Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women With Elevated Risk of Breast Cancer (vol 299, pg 2151, 2008)
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 cancer. From April 2004 to February 2006, 2809 women, with at least heterogeneously dense breast tissue in at least 1 quadrant, were recruited from 21 sites to undergo mammographic and physician-performed ultrasonographic examinations in randomized order by a radiologist masked to the other examination results. Reference standard was defined as a combination of pathology and 12-month follow-up and was available for 2637 (96.8%) of the 2725 eligible participants. Diagnostic yield, sensitivity, specificity, and diagnostic accuracy (assessed by the area under the receiver operating characteristic curve) of combined mammography plus ultrasound vs mammography alone and the positive predictive value of biopsy recommendations for mammography plus ultrasound vs mammography alone. Forty participants (41 breasts) were diagnosed with cancer: 8 suspicious on both ultrasound and mammography, 12 on ultrasound alone, 12 on mammography alone, and 8 participants (9 breasts) on neither. The diagnostic yield for mammography was 7.6 per 1000 women screened (20 of 2637) and increased to 11.8 per 1000 (31 of 2637) for combined mammography plus ultrasound; the supplemental yield was 4.2 per 1000 women screened (95% confidence interval [CI], 1.1-7.2 per 1000; P = .003 that supplemental yield is 0). The diagnostic accuracy for mammography was 0.78 (95% CI, 0.67-0.87) and increased to 0.91 (95% CI, 0.84-0.96) for mammography plus ultrasound (P = .003 that difference is 0). Of 12 supplemental cancers detected by ultrasound alone, 11 (92%) were invasive with a median size of 10 mm (range, 5-40 mm; mean [SE], 12.6 [3.0] mm) and 8 of the 9 lesions (89%) reported had negative nodes. The positive predictive value of biopsy recommendation after full diagnostic workup was 19 of 84 for mammography (22.6%; 95% CI, 14.2%-33%), 21 of 235 for ultrasound (8.9%, 95% CI, 5.6%-13.3%), and 31 of 276 for combined mammography plus ultrasound (11.2%; 95% CI. 7.8%-15.6%). Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives. clinicaltrials.gov Identifier: NCT00072501.
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[Show abstract] [Hide abstract] ABSTRACT: PURPOSE: To assess the performance of QuantraTM in reproducing BI-RADS® mammographic breast density (MBD) assessment. METHODS: Two methods of MBD assessment were used (QuantraTM and BI-RADS®). Volumetric breast density measurement from 292 raw projection images was performed using QuantraTM. BI-RADS® assessment was performed by three radiologists and a majority report (consensus of at least two radiologists) was generated. Interreader agreement (κ), agreement, and the sensitivity and specificity of QuantraTM in reproducing BI-RADS® rating were calculated on a four-grade (1, 2, 3, and 4) and two-grade (1–2 vs. 3–4) scale. RESULTS: The majority BI-RADS® report in the dataset consisted of 9.6% (n = 28), 35.3% (n = 103), 27.1% (n = 79), and 28.1% (n = 82) for BI-RADS® 1, 2, 3, and 4 respectively. Intra-reader agreement (κ) was 0.86 (95%CI: 0.83 – 0.91) to 0.88 (95%CI: 0.85 – 0.93) on a four-grade and 0.88 (95%CI: 0.83 – 0.92) to 0.91 (95%CI: 0.88 – 0.95) on a two-grade scale. Inter-reader agreement (κ) was substantial [0.66 (95%CI: 0.62 – 0.71) to 0.75 (95%CI: 0.70 – 0.81)] on a four-grade scale and substantial to almost perfect [0.77 (95%CI: 0.73 – 0.82) to 0.89 (95%CI: 0.84 – 0.93)] on a two-grade scale. QuantraTM correctly classified 35.7%, 91.2%, 88.6%, and 50.3% of BI-RADS® 1, 2, 3, and 4 respectively. It also demonstrated 91.3% sensitivity and 83.6% specificity in reproducing BI-RADS® on a two-grade scale (1–2 vs. 3–4). CONCLUSION: QuantraTM has limited performance in reproducing BI-RADS® rating on a four-grade scale, however, highly reproduces BI-RADS® assessment on a two-grade scale. © (2016) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.
