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PubMed1994

Tumor registry audit of mammography in community practice.

The 395 analytic breast cancers logged into a community hospital tumor registry from 1988 to 1992 included information as to (1) the mode of detection and (2) the time interval since prior mammography. Mammography alone detected 44% of the cancers in women under 50 years of age and 47% of the cancers in women over 50 years of age. The American Joint Committee on Cancer's 1988 "Manual for Staging of Cancer" TNM staging of mammographically detected cancers in both age groups was similar, ie, there were 89% stage 0/1 in women aged under 50 and 86% in women over age 50. Twenty-one percent of the mammographically detected cancers were in women under age 50, whereas a disproportionate 36% of the "interval cancers" occurred in this group. A ratio of the number of mammographically detected cancers to the number of interval cancers was 5.8 in women over age 50 and 2.7 in women under age 50. This ratio fell to 1.7 when the time interval following prior mammography was 2 years. Correctable errors accounted for 21% of the interval cancers.

Age Factors↗
PubMed1991

Screening mammography rates and barriers to use: a Los Angeles County survey.

The use of screening mammography among women 40 years of age and older in Los Angeles County was assessed through a random digit dial telephone interview. The sample of 802 women represents a large urban population with substantial proportions of blacks, Hispanics, and Asians. The survey obtained information regarding adherence to the ACS/NCI screening mammography guidelines, perceived benefits of early detection and mammography, perceived threat of developing breast cancer, and barriers to utilization. The results showed that 71% of the women had had at least one mammogram, with 49% having received a screening mammogram according to the guidelines for their age. Less than half the respondents knew the screening guidelines for their age, with women ages 40-49 years being less knowledgeable than women greater than or equal to 50 years old (29 vs 58% answering correctly). A logistic regression analysis predicting the likelihood of having obtained a screening mammogram according to the guidelines found the following to be predictive: concern over radiation (negative association), age (negative association), family history, knowledge of guidelines, and cost of a mammogram (negative association). Other demographic factors and beliefs were not significantly related to this dependent variable.

Adult↗
PubMed1990

Pressure measurements during automatic breast compression in mammography.

Breast compression during X-ray mammography results in improved image quality at a lower radiation dose to the patient, and, as a consequence, the Department of Health recommends that automatic breast compression devices are fitted to mammographic X-ray units. However, the degree of breast compression is not standardized and can vary depending on the size of the patient, the particular mammography X-ray unit and the conditions of its use. A pressure measuring system was used to determine accurately the pressure on the breast. This system takes the form of a fluid-filled neonatal cuff connected to a pressure transducer by a fluid line. The pressure measuring system was calibrated and tested, first without and then with the patients, to assess its practical feasibility. The elements of the pressure measuring system, the techniques involved in its calibration and its use on patients in the clinical environment are described here. The system has proved to be a quick and simple method of relating the pressure on the breast to the pressure reading of the mammography X-ray unit.

Automation↗
PubMed1996

The simultaneous analysis of patient, physician and group practice influences on annual mammography performance.

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Aged↗
PubMedDate not supplied

Smoking status and mammography in a statewide survey.

The association between smoking status and mammography was examined for women aged 40 to 75 (n = 2902), who were recruited through a statewide random digit dial survey. Controlling for income, education, age, marital status, ethnicity, and self-rated health, logistic regression showed that current smokers were less likely to be screened on each of three indicators of mammography status. Less than a high school education, income less than $20,000, martial status, and age also showed associations with screening. Having a recent medical visit was important for screening specifically among the women who smoked (n = 851). Smoking may pose a challenge to achieving national mammography goals.

Adult↗
PubMed1992

Screening mammography program delay recommended by Manitoba working group: issues for radiology.

