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PubMed2001

Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations.

PURPOSE: To prospectively compare full-field digital mammography (FFDM) with screen-film mammography (SFM) for cancer detection in a screening population. MATERIALS AND METHODS: At two institutions, 4,945 FFDM examinations were performed in women aged 40 years and older presenting for SFM. Two views of each breast were acquired with each modality. SFM and FFDM images were interpreted independently. Findings detected with either SFM or FFDM were evaluated with additional imaging and, if warranted, biopsy. RESULTS: Patients in the study underwent 152 biopsies, which resulted in the diagnosis of 35 breast cancers. Twenty-two cancers were detected with SFM and 21 with FFDM. Four were interval cancers that became palpable within 1 year of screening and were considered false-negative findings with both modalities. The difference in cancer detection rate was not significant. FFDM had a significantly lower recall rate (11.5%; 568 of 4,945) than SFM (13.8%; 685 of 4,945) (P <.001, McNemar chi(2) model; P <.03, generalized estimating equations model). The positive biopsy rate for findings detected with FFDM (30%; 21 of 69) was higher than that for findings detected with SFM (19%; 22 of 114), but this difference was not significant. CONCLUSION: No difference in cancer detection rate has yet been observed between FFDM and SFM. FFDM has so far led to fewer recalls than SFM.

Biopsy↗
PubMed1998

The impact of mammography quality improvement legislation in Michigan: implications for the National Mammography Quality Standards Act.

OBJECTIVES: This study examined the impact of state legislation on mammography quality and access in Michigan. METHODS: The impact of state legislation was analyzed with respect to utilization, numbers of machines and facilities, and image quality. RESULTS: The legislation had a positive effect on image quality improvement, had no impact on utilization by women aged 50 years and above, and resulted in few facility closures. CONCLUSIONS: Michigan's legislative intervention appears to have had a positive effect on efforts to improve mammography quality assurance with implications for other federal and state efforts to achieve quality assurance in health care delivery.

Aged↗
PubMed1992

[Analysis of the difference between the results of complex mammography and histology-- a contribution to the sensitivity and specificity of mammography].

Of a total of 18,500 mammographic examinations of our own patients, 1393 diagnosis had been confirmed by histology. In 89 cases (6.39%) where x-ray diagnosis did not agree with histological findings, we re-assessed the mammographies retrospectively. 29% of the false negative diagnosis proved retrospectively to be due to errors on the part of the examiner, whereas in the remaining 24 patients the carcinoma of the breast could be visualized by mammography (3.8% of all histologically confirmed malignomas). In the 41 false positive findings the x-ray symptoms "focus with radial ramifications" and "microcalcifications" were the most frequent causes of performing a diagnostic extirpation. Sensitivity of the mammographic method in identifying a carcinoma was 94.8% and the specificity 94.6%. The causes of erroneous assessment are discussed and the need for performing complex diagnosis of the breast is underlined.

Adult↗
PubMed1997

The role of past mammography and future intentions in screening mammography usage.

Screening mammography is effective in the early detection of breast cancer among women aged 50 through 69, but under utilization by the target age group is common. The present study determined how past mammography behavior and intentions to have a mammogram were related to screening behaviors, attitudes, and beliefs. Participants were 1211 Alberta women aged 40 through 75 without breast cancer who were surveyed in a population-based random digit dial telephone interview. The response rate was 78%. Based on the stages of change and adoption models, women were grouped as Screeners (N = 363, 30%), who had had a "checkup" mammogram in the past 24 months and intended to have another in the next 24 months; Intenders (N = 355, 28%), who had not had a mammogram in the past 24 months but intended to have one in the next 24 months; and Nonparticipants (N = 513, 42%), who neither had had a mammogram in the past 24 months nor intended to have one in the next 24 months. Compared with Screeners, both Intenders and Nonparticipants were more likely to live in the rural areas and to have lower educational levels. Nonparticipants were also older, less likely to be married, of lower income, and less likely to be employed outside of the home. Separate logistic regression analyses showed that both Intenders and Nonparticipants were significantly less able to encourage a friend to have a mammogram (OR = 2.7 and 4.4, respectively), more likely to believe that most women were not getting screening mammograms (OR = 1.7 and 2.9, respectively), and less likely to believe symptoms were not needed for mammograms (OR = 0.3 and 0.1, respectively). In addition, Nonparticipants were also significantly more likely to believe that getting a mammogram would not reassure others (OR = 4.0) and less able to talk to a doctor about getting a mammogram (OR = 5.2). Adoption of screening can be seen as a continuum in which Screeners had the most positive and Nonparticipants the most negative breast cancer screening attitudes, beliefs, and early detection behaviors. The importance of physician referral and utilization of other information dissemination channels was highlighted.