- "Lower BD has been shown to be associated with lower breast cancer risk  . Therefore, mammographic breast density (MBD) information can be used in combination with other risk factors for breast cancer risk stratification, and selection of more appropriate screening pathways such as ultrasound  , magnetic resonance imaging (MRI)  or digital breast tomosynthesis (DBT)  to enhance visualization features of cancer in dense breasts . MBD information can also be used for monitoring the efficacy of chemopreventive strategies101112 . "
[Show abstract] [Hide abstract] ABSTRACT: In this work, tissue stiffness estimates are used to differentiate between benign and malignant breast masses in a group of pre-biopsy patients. The rationale is that breast masses are often stiffer than healthy tissue; furthermore, malignant masses are stiffer than benign masses. The comb-push ultrasound shear elastography (CUSE) method is used to noninvasively assess a tissue???s mechanical properties. CUSE utilizes a sequence of simultaneous multiple laterally spaced acoustic radiation force (ARF) excitations and detection to reconstruct the region of interest (ROI) shear wave speed map, from which a tissue stiffness property can be quantified. In this study, the tissue stiffnesses of 73 breast masses were interrogated. The mean shear wave speeds for benign masses (3.42 ?? 1.32 m/s) were lower than malignant breast masses (6.04 ?? 1.25 m/s). These speed values correspond to higher stiffness in malignant breast masses (114.9 ?? 40.6 kPa) than benign masses (39.4 ?? 28.1 kPa and p < 0.001), when tissue elasticity is quantified by Young???s modulus. A Young???s modulus >83 kPa is established as a cut-off value for differentiating between malignant and benign suspicious breast masses, with a receiver operating characteristic curve (ROC) of 89.19% sensitivity, 88.69% specificity, and 0.911 for the area under the curve (AUC).
- "Conventional B-mode US is used as an adjunct to mammography for breast imaging to improve sensitivity –. However, B-mode US has shown low specificity in the differentiation of benign from malignant breast masses –. To increase specificity , breast masses are categorized according to the Breast Imaging-Reporting and Data System (BI-RADS) criteria defined by the American College of Radiology (ACR) , . "
[Show abstract] [Hide abstract] ABSTRACT: The purpose of this study is to investigate whether having a mammogram on differing manufacturer equipment will affect a woman's breast density (BD) measurement. The data set comprised of 40 cases, each containing a combined image of the left craniocaudal (LCC) and left mediolateral oblique (LMLO). These images were obtained from 20 women age between 42–89 years. The images were acquired on two imaging systems (GE and Hologic) one year apart. Volumetric BD was assessed by using Volpara Density Grade (VDG) and average BD% (AvBD%). Twenty American Board of Radiology (ABR) examiners assessed the same images using the BIRADS BD scale 1-4. Statistical comparisons were performed on the means using Mann-Whitney, on correlation using Spearman's rank coefficient of correlation and agreement using Cohen's Kappa. The absolute median BIRADS difference between GE and Hologic was 0.225 (2.00 versus 2.00; p<0.043). The VDG measures for GE was not statistically different to Hologic (2.00 versus 2.00; p<0.877), likewise the median AvBD% for the GE and Hologic systems showed no difference (6.51 versus 6.79; p<0.935). BIRADS for GE and Hologic systems showed strong positive correlation (ρ=0.904; p<0.001), while the VDG (ρ=0.978; p<0.001) and AvBD% (ρ=0.973; p<0.001) showed very strong positive correlations. There was a substantial agreement between GE and Hologic systems for BIRADS density shown with Cohen's Kappa (κ=0.692; p<0.001), however the systems demonstrated an almost perfect agreement for VDG (κ=0.933; p<0.001).
- "Measuring BD is important for breast cancer risk prediction and for recommending appropriate imaging pathway. Women with increased BD need further imaging such as Ultrasound (US) or Magnetic Resonance Imaging (MRI) to better visualize structures within the dense tissue [6, 7]. However, a number BD features such as the method of measurement, ACR BIRADS density definitions and legislative requirements around informing woman are not standardized. "
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