Jules H Sumkin

• Magee-Womens Hospital

Background Digital breast tomosynthesis (DBT) is often inadequate for screening women with a personal history of breast cancer (PHBC). The ongoing prospective Tomosynthesis or Contrast-Enhanced Mammography, or TOCEM, trial includes three annual screenings with both DBT and contrast-enhanced mammography (CEM). Purpose To perform interim assessment o...

Background Background parenchymal enhancement (BPE) at dynamic contrast-enhanced (DCE) MRI of cancer-free breasts increases the risk of developing breast cancer; implications of quantitative BPE in ipsilateral breasts with breast cancer are largely unexplored. Purpose To determine whether quantitative BPE measurements in one or both breasts could b...

Objective Evaluate lesion visibility and radiologist confidence during contrast-enhanced mammography (CEM)-guided biopsy. Methods Women with BI-RADS ≥4A enhancing breast lesions were prospectively recruited for 9-g vacuum-assisted CEM-guided biopsy. Breast density, background parenchymal enhancement (BPE), lesion characteristics (enhancement and c...

Information in digital mammogram images has been shown to be associated with the risk of developing breast cancer. Longitudinal breast cancer screening mammogram examinations may carry spatiotemporal information that can enhance breast cancer risk prediction. No deep learning models have been designed to capture such spatiotemporal information over...

Convolutional Neural Networks (CNNs) are traditionally trained solely using the given imaging dataset. Additional clinical information is often available along with imaging data but is mostly ignored in the current practice of data-driven deep learning modeling. In this work, we propose a novel deep curriculum learning method that utilizes radiomic...

Background The abundance of immune and stromal cells in the tumor microenvironment (TME) is informative of levels of inflammation, angiogenesis, and desmoplasia. Radiomics, an approach of extracting quantitative features from radiological imaging to characterize diseases, have been shown to predict molecular classification, cancer recurrence risk,...

Purpose To investigate two deep learning‐based modeling schemes for predicting short‐term risk of developing breast cancer using prior normal screening digital mammograms in a case‐control setting. Methods We conducted a retrospective Institutional Review Board‐approved study on a case‐control cohort of 226 patients (including 113 women diagnosed...

Background Staging newly diagnosed breast cancer by using dynamic contrast material-enhanced MRI is limited by access, high cost, and false-positive findings. The utility of contrast-enhanced mammography (CEM) and 99mTc sestamibi-based molecular breast imaging (MBI) in this setting is largely unknown. Purpose To compare extent-of-disease assessment...

Rationale and objectives: To preliminarily asses if Contrast Enhanced Digital Mammography (CEDM) can accurately reduce biopsy rates for soft tissue BI-RADS 4A or 4B lesions. Materials and methods: Eight radiologists retrospectively and independently reviewed 60 lesions in 54 consenting patients who underwent CEDM under Health Insurance Portabili...

Purpose: False positives in digital mammography screening lead to high recall rates, resulting in unnecessary medical procedures to patients and health care costs. This study aimed to investigate the revolutionary deep learning methods to distinguish recalled but benign mammography images from negative exams and those with malignancy. Experimenta...

We investigated automated quantitative measures of background parenchymal enhancement (BPE) derived from an early versus delayed post-contrast sequence in breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for association with breast cancer presence in a case-control study. DCE-MRIs were retrospectively analyzed for 51 cancer cas...

Objective: The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria. Materials and method...

Background We investigated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) contrast enhancement kinetic variables quantified from normal breast parenchyma for association with presence of breast cancer, in a case-control study. Methods Under a Health Insurance Portability and Accountability Act compliant and Institutional Review Boa...

Performance changes in a binary environment when using additional information is affected only when changes in recommendations are made due to the additional information in question. In a recent study, we have shown that, contrary to general expectation, introducing prior examinations improved recall rates, but not sensitivity. In this study, we as...

Objectives: This study compared persistent breast pain among women who received breast-conserving surgery for breast cancer and women without a history of breast cancer. Methods: Breast cancer survivors (n=200) were recruited at their first postsurgical surveillance mammogram (6 to 15 mo postsurgery). Women without a breast cancer history (n=150...

Purpose Fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) estimated from breast dynamic contrast enhanced MRI (DCE-MRI) have been correlated with breast cancer risk. We performed a preliminary study assessing in a small cohort of breast cancer patients the relationship between FGT and BPE both quantified from cancer-unaffecte...

