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PubMed1993

Recent trends in breast cancer incidence, mortality, and mammography.

The recent trends in mammography, and in breast cancer incidence and mortality, demonstrate the impact of an effective cancer control effort. The number of women over age 40 years who have ever had mammography has increased over 200% since 1980. Concomitantly, breast cancer incidence has increased about 32%, with nearly all of the increase in early stage disease. Analytic studies of these changes have demonstrated persuasively that the vast majority of this increase is temporary and is attributable to the lead-time afforded by mammography. As a result of this early detection and treatment of breast cancer, mortality has begun to decline in 1991-92. Although the search for practical preventive measures should continue, the benefits of early detection can be realized now. Further research is needed to define age groups most appropriately screened and the optimum intervals for screening.

Adult↗
PubMed1995

New modalities in breast imaging: digital mammography and magnetic resonance imaging.

Mammography is currently the only screening method available with proven capability to diagnose nonpalpable breast cancer. However, mammography does not detect all cancers. Cancers are more difficult to detect in radiographically dense breasts because lesions are obscured by breast tissue. Digital mammography and magnetic resonance imaging of the breast may minimize the problems associated with screening dense breasts. If these methods prove to be useful, more cancers could be detected at an earlier stage.

Breast↗
PubMed1995

The use of thallium-201 in the preoperative detection of breast cancer: an adjunct to mammography and ultrasonography.

Thallium-201 breast scans were performed preoperatively in 72 female patients with breast abnormalities detected by mammography and/or ultrasonography (7.5-13 MHz), in order to differentiate benign from malignant breast disease. Informed consent was obtained from each patient. Scintigraphy consisted of anterior and oblique planar images of the affected breast and axilla at 10 min and 3 h following the injection of 201Tl chloride (110 MBq). All 201Tl scans were interpreted without prior knowledge of surgery data. Pathological features of breast malignancies, such as tumour size, axillary lymph node metastases, tumour grading, lymphatic vascular channel invasion and receptor status, were analysed for their association with 201Tl uptake by tumour cells. A total of 76 breast lesions were assessed in the study. On final histological diagnosis, there were 56 malignant tumours, 14 benign nodules (9 fibroadenomas, two cases of adenosis, two cases of focal fibrosis and one case of epitheliosis) and six atypical lesions (atypical ductal or lobular hyperplasia). Thallium scintigraphy was shown to have high accuracy (92%) in detecting breast cancer, better than mammography (74%) and ultrasonography (84%). Almost all (51/56) breast cancers showed greater 201Tl activity than surrounding normal breast tissue while there was no significant increase in 201Tl activity above background in all but one (19/20) case of non-malignant disease. 201Tl activity within breast tumours, calculated as tumour/background (T/B) ratio, ranged between 1.2 and 2.5 with a mean value of 1.45. In our experience the concentration of thallium in the breast cancer seems to be primarily dependent on vascularity and tumour size rather than tumour grading, lymphatic/vascular invasion or receptor status. 201Tl scan sensitivity was 97% for malignant lesions larger than 1.5 cm (n = 35) and 80% for lesions of 1.5 cm or less (n = 21); however, five of the eight breast cancers smaller than 1.0 cm were also detectable by 201Tl scintigraphy, compared with five out of seven by mammography. Thallium scintigraphy would not be useful in evaluating the axilla for lymph node metastases (sensitivity 27%, specificity 77%).

Adult↗
PubMed1994

Radiation dose and risk in screening mammography.

Screening mammography has not yet become a standard procedure. There are great variations in image quality and radiation dose. Mean glandular dose has become the most frequently used description of radiation dose in screening mammography. Because of the low energy x-ray beam required for the procedure, the use of mean glandular dose as the radiation exposure indicator may cause a misunderstanding of the dose-risk relationship and result in confusion about radiation exposure and the risk of induced neoplasm. Data are presented to show that increases in both maximum glandular dose and imparted energy are greater than the increases in mean glandular dose with comparable increases in breast thickness. In the future, an indication of total imparted energy should replace the use of mean glandular dose as the standard for describing radiation dose in screening mammography.

Body Constitution↗
PubMed2000

Underutilizers of mammography screening today: characteristics of women planning, undecided about, and not planning a mammogram.

