95% confidence interval: 1.06-1.84). CONCLUSIONS Pandemic-induced prolonged screening intervals were not associated with the tumor characteristics and treatment of SDCs, but did increase the risk of a histopathological grade 3 IC. This study provides insights into the possible effects of extending the screening interval.
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Affiliation(s)
- Anouk H Eijkelboom
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Oslo, Norway.
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Jan F Nygård
- Department of Register Informatics, Cancer Registry Norway, P.O. Box 5313, 0304 Oslo, Norway.
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Oslo, Norway; Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. 6050, 9037, Tromsø, Norway.
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
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Behrens A, Fasching PA, Schwenke E, Gass P, Häberle L, Heindl F, Heusinger K, Lotz L, Lubrich H, Preuß C, Schneider MO, Schulz-Wendtland R, Stumpfe FM, Uder M, Wunderle M, Zahn AL, Hack CC, Beckmann MW, Emons J. Predicting mammographic density with linear ultrasound transducers. Eur J Med Res 2023; 28:384. [PMID: 37770952 PMCID: PMC10537934 DOI: 10.1186/s40001-023-01327-9] [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: 04/05/2022] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments. METHODS We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON® 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models. RESULTS Gray level bins and PMD correlated to a certain extent. Spearman's ρ ranged from - 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R2, 0.255). Overall, ultrasound images from the VOLUSON® 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms. CONCLUSIONS In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
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Affiliation(s)
- Annika Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Hannah Lubrich
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline Preuß
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael O Schneider
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna L Zahn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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Taneepanichskul S, Chuemchit M, Wongsasuluk P, Sirichokchatchawan W, Hounnaklang N, Zongram O, Sematong S, Viwattanakulvanid P, Herman B. Practice, confidence and continuity of breast self-examination among women in Thailand during COVID-19 pandemic: a cross-sectional study. BMJ Open 2023; 13:e071306. [PMID: 37527895 PMCID: PMC10394538 DOI: 10.1136/bmjopen-2022-071306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Breast self-examination (BSE) is the most feasible screening tool compared with clinical breast examination and mammography. It is crucial to address the associated factors of practising BSE to develop a targeted BSE promotion programme and improve the BSE quality in Thai women, particularly during the COVID-19 pandemic. DESIGN AND SETTING We conducted a cross-sectional study in Thailand's north and northeast region from March 2020 to November 2022. PARTICIPANTS This study involved 405 women aged 30-70 years old. VARIABLES AND OUTCOMES Demographic information, health status and BSE were collected using a modified questionnaire based on the Champion Health Belief Model. The outcomes were ever-practising BSE, BSE practice within the last 6 months, continuity of BSE and confidence in doing BSE. Logistic regression and decision tree analysis identified the associated factors. RESULTS 75.55% of participants ever performed BSE. Around 74.18% did BSE within the last 6 months. Diploma graduates (adjusted OR (aOR) 25.48, 95% CI 2.04 to 318.07), 21-40 reproductive years (aOR 4.29, 95% CI 1.22 to 15.08), ever pregnant (aOR 3.31, 95% CI 1.05 to 10.49), not drinking alcohol (aOR 2.1, 95% CI 1.04 to 4.55), not receiving hormone replacement (aOR 5.51, 95% CI 2.04 to 14.89), higher knowledge (aOR 1.29, 95% CI 1.09 to 1.52), attitude (aOR 1.15, 95% CI 1.05 to 1.26) and practice/cues of action towards BSE were associated with ever-practising BSE. Frequent high-fat diet, high awareness of breast cancer, lower knowledge of BSE and lower attitude toward BSE were associated with not practising BSE within 6 months and BSE discontinuation. Only high knowledge of BSE was associated with absolute confidence in BSE (p<0.05). CONCLUSION Despite having a higher percentage than other studies in different countries prior to the pandemic, it is still crucial to improve knowledge of BSE to encourage BSE practice, confidence and continuity of BSE in Thai women. Moreover, the BSE campaign should target women with prolonged exposure to oestrogen and sedentary lifestyle.
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Affiliation(s)
| | - Montakarn Chuemchit
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Pokkate Wongsasuluk
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Onuma Zongram
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Saowanee Sematong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Bumi Herman
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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15
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Urban LABD, Chala LF, Paula IBD, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, Oliveira TMGD, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e480-e488. [PMID: 37683660 PMCID: PMC10491472 DOI: 10.1055/s-0043-1772498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. METHODS Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. RECOMMENDATIONS Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.
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Affiliation(s)
| | - Luciano Fernandes Chala
- National Mammography Commission, Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Carlos Shimizu
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | | | - Flávia Engel Aduan
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
| | | | | | - Henrique Lima Couto
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - Gustavo Machado Badan
- National Mammography Commission, Representative of the Brazilian Society of Mastology, São Paulo, SP, Brazil
| | - José Luis Esteves Francisco
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | - Thaís Paiva Moraes
- National Mammography Commission, Representative of the Brazilian Federation of Associations of Gynecology and Obstetrics, São Paulo, SP, Brazil
| | | | - João Emílio Peixoto
- Brazilian College of Radiology and Diagnostic Imaging, São Paulo, SP, Brazil
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16
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Urban LABD, Chala LF, de Paula IB, Bauab SDP, Schaefer MB, Oliveira ALK, Shimizu C, de Oliveira TMG, Moraes PDC, Miranda BMM, Aduan FE, Rego SDJF, Canella EDO, Couto HL, Badan GM, Francisco JLE, Moraes TP, Jakubiak RR, Peixoto JE. Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations. Radiol Bras 2023; 56:207-214. [PMID: 37829583 PMCID: PMC10567087 DOI: 10.1590/0100-3984.2023.0064-en] [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: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities.Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.
