Etta Pisano

• Medical University of South Carolina

Background: The primary aim of the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) is to determine whether women randomly assigned to be screened through 3-5 rounds with tomosynthesis (TM) have fewer advanced cancers than the population screened with digital mammography (DM) over 3-8 years after entry. In addition, there are 15 secondary...

This paper explores the design considerations and hurdles encountered by the CHinA National CancEr Screening (CHANCES) Trial and the Tomosynthesis Mammographic Imaging Screening Trial (TMIST), both aimed at advancing cancer screening research. Before population-based cancer screening programs are launched, it is important to have confidence that th...

Background The United States Preventative Services Task Force in their 2023 recommendations identified areas where more research data is needed to inform future breast cancer screening recommendations. Research areas identified are: improve clinicians and patients understanding and evaluation of dense breast tissue on a screening mammogram, benefit...

TPS10614 Background: The ECOG-ACRIN Tomosynthesis Mammographic Imaging Screening Trial (TMIST), which opened in 2017, is a randomized trial designed to assess whether Tomosynthesis Mammography (TM) should replace Digital Mammography (DM) for breast cancer screening. It is hypothesized that women assigned to TM for 3-5 screening rounds will have few...

TPS10609 Background: ECOG-ACRIN launched the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) through the National Cancer Institute’s National Clinical Trials Network (NCTN)— a network of academic medical centers, community hospitals, and private clinical practices that are committed to participating in NCI-funded clinical trials. The NCI...

Objective: The objective of our study was to determine the accuracy of preoperative measurements for detecting pathologic complete response (CR) and assessing residual disease after neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer. Subjects and methods: The American College of Radiology Imaging Network 6657 Trial p...

Purpose: To estimate the accuracy of predicting response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer using MR spectroscopy (MRS) measurements made very early in treatment. Materials and methods: This prospective Health Insurance Portability and Accountability Act (HIPAA)-compliant protocol was approved by t...

Purpose: To evaluate volumetric magnetic resonance (MR) imaging for predicting recurrence-free survival (RFS) after neoadjuvant chemotherapy (NACT) of breast cancer and to consider its predictive performance relative to pathologic complete response (PCR). Materials and methods: This HIPAA-compliant prospective multicenter study was approved by i...

Breast tomosynthesis, a three-dimensional x-ray based breast imaging technology, has been available for clinical use in the United States since 2011. In this paper we review the literature on breast cancer screening with this new technology including where gaps in knowledge remain.

Systems and methods for detecting an image of an object using a multi-beam imaging system from an x-ray beam having a polychromatic energy distribution are disclosed. According to one aspect, a method can include generating a first X-ray beam having a polychromatic energy distribution. Further, the method can include positioning a plurality of mono...

Objective: The purpose of this study was to assess the impact of computer-aided detection (CAD) systems on the performance of radiologists with digital mammograms acquired during the Digital Mammographic Imaging Screening Trial (DMIST). Materials and methods: Only those DMIST cases with proven cancer status by biopsy or 1-year follow-up that had...

Another spirited debate has ensued over the benefits of breast cancer screening,1 freshly stimulated by the recent publication of the 25-year follow-up results of the Canadian National Breast Screening Study (CNBSS) that showed no difference in breast cancer–related mortality in screened women vs controls.2 This latest controversy developed even th...

Importance: False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force. Objective: To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, and attitu...

New “Sunshine Act” requirements for disclosure by pharmaceutical and medical device companies of payments to faculty have led to increased conversation about conflict of interest (COI).1 Conflict of interest is defined as “circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced...

LEARNING OBJECTIVES 1) Understand the published literature on the use of tomosynthesis for breast cancer screening. 2) Understand the proposed trial design for the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) and what that trial adds to the available data on tomosynthesis.

LEARNING OBJECTIVES 1) To understand the impetus for job change across the career of radiologists in practice and academia. 2) To learn about nontraditional and traditional career opportunities open to radiologists. 3) To learn about the challenges, both professional and personal, of pursuing career path changes.

The purpose of this article is to correlate various ultrasound features of breast cancer with tumor grade, and with estrogen, progesterone, and ERRB2 (formerly HER2) receptor status as well as to assess the predictive value of these features. The features of breast cancers found by using ultrasound between January 2010 and June 2011 were reviewed f...

The Medical University of South Carolina launched a systematic plan to infuse diversity among its students, resident physicians, and faculty in 2002. The dean and stakeholders of the College of Medicine (COM) embraced the concept that a more population-representative physician workforce could contribute to the goals of providing quality medical edu...

