Women's Imaging News

Based a new study published in the journal Radiology, the rate at which women are called back for supplementary imaging, following a screened mammography might be higher at hospitals than at community office clinics/practices, which is mostly credited to the differences among the patients. Researchers note that the data collected during the study offers insight into the limitations surrounding recall rates as a quality measure for breast cancer screening. The Centers for Medicare & Medicaid Services selected the screening mammography recall rate as one of eight physician performance measures in 2006. In addition, the American College of Radiology (ACR) and the Agency for Healthcare Research and Quality recommend a target rate of less than 10 percent. Albeit the universal recall rate goals, the measure itself is strongly affected by patient factors, such as age, breast density, use of hormone replacement therapy, interval since the previous mammogram, and previous benign biopsy results. Recall rates for mammography are reflected in the percentage of women who undergo screening and are called back for further testing. Since recalls involve anxiety for patients and additional costs, there have been efforts to keep these rates as low as possible. "Recall rate by itself is used as a quality indicator by the federal government. Therefore, it remains important to understand the factors that influence recall rate for individuals and practices,” said Radiologist at the Rhode Island Hospital and the Alpert School of Medicine at Brown University in Providence, R.I., Ana Lourenco, M.D. In an attempt to better understand such elements, Lourenco and the rest of the research team examined data between May 2008 and September 2011. Their point of focus was on five radiologists with breast imaging knowledge who read/interpreted mammograms at both academic medical centers and community practices. The radiologists read/interpreted a sum of 74,297 screening mammograms (37,691 mammograms at the academic center and 36,606 at the community practice during the study period). The total recall of patients tallied to 5,799, for an overall recall rate of 7.8 percent. At 6.9 percent, the recall rate at the community site was significantly lower than the hospital rate of 8.6 percent. "For every radiologist, the recall rate was significantly lower in community practice than in the hospital setting," said Lourenco. Moreover, when researchers compared the two groups of patients, they found crucial differences which could have possibly affected recall rates. It was discovered that considerably more hospital patients had undergone previous surgeries and biopsies. A little more than 13 percent of the patients at the hospital location had medical backgrounds of surgery, as opposed to 5.6 percent at the community site, while 7 percent of hospital patients had undergone biopsies, compared with 1.4 percent at the community site. "These patients may have more complicated mammograms to interpret or may be at higher risk for cancer than patients at the community site. Higher risk patients would be expected to increase the recall rate of the population,” said Lourenco. One other major factor was patients’ ages. Average age of patients at the hospital was 56 years, compared to the average age of 63 years at the community site. "Younger age has been associated with higher recall rates," added Lourenco. For the time being, Lourenco credits all the effort put forth in developing quality metrics for breast cancer screening. However, she cautions that recall rates are influenced by elements beyond a radiologist's control; and therefore cannot be the sole determinant of the quality of a radiologist or an ... Read more

Last month, radiologists with Magee-Womens Hospital of UPMC performed the nation’s very first 3-D guided breast biopsy, making it the sole U.S. center to fully complete and provide this kind of sophisticated biopsy procedure for the advantage of its patients. This new system goes hand in hand with the 3-D screening equipment known as breast tomosynthesis that Magee radiologists helped develop. 3-D guided biopsies permit the localization and precise marking of regions of interest using 3-D mammography, which establishes a full reconstruction of the breast, giving radiologists the capability to make out certain abnormalities which can be difficult to identify with conventional screening practices. The new 3-D biopsy system, which was granted approval by the Food and Drug Administration (FDA), was developed by Hologic, Inc. and has various advantages over conventional stereotactic biopsy procedures, including quicker abrasion targeting, condensed patient procedure time and reduced radiation exposure. "This biopsy option is especially valuable for women with breast lesions that are hard to reach with standard biopsy procedures, as well as for women with