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Affiliation(s)
- Linei Augusta Brolini Delle Urban
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Luciano Fernandes Chala
- Coordinator of the National Mammography Commission of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ivie Braga de Paula
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Marcela Brisighelli Schaefer
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ana Lúcia Kefalás Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Carlos Shimizu
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Tatiane Mendes Gonçalves de Oliveira
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Paula de Camargo Moraes
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Beatriz Medicis Maranhão Miranda
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Flávia Engel Aduan
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Salete de Jesus Fonseca Rego
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ellyete de Oliveira Canella
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Henrique Lima Couto
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - Gustavo Machado Badan
- Members of the National Mammography Commission, Representatives of the Sociedade Brasileira de Mastologia (SBM), Rio de Janeiro, RJ, Brazil
| | - José Luis Esteves Francisco
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Thaís Paiva Moraes
- Members of the National Mammography Commission, Representatives of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO), Rio de Janeiro, RJ, Brazil
| | - Rosangela Requi Jakubiak
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - João Emílio Peixoto
- Members of the National Mammography Commission, Representatives of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
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Ding W, Fan Z, Xu Y, Wei C, Li Z, Lin Y, Zhu J, Ruan G. Magnetic resonance imaging in screening women at high risk of breast cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33146. [PMID: 36897691 PMCID: PMC9997824 DOI: 10.1097/md.0000000000033146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is more accurate than mammography in screening for breast cancer. Exposure to ionizing radiation from repeated diagnostic X-rays may be a cause of breast cancer. METHODS We conducted systematic searches on PubMed, Cochrane and Embase to identify studies on women who underwent mammography or MRI screening. A meta-analysis was performed to compare the detection rate of breast cancer by mammography, MRI or both. RESULTS A total of 18 diagnostic publications were identified and included in the meta-analysis. Among the 1000 screened women, MRI alone increased the detection rate of breast cancer by 8 compared with mammography alone (RR 0.48, 95% CI 0.42-0.54), and MRI plus mammography increased the detection rate of breast cancer by 1 compared with MRI alone (RR 0.86, 95% CI 0.78-0.96). Subgroup analysis demonstrated that the diagnostic efficacy of MRI plus mammography in breast was obviously better than that of MRI alone or mammography alone. CONCLUSIONS Screening with MRI alone might be the best choice for women at high risk of breast cancer.
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Affiliation(s)
- Wu Ding
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Zaiwei Fan
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Yuehuai Xu
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Chunshou Wei
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Yingli Lin
- Department of Early Childhood Education, Shaoxing Vocational and Technical College, Shaoxing, China
| | - Jianming Zhu
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Guodong Ruan
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
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18
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Radiation-Free Microwave Technology for Breast Lesion Detection Using Supervised Machine Learning Model. Tomography 2023; 9:105-129. [PMID: 36648997 PMCID: PMC9844448 DOI: 10.3390/tomography9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Mammography is the gold standard technology for breast screening, which has been demonstrated through different randomized controlled trials to reduce breast cancer mortality. However, mammography has limitations and potential harms, such as the use of ionizing radiation. To overcome the ionizing radiation exposure issues, a novel device (i.e. MammoWave) based on low-power radio-frequency signals has been developed for breast lesion detection. The MammoWave is a microwave device and is under clinical validation phase in several hospitals across Europe. The device transmits non-invasive microwave signals through the breast and accumulates the backscattered (returned) signatures, commonly denoted as the S21 signals in engineering terminology. Backscattered (complex) S21 signals exploit the contrast in dielectric properties of breasts with and without lesions. The proposed research is aimed to automatically segregate these two types of signal responses by applying appropriate supervised machine learning (ML) algorithm for the data emerging from this research. The support vector machine with radial basis function has been employed here. The proposed algorithm has been trained and tested using microwave breast response data collected at one of the clinical validation centres. Statistical evaluation indicates that the proposed ML model can recognise the MammoWave breasts signal with no radiological finding (NF) and with radiological findings (WF), i.e., may be the presence of benign or malignant lesions. A sensitivity of 84.40% and a specificity of 95.50% have been achieved in NF/WF recognition using the proposed ML model.
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19
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Pabico LJ, Jaron JN, Mosqueda ME, Wu JJ, Tiongco RE, Albano PM. Diagnostic Efficiency of Serum-Based Infrared Spectroscopy in Detecting Breast Cancer: A Meta-Analysis. Lab Med 2023; 54:98-105. [PMID: 35960788 DOI: 10.1093/labmed/lmac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The advancement of Fourier transform infrared (FTIR) spectroscopy as a potential diagnostic tool in the clinical setting has been studied over the years, particularly its application in cancer diagnostics. OBJECTIVE To summarize previous research on FTIR spectroscopy in detecting breast cancer using serum specimens. METHODS Related literature was searched and screened from various databases. Relevant data were then extracted, tabulated, and analyzed using Meta-DiSc 1.4 software. RESULTS Sensitivity and specificity rates were 90% to 100% and 80% to 95%, respectively. The area under the receiver operating characteristic curve was at 0.9729, indicating that serum analysis via FTIR spectroscopy can accurately discriminate between healthy individuals and patients with breast cancer. CONCLUSION Overall, FTIR spectroscopy for breast cancer diagnosis using serum specimens shows promising results. However, further studies are still needed to validate these claims.
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Affiliation(s)
- Louise Julie Pabico
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila, Philippines
| | - Jennica Naiomi Jaron
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila, Philippines
| | - Marc Erickson Mosqueda
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila, Philippines
| | - Jorge Jaesen Wu
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila, Philippines
| | - Raphael Enrique Tiongco
- Department of Medical Technology, College of Allied Medical Professions, Angeles University Foundation, Angeles City, Philippines
| | - Pia Marie Albano
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
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Muacevic A, Adler JR, Choudhari SG. Thermography as a Breast Cancer Screening Technique: A Review Article. Cureus 2022; 14:e31251. [PMID: 36505165 PMCID: PMC9731505 DOI: 10.7759/cureus.31251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
Globally, breast cancer is the most frequently occurring cancer in women and is the reason for more disability-adjusted life years lost than any other type of cancer. Hence, early screening plays a vital role in reducing breast cancer mortality. Although mammography is the standard procedure used for screening and diagnosis of breast cancer, it still has some limitations. Other methods used for screening include ultrasound and clinical breast examination. Despite its limitations, mammography is the gold standard for screening breast malignancy. Another emerging method for screening is thermography. With recent technological advances, breast cancer screening through thermography has demonstrated several advantages over existing modalities. For this review, a literature search was performed using databases such as PubMed, Google Scholar, and ScienceDirect. The keywords searched included breast cancer, early detection, breast cancer screening, mammography, and thermography. This review discusses the benefits of thermography showing that it can be a significant modality for breast cancer screening. The recent developments in thermal sensors, imaging protocols, and computer-aided software diagnostics hold great promise for making this technique a mainstream screening method for cancer. Moreover, the use of artificial intelligence and thermal imaging to detect early-stage breast cancer can provide impressive results. Therefore, thermography will be a promising technology for the early detection of breast cancer.