As a potential biomarker for women's cardiovascular and chronic kidney diseases, breast arterial calcification (BAC) in mammography has become an emerging research topic in recent years. To provide more objective measurement for vascular structures with calcium depositions in mammography, a new computerized method is introduced in this paper to del...

The purpose of this study was to assess the sensitivities and false-detection rates of two computer-aided detection (CADe) systems when applied to digital or film-screen mammograms in detecting the known breast cancer cases from the Digital Mammographic Imaging Screening Trial (DMIST) breast cancer screening population. Available film-screen and di...

To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer. The HIPAA-compliant protocol and the informed consent process were approved by the American College of Radiology Institutional Review Board and local-sit...

The purpose of this study was to assess the performance of a MicroDose photon-counting full-field digital mammography (PCM) system in comparison to full-field digital mammography (FFDM) for area under the receiver-operating characteristic (ROC) curve (AUC), sensitivity, specificity, and feature analysis of standard-view mammography for women presen...

Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening. To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer. Fr...

Purpose: The goal of this study was to begin quantifying the performance of a second generation diffraction enhanced imaging (DEI) system designed to reduce imaging time from our first generation system. Background: DEI, a phase contrast x-ray imaging modality, generates images with enhanced soft tissue contrast at a lower dose than conventional ra...

The objective of our study was to compare the performance of positron emission mammography (PEM) with that of MRI in the evaluation of the contralateral breast of women with newly diagnosed cancer. Four hundred seventy-two women with newly diagnosed breast cancer offered breast-conserving surgery from September 2006 through November 2008 consented...

CONCLUSION This new DEI prototype allows for reduced imaging times. The next conventional tube-based DEI system will further reduce the required imaging time and be focused on breast imaging as the clinical application. BACKGROUND Diffraction enhanced imaging (DEI) is a type of phase contrast x-ray imaging with improved soft tissue contrast at a l...

Mammographic technology has improved dramatically in the last two decades. The advent of digitally acquired mammograms offers the possibility of further improvements in early breast cancer detection. Specifically, digital acquisition systems decouple the process of X-ray photon detection from image display by using a primary detector that directly...

Diffraction-enhanced imaging (DEI) is a type of phase contrast x-ray imaging that has improved image contrast at a lower dose than conventional radiography for many imaging applications, but no studies have been done to determine if DEI might be useful for diagnosing lung injury. The goals of this study were to determine if DEI could differentiate...

Although breast cancer screening with mammography and magnetic resonance imaging (MRI) is recommended for breast cancer-susceptibility gene (BRCA) mutation carriers, there is no current consensus on the optimal screening regimen. The authors used a computer simulation model to compare 6 annual screening strategies (film mammography [FM], digital ma...

Purpose: Diffraction enhanced imaging (DEI) generates image contrast in a fundamentally different way than absorption x‐ray imaging—the refraction and extinction of x‐rays yield unique contrast. The purpose of this study was to measure the apparent absorption coefficient of the lung tissue in normal rats and to quantify the difference in contrast b...

To determine (a) how often the Breast Imaging Reporting and Data System (BI-RADS) category 3 was used in the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST), either at the time of screening mammography or after work-up, (b) how often subjects actually returned for the recommended follow-up...

Diffraction enhanced imaging (DEI), also called analyzer-based imaging (ABI), cultivated within the synchrotron community, has the potential to revolutionize medical imaging through reduced dose and enhanced contrast imaging. DEI was invented at the National Synchrotron Light Source (NSLS) in the mid-1990s [3]; similar imaging approaches were inde-...

Proceedings: AACR 101st Annual Meeting 2010‐‐ Apr 17‐21, 2010; Washington, DC Background: In 2002 the Women's Health Initiative (WHI) reported an increased rate of breast cancer with estrogen and progestin therapy (EPT). Percent mammographic density (MD) is one of the strongest predictors of breast cancer risk and may be a useful intermediate mark...

Dietary intake of vitamin D and calcium may be related to risk of breast cancer, possibly by affecting mammographic density. However, the few studies that have evaluated the association between these nutrients and mammographic density in postmenopausal women have had inconsistent results. We conducted a cross-sectional analysis in 808 participants...

To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer. Four hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November...

In this article, the published literature on the role of screening mammography in the detection of ductal carcinoma in situ (DCIS) is reviewed. This includes what is known about the detection of DCIS in different demographic groups. Finally the author describes her views on how the field might be advanced.