Using concepts from the Precaution Adoption Process Model, we identified behavioral factors, sociodemographic and psychosocial variables, and beliefs about breast cancer that discriminated among women at different stages with regard to their intention to obtain mammography screening. An independent survey company conducted telephone interviews with 2,507 women aged 50 to 80 who were identified as underutilizers of mammography screening. Each underutilizer was assigned to one of three stages with regard to intention to get a mammogram: (a) definitely planning, (b) thinking about, and (c) not planning. Estimated actual risk of breast cancer, perceived risk to breast cancer, worry about breast cancer, and fear of learning from a mammogram that one has breast cancer were variables found to be significantly associated with intention to obtain a mammogram for several subgroups of underutilizing women. There are significant behavioral and psychosocial variables, beliefs and feelings about breast cancer, and demographic characteristics that distinguish underutilizing women at various stages with regard to intention to obtain mammography screening. Our findings provide new information that could help the health care professional motivate women who are not planning to utilize this preventive health measure to become regular utilizers.

Aged↗
PubMed2002

The role of contrast-enhanced MR mammography for determining candidates for breast conservation surgery.

PURPOSE: The aim of this study was to assess the impact of preoperative magnetic resonance mammography (MRM) on the surgical determination of breast conservation treatment for breast cancer patients. METHODS: From September 1997 to March 2000, 57 consecutive breast conservation treatment candidates were prospectively evaluated with conventional imaging studies (mammography and ultrasonography) and preoperative MRM. RESULTS: In 47 of 54 (87% ) breast cancer patients breast conservation surgery (BCS) was indicated on the basis of mammography (MMG) and ultrasonography (US). However in 40 of the 54 (74% ) patients BCS was indicated on the basis of MRM. Thirty-eight of the 40 patients ultimately underwent BCS and only 1 showed a positive margin. There were 7 patients whose MRM findings suggested that more aggressive treatment than BCS was needed but for whom US/MMG suggested that BCS was appropriate. Five of the 7 patients underwent mastectomy rather than BCS based on the MRM findings, which were justified by post-surgical histological findings. Of the 2 remaining patients who underwent BCS, one had a positive histological margin and one had recurrence, both of which resulted in salvage mastectomy. CONCLUSION: Our study suggests that high resolution preoperative MRM provides more accurate information compared with US and MMG for selecting candidates for BCS. Using MRM as a routine staging tool may reduce unnecessary repeated excisions. A larger study will be required to confirm these findings and to define the patients most likely to benefit from breast MR imaging.

Adult↗
PubMed1995

Clinical use of digital mammography: the present and the prospects.

Digital mammography is likely to replace the current routine breast imaging technology in the future because it offers advantages that should lead to both improved image quality and interpretation. Hopefully, this will result in earlier detection in breast screening programs and decreased mortality from the most frequently diagnosed of all cancers after skin cancer, which is far less deadly. At present, digital mammography has a limited clinical role; in the United States, it has been used for several years to localize lesions for tissue sampling using small field of view digital detectors. Once whole breast digital detectors are available, it seems clear that applying computer techniques to enhance and analyze the collected digital data will become routine. Results reported over the last decade indicate that computer-aided diagnosis can improve radiologists' observational performance, and it is likely that computer techniques to routinely enhance the decision-making ability of the average to below-average radiologist to the level of an expert will be developed. There are obstacles to these advances, but the combination of realizable technological solutions and the importance of the breast cancer problem clinically should provide sufficient where-withal and impetus to make digital mammography a clinical reality.

Breast Neoplasms↗
PubMed1995

Opinion: a prototype for a computerized national mammography registry and tracking system using telecommunications and the Internet.

In this report, we analyze the feasability and discuss the potential benefits of using currently available technology for the wide-area registration and tracking of mammography patients. In our prototype, three dissimilar computer systems transmitted mammographic data (demographics and the results of mammograms) in a standardized format to a central data repository. Two of the three systems were dedicated computerized mammography systems and one was a general-purpose radiology information system. High-speed modems and the Internet were used to connect with the central repository, which could be queried in real time by remote users. Our results indicated that a busy mammography practice, using the slowest transmission method we tested (14-kilobaud modem), could transmit several days of mammographic data to a central repository in a matter of minutes. To implement systems that provide nation-wide mammographic tracking and follow up, more in-depth planning, development, and testing are necessary.

Computer Communication Networks↗
PubMed1997

A pilot study of eye movement during mammography interpretation: eyetracker results and workstation design implications.