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Pepłońska B, Mirowski M, Kałużny P, Domienik-Andrzejewska J. Ionizing radiation and volumetric mammographic density. Int J Occup Med Environ Health 2022; 35:635-649. [PMID: 35913368 PMCID: PMC10464803 DOI: 10.13075/ijomeh.1896.01916] [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: 09/16/2021] [Accepted: 05/20/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES Mammographic density (MD) refers to the percentage of dense tissue of an entire breast and was proposed to be used as a surrogate marker for breast cancer. High-dose ionizing radiation (IR) has been recognized as a breast cancer risk factor. The aim of our study was to investigate association between lifetime low dose ionizing radiation (LDIR) and MD. MATERIAL AND METHODS A cross-sectional study included 467 women aged 40-60 years who underwent screening mammography in Łódź, Poland. The digital mammography examination of the breasts included both craniocaudal and mediolateral oblique views. The volumetric breast density (VBD) (%) and fibrograndular tissue volume (FG) (cm3) were determined based on the analysis of mammographic image ("for processing") using Volpara Imaging Software. The exposure to IR was estimated for each individual, based on the data from interviews about diagnostic or therapeutic medical procedures performed in the area of the neck, chest, abdomen and spine, which involved X-rays and γ rays and the data about the doses derived from literature. Linear and logistic regression were fitted with VBD and FG as the outcomes and organ breast dose, effective dose and number of mammographies as the determinants, adjusted for major confounders. RESULTS The analyses showed no association between VBD or FG and the breast organ dose or the effective dose. The only significant finding observed concerned the association between the number of mammographies and the FG volume with β coefficient: 0.028 (95% CI: 0.012-0.043), and predicted mean FG volume >13.4 cm3 among the women with >3 mammographies when compared to those with none. CONCLUSIONS This study does not, in general, provide support for the positive association between LDIR and MD. The weak association of the FG volume with the number of mammographies warrants further verification in larger independent studies. Int J Occup Med Environ Health. 2022;35(5):635-49.
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Affiliation(s)
- Beata Pepłońska
- Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Łódź, Poland
| | - Mateusz Mirowski
- Nofer Institute of Occupational Medicine, Department of Radiation Protection, Łódź, Poland
| | - Paweł Kałużny
- Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Łódź, Poland
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. RRIMS: Radiation Risk In Mammography Screening - a novel model for predicting the lifetime dose and risk of radiation-induced breast cancer from the first screening visit. BJR Open 2022; 4:20220028. [PMID: 38525172 PMCID: PMC10958679 DOI: 10.1259/bjro.20220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Radiation Risk In Mammography Screening (RRIMS) builds on the prototype, formerly known as Breast-iRRISC, to develop a model that aims to establish a dose and risk profile for females by calculating their lifetime mean glandular dose (MGD) for each age of screening between 40 and 75 years, using only the information from her first screening visit. This is then used to allocate her to a dose category and estimate the lifetime risk of radiation-induced breast cancer incidence and mortality for a population of females in that category. Methods This model training was developed using a large dataset of Hologic images containing a total of 20,232 images from 5,076 visits from 4,154 females. The female's breast characteristics and exposure parameters were extracted from the images to calculate the female's MGD throughout a lifetime of screening from just her first screening visit, using modelling of various parameters and their change through time. Results This development has ultimately provided a model that uses the female's first screening visit to calculate the received MGD for all ages of potential screening. This has enabled the allocation of females to either a low-, medium-, or high-dose category, ultimately followed by the lifetime effective risk (LER) estimation for any screening attendance pattern. A female in the low-dose category undergoing biennial screening from 50 to 74 years would expect a risk of radiation-induced breast cancer incidence and mortality of 8.64 and 2.61 cases per 100,000 females, respectively. Similarly, a female in the medium- or high-dose category undergoing the same regimen would expect an incidence and mortality risk of 11.76 and 3.55, and 15.08 and 4.55 cases per 100,000 females, respectively. Conclusions This novel approach of establishing a female's dose profile and lifetime risk from a single visit will further assist females in their informed consent on breast screening attendance and help inform policy-makers when exploring the benefits and drawbacks of various screening patterns and frequencies. Advances in knowledge RRIMS is a novel tool that enables the assessment of a female's lifetime dose and risk profile using only the information from her first screening visit.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, Australia
| | - Warren M. Reed
- Faculty of Medicine and Health, Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, Australia
| | - Mo'ayyad E. Suleiman
- Faculty of Medicine and Health, Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, Australia
| | - Patrick C. Brennan
- Faculty of Medicine and Health, Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, Australia
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Regression Analysis between the Different Breast Dose Quantities Reported in Digital Mammography and Patient Age, Breast Thickness, and Acquisition Parameters. J Imaging 2022; 8:jimaging8080211. [PMID: 36005454 PMCID: PMC9409844 DOI: 10.3390/jimaging8080211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Breast cancer is the leading cause of cancer death among women worldwide. Screening mammography is considered the primary imaging modality for the early detection of breast cancer. The radiation dose from mammography increases the patients’ risk of radiation-induced cancer. The mean glandular dose (MGD), or the average glandular dose (AGD), provides an estimate of the absorbed dose of radiation by the glandular tissues of a breast. In this paper, MGD is estimated for the craniocaudal (CC) and mediolateral–oblique (MLO) views using entrance skin dose (ESD), X-ray spectrum information, patient age, breast glandularity, and breast thickness. Moreover, a regression analysis is performed to evaluate the impact of mammography acquisition parameters, age, and breast thickness on the estimated MGD and other machine-produced dose quantities, namely, ESD and organ dose (OD). Furthermore, a correlation study is conducted to evaluate the correlation between the ESD and OD, and the estimated MGD per image view. This retrospective study was applied to a dataset of 2035 mammograms corresponding to a cohort of 486 subjects with an age range of 28–86 years who underwent screening mammography examinations. Linear regression metrics were calculated to evaluate the strength of the correlations. The mean (and range) MGD for the CC view was 0.832 (0.110–3.491) mGy and for the MLO view was 0.995 (0.256–2.949) mGy. All the mammography dose quantities strongly correlated with tube exposure (mAs): ESD (R2 = 0.938 for the CC view and R2 = 0.945 for the MLO view), OD (R2 = 0.969 for the CC view and R2 = 0.983 for the MLO view), and MGD (R2 = 0.980 for the CC view and R2 = 0.972 for the MLO view). Breast thickness showed a better correlation with all the mammography dose quantities than patient age, which showed a poor correlation. Moreover, a strong correlation was found between the calculated MGD and both the ESD (R2 = 0.929 for the CC view and R2 = 0.914 for the MLO view) and OD (R2 = 0.971 for the CC view and R2 = 0.972 for the MLO view). Furthermore, it was found that the MLO scan views yield a slightly higher dose compared to CC scan views. It was also found that the glandular absorbed dose is more dependent on glandularity than size. Despite being more reflective of the dose absorbed by the glandular tissue than OD and ESD, MGD is considered labor-intensive and time-consuming to estimate.