The purpose of this study was to determine the acquisition and interpretation times of screen-film mammography and soft-copy digital mammography in a diagnostic mammography center. The study was conducted in three phases for patients presenting for clinical diagnostic workup to a mammography clinic. In the first phase, technologist acquisition and...

The use of breast computed tomography (CT) has been limited by radiation hazard and image quality. The objective of this study was to compare radiation doses and image quality for different 64-channel multidetector row CT (MDCT) parameters, and to potentially provide optimal CT parameters for breast imaging. For assessment of radiation doses, CT do...

Conventional mammography can not distinguish between transmitted, scattered, or refracted x-rays, thus requiring breast compression to decrease tissue depth and separate overlapping structures. Diffraction-enhanced imaging (DEI) uses monochromatic x-rays and perfect crystal diffraction to generate images with contrast based on absorption, refractio...

The purpose of our study was to compare the technical performance of full-field digital mammography (FFDM) and screen-film mammography. The American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial enrolled 49,528 women to compare FFDM and screen-film mammography for screening. For quality assurance purposes, techni...

To determine reasons for nonparticipation in a trial of supplemental screening with magnetic resonance (MR) imaging after mammography and ultrasonography (US). Women(n = 2809) at elevated risk of breast cancer were enrolled in the American College of Radiology Imaging Network 6666 US Screening Protocol at 21 institutions. Fourteen institutions met...

Imaging and local therapy are important modalities for detection and management of localized breast cancer. Improvements in screening and local therapy have contributed to reduced breast cancer-associated morbidity and mortality. The Coalition of Cancer Cooperative Groups (CCCG) convened the Scientific Leadership Council (SLC) in breast cancer, an...

PURPOSE To determine the most accurate method to assess residual disease post chemotherapy, prior to surgery in patients with locally advanced breast cancer. ACRIN 6657 is a multi-center study of MRI for measurement of breast tumor response to neoadjuvant chemotherapy. METHOD AND MATERIALS This IRB approved study enrolled women between May 2002 an...

Increased mammographic density is associated with increased breast cancer risk and reduced sensitivity of screening mammography and is related to hormone exposure. However, the effects of conjugated equine estrogens (CEEs) alone on mammographic density in diverse racial/ethnic populations are not established. We examined the effect of CEE alone on...

In conventional projection radiography, cartilage and other soft tissues do not produce enough radiographic contrast to be distinguishable from each other. Diffraction-enhanced imaging (DEI) uses a monochromatic x-ray beam and a silicon crystal analyzer to produce images in which attenuation contrast is greatly enhanced and x-ray refraction at tiss...

Conventional mammographic image contrast is derived from x-ray absorption, resulting in breast structure visualization due to density gradients that attenuate radiation without distinction between transmitted, scattered, or refracted x-rays. Diffraction-enhanced imaging (DEI) allows for increased contrast with decreased radiation dose compared to c...

To determine which factors contributed to the Digital Mammographic Imaging Screening Trial (DMIST) cancer detection results. This project was HIPAA compliant and institutional review board approved. Seven radiologist readers reviewed the film hard-copy (screen-film) and digital mammograms in DMIST cancer cases and assessed the factors that contribu...

Diffraction-enhanced imaging (DEI) is a new x-ray imaging modality that has been shown to enhance contrast between normal and cancerous breast tissues. In this study, diffraction-enhanced imaging in computed tomography (DEI-CT) mode was used to quantitatively characterize the refraction contrasts of the organized structures associated with invasive...

529 Background: American College of Radiology Imaging Network (ACRIN) trial 6657, the imaging component of the I-SPY trial (CALGB 150007/150012), is testing MRI for predicting response to treatment and stratifying risk-of-recurrence in patients with locally-advanced breast cancer. We report preliminary results evaluating MRI for prediction of patho...

To compare radiologists' performance in detecting breast cancer when reading full-field digital mammographic (FFDM) images either displayed on monitors or printed on film. This study received investigational review board approval and was HIPAA compliant, with waiver of informed consent. A reader study was conducted in which 26 radiologists read scr...

The aim of this study was to determine if patients who underwent partial-breast irradiation followed by segmental mastectomies had fewer mammographic changes on the first post-treatment mammogram than those who underwent segmental mastectomies followed by whole-breast irradiation. Subjects enrolled in a study of partial-breast irradiation therapy a...