arthritis or other physical issues that make traditional biopsy difficult," said Chief of radiology at Magee, Jules Sumkin, D.O. A lot of the preliminary 3-D research was carried out at Magee, whose research team is still regarded as the most widely published group in the U.S. in this specific field of technology. "The ability for us to provide 3-D guided biopsy to our patients represents an exciting new example of our leadership in this area. Magee radiologists continue to play a pivotal role in the development and advancement of this technology,” declared Sumkin. In conventional-guided biopsies, known as stereotactic biopsies, images are taken at two differing angles of the breast to determine depth of the possible abrasion. The three-dimensional technology has the ability to calculate abrasion depth at higher accuracy rates. Not all women are in need of a biopsy; but those who do (especially those with hard to detect cancers) will greatly benefit from 3-D guided biopsies. "If we can do a biopsy with ultrasound guidance, that's preferable. But there is a subset of patients where you can't find it by ultrasound because of body variations,” said Sumkin. “During a 3-D biopsy a patient sits upright rather than lying on a table. This benefits women who have difficulty lying down due to arthritis or other health complications.” Other advantages include, shortened procedure time and exposure to radiation is significantly lessened; since stereotactic biopsies call for at least two images be taken, more X-ray doses are required. “Unlike stereotactic biopsies, which require expensive, standalone machines, 3-D biopsies are performed using a piece of equipment attached directly to tomosynthesis machines, which is a huge cost saving,” added Sumkin. However, tomosynthesis is still less common than two-dimensional mammography, as Sumkin drew on the reluctance to bring such pricy technology. "For a hospital to buy this equipment and not be reimbursed for it does not work in this day and age," he said, estimating only about six or seven tomosynthesis machines in Pittsburgh. By offering women the very latest in mammography and breast biopsy technology, Magee foresees more women regularly screened for breast cancer. Breast cancer is the second-leading cause of cancer related deaths among women, surpassed only by lung cancer. Statistical data shows that one in eight women are likely to be diagnosed with the disease. The stage at which breast cancer is discovered often plays a crucial role, in a woman’s chances of survival. If identified early, the five-year survival rate sits at a promising 98 percent. Sumkin also cites Magee has performed 50 to 60 3-D guided breast biopsies. He remains optimistic for the future of this 3-D technology and expects it to fall into many patients’ insurance plans; for tomosynthesis helps physicians detect and treat fatal cancers early, which in the long run is less costly than treatment at later stages of the ... Read more

VuCOMP, Inc. and the Mankato Clinic in Minnesota, U.S.A. recently announced the installation of a highly advanced computer aided detection system for mammography. The system, known as the M-Vu CAD, has been built to supply an unparalleled level of performance and execution in assisting radiologists locate and detect breast cancer at a much earlier stage. The system captures and examines images from Mankato Clinic’s new Fujifilm Aspire HD Plus and IMS Giotto 3DL digital mammography machines. These two leading technologies combined, make Mankato’s Diagnostic Imaging Department a bonafide leader with unrivaled abilities and possibilities in breast cancer diagnosis. VuCOMP’s CAD system analyzes mammographic images and marks areas of suspicion using sophisticated mathematical algorithms. “What I like most about VuCOMP’s CAD system is its sensitivity, and the specificity is actually very good to the point where we trust it more than the previous CAD system that we used,” said Mankato Clinic Diagnostic Radiologist Maureen Magut, M.D. “I have found this to be very helpful, particularly in the evaluation of dense breasts. The system is also exceptional in identifying microcalcifications that I had not myself found. Another significant strength is that it picks up a lot more asymmetric densities than with our previous CAD system.” In addition, Mammography Manager at Mankato Clinic, Glenda Beeck notes that the VuCOMP CAD system serves almost like a second radiologist, helping to locate and identify cancers that radiologists might not fully see upon first glance. ''The exceptional aspect of this technology, is that it increases diagnostic confidence while also reducing false positives. Areal breakthrough for CAD systems,” she said. The VuCOMP CAD system was issued FDA approval for digital mammography in October 2012. Most recently implemented FDA guidelines have considerably altered CAD performance, setting a