Purpose Background parenchymal enhancement (BPE) estimated from breast dynamic contrast enhanced MRI (DCE-MRI) has been correlated with breast cancer risk. Multiple time-point post-contrast-subtracted sequences are acquired in typical clinical breast DCE-MRI protocols. We quantitatively assessed BPE using fully automated computer algorithms and inv...

To assess radiologists' perceptions of how the new Breast Density Notification Act (BDNA) of Pennsylvania would affect their breast density reporting and their actual reporting patterns after implementation. Under an institutional review board-approved protocol, we surveyed 21 radiologists about how they believe the new law affected their breast de...

Breast magnetic resonance imaging (MRI) is recommended as an adjunct to mammography for women who are considered at elevated risk of developing breast cancer. As a key component of breast MRI, dynamic contrast-enhanced MRI (DCE-MRI) uses a contrast agent to provide high intensity contrast between breast tissues, making it sensitive to tissue compos...

Purpose: To assess the effect of and interaction between the availability of prior images and digital breast tomosynthesis (DBT) images in decisions to recall women during mammogram interpretation. Materials and methods: Verbal informed consent was obtained for this HIPAA-compliant institutional review board-approved protocol. Eight radiologists...

Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing...

Objective: The purpose of this study was to compare two methods of combining tomosynthesis with digital mammography by assessing diagnostic accuracy and recall rates for digital mammography alone and digital mammography combined with one-view tomosynthesis and two-view tomosynthesis. Subjects and methods: Three hundred ten cases including biopsy...

Purpose: To assess interpretation performance and radiation dose when two-dimensional synthesized mammography (SM) images versus standard full-field digital mammography (FFDM) images are used alone or in combination with digital breast tomosynthesis images. Materials and methods: A fully crossed, mode-balanced multicase (n = 123), multireader (n...

In our opinion, there is no such thing as overdiagnosis; there is only suboptimal use of accurate information, suboptimal management, or both, and there may be many instances of overtreatment in women in whom these abnormal findings have been detected.

Purpose: To compare radiologists' diagnostic accuracy and recall rates for breast tomosynthesis combined with digital mammography versus digital mammography alone. Materials and methods: Institutional review board approval was obtained at each accruing institution. Participating women gave written informed consent. Mediolateral oblique and crani...

Purpose: To compare the diagnostic performance of breast tomosynthesis versus supplemental mammography views in classification of masses, distortions, and asymmetries. Materials and methods: Eight radiologists who specialized in breast imaging retrospectively reviewed 217 consecutively accrued lesions by using protocols that were HIPAA compliant...

To improve efficacy of breast cancer screening and prevention programs, it requires a risk assessment model with high discriminatory power. This study aimed to assess classification performance of using computed bilateral mammographic density asymmetry to predict risk of individual women developing breast cancer in near-term. The database includes...

The objective of our study was to assess the incidence of associated malignancy when microscopic radial scars and microscopic intraductal papillomas are encountered at percutaneous biopsy for lesions that otherwise reveal benign histopathology. A search of the pathology database for the period from December 14, 2006, through December 21, 2009, iden...

The FDA recently approved Digital Breast Tomosynthesis (DBT) for use in screening for the early detection of breast cancer. However, MQSA qualification for interpreting DBT through training was noted as important. Performance issues related to training are largely unknown. Therefore, we assembled a unique computerized training module to assess radi...

In order to establish a personalized breast cancer screening program, it is important to develop risk models that have high discriminatory power in predicting the likelihood of a woman developing an imaging detectable breast cancer in near-term (e.g., <3 years after a negative examination in question). In epidemiology-based breast cancer risk model...

After developing a multi-probe resonance-frequency electrical impedance spectroscopy (REIS) system aimed at detecting women with breast abnormalities that may indicate a developing breast cancer, we have been conducting a prospective clinical study to explore the feasibility of applying this REIS system to classify younger women (< 50 years old) in...

The purpose of our study was to assess diagnostic performance when retrospectively interpreting full-field digital mammography (FFDM) and breast tomosynthesis examinations under a free-response receiver operating characteristic (FROC) paradigm. We performed FROC analysis of a previously reported study in which eight experienced radiologists interpr...