Digital mammography can potentially improve mammography image and interpretation quality. On-line interpretation from a workstation may improve interpretation logistics and increase availability of comparison images. Interpretation of eight 4k- x 5k-pixel mammograms on two to four 2k- x 2.5k-pixel monitors is problematic because of the time spent in choosing which images display on which monitors, and zooming and roaming on individual images that are too large to display completely at full resolution. The authors used an eyetracker to measure radiologists viewing behavior during mammography interpretation with film on a viewbox. It was observed that a significant portion of the mammographers' time is spent viewing "comparison pairs" (typically two or more comparisons per case), such as the left mediolateral and craniocaudal images or old and new images. From the eyetracker measurements, we estimated that the number of image display, roam, and zoom operations decreases from an average of 64 for one monitor to 31 for four monitors, with the largest change going from one to two monitors. We also show that fewer monitors with a faster response time is superior to more monitors with a slower response time. Finally, the authors demonstrate the applicability of time-motion analysis to mammographic workstation design.

Adult↗
PubMed1999

The effect of the antiscatter grid on full-field digital mammography phantom images.

Computer Analysis of Mammography Phantom Images (CAMPI) is a method for making quantitative measurements of image quality. This article reports on a recent application of this method to a prototype full-field digital mammography (FFDM) machine. Images of a modified ACR phantom were acquired on the General Electric Diagnostic Molybdenum Rhodium (GE-DMR) FFDM machine at a number of x-ray techniques, both with and without the scatter reduction grid. The techniques were chosen so that one had sets of grid and non-grid images with matched doses (200 mrads) and matched gray-scale values (1500). A third set was acquired at constant 26 kVp and varying mAs for both grid conditions. Analyses of the images yielded signal-to-noise-ratio (SNR), contrast and noise corresponding to each target object, and a non-uniformity measure. The results showed that under conditions of equal gray-scale value the grid images were markedly superior, albeit at higher doses than the non-grid images. Under constant dose conditions, the non-grid images were slightly superior in SNR (7%) but markedly less uniform (60%). Overall, the grid images had substantially greater contrast and superior image uniformity. These conclusions applied to the whole kVp range studied for the Mo-Mo target filter combination and 4 cm of breast equivalent material of average composition. These results suggest that use of the non-grid technique in digital mammography with the GE-DMR-FFDM unit, is presently not warranted. With improved uniformity correction procedure, this conclusion would change and one should be able to realize a 14% reduction in patient dose at the same SNR by using a non-grid technique.

Artifacts↗
PubMed2002

[Soft copy versus hard copy findings in digital mammography].

The advantages of full field digital mammography are the excellent and reliable image quality and the reduction of radiation exposure. Image acquisition and display are decoupled in digital mammography allowing for optimization of both independently. Image displays are currently either hardcopy produced with a laser printer or softcopy using a computer monitor. Since the amount of data is high the hardware and software must meet specific technical specifications. The diagnostic accuracy of softcopy and hardcopy interpretation is comparable if a high resolution laser printer and a high quality workstation with high spatial and contrast resolution monitors are used. However, using film display the potential benefits of digital mammography in terms of manipulation of the data is lost. Additional diagnostic benefits might be gained by the combination of softcopy display and computer assisted diagnosis (CAD) and telemammography.

Breast Neoplasms↗
PubMed2002

[Digital full field mammography after breast augmentation].

PURPOSE: The use of digital full field mammography for imaging augmented breasts. METHODS: Images of a sponge, as a tissue equivalent, partly covered with one of three different implants (silicone, silicone/saline, saline) were obtained using digital and film-screen technique. The visualisation of the sponge structure covered by the implant and next to the implant was evaluated by two radiologists. Results were compared to clinical results from 35 patients with implants. RESULTS: Two images with different parameter settings have to be obtained to visualize the covered sponge structure and the structure around the implant with film-screen technique. Digital mammography allows assessment of both areas using one image at different window settings. The assessability of covered structures depends on the type of implant. These results are in keeping with our clinical experiences. CONCLUSION: Digital mammography allows equal or better assessment of covered and non-covered tissue in augmented breasts without the need for additional exposures.

Breast Diseases↗
PubMed2002

[Optical density of phantom images of different mammography equipment using various exposure conditions].

The requirements for the target value of the mean optical density (o.d.) including proper tolerances of mammograms are determined in the "European Protocol for the Quality of the Physical and Technical Aspects of Mammography Screening (EPMS)". These requirements are not only applicable to screening mammography. 22 mammography devices were tested with exposures of test phantoms using different kV and thickness of PMMA and with sensitometric step wedges to check the processing conditions. Only five of 22 devices fulfill all requirements of EPMS to the opt. density. These results are caused by three reasons: first, wrong locking of optical density under standard exposure conditions; second, wrong compensation of the optical density by the automatic exposure control due to varing tube voltage (kV) and PMMA thickness and third, an inadequate back coupling to the processing conditions. All tested devices are not conspicuous in respect to the results of constancy tests according DIN 6868-2 [2] and DIN 6868-7 [3]. It is obvious, that the claimed devices are not properly adjusted in the acceptance test according DIN 6868-52 (1990-12) [4]. Respectively the tolerances, used do not fulfill the requirements to proper density in mammograms.