new standard for all systems to meet and follow, and now recommend all-inclusive studies have proven that radiologists are much more effective and efficient when they employ CAD technology. “Dr. Magut’s experience with our product is further validation of what other users are saying. VuCOMP is working hard to significantly improve our CAD performance even more in the near future,” said President and CEO of VuCOMP, Jeff Wehnes. VuCOMP, Inc. is a private company that designs, develops, and markets computer-aided detection systems (CAD) for automatic analysis of medical images. The employees of VuCOMP are dedicated to providing an unprecedented level of detection technology to help radiologists find disease at earlier stages and save lives. For more visit their webistie at ... Read more

Most recently, the method of deformable image registration (DIR) has been developed and tested in the hopes of providing more accurate image-guided radiotherapy and adoptive radiotherapy. DIR use in the localization of tumor bed may be possible employing preoperative imaging work-up without the need of additional study for the sole purpose of radiotherapy planning. Therefore, the study aimed to assess the feasibility of initial PET-CT in localization of the tumor bed through the method of deformable image registration with planning CT.Whole breast irradiation after breast conserving surgery is one of the basic treatments for the patients with early-stage breast cancer. Following breast irradiation, it has been noted that significant improvement in local tumor bed control has sharply risen; yet attaining the desired level of control of localization in the tumor bed is vital. CT-based simulation, in which lumpectomy cavity and surgical clips provide localizing information, has been used to determine whether the tumor bed had been improved. However, due to the poor visualization of lumpectomy cavity and absence of surgical clips, it is difficult to determine the tumor bed in some instances. Radiation oncologists determine tumor bed by looking at surgical scar markings and preoperative images that include mammography, ultrasonography, and breast MR. However, there exists flaws in these methods as well, since surgical scars are not always representational of the exact location of the tumor bed, and the use of preoperative images differs from CT simulation, as there may be a geographic discrepancy in the estimation of tumor bed. Some studies suggest that breast MR coupled with CT offers more accurate results on tumor bed localization, however the option is not always made available. Twenty-five patients who had received an initial diagnostic PET-CT and underwent breast-conserving surgery with surgical clips in tumor bed were selected for the study. In every single patient, two target volumes were separately outlined on planning CT; 1) target volume based on surgical clips with a margin of 1 cm (TVclip) and 2) tumor volume based on 90% of maximum SUV on PET-CT registered by DIR (TVPET). The percent of TVPET in TVclip (Vin) was determined and the distance between the two center points of the two volumes (Dcenter) was also taken into account. Automatic rigid image registration (RIR) was the first step of DIR between diagnostic PET-CT and planning CT. After RIR, DIR was lead to the next step. The spatial discrepancy of nipple between the two images was measured in each step and compared to assess the performance of the DIR process of breast tissue. For RIR, the distance between the nipples between PET-CT and planning CT ranged from 0.4 to 3.9 cm (average, 2.3) and following the DIR process it ranged from 0.0 to 3.4 cm (average, 0.8).Dcenter between two volumes was 1.4 cm (range, 0.33 – 2.53). Average Vin was 94.8 percent (range, 60.9-100) and 100 percent in 18 out of 25 patients. When compared to the center of TVclip the center of TVPE tended to be located posteriorly (average 0.3 cm, standard deviation 0.6), laterally (average 0.3cm, standard deviation 0.8) and inferiorly (average 0.4 cm, standard deviation, 0.9). Based on the results, researchers were able to conclude that with the use of DIR, initial diagnostic PET-CT can be a feasible indicator to localize the tumor bed in breast cancer ... Read more