Diffraction-enhanced imaging (DEI) is a new x-ray imaging modality that differs from conventional radiography in its use of three physical mechanisms to generate contrast. DEI is able to generate contrast from x-ray absorption, refraction, and ultra-small-angle scatter rejection (extinction) to produce high-contrast images with a much lower radiati...

#6043 Background: ACRIN 6657, the imaging component of the I-SPY trial (CALGB 150007/150012), is a multi-center study testing the ability of MRI to provide in-vivo quantification of breast tumor response to neoadjuvant chemotherapy, for early prediction of response and stratification of risk-of-recurrence following treatment. We report results from...

Scholarly activity, which may include research, is now a required element of resident training. In addition, residents are required to participate in a systems-based practice or quality improvement project. Residency programs are expected to provide training for these endeavors but may lack the necessary resources. This work is intended to provide...

To compare the diagnostic accuracy of two continuous screening tests, a common approach is to test the difference between the areas under the receiver operating characteristic (ROC) curves. After study participants are screened with both screening tests, the disease status is determined as accurately as possible, either by an invasive, sensitive an...

Conventional mammographic image contrast is derived from x-ray absorption, resulting in breast structure visualization due to density gradients that attenuate radiation without distinction between transmitted and scattered or refracted x-rays. This leads to image blurring and contrast reduction, hindering the early detection of small or otherwise o...

A fully automatic algorithm is developed for breast arterial calcification extraction in mammograms. This algorithm is implemented in two major steps: a random-walk based tracking step and a compiling and linking step. With given seeds from detected calcification points, the tracking algorithm traverses the vesselness map by exploring the uncertain...

PURPOSE Purpose: To assess the clinical utility of emerging digital tomosynthesis (DT) technology and improve breast cancer detection in women with heterogeneously dense (HD) and extremely dense (ED) breasts. To evaluate mass conspicuity on DT compared to DM in HD and ED breasts. To assess reader preference and workflow issues of DT compared to DM....

PURPOSE The diffraction enhanced imaging (DEI) method is an x-ray imaging technique capable of generating image contrast from x-ray absorption, refraction, and ultra-small angle scatter rejection (extinction). Previous studies in breast tissue have demonstrated significant gains in contrast when compared to conventional radiography, but the technic...

PURPOSE To evaluate the factors that may have contributed to the results of DMIST METHOD AND MATERIALS 9 radiologist readers reviewed film and digital mammograms of the DMIST cancer cases and assessed factors contributing to lesion visibility on both modalities. Generalized logistic regression models were used to analyze the combined and condensed...

To evaluate how the insurance status of women diagnosed with breast cancer correlates with size and stage at the time of diagnosis. The age-adjusted incidence of early- and late-stage breast cancer as determined by the tumor node metastasis classification system of stages in situ, local, regional, or distant was calculated for insured and uninsured...

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer p...

Screening ultrasound may depict small, node-negative breast cancers not seen on mammography. To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography vs mammography alone in women at elevated risk of breast can...

We explored diffraction enhanced imaging (DEI) in both planar and computed tomography (CT) modes for early detection of beta amyloid deposition, a hallmark feature in Alzheimer's disease (AD). Since amyloid plaques precede clinical symptoms by years, their early detection is of great interest. These findings were correlated with results from synchr...

To retrospectively compare the accuracy for cancer diagnosis of digital mammography with soft-copy interpretation with that of screen-film mammography for each digital equipment manufacturer, by using results of biopsy and follow-up as the reference standard. The primary HIPAA-compliant Digital Mammographic Imaging Screening Trial (DMIST) was appro...

To retrospectively compare the accuracy of digital versus film mammography in population subgroups of the Digital Mammographic Imaging Screening Trial (DMIST) defined by combinations of age, menopausal status, and breast density, by using either biopsy results or follow-up information as the reference standard. DMIST included women who underwent bo...

The DMIST (Digital Mammography Imaging Screening Trial) reported improved breast cancer detection with digital mammography compared with film mammography in selected population subgroups, but it did not assess the economic value of digital relative to film mammography screening. To evaluate the cost-effectiveness of digital mammography screening fo...

This article outlines the reasons that many radiology practices are converting to digital mammography. In addition, it provides basic information about the issues that must be considered in making the transformation. These issues include technical matters regarding image display, storage, and retrieval as well as clinical and ergonomic consideratio...