Adult↗
PubMed1999

Confrontation of mammography systems in flanders with the European Guidelines for Quality Assurance in mammography screening. Analysis of initial results.

From May 1997 to April 98, 30 radiological centers made an agreement with the Leuvens Universitair Centrum voor Kankerpreventie (LUCK) for the work out of physical and technical quality control in mammography screening. A protocol was used based on the European Guidelines for Quality Assurance. The reports of all 30 acceptance tests were retrospectively reviewed. The following parts showed to be most critical: alignment of radiation field and film in the bucky, tube voltage precision, automatic exposure controller, average optical density of a standard exposure, dark room and its safe lights. The mean film gradient was in the majority of the centers higher than what is prescribed in the European document. This is acceptable and even desirable whenever daily quality control shows that the development system is sufficiently stable. Although it is difficult to compare the scores for the specific tests with results in other countries, there is evidence that the tendencies are very similar.

Absorptiometry, Photon↗
PubMed1989

[Mammography screening in Tromsö. Realization and results of the first mammography screening in Norway].

The screening was carried out as a part of a health survey. Women aged 40 or more, (N = 4,290), were eligible. The acceptance rate were 84.4%. Altogether 5.3% was selected fro detailed mammographic examination, 1.7% were referred to a surgeon and 1.1% underwent surgery. In ten (25%) of them breast cancer was proven histologically. The mammograms were read independently by two radiologists. The predictive value was highest if only women on which both radiologists agreed were referred to detailed mammography. Of the women attending the health survey, 98% in the urban and, 79% in the rural part of the municipality were screened for breast cancer. The latter group had to make an appointment and travel to the city center to have their mammograms taken. The interpretation of the breast cancer screening was centrally administered. The follow-up was organized locally.

Adult↗
PubMed1998

Mammography screening for breast cancer in Copenhagen April 1991-March 1997. Mammography Screening Evaluation Group.

A biennial mammography screening programme started for all women aged 50-69 in the municipality of Copenhagen, Denmark, on 1 April 1991. We report here on the outcome of the first three invitation rounds. Copenhagen has approximately 40,000 female residents aged 50-69. The Copenhagen Municipality IT Service runs the data files and issues the invitations based on the daily updated population register. Screening takes place at a special clinic at Bispebjerg Hospital, and since 1 September 1996 all assessment and surgery take place at Rigs-hospitalet. The first invitation round covered the period April 1991 to April 1993, the second invitation round the period May 1993 to May 1995, and the third invitation round the period June 1995 to March 1997. By now in total 120,772 invitations have been issued, 84,036 screening tests have been performed, 4110 women have been assessed with additional tests, 1057 women have undergone surgery, and 697 cases of invasive breast cancer cases or carcinoma in situ have been detected. The number of women screened during each of the three invitation rounds as a percentage of the target population aged 50-69 was 71%, 65% and 63%, respectively. It is possible for a woman to notify the programme if she does not want to be invited, and this caused the coverage to decline. The participation rate among the invited women was 71%, 69% and 70%, respectively. Ninety percent of those screened the first and second times and invited the third time participated. The number of screen detected invasive breast cancers of carcinoma in situ cases per 1000 participants during each invitation round was 11.9; 6.3; and 6.1, respectively. When compared with the incidence of invasive breast cancer in Copenhagen before screening, the ratios were 4-7 for all first time screened and 2 for all second or third time screened. Among the 697 screen detected cases, 84% were invasive breast cancers and 11% carcinoma in situ in women not previously known with breast cancer, and 5% were second primary breast cancers. Fifty two invasive interval cancers were found when women who tested negative during the first invitation round were followed up for two years in the Danish Cancer Register and the files of invasive breast cancers of the Danish Breast Cancer Cooperative Group. Compared with the incidence of invasive breast cancer in Copenhagen before screening this gave a proportionate interval cancer rate of 0.34 (95% confidence interval 0.26-0.45). Eight percent of the women who ever participated in the programme had experienced at least one false positive screening test, and 10% of the women who participated all three times in the programme had experienced at least one false positive test. The assessment was an efficient procedure for the sorting out of the false positive screening tests. During the third invitation round, three quarters of those who underwent surgery had either invasive breast cancer or carcinoma in situ. The participation rate in the present programme is relatively low as are the participation rates in other large cities. However, the programme is well accepted among those who participate, as a high proportion of these women come back. The detection rates compared with the previous incidence of invasive breast cancer indicate a good performance of the programme, and so does the proportionate interval cancer rate following the first invitation round. The programme is thus functioning well. The relatively low coverage and the flow in the target population limit the reduction in breast cancer mortality to be expected from the screening programme in the Copenhagen municipality.