Nearly 40,000 American women run the risk of dying from breast cancer annually due to breast density. “Knowledge is power when it comes to your health,” said radiologist at Baptist Health Breast Center, Dr. Cristina Vieira. Breast radiologist at the University of Miami Sylvester Comprehensive Cancer Center, Dr. Monica Yepes also explained that when reading a mammogram a radiologist can determine the density of the breasts. The more fibro-glandular tissue than fatty tissue, the denser the breasts are. Radiologists then rate breast density on a scale of one (least dense) to four (most dense) using the Breast Imaging Reporting and Data System (BI-RADS) of the American College of Radiology. Typically, most women find themselves at a three or four on the breast density scale, but Yepes assures that this is normal; as breast density fluctuates overtime by several factors such as hormone replacement therapy, or large amounts of weight gain or loss. However, physicians are aware dense breasts don’t always equate to breast cancer. Chief of Women’s Imagine for Radiology Associates of Florida, Dr. Mary Hayes mentions that if two patients are similar but one has denser breasts, both patients will respond the same way to the cancer. The only difference lies in detecting cancer in dense breast tissue. On a mammogram, fatty breast tissue is displayed in gray or black, while fibro-glandular tissues as well as many cancers appear white. “So detecting a cancer among the dense tissue is like looking for a snowball in a snowstorm or the stars in the daytime sky,” said Hayes. While mammographies are the current standard for detecting breast cancer, Hayes considers other alternatives such as 3-D mammography or tomosynthesis as better-suited tools for detecting breast cancer in denser tissue. “The machine looks much like the one used for traditional mammography but instead of taking one picture, it produces an image that resembles the pages of a book. Each ‘page’ represents a one millimeter thickness of your compressed breast. If there is any dense breast tissue or other features that are causing the potential cancer to hide, we can unravel them,” said Hayes. Hayes also notes that with the 3D technology false positives (number of times women are recalled to check on somethings that ends up as benign) reduced by 20 percent. “A mammogram gives doctors a picture of the overall appearance of the breasts that can be compared from year to year. The 3-D image on the other hand lets them drill down and look millimeter by millimeter, page by page through that breast,” said Hayes. Yet it is by no means an attempt to remove standard mammograms, as both technologies can be utilized in complementary fashion. After receiving a mammogram and tomosynthesis a patient and physician can discuss their breast density and take the appropriate steps in terms of the patient’s age, family, and medical histories. Women have already launched groups such as How Dense Are you (areyoudense.org), as they strive to pass state and legislation requiring women to be given more information about dense breasts in the letter, notifying them of the results of their mammograms. However, Yepes notes the call for legislation is unnecessary if women took responsibility for their health and instigated a discussion about breast density with their doctor. “Together we can weigh the pros and cons,” she ... Read more

Women's Life Imaging Center recent acquisition of two Hologic Selena Dimensions 3D mammogram machines, has become a leader in mammographic technology, as it is the sole establishment on the Seacoast that provides the latest in breast cancer screening and diagnostic tools and methods. The facility mainly receives and treats patients from Wentworth-Douglass Hospital in Dover and Frisbie Memorial Hospital in Rochester as both institutions do not offer mammography screenings themselves. "But we have a lot of women who come from Maine and even northern Massachusetts," adds Operations Manager for the Center, Beth Beaudin. "There are other 3D machines in the state, but none that I know of in Maine." It is commonly known amongst physicians and women that early detection is often crucial and plays a major role in diagnosing and treating breast cancer. Over the last few years, mammograms have come under heavy fire for failing to identify some breast cancers due to breast tissue density. While other professionals claim that mammograms tend to over-react that lead to otherwise unnecessary biopsies.  Yet the new digital 3D mammogram called breast tomosynthesis, is a ground-breaking technology that allows radiologists the means to detect and classify individual breast structures without the confusion of overlying tissue. Unlike an immobile 2D digital mammogram system, the X-ray arm of the breast tomosynthesis posses the ability to span 15 degrees above the breast, documenting several different images in one setting. The radiologist is also able to view the breast tissue in one-millimeter layers. "There is much better visualization of the breast tissue. Things jump out more that may have been hidden before,” said supervisor of the technologists at the center, Cheri Farnham. Farnham compared it to looking at a 3D image of a cloud with the ability to see inside that cloud. "Doctors are able to see more and be more confident in their findings. In many cases, it reduces the 'dreaded call-back' for additional views,” said Beaudin. By use of the 3D mammography technology, radiologists can sift through images of the breast with gentle ease, as one would flip through a