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Kopans DB. Missed it By That Much! Acad Radiol 2022; 29:1046-1047. [PMID: 35545478 DOI: 10.1016/j.acra.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
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Quality of Informed Consent in Mammography Screening-The Polish Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116735. [PMID: 35682316 PMCID: PMC9180228 DOI: 10.3390/ijerph19116735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/20/2022] [Accepted: 05/29/2022] [Indexed: 01/25/2023]
Abstract
Breast cancer is one of the leading forms of cancers in women worldwide. In Poland, it accounts for approx. 20% of all cancers diagnosed, with approximately 11,000 new cases and 5000 deaths from this disease annually. To prevent unfavourable statistics, Poland introduced free breast cancer screening programmes, available to women aged 50-69. Over a million women take advantage of this programme each year. The aim of the research was to assess the quality of consent women give prior to mammography screening and address the question of whether this quality is sufficient to make an informed choice. The study was conducted on a representative group of 600 Polish women over 50 years old (475 of them had undergone mammography screening), who agreed to take part in the study. Using the computer-assisted interview technology (CATI) method, all women were asked about their perception of breast cancer and screening and those who had undergone mammography were quizzed about the consent process. They will form the focus of this research. The validated tool contained items on both the benefits and risks of screening. The results indicate that the quality of informed consent was insufficient. A discrepancy was observed in the awareness between the benefits and risks of mammography screening. The main motivations to undergo screening were: prophylactic purposes and the free-of-charge nature of this health service. Population-based screening programmes for breast cancer should be reconsidered in terms of information policy, and the quality of informed consent should be increased.
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Overdetection of Breast Cancer. Curr Oncol 2022; 29:3894-3910. [PMID: 35735420 PMCID: PMC9222123 DOI: 10.3390/curroncol29060311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
Overdetection (often referred to as overdiagnosis) of cancer is the detection of disease, such as through a screening program, that would otherwise remain occult through an individual’s life. In the context of screening, this could occur for cancers that were slow growing or indolent, or simply because an unscreened individual would have died from some other cause before the cancer had surfaced clinically. The main harm associated with overdetection is the subsequent overdiagnosis and overtreatment of disease. In this article, the phenomenon is reviewed, the methods of estimation of overdetection are discussed and reasons for variability in such estimates are given, with emphasis on an analysis using Canadian data. Microsimulation modeling is used to illustrate the expected time course of cancer detection that gives rise to overdetection. While overdetection exists, the actual amount is likely to be much lower than the estimate used by the Canadian Task Force on Preventive Health Care. Furthermore, the issue is of greater significance in older rather than younger women due to competing causes of death. The particular challenge associated with in situ breast cancer is considered and possible approaches to avoiding overtreatment are suggested.
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The risk of increasing tumor malignancy after PET diagnosis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
This manuscript reviews evidences underlying the estimation of risk of malignancy enhancement of advanced aggressive cancers as a result of the gamma radiation emitted by tracers used in PET diagnostics. We conclude that among many cancers, such a phenomenon likely occurs, particularly in tumor cells with an aggressive biology in the advanced stages of their development, e.g. prostate cancer, melanoma and colorectal cancer. Moreover, we surmise based on gathered evidence that fluorine -18 (18F) labeled pharmaceuticals (18F-deoxyglucose and 18F-choline), commonly used in positron emission tomography (PET) can lead to malignancy enhancement of diagnosed cancer, manifesting as accelerated infiltration of the neighboring tissue, accelerated metastasis and/or radio- and chemotherapy resistance. In this review, some suggestions on future studies verifying this concept are also proposed. If our concerns are justified, it might be appropriate in the future to consider this assumption at the stage of deciding whether to undertake PET monitoring in some patients with advanced aggressive cancer.
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Park CKS, Xing S, Papernick S, Orlando N, Knull E, Toit CD, Bax JS, Gardi L, Barker K, Tessier D, Fenster A. Spatially tracked whole-breast three-dimensional ultrasound system toward point-of-care breast cancer screening in high-risk women with dense breasts. Med Phys 2022; 49:3944-3962. [PMID: 35319105 DOI: 10.1002/mp.15632] [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: 11/25/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mammographic screening has reduced mortality in women through the early detection of breast cancer. However, the sensitivity for breast cancer detection is significantly reduced in women with dense breasts, in addition to being an independent risk factor. Ultrasound (US) has been proven effective in detecting small, early-stage, and invasive cancers in women with dense breasts. PURPOSE To develop an alternative, versatile, and cost-effective spatially tracked three-dimensional (3D) US system for whole-breast imaging. This paper describes the design, development, and validation of the spatially tracked 3DUS system, including its components for spatial tracking, multi-image registration and fusion, feasibility for whole-breast 3DUS imaging and multi-planar visualization in tissue-mimicking phantoms, and a proof-of-concept healthy volunteer study. METHODS The spatially tracked 3DUS system contains (a) a six-axis manipulator and counterbalanced stabilizer, (b) an in-house quick-release 3DUS scanner, adaptable to any commercially available US system, and removable, allowing for handheld 3DUS acquisition and two-dimensional US imaging, and (c) custom software for 3D tracking, 3DUS reconstruction, visualization, and spatial-based multi-image registration and fusion of 3DUS images for whole-breast imaging. Spatial tracking of the 3D position and orientation of the system and its joints (J1-6 ) were evaluated in a clinically accessible workspace for bedside point-of-care (POC) imaging. Multi-image registration and fusion of acquired 3DUS images were assessed with a quadrants-based protocol in tissue-mimicking phantoms and the target registration error (TRE) was quantified. Whole-breast 3DUS imaging and multi-planar visualization were evaluated with a tissue-mimicking breast phantom. Feasibility for spatially tracked whole-breast 3DUS imaging was assessed in a proof-of-concept healthy male and female volunteer study. RESULTS Mean tracking errors were 0.87 ± 0.52, 0.70 ± 0.46, 0.53 ± 0.48, 0.34 ± 0.32, 0.43 ± 0.28, and 0.78 ± 0.54 mm for joints J1-6 , respectively. Lookup table (LUT) corrections minimized the error in joints J1 , J2 , and J5 . Compound motions exercising all joints simultaneously resulted in a mean tracking error of 1.08 ± 0.88 mm (N = 20) within the overall workspace for bedside 3DUS imaging. Multi-image registration and fusion of two acquired 3DUS images resulted in a mean TRE of 1.28 ± 0.10 mm. Whole-breast 3DUS imaging and multi-planar visualization in axial, sagittal, and coronal views were demonstrated with the tissue-mimicking breast phantom. The feasibility of the whole-breast 3DUS approach was demonstrated in healthy male and female volunteers. In the male volunteer, the high-resolution whole-breast 3DUS acquisition protocol was optimized without the added complexities of curvature and tissue deformations. With small post-acquisition corrections for motion, whole-breast 3DUS imaging was performed on the healthy female volunteer showing relevant anatomical structures and details. CONCLUSIONS Our spatially tracked 3DUS system shows potential utility as an alternative, accurate, and feasible whole-breast approach with the capability for bedside POC imaging. Future work is focused on reducing misregistration errors due to motion and tissue deformations, to develop a robust spatially tracked whole-breast 3DUS acquisition protocol, then exploring its clinical utility for screening high-risk women with dense breasts.