UNLABELLED: Assignment: A working group, appointed by government, examined the advisability of implementing a mammography screening program and prepared a cost analysis. ANALYSIS: Present Manitoba activity (45,695) is a mixture of clinical mammography (10,000) and unorganized screening, mammographies (35,695) at an annual screening cost of $2.8 million. Canadian policy reports, program descriptions in other countries and critical reviews were analyzed. A steady-state clinical and financial model was constructed. A controlled screening program enrolling 80% of women 50-69 years will cost $2.6 million per year plus $0.65 million new clinical costs limited to 4 years. Recommendations; Six were made: delay implementation awaiting more evidence of benefit, discourage use in asymptomatic women under 50 years, develop information programs for women and health professionals, establish an advisory group and participate in research directed to a eventual decision.

Adult↗
PubMedDate not supplied

Screening for breast cancer with mammography.

Mammography is generally accepted as a useful problem-solving clinical tool in characterizing known breast lesions, so that appropriate and timely treatment can be given. However, it remains grossly underutilized at what it does best: screening. The major strengths of mammography are a) its ability to detect breast cancer at a smaller, potentially more curable stage than any other examination, and b) its proved efficacy in reducing breast cancer mortality in asymptomatic women aged 40-74. If, as has recently been estimated, screening with mammography and physical examination can be expected to lower breast cancer deaths by 40%-50% among those actually examined (13), then the lives of almost 20,000 U.S. women might be saved each year if screening were to become very widely used. The challenges of the next decade are clear, to mount much more effective campaigns to educate physicians and lay women about the life-saving benefits of breast cancer screening, to devise increasingly effective and lower cost screening strategies, to further improve the current high quality of mammographic imaging despite its increasing proliferation, and to train large numbers of breast imaging specialists to guarantee that the growing case load of screening and problem-solving mammograms is interpreted with a very high level of skill.

Adult↗
PubMed1996

Pain and discomfort during mammography.

The aim of this prospective study was to investigate associations of mammography pain and discomfort with sociodemographics, personal history and psychological and situational factors. Subjects were women with a negative screening finding (n = 883) from a random sample of 50-year-old Finnish women attending their first breast cancer screening. Questionnaires were sent 1 month before the screening invitation and 2 months after screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely). Linear regression analyses showed that anticipation of pain and discomfort was the most powerful factor explaining pain and discomfort among women with earlier mammography. However, it had no effect among women without earlier mammography, for whom screening-related nervousness and perceptions of staff were crucial. Suggested interventions include better information before screening, a friendly screening atmosphere and empathetic, supportive staff behaviour, especially towards women having their first mammogram, encouraging them to feel more at ease and distracted from pain.

Attitude to Health↗
PubMed2005

The effects of gray scale image processing on digital mammography interpretation performance.

RATIONALE AND OBJECTIVES: To determine the effects of three image-processing algorithms on diagnostic accuracy of digital mammography in comparison with conventional screen-film mammography. MATERIALS AND METHODS: A total of 201 cases consisting of nonprocessed soft copy versions of the digital mammograms acquired from GE, Fischer, and Trex digital mammography systems (1997-1999) and conventional screen-film mammograms of the same patients were interpreted by nine radiologists. The raw digital data were processed with each of three different image-processing algorithms creating three presentations-manufacturer's default (applied and laser printed to film by each of the manufacturers), MUSICA, and PLAHE-were presented in soft copy display. There were three radiologists per presentation. RESULTS: Area under the receiver operating characteristic curve for GE digital mass cases was worse than screen-film for all digital presentations. The area under the receiver operating characteristic for Trex digital mass cases was better, but only with images processed with the manufacturer's default algorithm. Sensitivity for GE digital mass cases was worse than screen film for all digital presentations. Specificity for Fischer digital calcifications cases was worse than screen film for images processed in default and PLAHE algorithms. Specificity for Trex digital calcifications cases was worse than screen film for images processed with MUSICA. CONCLUSION: Specific image-processing algorithms may be necessary for optimal presentation for interpretation based on machine and lesion type.

Algorithms↗
PubMed2005

Multimodality computerized diagnosis of breast lesions using mammography and sonography.