newspaper or book. The examine itself is identical to the 2D digital procedure, however there is no added density needed and it requires a few seconds longer to view each image. "The only downside right now is the storage system. They are huge files and we need to have the capacity to store them,” said Beaudin. Women's Life Imaging Center has nine radiology technicians and two dedicated radiologists from Seacoast Radiology to read the mammograms on the spot. As for a screening mammogram, data is delivered to the patient’s physician within 28 to 48 hours. The patient then meets with the radiologist to look at methods of additional testing, like breast ultrasound and/or biopsy, which is performed at the center. "We do about 62 to 70 mammograms a day. In addition, we do about 12 to 18 breast ultrasounds a day and 40 to 50 biopsies each month,” said Beaudin. The center also provides bone densitometry exams, having received its authorization from the American College of Radiology. "We also have a program called 'Peace of Mind' for women with a low income or no insurance. No woman should say she didn't have her yearly mammogram because she couldn't afford it,” said ... Read more

Based on a study conducted by the Mayo Clinic and other participants have discovered that rural women with breast cancers are less likely to be administered supplementary radiation therapy following a lumpectomy, which is a breast-sparing surgery that takes out only tumors and surrounding tissue, than their urban counterparts. The difference is one of many rural discrepancies in breast cancer diagnosis and method of treatment, the researchers found. The discoveries are set to be revealed at the Academy Health Annual Research Meeting in Baltimore. "These study results are concerning. All women should receive guideline recommended cancer care, regardless of where they live,” said associate scientific director, Surgical Outcomes, Mayo Clinic Center for the Science of Health Care Delivery, Elizabeth Habermann, Ph.D. By using the 1996 to 2008 California Cancer Registry, the research teams from Mayo Clinic, the University of Minnesota and Georgetown University, examined the treatment administered to approximately 350,000 urban and rural women, who all had stages of breast cancer. And despite there being no real difference in mortality rates between the two groups, researchers discovered that rural women were less likely to have their estrogen receptor status tested and their tumor scaled and rated, which are two crucial steps in the diagnostic process for breast cancer. Furthermore, rural women were also more prone to selecting and settling on the procedure of mastectomy, which is the complete removal of the breast, over a lumpectomy procedure. The study eventually determined that rural women who selected lumpectomy were less likely to receive supplementary radiation therapy after the surgery. "The lumpectomy findings are worrisome because lack of follow-up radiation therapy could lead to recurrence, another surgery, and another time period of concern for the woman and her family," said Habermann. The research team suggested delving deeper into the findings that suggest rural women are less likely to prefer breast conserving therapy and receive recommended cancer diagnosis and treatment. From there, conferences and seminars can then be held to discuss and address the disparity gaps that exist between rural and urban ... Read more

For patients with advanced breast cancer, positron emission tomography (PET) and magnetic resonance (MR) imaging can enhance the quality of life and increase chances of survival by supplying doctors with information on the efficiency of chemotherapy prior to surgery. The researchers who shared their findings at the annual meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) held in Vancouver (BC, Canada), June 2013, combined individual imaging systems, PET, MR, and computed tomography (CT), to outline the course of chemotherapy before surgery, referred to as neoadjuvant chemotherapy. All these diverse imaging units supply corresponding information, both structural and physiologic, on how chemotherapy will be disseminated throughout the body to eliminate breast cancer and metastatic tumors. Researchers utilized a dedicated molecular imaging agent called F-18 fluorodeoxyglucose (FDG) that operates as a biomarker for cellular metabolism with PET to mark areas of cancer metastasis. “Previous studies have shown that, separately, FDG PET and dynamic enhanced MR imaging can provide a prediction of how patients will respond to neoadjuvant treatment, but we have improved upon this concept by combining the two techniques side by side,” said current director of the department of nuclear medicine, and until 2006, director of the National Radiation Emergency Medical Center of the Korea Institute of Radiological and Medical Sciences (Seoul, Republic of