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Affiliation(s)
- Claire Keun Sun Park
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Shuwei Xing
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Samuel Papernick
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Nathan Orlando
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Eric Knull
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Carla Du Toit
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jeffrey Scott Bax
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Lori Gardi
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Kevin Barker
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - David Tessier
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Division of Imaging Sciences, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Br J Cancer 2022; 126:673-688. [PMID: 34837076 PMCID: PMC8854566 DOI: 10.1038/s41416-021-01521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 06/20/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations. METHODS We searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach. RESULTS We included one RCT, 13 observational, and 11 modelling studies. In women 50-69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45-49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50-69. In women 70-74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low. CONCLUSIONS In women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50-69. In younger women, annual screening may have a less favourable balance, while in women aged 70-74 years longer screening intervals may be more favourable.
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Covington MF, Mrose HE, Brown M. At Which Mean Glandular Dose Does the Benefit of Breast Cancer Deaths Averted Equal the Risk of Lives Lost to Screening From Radiation-induced Malignancy for Mammography With and Without Tomosynthesis? JOURNAL OF BREAST IMAGING 2022; 4:25-30. [PMID: 38422413 DOI: 10.1093/jbi/wbab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To estimate benefit-to-radiation-risk mean glandular dose (MGD) equivalence values for screening mammography, defined as the yearly MGD (over a 10-year period) at which the estimated benefit of mammography in terms of deaths averted equals the estimated risk of lives lost to screening due to radiation exposure (a benefit-to-risk ratio of 1). METHODS Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 for mammography and tomosynthesis using previously published methodology. The MGD values at which estimated benefit equals risk were tabulated. RESULTS The MGD values at which benefit-to-risk equivalence points were met for digital screening mammography are 63 milligray (mGy) (ages 40-49), 88 mGy (ages 50-59), 176 mGy (ages 60-69), and 336 mGy (ages 70-79). The MGD values that met benefit-to-risk equivalence for screening tomosynthesis plus digital mammography or synthetic mammography are 80 mGy (ages 40-49), 111 mGy (ages 50-59), 224 mGy (ages 60-69), and 427 mGy (ages 70-79). CONCLUSION Cutoff MGD values at which the estimated benefit from screening equals the estimated risk are well above standard screening MGD exposures. Care is necessary to ensure that threshold values are not exceeded during a screening exam, particularly for women ages 40-49 years old when using digital mammography plus tomosynthesis (due to an approximate doubling of dose per exam that will more readily exceed cutoff MGD values) and when many additional views are obtained.
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Affiliation(s)
- Matthew F Covington
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
- Huntsman Cancer Institute Center for Quantitative Cancer Imaging, Salt Lake City, UT, USA
| | - Helen E Mrose
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, UT, USA
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Kim LS, Lannin DR. Breast Cancer Screening: Is There Room for De-escalation? CURRENT BREAST CANCER REPORTS 2022; 14:153-161. [PMID: 36404936 PMCID: PMC9640864 DOI: 10.1007/s12609-022-00465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Purpose of Review Breast cancer screening is highly controversial and different agencies have widely varying guidelines. Yet it is currently used extensively in the USA and frequently the thought is "the more, the better." The purpose of this review is to objectively assess the risks and benefits of screening mammography and consider whether there may be areas where it could be de-escalated. Recent Findings Over the past few years, there have been several meta-analyses that are concordant, and it is now agreed that the main benefit of screening mammography is about a 20% reduction in breast cancer mortality. This actually benefits about 5% of patients with mammographically detected tumors. We now appreciate that the main harm of screening is overdiagnosis, i.e. detection of a cancer that will not cause the patient any harm and would not have ever been detected without the screening. This currently represents about 20 to 30% of screening detected cancers. Finding extra cancers with more intense screening is not always good, because in this situation, the risk of overdiagnosis increases and the benefit decreases. In some groups, the risk of overdiagnosis approaches 75%. Summary Our goal should be not only to find more cancers, but to avoid finding cancers that would never have caused the patient any harm and lead to unnecessary treatment. The authors suggest some situations where it may be reasonable to de-escalate screening.
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Affiliation(s)
- Leah S. Kim
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
| | - Donald R. Lannin
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
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Zerrad FE, Taouzari M, Makroum EM, El aoufi J, Islam MT, Özkaner V, Abdulkarim YI, Karaaslan M. Multilayered metamaterials array antenna based on artificial magnetic conductor's structure for the application diagnostic breast cancer detection with microwave imaging. Med Eng Phys 2022; 99:103737. [DOI: 10.1016/j.medengphy.2021.103737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 12/21/2022]
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Hooshmand S, Reed WM, Suleiman ME, Brennan PC. A review of screening mammography: The benefits and radiation risks put into perspective. J Med Imaging Radiat Sci 2021; 53:147-158. [PMID: 34969620 DOI: 10.1016/j.jmir.2021.12.002] [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: 09/16/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION/BACKGROUND In medical imaging a benefit to risk analysis is required when justifying or implementing diagnostic procedures. Screening mammography is no exception and in particular concerns around the use of radiation to help diagnose cancer must be addressed. METHODS The Medline database and various established reports on breast screening and radiological protection were utilised to explore this review. RESULTS/DISCUSSION The benefit of screening is well argued; the ability to detect and treat breast cancer has led to a 91% 5-year survival rate and 497 deaths prevented from breast cancer amongst 100,000 screened women. Subsequently, screening guidelines by various countries recommend annual, biennial or triennial screening from ages somewhere between 40-74 years. Whilst the literature presents different perspectives on screening younger and older women, the current evidence of benefit for screening women <40 and ≥75 years is currently not strong. The radiation dose and associated risk delivered to each woman for a single examination is dependent upon age, breast density and breast thickness, however the average mean glandular dose is around 2.5-3 mGy, and this would result in 65 induced cancers and 8 deaths per 100,000 women over a screening lifetime from 40-74 years. This results in a ratio of lives saved to deaths from induced cancer of 62:1. CONCLUSION Therefore, compared to the potential mortality reduction achievable with screening mammography, the risk is small.
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Affiliation(s)
- Sahand Hooshmand
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia.
| | - Warren M Reed
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, The Discipline of Medical Imaging Sciences, The University of Sydney, Susan Wakil Health Building (D18), Sydney, NSW 2050, Australia
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Convolutional Neural Networks for Breast Density Classification: Performance and Explanation Insights. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app12010148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We propose and evaluate a procedure for the explainability of a breast density deep learning based classifier. A total of 1662 mammography exams labeled according to the BI-RADS categories of breast density was used. We built a residual Convolutional Neural Network, trained it and studied the responses of the model to input changes, such as different distributions of class labels in training and test sets and suitable image pre-processing. The aim was to identify the steps of the analysis with a relevant impact on the classifier performance and on the model explainability. We used the grad-CAM algorithm for CNN to produce saliency maps and computed the Spearman’s rank correlation between input images and saliency maps as a measure of explanation accuracy. We found that pre-processing is critical not only for accuracy, precision and recall of a model but also to have a reasonable explanation of the model itself. Our CNN reaches good performances compared to the state-of-art and it considers the dense pattern to make the classification. Saliency maps strongly correlate with the dense pattern. This work is a starting point towards the implementation of a standard framework to evaluate both CNN performances and the explainability of their predictions in medical image classification problems.