To prospectively determine cancer yield, callback and biopsy rates, and positive predictive value (PPV) of mammography, magnetic resonance (MR) imaging, and ultrasonography (US) in women at high risk for breast cancer. The study was approved by the institutional review board and was HIPAA compliant, and informed consent was obtained. We conducted a...

The American Cancer Society (ACS), in 2003, found that nonconventional screening measures such as magnetic resonance imaging (MRI) might be suitable for women at increased risk of breast cancer, but there was not enough evidence to warrant making recommendations. Since then, more information on MRI screening has become available, and an expert pane...

We sought to compare the cancer detection rate and receiver operating characteristic (ROC) area under the curve of full-field digital mammography, screen-film mammography, and a combined technique that allowed diagnosis if a finding was suspicious on film mammography, on digital mammography, or both. We used the data originally analyzed by Lewin an...

We sought to determine which factors affected the decrease in average glandular dose recorded at the annual U.S. Food and Drug Administration Mammography Quality Standards Act inspections of mammography equipment in North Carolina from 2002 through 2005. Average glandular dose, half-value layer, kVp, equipment age, processing speed, and system spee...

604 Background: There is wide variation in the use of breast MRI to screen the contralateral breast in patients recently diagnosed with unilateral breast cancer. Some centers routinely scan all patients with a recent diagnosis of breast cancer while others restrict breast MRI to patients with dense breast tissue, patients who are pre-menopausal, or...

The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography. A total of 198 English-speaking women, with no personal or family history of breast cancer, were recruited and randomized to four groups when they presented...

The purpose of this study was to determine whether there are identifiable factors that dissuade female medical students from entering the field of radiology. An anonymous survey was completed by medical students at the end of their third- or fourth-year radiology clinical clerkships at five institutions. In addition to demographic data and residenc...

Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast...

New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recomme...

LEARNING OBJECTIVES To define Stage 1 breast cancer. To understand treatment options for women with Stage 1 breast cancer and the data supporting those therapies. To understand the variability of the metastatic potential of different types of Stage 1 breast cancers.

PURPOSE The National Cancer Institute and the American College of Radiology sponsored the Digital Mammographic Imaging Screening Trial, which enrolled 49528 women at 33 centers in the US and Canada. All women underwent both digital and film mammography which were interpreted by two separate readers for each woman, one for each examination. The stud...

PURPOSE The objective of this study was to determine the effect of breast density on the diagnostic accuracy of digital mammography versus screen-film mammography. METHOD AND MATERIALS In this retrospective study readers interpreted mammograms from 320 asymptomatic women who underwent screening mammography, selected from those enrolled into ACRIN...

To compare two display technologies, cathode ray tube (CRT) and liquid crystal display (LCD), in terms of diagnostic accuracy for several common clinical tasks in digital mammography. Simulated masses and microcalcifications were inserted into normal digital mammograms to produce an image set of 400 images. Images were viewed on one CRT and one LCD...

Develop a fully automated, objective method for evaluating morphology on breast magnetic resonance (MR) images and evaluate effectiveness of the new morphologic method for detecting breast cancers. We present a new automated method (morphologic blooming) for identifying and classifying breast lesions on MR that measures margin sharpness, a characte...

HER-2/neu is a valuable prognostic and therapeutic marker in primary breast carcinoma. The objective of this study was to determine the mammographic and patient characteristics (age) that correlate with HER-2/neu overexpression in primary breast carcinoma. HER-2/neu characteristics and preoperative mammograms were available in 498 patients with 543...

Diagnostic mammography is performed on women with clinical symptoms that suggest breast cancer or women for whom further mammographic evaluation has been requested because of an abnormal screening mammography. We assessed whether the use of full-field digital mammography would improve the positive predictive value (PPV) for the diagnosis of breast...

To determine the speed, accuracy, ease of use, and user satisfaction of various electronic data entry platforms for use in the collection of mammography clinical trials data. Four electronic data entry platforms were tested: standalone personal digital assistant (PDA), Tablet PC, digitizer Tablet/PDA Hybrid (DTP Hybrid), and digital pen (d-pen). St...

This paper on digital mammography image acquisition is 1 of 3 papers written as part of an intersociety effort to establish image quality standards for digital mammography. The information included in this paper is intended to support the development of an ACR guideline on image quality for digital mammography. The topics of the other 2 papers are...

This paper on digital mammography image storage, retrieval, and transmission is 1 of 3 papers written as part of an intersociety effort to establish image quality standards for digital mammography. The information included in this paper is intended to support the development of an American College of Radiology (ACR) guideline on image quality for d...