Korea), Sang Moo Lim, MD. “Using both FDG PET and MR imaging to predict cancer progression-free survival allows us to apply more aggressive therapies that could potentially halt patients’ cancers and extend their lives.” The study, which calculated the overall survival rate following chemotherapy, enrolled 44 women known to have advanced breast cancer. All patients were subjected to three rounds of neoadjuvant chemotherapy and whole-body FDG PET/CT, breast MR, and delayed breast PET/CT totaling four times. Once before the first round of chemotherapy, then again following the first round, then after the second round, and finally once more before undergoing surgery, to assess and verify disease-free survival. Data results showed that patient survival with no resurgence of cancer after neoadjuvant chemotherapy was gauged to be a little under three months to around three years for an average rate of 661 days. “Additionally, this study demonstrates the collective potential of these imaging systems, which provides evidence that fused PET/MR utilizing both metabolic and vascular perfusion imaging can benefit patients. Together, these techniques can help clinicians classify patients and provide risk stratification to not only predict cancer recurrence after treatment but also avoid chemotherapy for those who probably would benefit more from an alternative treatment,” said Lim. The study exhibited great promise when merging PET and MR imaging, supplying added evidence of the pros of simultaneous PET/MR imaging. “This extends beyond just breast cancer. We could potentially apply these technologies to other malignancies and develop some brilliant methods to improve clinical outcomes. Considering the results of our research, we now need to further develop the technology not just imaging systems, but tracers and biomarkers to advance our field. Research and development in nuclear medicine and molecular imaging can satisfy these demands for the future,” concluded ... Read more

Based on a Belgian study published online in European Radiology, radiologists interpreting breast screening studies had similar performances irrespective of whether the images were obtained using computed radiography (CR) or digital radiography (DR) mammography systems. Yet, DR still registered at a lower dose than CR. Lately, researchers have voiced concern about the efficiency of CR-related mammography as opposed to DR. In another study conducted by Canadian researchers and published in Radiology, it was noted that CR was 21% less effective than DR in cancer recognition. However, lead author of the Belgian study, Dr. Hilde Bosmans, of University Hospitals Leuven, and her team point out that their study’s findings suggest that the concern is foundationless. “Our screening indicators are reassuring for the use of CR and DR. Screening performance parameters for CR and DR technology are not significantly different,” noted the study. Data which assesses CR procedures in a screening set-up are quite sparse, irrespective of the fact that most of these systems are broadly used across Europe. In an effort to set things right, the team weighed technical and clinical screening performance restrictions between the two systems, including data from 73,008 women screened with CR and 116,945 women screened with DR between 2008 and 2010; with both groups being screened twice. Clinical determinants that were taken into account by the team were recall rate, cancer detection rate, percentage of ductal carcinoma in situ identified, percentage of cancers with T-scores smaller than 1 cm, and positive predictive value. The study itself yielded interesting results. From the study it was shown that: 1.  Recall rates for CR and DR in the first round of screening were 5.48% compared with 5.61%; subsequent screening rounds had recall rates of 2.52% and 2.65%.2.  Cancer detection rates were 0.52% for CR and 0.53% for DR.3.  Rates of ductal carcinoma in situ (DCIS) were 0.08% for CR and 0.11% for DR.4.  Rates of cancers with T-scores smaller than 1 cm were 0.11% for both technologies.5.  The positive predictive value of CR was 18.45% compared with DR's 18.64%. Yet none of these parameters presented any significant differences between CR and DR systems. However, there was one slight difference in the two technologies, that being, both of them required different mean glandular dose (MGD). The study determined this by calculating the MGD level of standard procedure and noted that CR's MGD was 2.16 mGy, while DR’s was 1.35 mGy, a 60% difference. And while these calculations still fall under the guidelines issued in 2006 by the European Council, Bosmans and her team believe CR’s higher MGD should be factored in. "The higher doses used with CR technology versus DR for a screening examination at the age of 50 years could lead to an extra 1.6 radiation-induced cancers per 100,000 women screened. However, the expected benefit of reduction in premature mortality afforded by routine mammographic screening in terms of either lives saved or years of life saved greatly exceeds this risk,” they ... Read more