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Comparison of Mean Glandular Dose between Full-Field Digital Mammography and Digital Breast Tomosynthesis. Healthcare (Basel) 2021; 9:healthcare9121758. [PMID: 34946484 PMCID: PMC8700789 DOI: 10.3390/healthcare9121758] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/02/2021] [Accepted: 12/12/2021] [Indexed: 11/23/2022] Open
Abstract
Early detection of breast cancer is diagnosed using mammography, the gold standard in breast screening. However, its increased use also provokes radiation-induced breast malignancy. Thus, monitoring and regulating the mean glandular dose (MGD) is essential. The purpose of this study was to determine MGD for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in the radiology department of a single centre. We also analysed the exposure factors as a function of breast thickness. A total of 436 patients underwent both FFDM and DBT. MGD was auto calculated by the mammographic machine for each projection. Patients’ data included compressed breast thickness (CBT), peak kilovoltage (kVp), milliampere-seconds (mAs) and MGD (mGy). Result analysis showed that there is a significant difference in MGD between the two systems, namely FFDM and DBT. However, the MGD values in our centre were comparable to other centres, as well as the European guideline (<2.5 mGy) for a standard breast. Although DBT improves the clinical outcome and quality of diagnosis, the risk of radiation-induced carcinogenesis should not be neglected. Regular quality control testing on mammography equipment must be performed for dose monitoring in women following a screening mammography in the future.
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Influence of double layer filter on mean glandular dose (MGD) and image quality in low energy image of contrast enhanced spectral mammography (LE-CESM). Radiography (Lond) 2021; 28:340-347. [PMID: 34838440 DOI: 10.1016/j.radi.2021.11.004] [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: 07/22/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate mean glandular dose (MGD) and image quality in low energy imaging from contrast-enhanced spectral mammography (CESM) when using double-layer filtration. METHODOLOGY A dedicated phantom was used to quantitatively estimate the MGD and image quality. The target slab of the phantom consisted of three iodine coins having a concentration of 1.0 mgI/cm3, 2.0 mgI/cm3, 4.0 mgI/cm3, a 100% adipose equivalent coin and a 100% glandular equivalent coin. The phantom was exposed using a semiautomated function at 28 k, 30 kV and 32 kV. MGD. Contrast to noise ratio (CNR) and figure of merit (FOM) were estimated for Mo/Rh, Mo/Rh + Cu, Mo/Rh + Al and Mo/Rh + Cd combinations using three breast equivalent compositions. RESULTS MGD was reduced up to a maximum of 1.03 mGy from 1.17 mGy for 100% adipose tissue. 1.18 mGy from 1.34 mGy for 50% glandular tissue and 1.39 mGy from 1.72 mGy for the 100% glandular phantom when using double-layer filtration. All of the above-mentioned results were obtained for the 50 mm phantom using 32 kV. CNR and FOM values were not significantly reduced with a double-layer filter when compared to a single-layer filter. CONCLUSION The present study concluded that Mo/Rh + Cu is the best combination to reduce the MGD significantly when compared to Mo/Rh + Al or Mo/Rh + Cd. Mo/Rh + Cu also achieved optimal image quality when compared to the Mo/Rh single filter combination. IMPLICATIONS OF PRACTICE The use of a double-layer filter in low energy imaging of CESM results in a significant reduction in MGD without degrading the quality of the image.
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Mainprize JG. To Use Tomosynthesis or Not in the Augmented Breast? JOURNAL OF BREAST IMAGING 2021; 3:701-702. [PMID: 38424934 DOI: 10.1093/jbi/wbab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Indexed: 03/02/2024]
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A Review of Breast Cancer Risk Factors in Adolescents and Young Adults. Cancers (Basel) 2021; 13:cancers13215552. [PMID: 34771713 PMCID: PMC8583289 DOI: 10.3390/cancers13215552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Cancer diagnosed in patients between the ages of 15 and 39 deserves special consideration. Diagnoses within this cohort of adolescents and young adults include childhood cancers which present at an older age than expected, or an early presentation of cancers that are typically observed in older adults, such as breast cancer. Cancers within this age group are associated with worse disease-free and overall survival rates, and the incidence of these cases are rising. Knowing an individual’s susceptibility to disease can change their clinical management and allow for the risk-testing of relatives. This review discusses the risk factors that contribute to breast cancer in this unique cohort of patients, including inherited genetic risk factors, as well as environmental and lifestyle factors. We also describe risk models that allow clinicians to quantify a patient’s lifetime risk of developing disease. Abstract Cancer in adolescents and young adults (AYAs) deserves special consideration for several reasons. AYA cancers encompass paediatric malignancies that present at an older age than expected, or early-onset of cancers that are typically observed in adults. However, disease diagnosed in the AYA population is distinct to those same cancers which are diagnosed in a paediatric or older adult setting. Worse disease-free and overall survival outcomes are observed in the AYA setting, and the incidence of AYA cancers is increasing. Knowledge of an individual’s underlying cancer predisposition can influence their clinical care and may facilitate early tumour surveillance strategies and cascade testing of at-risk relatives. This information can further influence reproductive decision making. In this review we discuss the risk factors contributing to AYA breast cancer, such as heritable predisposition, environmental, and lifestyle factors. We also describe a number of risk models which incorporate genetic factors that aid clinicians in quantifying an individual’s lifetime risk of disease.
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Tamam N, Salah H, Rabbaa M, Abuljoud M, Sulieman A, Alkhorayef M, Bradley D. Evaluation of patients radiation dose during mammography imaging procedure. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Orringer CE, Blaha MJ, Stone NJ. Coronary artery calcium scoring in patients with statin associated muscle symptoms: Prescribing statins for those most likely to benefit. J Clin Lipidol 2021; 15:782-788. [PMID: 34688585 DOI: 10.1016/j.jacl.2021.09.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/07/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
For primary prevention, statin therapy reduces the incidence of atherosclerotic cardiovascular disease (ASCVD) events in adults with intermediate or high estimated 10-year risk using traditional population-based risk calculators. While a variety of reported symptoms may limit statin adherence, muscle complaints, whether typical or atypical of that associated with statin therapy, are the most common reported by patients. Because additional testing, alteration in the patient's medical regimen and subsequent medical visits are often required, an informed clinician-patient discussion and shared decision making are necessary to achieve the best outcomes. The authors provide support for the perspective that coronary calcium scoring, by individualizing estimated risk and helping to identify those most likely to benefit, plays a vital role in preventive therapy decision-making for the primary prevention patient with troublesome muscle complaints attributed to statin therapy.