RATIONALE AND OBJECTIVES: The purpose of this study is to investigate the use of computer-extracted features of lesions imaged by means of two modalities, mammography and breast ultrasound, in the computerized classification of breast lesions. MATERIAL AND METHODS: We performed computerized analysis on a database of 97 patients with a total of 100 lesions (40 malignant, 40 benign solid, and 20 cystic lesions). Mammograms and ultrasound images were available for these breast lesions. There was an average of three mammographic images and two ultrasound images per lesion. Based on seed points indicated by a radiologist, the computer automatically segmented lesions from the parenchymal background and automatically extracted a set of characteristic features for each lesion. For each feature, its value averaged over all images pertaining to a given lesion was input to a Bayesian neural network for classification. We also investigated different approaches to combine image-based features into this by-lesion analysis. In that analysis, mean, maximum, and minimum feature values were considered for all images representing a lesion. We considered performance by using a leave-one-lesion-out approach, based on image features from mammography alone (two to five features), ultrasound alone (three to four features), and a combination of features from both modalities (three to five features total). RESULTS: For the classification task of distinguishing cancer from other abnormalities in a lesion-based analysis by using a single modality, areas under the receiver operating characteristic curves (A(z) values) increased significantly when the computer selected the manner (mean, minimum, or maximum) in which image-based features were combined into lesion-based features. The highest performance was found for lesion-based analysis and automated feature selection from mean, maximum, and minimum values of features from both modalities (resulting in a total of four features being used). That A(z) value for the task of distinguishing cancer was 0.92, showing a statistically significant increase over that achieved with features from either mammography or ultrasound alone. CONCLUSION: Computerized classification of cancer significantly improved when lesion features from both modalities were combined. Classification performance depended on specific methods for combining features from multiple images per lesion. These results are encouraging and warrant further exploration of computerized methods for multimodality imaging.

Breast Neoplasms↗
PubMed2006

Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions?

RATIONALE AND OBJECTIVES: The goal of the present study was to compare the sensitivity and specificity of elastography with that of B-mode ultrasound (US) and mammography. MATERIALS AND METHODS: A total of 300 patients with histologically confirmed breast lesions (168 benign, 132 malignant) were included. Evaluation was by means of the three-dimensional finite-element method. The data are color-coded and superimposed on the B-mode US scan. The images were evaluated by two independent readers. The results were compared with mammography, histology, and the data obtained by previous US investigations. Sensitivities and specificities were calculated. RESULTS: Sensitivity and specificity in the differentiation of benign and malignant lesions were 87% and 85%, respectively, for mammography and 94% and 83% for B-mode US. The two examiners were in very good agreement in their evaluation of the elastograms (kappa: 0.86). Elastography had a sensitivity of 82% and a specificity of 87%. Elastography was superior to B-mode US in diagnosing Breast Imaging Reporting and Data System (BI-RADS) 3 lesions (92% vs. 82% specificity) and in lipomatous involution (80% vs. 69% specificity). CONCLUSION: Elastography in breast lesions showed a higher specificity and a lower sensitivity in comparison with B-mode sonography. Elastography may be beneficial in BI-RADS 3 lesions and in lipomatous involution.

Adolescent↗
PubMed2006

Women with cerebral palsy and breast cancer screening by mammography.

Women with cerebral palsy and breast cancer screening by mammography. We emphasize the need to identify specific barriers to participation in breast cancer screening by mammography experienced by women with cerebral palsy (CP). Mammography screening has been found to reduce mortality rates by 30%, but women with disabilities such as CP underuse this important preventive medicine facility, potentially leading to delay in diagnosis of breast cancer and a less favorable prognosis. Because equity in health care is compromised through underutilization by these women, barriers to participation and successful outcomes must be investigated. Barriers such as appropriate information, transport, and assistance prevent women with CP from getting to the facility. Once there, communication difficulties, physical limitations, psychologic barriers, and staff attitudes become barriers to a successful outcome. Education for health personnel as well as adaptation of the mammographic technique to suit the physical limitations of women with CP are critical to increasing participation and ensuring successful outcomes. Importantly, there is a need to identify women for whom having a mammogram is not an option and for whom alternative breast screening methods should be provided.