A newly released study conducted in the UK proposes that screening for breast cancer does not necessarily diminish the rate of deaths from the disease. The study, which looked at data spanning over a 40 year time period of mammograms, adds to the debate regarding whether or not it is the actual screening or improvement in treatment that is responsible for the drop in rates of death caused by breast cancer. The study was carried out by researchers from the Department of Public Health at the University of Oxford, report their findings online in the June issue of the Journal of the Royal Society of Medicine. Lead author Toqir Mukhtar and her team looked at and evaluated mortality rates documented before and after 1988, the year during which the National Health Service Breast Screening Program first began. The team was somewhat limited in the respect that they could only account for breast cancer deaths with the Oxford area, due to this being the only region of England where death certificates document all causes of death, and not simply highlighting the cause, before the commencement of the screening program. Comparing and contrasting the data findings with death rates for England as a whole, the team found no tenable facts, in having 40 years of data, that suggested a greater cause of deaths in women other than those who underwent breast screening. Such findings eventually challenged a prior study featured in The Lancelot in 2012, which reported that patients who are asked to come back for a mammogram screening have a 20 percent lower risk of breast cancer death than those who do receive the screening. Yet, that particular study in 2012 also noted that for every death prevented by a breast cancer screening, three patients are usually over-diagnosed and treated for the disease. Mukhtar clarifies the aim of her and her team’s study is not to discredit the positives in breast screenings for most women, but that any such result is not substantial enough to present at the population level. In addition, Mukhtar also mentions the difficulties in attempting to gauge the overall effectiveness of mammogram screenings when the past 20 years have witnessed a tremendous strive in improved treatments and in the technology used to perform the screening. Mukhtar believes all these changes should be taken into account. "Measuring the effectiveness of mammography screening is a fundamental area of concern in countries which have established mammography screening programs,” she said. In conclusion Mukhtar notes that clinical trials prove one must wait for several years after a screening program, before any significant reductions in death are seen. "Yet our data shows that there is no evidence of an effect of mammographic screening on breast cancer mortality at the population level over an observation period of almost 40 years,” she ... Read more

Ohio researches have discovered that by adding shear-wave elastography to a second-viewing breast ultrasound study conducted after dynamic contrast-enhanced MRI (DCE-MRI) can identify almost a third more cancers than B-mode ultrasound. A study of 73 women showed, shear-wave elastography bumped up cancer identification on a second-viewing ultrasound by 31%. Director of breast imaging at University Hospitals Case Medical Center in Cleveland, Dr. Donna Plecha noted shear-wave elastography has a high negative predictive value, increasing the prospects that findings will have a correlation with pathology; and its ability to detect subtle cancers during second-look ultrasound after DCE-MRI. Following DCE-MRI, second-look ultrasound offers visualization of lacerations and gives-way to instant ultrasound-directed biopsy. Shear-wave elastography assesses rigidity by determining proliferation shear waves within tissue. Therefore 73 women (ages 21-84 with average age of 52) received shear-wave elastography during their second-look ultrasound after one or more abrasions were found on DCE-MRI. MRI studies were carried-out on either a Magnetom Avanto or Magnetom Espree 1.5-tesla scanner using a specialized breast coil. Lacerations that were BI-RADS category 4 and 5 after DCE-MRI were assessed using second-look ultrasound, with both B-mode ultrasound and shear-wave elastography completed using an Aixplorer ultrasound system with a 12-5 MHz linear-array transducer. Patients were originally scanned with B-mode ultrasound and if a correlation existed with the MRI-detected lesion, then shear-wave elastography was deployed to charter tissue rigidity. Qualitative color shear-wave elastographic rigidity was used for all lacerations using a five-point color-scheme of highest elasticity in the accumulation and surrounding parenchyma. All 96 