The authors developed and tested a multiprobe-based resonance-frequency-based electrical impedance spectroscopy (REIS) system. The purpose of this study was to preliminarily assess the performance of this system in classifying younger women into two groups, those ultimately recommended for biopsy during imaging-based diagnostic workups that followe...

The aim of this study was to preliminarily assess the performance of a new, resonance-frequency electrical impedance spectroscopy (REIS) system in identifying young women who were recommended to undergo breast biopsy following imaging. A seven-probe REIS system was designed and assembled and is currently being prospectively tested. During examinati...

The purpose of this article is to compare the ability of digital breast tomosynthesis and full field digital mammography (FFDM) to detect and characterize calcifications. One hundred paired examinations were performed utilizing FFDM and digital breast tomosynthesis. Twenty biopsy-proven cancers, 40 biopsy-proven benign calcifications, and 40 random...

To investigate the feasibility of converting a computer-aided detection (CAD) scheme for digitised screen-film mammograms to full-field digital mammograms (FFDMs) and assessing CAD performance on a large database. The database included 6478 FFDM images acquired on 1120 females, with 525 cancer cases and 595 negative cases. The database was divided...

The purpose of our study was to subjectively compare additional mammographic views to digital breast tomosynthesis (DBT) in the characterizing of known masses, architectural distortions, or asymmetries. Four experienced radiologists serially reviewed the imaging studies of 25 women with known masses, including full-field digital mammography (FFDM),...

To compare time to interpretation and diagnostic performance levels during repeat readings of full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in a retrospective study. Three experienced radiologists twice interpreted 125 selected examinations, 35 with verified cancers and 90 negative for cancer during a period of 22 mon...

A new resonance-frequency based electronic impedance spectroscopy (REIS) system with multi-probes, including one central probe and six external probes that are designed to contact the breast skin in a circular form with a radius of 60 millimeters to the central ("nipple") probe, has been assembled and installed in our breast imaging facility. We ar...

The aim of this study was to assess similarities and differences between methods of performance comparisons under binary (yes or no) and receiver-operating characteristic (ROC)-type pseudocontinuous (0-100) rating data ascertained during an observer performance study of interpretation of full-field digital mammography (FFDM) versus FFDM plus digita...

Pelvic ultrasound (Fig. 1) demonstrates a bilobed extrauterine mass containing linear segmented hyperechoic structures suggestive of a fetus (with fetal spine). Pelvic MRI (Fig. 2) demonstrates that the mass has a fetal shape and contains fetal structures (cephalic position). Pelvic MRI (left image-T1w axial, right image-T2w coronal) demonstrating...

The purpose of this study was to compare in a retrospective observer study the diagnostic performance of full-field digital mammography (FFDM) with that of digital breast tomosynthesis. Eight experienced radiologists interpreted images from 125 selected examinations, 35 with verified findings of cancer and 90 with no finding of cancer. The four dis...

In our previous study, we reported on the development and preliminary testing of a prototype resonance electrical impedance spectroscopy (REIS) system with a pair of probes. Although our pilot study on 150 young women ranging from 30 to 50 years old indicated the feasibility of using REIS output sweep signals to classify between the women who had n...

To investigate consistency of the orders of performance levels when interpreting mammograms under three different reading paradigms. We performed a retrospective observer study in which nine experienced radiologists rated an enriched set of mammography examinations that they personally had read in the clinic ("individualized") mixed with a set that...

The authors investigated radiologists, performances during retrospective interpretation of screening mammograms when using a binary decision whether to recall a woman for additional procedures or not and compared it with their receiver operating characteristic (ROC) type performance curves using a semi-continuous rating scale. Under an Institutiona...

To compare radiologists' performance during interpretation of screening mammograms in the clinic with their performance when reading the same mammograms in a retrospective laboratory study. This study was conducted under an institutional review board-approved, HIPAA-compliant protocol; the need for informed consent was waived. Nine experienced radi...

To determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer. Intra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically imme...

Electrical impedance spectroscopy has been investigated with but limited success as an adjunct procedure to mammography and as a possible pre-screening tool to stratify risk for having or developing breast cancer in younger women. In this study, the authors explored a new resonance frequency based [resonance electrical impedance spectroscopy (REIS)...

Experts may agree in most decisions that they make when they read a case set of digital mammograms, but eye-position tracking studies suggest that they use very different visual search strategies to make such decisions. If indeed each expert uses a unique strategy, it may be very difficult to teach radiology trainees effective ways to search the ba...