Attitude of Health Personnel↗
PubMedDate not supplied

Evaluation of the three-time-point method for diagnosis of breast lesions in contrast-enhanced MR mammography.

PURPOSE: To evaluate the three-time-point (3TP) method for diagnosis of breast lesions detected on contrast-enhanced MR mammography. MATERIALS AND METHODS: MR imaging was performed in 40 women with 120 suspected breast lesions in mammography and/or sonography. The contrast kinetics was converted by 3TP software on a pixel-by-pixel basis into color-coded images. Lesion diagnosis was made by analysis of color intensity and color hue. The 3TP results were compared with the results of the region-of-interest (ROI) method. In 16 patients, we were able to correlate the results with histopathological findings. RESULTS: The 3TP method could successfully be performed in all MR mammographies. Forty (33%) lesions had a diameter of less than 5 mm, 56 (47%) lesions between 5 and 10 mm, and 24 (20%) lesions were greater than 1 cm. Of all 120 lesions, 65 (54%) showed heterogeneous contrast enhancement. In 117 (97%) of all 120 lesions the results of ROI and the automated 3TP method were considered equivalent. However, in three lesions the manual ROI differed from the 3TP method. After a second, repeated manual ROI placement, we were able to confirm equivalent results with the 3TP images as well. CONCLUSIONS: The 3TP method automatically and reliably converts contrast kinetic information of the entire breast into a color-coded image. The 3TP method presents kinetic information of the entire dynamic series in an easy-to-interpret format and this automated method may allow to forego time-consuming and sometimes subjective manual ROI placements. This method displays the heterogeneity of the contrast enhancement pattern often observed in malignant lesions and makes it usable as diagnostic criterion.

Adult↗
PubMed2005

Detection of clustered microcalcifications in small field digital mammography.

The most frequent symptoms of ductal carcinoma recognised by mammography are clusters of microcalcifications. Their detection from mammograms is difficult, especially for glandular breasts. We present a new computer-aided detection system for small field digital mammography in planning of breast biopsy. The system processes the mammograms in several steps. First, we filter the original picture with a filter that is sensitive to microcalcification contrast shape. Then, we enhance the mammogram contrast by using wavelet-based sharpening algorithm. Afterwards, we present to radiologist, for visual analysis, such a contrast-enhanced mammogram with suggested positions of microcalcification clusters. We have evaluated the usefulness of the system with the help of four experienced radiologists, who found that it significantly improves the detection of microcalcifications in small field digital mammography.

Algorithms↗
PubMed2007

Who gets screened, and where: a comparison of organised and opportunistic mammography screening in Geneva, Switzerland.

It is unclear whether introducing organised mammography screening programmes in a population where opportunistic screening is prevalent results in the two types of screening mainly competing against each other or attracting different groups of women. To compare women who participate in organised screening and those who prefer opportunistic screening, we conducted a prospective study of 932 women followed for 8 months after an invitation to participate in the first round of an organised screening programme in Geneva, Switzerland. All women were aged 50-69 years and were due for a mammogram according to local guideline. Of the 932 participants, 11.6% had an organised and 39.4% an opportunistic mammogram during follow-up. Women who were in the stage of contemplation, had favourable attitude toward mammography screening, and perceived their risk of breast cancer to be high were more likely to have a mammogram (either organised or opportunistic). Compared to women who had an opportunistic mammogram, women with an organised mammogram were less positive about screening, less likely to be in maintenance at baseline (adjusted odds ratio (OR), 3.0; 95% confidence interval (CI), 1.7-5.5), to have a history of benign breast disease (OR, 2.4; 95% CI, 1.2-5.1) and to perceive their financial situation as comfortable (OR, 1.7; 95% CI, 1.1-2.8). Although screening uptake was low, the programme appeared to attract women in lower socio-economic strata who did not usually undergo mammography screening.

Aged↗
PubMed2004

Conventional versus digital mammography in the analysis of screen-detected lesions with low positive predictive value.