lacerations were given ultrasound-guided or MRI-guided core biopsy and researchers documented pathology outcomes for all lacerations. Of the 96 lacerations, 28 (29%) were malignancies, 14 (14%) were high-risk lesions, and 55 (57%) were benign. Assembling elastography findings into weaker abrasions (elastography color scale of 1 or 2) and stronger abrasions (elastography color scale of 3, 4, and 5), shear-wave elastography had sensitivity of 95.2%, specificity of 70%, positive predictive value of 71.4%, and negative predictive value of 91%. Abrasions seen on second-look ultrasound were more likely to be of a cancerous origin than those seen only on MRI  (p = 0.006). Shear-wave elastography detected five of the 50 abrasions seen on second-look ultrasound, all of which were invasive cancer. Four were invasive ductal carcinoma and one was an invasive lobular carcinoma. Of the abrasions detected with DCE-MRI, 84 (87%) were masses; 48 (57%) were also found on second-look ultrasound, thus eliminating the need for an MRI biopsy. The remaining 12 (13%) were nonmass developments, with two (17%) detected on ultrasound. Ultrasound was significantly more likely to find mass enhancement (p = 0.012). "Ultrasound-guided biopsy of DCE-MRI BI-RADS category 4 or 5 lesions remains preferable to MRI biopsy because of its relative ease, lower cost, and improved patient comfort. The high negative predictive value of the five-point color score of maximum elasticity may help with the confidence level of the radiologist when correlating a benign biopsy result with the B-mode ultrasound image,” said Plecha. For now the next stage of research for Plecha and her team is to involve more patients in an attempt to raise statistical ... Read more

According to a study published online in Radiology, it was reported that radiologists who read less than 1,000 mammography studies each year might see a decline in overall diagnostic accuracy, compared to those who read more. Likewise, researchers from the University of Sydney in Australia discovered that intuitive mistakes were connected to poor performance in mammographic interpretation were affected by the number of readings radiologists performed year-round. The team also cited that 60 percent of all diagnostic errors in radiology stem from perceptual ones. Such errors result from a lack of knowledge of properly searching an image, inability to distinguish any irregularities, and flawed decision-making in respect to whether an abnormality discovered on an image is normal or a pathologic abrasion. "As long as radiologists interpret medical images, the human factor and its limitations on abnormality detection will continue to influence overall performance," lead author Mohammed Rawashdeh and his team noted. Their research also shows different countries expect different performance levels and annual number of readings that radiologists should log. In the U.S. the required number of readings is 490 per year. While in Australia and Canada the reading standard rests at 2,000 (although British Columbia demands 2,500 readings) and in the U.K. the yearly requirement is 5,000 readings. For this particular study, 116 radiologists read 60 mammographic cases, 20 of which were with cancer, while the remaining 40 were clean. The team then scored their confidence levels in their analyses on a scale of 1 to 5. Results were examined using the jackknife free-response receiver operator characteristics (JAFROC) scheme, which focuses on lesion location and range and is more telling of how radiologists specifically deduce images in medical practice. From the data collected, Rawashdeh and his team discovered that reader performance is closely associated with the number of years following full responsibility and aptitude as a radiologist; in accordance with the number of years reading mammograms, and the number of annual readings. The team’s findings showed that radiologists who read less than 1,000 images a year had significantly lower performance skills when evaluated compared to those who read over 1,000 (sometimes up to 5,000) images every year. Furthermore, readers with an average number of 1,000 or less mammograms did not considerably improve over the course of their careers. Instead their performances gradually suffered and dropped with increased years of reading mammograms. "This inverse relationship between performance and years of experience has important implications for radiology, as a reasonable assumption that a low volume of readings can be compensated for by years of experience is unfounded," said Rawashdeh. Incidentally the opposite was also true, as radiologists who read over 5,000 mammography images a year, progressed throughout their careers. "The true discriminating factor that separates individuals performing at the highest levels from others is the ability to recognize what is normal," Rawashdeh and his team ... Read more