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Affiliation(s)
- Carl E Orringer
- Department of Medicine, Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Neil J Stone
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Huang Y, Zheng S, Lai B. Analysis of the Mechanism of Breast Metastasis Based on Image Recognition and Ultrasound Diagnosis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4452500. [PMID: 34671449 PMCID: PMC8523227 DOI: 10.1155/2021/4452500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022]
Abstract
Breast cancer is one of the cancers with the highest incidence among women. In the late stage, cancer cells may metastasize to a distance, causing multiple organ diseases, threatening the lives of patients. The detection of lymph node metastasis based on pathological images is a key indicator for the diagnosis and staging of breast cancer, and correct staging decisions are the prerequisite and basis for targeted treatment. At present, the detection of lymph node metastasis mainly relies on manual screening by pathologists, which is time-consuming and labor-intensive, and the diagnosis results are variable and subjective. The automatic staging method based on the panoramic image calculation of the sentinel lymph node of the breast proposed in this paper can provide a set of standardized, high-accuracy, and repeatable objective diagnosis results. However, it is very difficult to automatically detect and locate cancer metastasis areas in highly complex panoramic images of lymph nodes. This paper proposes a novel deep network training strategy based on the sliding window to train an automatic localization model of cancer metastasis area. The training strategy first trains the initial convolutional network in a small amount of data, extracts false-positive and false-negative image blocks, and uses manual screening combined with automatic network screening to reclassify the false-positive blocks to improve the class of negative categories. Using mammography, ultrasound, MRI, and 18F-FDG PET-CT examinations, the detection rate and diagnostic accuracy of primary cancers in the breast of patients with axillary lymph node metastasis as the first diagnosis were obtained. The detection rate and diagnostic accuracy of breast MRI for primary cancers in the breast are much higher than those of X-ray, ultrasound, and 18F-FDG PET-CT (all P values <0.001). Mammography, ultrasound, and PET-CT examinations showed no difference in the detection rate and diagnostic accuracy of primary cancers in the breast of patients with axillary lymph node metastasis as the first diagnosis. Breast MRI should be used as a routine examination for patients with axillary lymph node metastasis as the first diagnosis. The primary breast cancer in the first diagnosed patients with axillary lymph node metastasis is often presented as localized asymmetric compactness or calcification on X-ray; it often appears as small focal mass lesions and ductal lesions without three-dimensional space-occupying effect on ultrasound.
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Affiliation(s)
- Yihong Huang
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, China
| | - Shuo Zheng
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, China
| | - Baoyong Lai
- Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China
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Fishman MDC, Rehani MM. Monochromatic X-rays: The future of breast imaging. Eur J Radiol 2021; 144:109961. [PMID: 34562745 DOI: 10.1016/j.ejrad.2021.109961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To present details about the innovative and disruptive technology of monochromatic X-rays and its application to breast imaging. METHODS To analyze results of studies done using a prototype system for breast imaging that generates monochromatic X-rays through fluorescence emission. To assess signal-to-noise ratio (SNR) as a measure of image quality at different doses in breast phantoms of different sizes and review the comparison of parameters with a standard mammography system. RESULTS Monochromatic X-rays reduce the radiation dose per mammogram by a factor of 5 to 10 times. For phantom simulating thick breast (9 cm), the SNR for monochromatic system was 2.6 times higher and the dose 4.2 times lower than the respective values obtained with the conventional system within the same 5 mm × 5 mm square area of the 100% glandular step wedge. For the conventional broadband system to equal the SNR of the monochromatic system, it would require a dose of 19 mGy, 29 times higher than the dose delivered by the monochromatic system. Contrast-enhanced digital mammography with monochromatic X-rays is shown to provide a simpler and more effective technique at substantially lower radiation dose. CONCLUSIONS Lowering radiation dose by a factor of 5 to 10 while maintaining image quality implies a major reduction in total exposure from breast cancer screening and dramatically less risk of radiation-induced cancers in at-risk women. The high SNRs for very thick breast phantoms provide strong evidence that screening with lower breast compression is possible while maintaining image quality.
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Affiliation(s)
- Michael D C Fishman
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Jiang G, Wei J, Xu Y, He Z, Zeng H, Wu J, Qin G, Chen W, Lu Y. Synthesis of Mammogram From Digital Breast Tomosynthesis Using Deep Convolutional Neural Network With Gradient Guided cGANs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2080-2091. [PMID: 33826513 DOI: 10.1109/tmi.2021.3071544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Synthetic digital mammography (SDM), a 2D image generated from digital breast tomosynthesis (DBT), is used as a potential substitute for full-field digital mammography (FFDM) in clinic to reduce the radiation dose for breast cancer screening. Previous studies exploited projection geometry and fused projection data and DBT volume, with different post-processing techniques applied on re-projection data which may generate different image appearance compared to FFDM. To alleviate this issue, one possible solution to generate an SDM image is using a learning-based method to model the transformation from the DBT volume to the FFDM image using current DBT/FFDM combo images. In this study, we proposed to use a deep convolutional neural network (DCNN) to learn the transformation to generate SDM using current DBT/FFDM combo images. Gradient guided conditional generative adversarial networks (GGGAN) objective function was designed to preserve subtle MCs and the perceptual loss was exploited to improve the performance of the proposed DCNN on perceptual quality. We used various image quality criteria for evaluation, including preserving masses and MCs which are important in mammogram. Experiment results demonstrated progressive performance improvement of network using different objective functions in terms of those image quality criteria. The methodology we exploited in the SDM generation task to analyze and progressively improve image quality by designing objective functions may be helpful to other image generation tasks.
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Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2021; 217:314-325. [DOI: 10.2214/ajr.20.24204] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lin CN, Lee KT, Chang SM, Wang JD. Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data. J Formos Med Assoc 2021; 121:633-642. [PMID: 34246512 DOI: 10.1016/j.jfma.2021.06.013] [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: 02/01/2021] [Revised: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/PURPOSE We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.
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Affiliation(s)
- Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ting Lee
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Robins T, Camacho J, Agudo OC, Herraiz JL, Guasch L. Deep-Learning-Driven Full-Waveform Inversion for Ultrasound Breast Imaging. SENSORS 2021; 21:s21134570. [PMID: 34283105 PMCID: PMC8272012 DOI: 10.3390/s21134570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
Ultrasound breast imaging is a promising alternative to conventional mammography because it does not expose women to harmful ionising radiation and it can successfully image dense breast tissue. However, conventional ultrasound imaging only provides morphological information with limited diagnostic value. Ultrasound computed tomography (USCT) uses energy in both transmission and reflection when imaging the breast to provide more diagnostically relevant quantitative tissue properties, but it is often based on time-of-flight tomography or similar ray approximations of the wave equation, resulting in reconstructed images with low resolution. Full-waveform inversion (FWI) is based on a more accurate approximation of wave-propagation phenomena and can consequently produce very high resolution images using frequencies below 1 megahertz. These low frequencies, however, are not available in most USCT acquisition systems, as they use transducers with central frequencies well above those required in FWI. To circumvent this problem, we designed, trained, and implemented a two-dimensional convolutional neural network to artificially generate missing low frequencies in USCT data. Our results show that FWI reconstructions using experiment data after the application of the proposed method successfully converged, showing good agreement with X-ray CT and reflection ultrasound-tomography images.