PURPOSE: To compare the performance of screen-film and digital mammography in the assessment of screen-detected breast lesions. MATERIALS AND METHODS: A series of 100 consecutive mammographic screen-detected lesions (65 masses, 6 architectural distortions, 29 microcalcifications) deserving diagnostic assessment and judged to have a low positive predictive value underwent screen-film mammography (SFM) and digital mammography by a Fuji computed radiography system (FCR) (double exposure, same view, without removing compression) of the corresponding breast. Three sets of images (SFM, hard copy and soft copy FCR) were read, blind of assessment outcome, by three experienced radiologists. For the three different imaging modalities a contrast-detail analysis, dose evaluation and diagnostic accuracy by means of ROC analysis were performed. At the end of the diagnostic workup all suspicious cases (20) underwent surgical biopsy and were histologically confirmed as cancers and the cases which were negative or benign at assessment (80) were followed up for a period of 12-20 months. During the follow-up period two more cases proved to be cancers at subsequent examinations. RESULTS: Contrast-detail analysis gives better image quality for FCR compared to SFM at the same delivered dose, whilst in ROC analysis the SFM (AUC 0.7158), hard copy FCR (AUC 0.7404) and soft copy FCR (AUC 0.7501) (chi(2)=1.30, p=0.5220) are equivalent. CONCLUSION: FCR has a diagnostic performance equivalent to SFM in the assessment of screen-detected lesions with a low positive predictive value for cancer and it may be safely included in routine screening practice.

Breast Neoplasms↗
PubMed2005

Computer-aided detection (CAD) in mammography: does it help the junior or the senior radiologist?

OBJECTIVES: To evaluate the impact of a computer-aided detection (CAD) system on the ability of a junior and senior radiologist to detect breast cancers on mammograms, and to determine the potential of CAD as a teaching tool in mammography. METHODS: Hundred biopsy-proven cancers and 100 normal mammograms were randomly analyzed by a CAD system. The sensitivity (Se) and specificity (Sp) of the CAD system were calculated. In the second phase, to simulate daily practice, 110 mammograms (97 normal or with benign lesions, and 13 cancers) were examined independently by a junior and a senior radiologist, with and without CAD. Interpretations were standardized according to BI-RADS classification. Sensitivity, Specificity, positive and negative predictive values (PPV, NPV) were calculated for each session. RESULTS: For the senior radiologist, Se slightly improved from 76.9 to 84.6% after CAD analysis (NS) (one case of clustered microcalcifications case overlooked by the senior radiologist was detected by CAD). Sp, PPV and PNV did not change significantly. For the junior radiologist, Se improved from 61.9 to 84.6% (significant change). Three cancers overlooked by the junior radiologist were detected by CAD. Sp was unchanged. CONCLUSION: CAD mammography proved more useful for the junior than for the senior radiologist, improving sensitivity. The CAD system may represent a useful educational tool for mammography.

Adult↗
PubMed2007

MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component.

PURPOSE: To determine the role of magnetic resonance (MR) mammography in detection and assessment of extent of tumors with extensive intraductal component (EIC+). MATERIAL AND METHODS: In a prospective study, 233 consecutive women with a suspicious lesion underwent preoperative MR mammography and 209 invasive ductal carcinomas were detected. We studied the prediction of intraductal spread on mammography (MX), ultrasound (US) and MR. We compared the size of the total lesion on MX, US and MR and correlated it with histopathology. Enhancement patterns on MR were described. RESULTS: Of 209 invasive ductal carcinomas, 50 were EIC+ (24%). MX predicted intraductal spread in EIC+ carcinomas in 48.5%, US in 34.2% and MR in 68%. Compared to MX and US, MR was best in assessment of total tumor size. On MR, ductal spread in EIC+ tumors presented as ductal or linear enhancement, long spicules, a regional enhancing area or nodules adjacent to a mass. CONCLUSION: MR had the highest sensitivity to predict intraductal spread and was superior in assessing total tumor size.

Adult↗