Currently, breast cancer screening protocols are based on a woman's age, but not on other risk factors or on the physical characteristics of her breasts. One commonly cited risk factor is dense breast tissue. This study is part of an effort to provide basic information needed to develop automatically, individualized screening protocols, by clarifyi...

Using electrical impedance spectroscopy (EIS) technology to detect breast abnormalities in general and cancer in particular has been attracting research interests for decades. Large clinical tests suggest that current EIS systems can achieve high specificity (>= 90%) at a relatively low sensitivity ranging from 15% to 35%. In this study, we explore...

The clinical utility of interactive computer-aided diagnosis (ICAD) systems depends on clinical relevance and visual similarity between the queried breast lesions and the ICAD-selected reference regions. The objective of this study is to develop and test a new ICAD scheme that aims improve visual similarity of ICAD-selected reference regions. A lar...

A core biopsy diagnosis of atypical ductal epithelial hyperplasia is upstaged on follow-up excisional biopsy (FUEB) to in situ or invasive carcinoma in about 20% of cases, thus prompting a FUEB. In contrast, upstaging information for a core biopsy diagnosis of pure lobular neoplasia (LN), without mass lesions or other risk-associated lesions is les...

Core needle biopsy (CNB) is used to sample both mammographically and ultrasound detected breast lesions. A diagnosis of ductal carcinoma in situ (DCIS) by CNB does not ensure the absence of invasive cancer upon surgical excision and as a result an upstaged patient may need to undergo additional surgery for axillary nodal evaluation. This study eval...

Many diagnostic problems involve the assessment of vascular structures or bronchial trees depicted in volumetric datasets, but previous algorithms for segmenting cylindrical structures are not sufficiently robust for them to be widely applied clinically. Local geometric information that is of importance in segmentation consists of voxel values and...

Objective: The benefit and cost of computer-assisted detection (CAD) mammography screening remains a topic of great interest in breast imaging. Our purpose is to reflect on and interleave two articles in this issue of the AJR that highlight the difficulty in assessing the actual benefit of using CAD from either retrospective or prospective studies...

This paper describes a high-quality, multisite telemammography system to enable "almost real-time" remote patient management while the patient remains in the clinic. One goal is to reduce the number of women who would physically need to return to the clinic for additional imaging procedures (termed "recall") to supplement "routine" imaging of scree...

To prospectively survey women undergoing screening mammography to assess their attitudes toward and preference for the level of recall rates given the possibility that an increase in recall rates may result in earlier detection of cancer. This HIPAA-compliant survey was performed with an institutional review board-approved protocol. Women who arriv...

Although computer-aided detection (CAD) systems were designed and approved for and are assumed to be used as a "second-reader", namely radiologists are expected to interpret mammograms and detect suspected abnormalities (i.e., micro-calcification clusters and masses) independently before viewing CAD results, it is not clear whether radiologists in...

Evidence-based screening guidelines are needed for women under 40 with a family history of breast cancer, a BRCA1 or BRCA2 mutation, or other risk factors. An accurate assessment of breast cancer risk is required to balance the benefits and risks of surveillance, yet published studies have used narrow risk assessment schemata for enrollment. Breast...

The purpose of this study was to develop and test a method for selecting "visually similar" regions of interest depicting breast masses from a reference library to be used in an interactive computer-aided diagnosis (CAD) environment. A reference library including 1000 malignant mass regions and 2000 benign and CAD-generated false-positive regions w...

Stereographic display has been proposed as a possible method of improving performance in reading computed tomographic (CT) examinations acquired for lung cancer screening. Optimizing such displays is important given the large volume of image data that must be evaluated for each of these examinations. This study is designed to explore certain tradeo...

Sentinel lymph node mapping as a constitutive component in the staging process for invasive breast cancer continues to gain acceptance. We have identified two patients with recurrent invasive breast cancer in whom contralateral sentinel lymph node uptake and metastases, respectively, were detected. Such findings have not been previously reported in...

The goal of mammography screening is to detect breast cancer at early stages, but because of the complexity of the breast parenchyma and the variability of signs of the disease, many cancers go unreported when initially visible on the mammogram. We compared the visual search strategy used by experienced mammographers in a case set where they examin...