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Affiliation(s)
- Thomas Robins
- Department of Earth Science and Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK; (T.R.); (O.C.A.)
| | - Jorge Camacho
- Ultrasound Systems and Technology Group (GSTU), Institute for Physical and Information Technologies (ITEFI), Spanish National Research Council (CSIC), 28006 Madrid, Spain;
| | - Oscar Calderon Agudo
- Department of Earth Science and Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK; (T.R.); (O.C.A.)
| | - Joaquin L. Herraiz
- Nuclear Physics Group and IPARCOS, Faculty of Physical Sciences, University Complutense of Madrid, CEI Moncloa, 28040 Madrid, Spain;
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lluís Guasch
- Department of Earth Science and Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK; (T.R.); (O.C.A.)
- Correspondence:
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Dzaye O, Berning P, Dardari ZA, Mortensen MB, Marshall CH, Nasir K, Budoff MJ, Blumenthal RS, Whelton SP, Blaha MJ. Coronary artery calcium is associated with increased risk for lung and colorectal cancer in men and women: the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2021; 23:708-716. [PMID: 34086883 DOI: 10.1093/ehjci/jeab099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/03/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study explored the association of coronary artery calcium (CAC) with incident cancer subtypes in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC is an established predictor of cardiovascular disease (CVD), with emerging data also supporting independent predictive value for cancer. The association of CAC with risk for individual cancer subtypes is unknown. METHODS AND RESULTS We included 6271 MESA participants, aged 45-84 and without known CVD or self-reported history of cancer. There were 777 incident cancer cases during mean follow-up of 12.9 ± 3.1 years. Lung and colorectal cancer (186 cases) were grouped based on their strong overlap with CVD risk profile; prostate (men) and ovarian, uterine, and breast cancer (women) were considered as sex-specific cancers (in total 250 cases). Incidence rates and Fine and Gray competing risks models were used to assess relative risk of cancer-specific outcomes stratified by CAC groups or Log(CAC+1). The mean age was 61.7 ± 10.2 years, 52.7% were women, and 36.5% were White. Overall, all-cause cancer incidence increased with CAC scores, with rates per 1000 person-years of 13.1 [95% confidence interval (CI): 11.7-14.7] for CAC = 0 and 35.8 (95% CI: 30.2-42.4) for CAC ≥400. Compared with CAC = 0, hazards for those with CAC ≥400 were increased for lung and colorectal cancer in men [subdistribution hazard ratio (SHR): 2.2 (95% CI: 1.1-4.7)] and women [SHR: 2.2 (95% CI: 1.0-4.6)], but not significantly for sex-specific cancers across sexes. CONCLUSION CAC scores were associated with cancer risk in both sexes; however, this was stronger for lung and colorectal when compared with sex-specific cancers. Our data support potential synergistic use of CAC scores in the identification of both CVD and lung and colorectal cancer risk.
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Affiliation(s)
- Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philipp Berning
- Department of Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Catherine Handy Marshall
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD 21287, USA
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Elmore JG, Lee CI. Keeping Pace With Technology Advances in Breast Cancer Screening: Synthetic 2D Images Outperform Digital Mammography. J Natl Cancer Inst 2021; 113:645-646. [PMID: 33372678 DOI: 10.1093/jnci/djaa208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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Golmakani MK, Hubbard RA, Miglioretti DL. Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests. Biometrics 2021; 78:1244-1256. [PMID: 33939839 DOI: 10.1111/biom.13484] [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: 04/06/2020] [Revised: 11/16/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
Screening tests are widely recommended for the early detection of disease among asymptomatic individuals. While detecting disease at an earlier stage has the potential to improve outcomes, screening also has negative consequences, including false positive results which may lead to anxiety, unnecessary diagnostic procedures, and increased healthcare costs. In addition, multiple false positive results could discourage participating in subsequent screening rounds. Screening guidelines typically recommend repeated screening over a period of many years, but little prior research has investigated how often individuals receive multiple false positive test results. Estimating the cumulative risk of multiple false positive results over the course of multiple rounds of screening is challenging due to the presence of censoring and competing risks, which may depend on the false positive risk, screening round, and number of prior false positive results. To address the general challenge of estimating the cumulative risk of multiple false positive test results, we propose a nonhomogeneous multistate model to describe the screening process including competing events. We developed alternative approaches for estimating the cumulative risk of multiple false positive results using this multistate model based on existing estimators for the cumulative risk of a single false positive. We compared the performance of the newly proposed models through simulation studies and illustrate model performance using data on screening mammography from the Breast Cancer Surveillance Consortium. Across most simulation scenarios, the multistate extension of a censoring bias model demonstrated lower bias compared to other approaches. In the context of screening mammography, we found that the cumulative risk of multiple false positive results is high. For instance, based on the censoring bias model, for a high-risk individual, the cumulative probability of at least two false positive mammography results after 10 rounds of annual screening is 40.4.
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Affiliation(s)
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California at Davis, Davis, California, USA
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Niroshani HS, Jeyasugiththan J, Senanayake G, Negishi T. Establishment of regional diagnostic reference levels for digital mammography in Western Province of Sri Lanka. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:79-96. [PMID: 33271512 DOI: 10.1088/1361-6498/abd075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The radiation dose to the breasts should be kept to a minimum as breast tissues are highly sensitive to radiation. In mammography, the mean glandular dose (MGD) is used to specify the patient dose. In this study, data on the MGD during diagnostic mammographic examinations was collected using the database from six digital mammography facilities available in the Western Province in Sri Lanka. Examinations involving breast pathology, breast implants, or compressed breast thicknesses (CBT) outside the range of 20-110 mm were excluded in this study. The mean MGD per breast was 3.50 mGy, with a mean CBT of 57 mm. The mean MGD per facility varies from 1.58 to 2.27 mGy, with overall 75th and 95th percentiles of 2.15 and 2.82 mGy, respectively. The 75th and 95th percentile MGD per image, for the average CBT of 57 ± 12 mm, were 2.00 and 2.65 mGy respectively. The 75th percentile value of the MGD is suggested for the Western Province and it depends on the specific CBT.
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Affiliation(s)
- H S Niroshani
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
- Department of Radiography & Radiotherapy, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | | | - G Senanayake
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Toru Negishi
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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