Aged↗
PubMed1995

[MR mammography at 0.5 tesla. I. Comparison of image quality and sensitivity of MR mammography at 0.5 and 1.5 T].

PURPOSE: To determine whether dynamic MR mammography is possible on midfield systems without loss of diagnostic sensitivity when compared to the standard highfield technique. MATERIALS AND METHODS: 42 consecutive patients were examined twice: Once using the standard dynamic 2D gradient echo technique at 1.5 T; a second examination was performed on a 0.5 T system. For the midfield examinations a 3D sequence with optimized T1 contrast was used to compensate for the shorter T1 relaxation times at 0.5 T. Subtraction images were calculated to improve detectability of enhancing lesions. RESULTS: Image quality was comparable on both systems. Mean enhancement of lesions was higher at 0.5 T/3D as compared to 1.5 T/2D (161% versus 112%). In malignant lesions, enhancement at 0.5 T/3D surpassed that at 1.5 T/2D in 88% of cases; average maximum signal intensity increase of cancers was significantly higher at 0.5 T/3D as compared to 1.5 T/2D (183% versus 108% relative to baseline). One satellite lesion of a recurrent carcinoma was detected on the 0.5 T/3D images only. CONCLUSION: A 3D gradient echo pulse sequence can be used to compensate for the T1 shortening effect of the lower field strength. With a 3D sequence, sensitivity of MRM at 0.5 T is even superior to that of the standard 2D highfield technique.

Adult↗
PubMed1995

[MR mammography at 0.5 tesla. II. The capacity to differentiate malignant and benign lesions in MR mammography at 0.5 and 1.5 T].

PURPOSE: To determine whether medium field strength (0.5 T) MR mammography is able to differentiate between benign and malignant lesions in the same way as a 1.5 T standard technique. MATERIAL: In 40 consecutive female patients with nodular lesions, examinations were carried out at 1.5 T (2D-FFE, TR/TE/FA 200/3.9/80) and 0.5 T (3D-FFE, 24/3.4/40). RESULTS: There was wide spread of the speed of enhancement of malignant tumours for both techniques (44%-145% with signal increase in the first minute of 42%-189%). In 15 out of 17 carcinomas, the rapidity of uptake and final degree of enhancement after contrast was higher during 0.5 T/3D measurements than it was for 1.5 T/2D images. Fibroadenomas and mastopathies showed similar enhancement characteristics for both techniques. Sharply defined "wash-out" was seen only in malignant lesions; it appeared ten times more frequently in the 0.5 T/3D examinations than at 1.5 T/2D. CONCLUSIONS: The distinction between benign and malignant lesions can be made with more certainty using medium field strength and 3D-FFE sequence than using the 2D high-field standard technique.

Breast↗
PubMed2001

[Can follow-up controls improve the accuracy of MR mammography? A retrospective analysis of MR mammography follow-up studies].

PURPOSE: To assess the change in diagnostic confidence between first and follow-up dynamic MR examination of the breast (MRM). METHODS: The reports of a total of 175 MRM in 77 patients (mean age 50 years; 36-76) with 98 follow-up MRM were analyzed. All examinations were performed as a dynamic study (Gd-DTPA, 0.16 mmol/kg; 6-7 repetitive studies). The change in diagnostic confidence was retrospectively classified as follows: controlled lesion vanished during follow-up (category I); diagnostic confidence increases during follow-up (II), more likely benign (IIa), more suspicious (IIb); no difference in diagnostic confidence (III). Long-term follow-up over an average of four years was obtained for 57 patients with category IIa/III findings. RESULTS: In 98 follow-up examinations, only two lesions vanished (2%). In 77/98 cases a category IIa lesion was diagnosed, in 11 cases a category IIb lesion. In 8 cases (8%) there was no change in diagnostic confidence during follow-up. Lesions in category IIb underwent biopsy in 10/11 cases, in one case long-term follow-up proved a completely regredient inflammatory change. In 8/11 suspicious findings (IIb) a malignant tumor was detected. The mean time interval between first and follow-up MRM was 8 months for I-IIb lesions, and 4 months for category III lesions. In the long-term follow-up two patients with a category IIa lesion developed a carcinoma in a different breast area after four and five years. CONCLUSION: MRM follow up increases the diagnostic confidence if the time interval is adequate (> 4 months). A persistently or increasingly suspicious finding warrants biopsy.

Adult↗