Objective: Positive predictive value (PPV1) has been used as one important indicator of the quality of screening mammography programs. We show how the relationship between sensitivity and recall rate may affect the operating point at which optimal (maximum) PPV1 occurs. Conclusion: Optimal (maximum) PPV1 can occur at any sensitivity level and sh...

To retrospectively evaluate whether recall, biopsy, and positive biopsy rates for a group of radiologists who met requirements of Mammography Quality Standards Act of 1992 (MQSA) demonstrated any change over time during a 27-month period (nine consecutive calendar quarters). Institutional review board approved study protocol, and informed consent w...

Radiologists' performance reviewing and rating breast cancer screening mammography exams using a telemammography system was evaluated and compared with the actual clinical interpretations of the same interpretations. Mammography technologists from three remote imaging sites transmitted 245 exams to a central site (radiologists), which they (the tec...

To compare performance of two computer-aided detection (CAD) systems and an in-house scheme applied to five groups of sequentially acquired screening mammograms. Two hundred nineteen film-based mammographic examinations, classified into five groups, were included in this study. Group 1 included 58 examinations in which verified malignant masses wer...

The widespread adoption of chest CT for lung cancer screening will greatly increase the workload of chest radiologists. Contributing to this effort is the need for radiologists to differentiate between localized nodules and slices through linear structures such as blood vessels, in each of a large number of slices acquired for each subject. To incr...

This study was designed to evaluate radiologists" ability to identify highly-compressed, digitized mammographic images displayed on high-resolution, monitors. Mammography films were digitized at 50 micron pixel dimensions using a high-resolution laser film digitizer. Image data were compressed using the irreversible (lossy), wavelet-based JPEG 2000...

Based on the need to increase the efficacy of chest CT for lung cancer screening, a stereoscopic display for viewing chest CT images has been developed. Stereo image pairs are generated from CT data by conventional stereo projection derived from a geometry that assumes the topmost slice being displayed is at the same distance as the screen of the p...

The authors investigated the correlation between recall and detection rates in a group of 10 radiologists who had read a high volume of screening mammograms in an academic institution. Practice-related and outcome-related databases of verified cases were used to compute recall rates and tumor detection rates for a group of 10 Mammography Quality St...

Computer-aided mammography is rapidly gaining clinical acceptance, but few data demonstrate its actual benefit in the clinical environment. We assessed changes in mammography recall and cancer detection rates after the introduction of a computer-aided detection system into a clinical radiology practice in an academic setting. We used verified pract...

To examine the performance and reproducibility of a commercially available computer-aided detection (CAD) system with a set of mammograms obtained in 100 patients who had undergone biopsy after positive findings at mammography. One hundred positive mammographic examinations (four views each), depicting 96 masses and 50 microcalcification clusters,...

Implications: We describe a case of a parturient with disseminated lymphangiomatosis involving the thorax, retroperitoneum, and lumbar vertebrae who received epidural labor analgesia. Clinical presentations vary depending on the organ systems involved, the extent of the disease, and the stage of pregnancy. Anesthetic implications are discussed.

The purpose of this preliminary investigation is to explore the possibility that electrical impedance measurements of the breast can ultimately be used to screen younger women for early detection of breast cancer. As a part of a comprehensive protocol to compare different modalities, participating women undergo a series of diagnostic examinations,...

We evaluated a telemammography system for reviewing and rating screening mammography in a clinical setting. Three remote sites transmitted 306 exams to a central site. Films were digitized at 50 micron pixel dimensions and compressed at a 50:1 ratio. At the central site images were displayed on a workstation with two high-resolution monitors. Five...

We evaluated a telemammography system for reviewing and rating screening mammography in a clinical setting. Three remote sites transmitted 306 exams to a central site. Films were digitized at 50 micron pixel dimensions and compressed at a 50:1 ratio. At the central site images were displayed on a workstation with two high-resolution monitors. Five...

We investigated a new approach to improve the performance of a computer-aided detection (CAD) scheme in identifying masses depicted on images acquired earlier ("prior"). The scheme was trained using a dataset with simulated mass features. From a database with images acquired during two consecutive examinations, 100 locations matched pairs of malign...

The authors evaluated performance changes in the detection of masses on "current" (latest) and "prior" images by computer-aided diagnosis (CAD) schemes that had been optimized with databases of current and prior mammograms. The authors selected 260 pairs of matched consecutive mammograms. Each current image depicted one or two verified masses. All...