Equipment Design↗
PubMed2004

[Breast cancer. Sonography and magnetic resonance mammography].

Breast cancer is the most common malignant tumor in women: Almost 10% will suffer from breast cancer during their life; almost half of these will die of it. The spectrum of radiologic methods for diagnosing breast cancer is wide, including X-ray mammography, ultrasound, magnetic resonance mammography, and minimally invasive biopsies. This second part of two covers ultrasound of the breast and magnetic resonance mammography.

Biopsy, Needle↗
PubMed1996

[Computer-assisted diagnosis in screening mammography].

Computer-aided diagnosis schemes in mammography aim at improving the mammographic detection of breast cancer. Through special computer algorithms, it is possible to automatically detect suspicious areas in mammographic images. Typical examples are schemes for automatic detection of microcalcifications and masses in mammography. The computer results may be presented to the reporting radiologist, with the computer acting as a diagnostic aid. Various computer-aided diagnosis schemes in mammography are introduced and possible clinical applications are discussed.

Algorithms↗
PubMed1996

[Cost-benefit analysis in mammography screening].

The Swedish Mammography-Screening trials have shown a long-term reduction in the mortality rate in women aged between 50-69 of up to 30%. The lower reduction in mortality observed in women aged 40-49 was not statistically significant. Long-term observation over 20 years) has shown that a radiation dose of 2.4 mGy for a 2-view-mammography per breast does not lead to an increase in occurrence of breast cancers. The advantage of screening with regard to a reduction in death rate, frequent use of breast cancerving therapy and the reduction by half in the average size of the tumor compared to control groups results in: A recommendation for quality controlled screening in Germany from the age of 50 to 70. The possible advantage for younger women must be examined in further trials. Screening in the form of a de-centralized check-up system is to be carried out by practising doctors in co-operation with hospitals which will be responsible for double findings, assessment of difficult cases and continuous cost evaluation. Quality assurance centres, reference and training centres are required. The mammography in curative check-ups will also benefit from a screening programme.

Adult↗
PubMed1997

[Digital magnification mammography in computed radiography. Initial clinical results].

INTRODUCTION: The combination of direct magnification mammography and computed radiography provides an improvement in spatial resolution of storage phosphor-based digital systems. A clinical study comparing conventional and digital direct magnification mammograms was performed. METHODS: 100 survey mammograms in 1.5-or 1.7-fold magnification and 50 4-fold spot magnification views were obtained with a prototype direct magnification mammography system and a storage phosphor-based digital system. An intraindividual comparison of these with previous conventional radiograms of the same patients was carried out. RESULTS: The diagnostic value of digital survey mammograms using the direct magnification technique is comparable to that of conventional radiograms of the breast, especially with regard to the identification of microcalcifications and lesions and the clinical consequences. Spot magnification views performed with this combination of techniques allowed improvement in the evaluation of microcalcifications. In 15% of cases, diagnostic procedures were adjusted accordingly. CONCLUSION: The combination of the direct magnification technique with digital storage phosphor radiography systems allows the performance of digital mammography by improving the overall spatial resolution. The diagnostic value of digital direct magnification survey mammograms was comparable to that of conventional mammograms. Digital 4-fold spot magnification views improved visualisation of the morphologic aspects of microcalcifications.

Breast Neoplasms↗
PubMed1997

[Direct radiographic magnification mammography with a new microfocus tube. Experimental studies of resolution and radiation exposure].

A recently developed X-ray unit for mammography using microfocal (spot size 0.12-0.05 mm) direct magnification radiography will soon be introduced into clinical practice. Unit arrangement and tube construction have been demonstrated. Mean surface dose was measured using PMMA-phantoms. A dose reduction of up to 50% was obtained in 1.7-fold magnification mammography (full sized views) compared with conventional techniques. The image quality was almost equivalent. However, in comparison with 1.7-fold magnification mammography, a comparable dose range for 4-fold magnifications with the microfocus system was measured with a substantial gain in spatial resolution. These findings satisfy the demands of a modern mammographic unit.

Equipment Design↗